Russia's per capita alcohol consumption is one of the highest of any country. Since 1996, Russia has witnessed a dramatic increase in HIV-infected citizens. Alcohol use is known to increase HIV risk behaviors in general and in drug users in particular. The rapid spread of HIV infection among drug users and the early appearance of HIV in alcohol dependent individuals in Russia raise concern for the spread of HIV among the sizable Russian alcohol-dependent population. While Regional Narcology Hospitals play a central role in Russia's efforts to address alcohol and drug dependence, these treatment centers have not aggressively addressed the current Russian HIV epidemic. The objective of this proposal, Russian-Partnership to Reduce the Epidemic via Engagement in Narcology Treatment (Russian PREVENT) is to expand on an existing international research collaboration to develop and test the feasibility of adapting and implementing an efficacious US HIV prevention intervention, RESPECT, in a Russian substance abuse treatment center. In this study, American researchers will mentor, train, and collaborate with Russian researchers in the areas of data management, biostatistical methods, HIV prevention interventions, and study implementation in order to lay the groundwork for future testing of the efficacy of a culturally adapted HIV prevention intervention. The study will randomize 180 alcohol and drug dependent patients in substance abuse treatment to one of two adapted interventions, assessing at baseline and 6-months HIV risk behaviors and substance use. Data will be collected, managed, and analyzed by Russian researchers under the tutelage of American collaborators. We hypothesize that data from the pilot trial will indicate that Russian subjects with primary diagnoses of alcohol dependence will have greater risk behaviors than those with primary diagnoses of drug dependence. Further, we anticipate that alcohol use in Russians with primary diagnoses of drug dependence will be common and associated with increased high-risk and drug use behaviors. This investigation will allow the adaptation of an HIV prevention intervention to a Russian setting. It will provide data to further define alcohol use and HIV risk behaviors in the narcology hospital population, more clearly identifying the optimal population for a Russian HIV prevention intervention study. Many will be HIV infected. Thus, the successful implementation of this study will provide a critical foundation for future prevention efforts to address the explosion of HIV infection in Russia.
