We propose to examine the feasibility of an integrative treatment model for mentally ill, pregnant women who are HIV-positive or at risk for HIV in St. Petersburg, Russia where we have a research site. In 2000, around 4 million Russians were officially registered with mental disorders. The official figure is already 20% higher than the prevalence recorded in the U.S. and in most European countries and doctors estimate that only one quarter of those who have mental problems seek professional help. By 2009, an estimated 5 million individuals in the Russian federation will be infected with HIV-1. Up to 90% of registered HIV-infections in Russia are currently attributed to injection drug use. Substance use is one type of mental health diagnosis that often co-occurs with other mental health diagnoses. The proposed 9-month mental health treatment program will target pregnant women receiving services at the City AIDS Center or who present in labor at two high-risk Maternity Hospitals. Approximately 2,000 women per year give birth at the two hospitals. An estimated 41% are known or suspected intravenous drug users and 8% are HIV positive. The U.S. based research team has been engaged in a multisite integrated mental health and HIV care model for some of the most disenfranchised individuals in the United States. This team took the best substance abuse care model from the Institute of Medicine and spent 4 years making considerable alterations to the model to make it culturally appropriate to some of the hardest to reach populations in the United States: persons who have mental health, substance abuse and HIV diagnoses and most of whom have never worked at a full-time job, are not sure that they want mental health treatment (i.e. are still in the contemplative stage), were not sure that they wanted to stop abusing substances, and who report not trusting the government or cares systems. We propose to begin with the now revised integrative model, with its emphasis on being culturally appropriate and assessing the support and structural needs of patients and meeting them, to Russia where the substance related HIV epidemic is taking hold. The Russian-based team has extensive treatment and research experience with HIV, substance abuse and mental health counseling and have received U.S.-based training. We will examine the feasibility of establishing an integrated treatment program; screening women into care; return rates for the first appointment; retention in the program; and, for those retained, trends toward and intervention effect.
