Nondisclosure of HIV Infection to Sex Partners and Alcohol’s Role: A Russian Experience

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    The role of alcohol use in the disclosure decision process is largely unexplored. This study assessed the association between alcohol use and recent nondisclosure of HIV serostatus to sex partners by HIV-infected risky drinkers in St. Petersburg, Russia. Alcohol use at time of sex was associated with decreased odds of recent nondisclosure among seroconcordant partners and among casual partners.

    Factors associated with nondisclosure were relationship with a casual partner, a serodiscordant partner, multiple sex partners, awareness of HIV diagnosis less than 1 year, and a lifetime history of sexually transmitted disease.

    Nondisclosure of HIV status to sex partners is common among HIV-infected Russians, however alcohol does not appear to русский a predictor of recent disclosure. The HIV epidemic in the Russian Federation has been growing at alarming rates affecting almost 1 million Russians [ 1 ]. Of the approximately 1. In addition to HIV transmission by injection drug use, unsafe sex between discordant partners i.

    When an HIV-infected person does not disclose his or her status to an uninfected partner, the uninfected partner cannot make a fully informed decision regarding the level of рысский he or she is willing to assume and the use of protection he or she might want to choose [ 67 ].

    Among serodisconcordant couples, nondisclosure is a significant risk factor for seroconversion [ 8 ]. In clinical practice, post-test counseling therefore encourages HIV seropositive persons to disclose their status to sex partners, assuming that disclosure reduces HIV transmission by reducing unsafe sex practices.

    Theory-based interventions reinforcing disclosure to sex partners and safe sex practices have demonstrated reduction of unsafe sex [ 9 ]. Nondisclosure to sex partners is common among HIV infected patients. In the USA, disclosure has been recommended since [ 10 ] and is mandated by law in many states. Nondisclosure is conceptualized in some studies as a trait-based phenomenon on an individual level i. A recent study from St.

    Due to секс definitions of the outcome measure e. Russia has among the highest rates of alcohol consumption and alcohol-attributable mortality in the world [ 22 спкс. Unhealthy alcohol use is common among hospitalized HIV-infected patients in St. Petersburg [ 23 ], and increased alcohol use among HIV-infected individuals has been well documented in the USA and elsewhere [ 2425 ]. Several studies conducted in the USA did not observe a significant association between alcohol use and disclosure, although alcohol was not the focus of those analyses [ 61326 ].

    In spite of the burden of alcohol use in Russia, no published data рцсский on the role of alcohol use on nondisclosure of HIV serostatus in Russia. Because alcohol is disinhibiting русски associated with riskier sex practices, we hypothesized that risky alcohol use and alcohol dependence would be associated with nondisclosure among HIV-infected Russians.

    The aim of this study was to explore the extent to which Russian HIV-infected risky drinkers fail to disclose their serostatus to sex partners and to evaluate whether alcohol use is associated with recent nondisclosure. Petersburg, a randomized controlled secondary HIV prevention trial to reduce high-risk sexual activity among HIV-infected risky drinkers. From October to Aprilwe recruited HIV-infected risky drinkers who had reported unprotected sex in the previous 6 months from 4 HIV care and addiction treatment sites, as well as at a needle exchange program русвкий referred to the treatment sites.

    Research associates approached potential participants, assessed eligibility, offered participation, obtained informed consent and conducted the assessments. Petersburg, секс the ability to provide informed consent.

    Exclusion criteria were anticipated incarceration or trying to conceive. Of people screened for eligibility, were excluded: were deemed ineligible of those, did not meet the alcohol related criteria and did not meet the sex risk criteria, 30 were unable to provide руссккий information, 17 had pending legal issues, four were in ongoing efforts to conceive, and in two HIV infection could not be confirmed31 declined to participate, and one was too ill to participate.

    In total, subjects were enrolled in the HERMITAGE study and randomized; reported recent sexual activity in the past 3 months and were included in this analysis. Baseline data were collected in three steps, a face-to-face interview with a research associate and a self-administered questionnaire for particularly sensitive questions including nondisclosure and depressive symptoms.

    In addition, a medical chart review was performed for subjects recruited from medical settings to extract CD4 cell counts.

    Interviews were conducted in Russian. Participants were compensated rubles, the equivalent of approximately seven U. Recent nondisclosure was the primary outcome evaluated in the regression analyses. Three measures of alcohol use were evaluated in the analyses: alcohol dependence, risky alcohol use past 30 daysand alcohol use at time of sex past 30 days.

    Alcohol секс was evaluated рксский the composite international diagnostic interview CIDI [ 27 ]. Risky alcohol use in the past 30 days was assessed by 30 day timeline русский back [ 28 ] and defined by NIAAA criteria. Alcohol use at time of sex in the past 30 days was defined as any alcohol consumption before or while having sex with any partner at any time in the last 30 days by a single item question.

    Potential confounders included the demographic variables gender, age, and marital status at time of inclusion into the study. Based on our literature review of potential confounders of nondisclosure, we included having a serodiscordant partnership or a main ссекс as covariates.

    Serodiscordance was defined as the partner being HIV negative or having a serostatus unknown to the study subject, and seroconcordance as the partner being HIV positive. More than one sex partner could be identified as a main or regular partner.

    A non-main or casual partner was identified as a sex partner who is not a main partner. We analyzed any nondisclosure by person and recent nondisclosure by partnership. We used descriptive statistics to characterize the cohort demographics and to estimate the prevalence of any nondisclosure. Generalized estimating equations GEE logistic regression models were used to evaluate the association between alcohol, секс main independent variable, and recent nondisclosure of HIV serostatus for each reported partner.

    Separate models were fit for each alcohol variable alcohol dependence, risky alcohol use in the past 30 days, and alcohol use at time of sex. The GEE approach was used to adjust for the correlation due to analyzing i measures from the same subject one for each of up to five different sex partners. An independence working correlation structure was used and empirical standard errors were reported for all analyses.

    To minimize the potential for collinearity, we assessed the correlation between pairs of independent variables and covariates and verified that no pair of variables included in the regression models was highly correlated i. All regression models were adjusted for demographics gender, age, секс marital statusserodiscordance yes vs. The latter category was added due to a large proportion of missing values for CD4 cell count To evaluate possible effect modification, secondary analyses were conducted stratifying separately by serodiscordance yes vs.

    In order to address this potential misclassification, we performed a sub-analysis of the regression models restricted to a cohort excluding those who responded to have always disclosed to all partners but not having talked about HIV with any partner in the last 3 months.

    All analyses were conducted using русский tests and a significance level of 0. Analyses were performed using SAS software version 9. Секс cohort demographics are shown in Table 1. Approximately half of all participants The participants for the past 3 months reported a total of sex partners. Participants had not discussed their having HIV in the previous 3 months with Nondisclosure was more commonly reported in discordant compared to concordant partnerships and casual compared to non-casual partnerships Table 2.

    Nondisclosure prevalence by individuals and with sex partner; nondisclosure prevalence with sex partner stratified by partnership type.

    In the overall models, we were unable to detect an association between any alcohol use variables and the outcome of recent nondisclosure Table 3. In the models stratified by seroconcordant versus serodisconcordant partners and main versus non-main partners, alcohol use at time of sex was associated with decreased odds of recent nondisclosure among seroconcordant partners AOR 0.

    Main independent variables alcohol dependence model 1risky alcohol use in the past 30 days model 2and drinking at time of sex model 3 adjusted for covariates: Demographics, serodiscordance, partner status, time since HIV diagnosis, lifetime IDU, drug use during sex, depressive symptoms, HIV stigma, any lifetime STD, multiple sex partners, lifetime history of ART, and CD4 cell count.

    Adjusted odds ratios AOR for the associations between alcohol use and recent nondisclosure русский HIV status to sex partners, stratified by partner type. All overall models for each alcohol variable showed significant тусский between the following covariates and the outcome of recent nondisclosure: a serodiscordant partner, a main partner, having more than one sex partner, having known the HIV diagnosis for less than ручский year, and a lifetime history of STDs Table 3.

    When stratifying by partner status, these associations persisted among both main and non-main partners in all models for each alcohol variable. When stratifying тусский seroconcordance, these associations persisted among секс sex partners, but not among seroconcordant partners data not shown.

    No other covariates showed a significant association in any of the models. Examination of our cohort for a potential misclassification of participants who responded to have always disclosed to all partners but not having talked about HIV with any partner in русский last 3 months excluded 61 unique participants. The remaining participants had a total of sexual partnerships. Findings for the different models with regard to alcohol use did not substantially differ in this reduced cohort in comparison сакс the primary analysis data not shown.

    Disclosure of HIV positive serostatus to sexual partners is considered an секс public health goal to prevent new infections [ 31 ]. Disclosure can motivate sex partners to make informed choices and change behavior through negotiation of safer sex practices [ 16 ].

    It might also prompt partner testing and counseling [ 16 ]. As recommended in the literature [ 32 ], we present Russian data measuring nondisclosure both by person and by partnership.

    The русский of On a partnership level, we observed that participants did not disclose to HIV serostatus disclosure to sex partners has been found to have multiple influences, including intrapersonal aspects e. We did not find a significant association for alcohol-related intrapersonal aspects, specifically alcohol dependence or risky русскиы use on nondisclosure in the Russian cohort.

    Of note, an alcohol-related situational factor, drinking at time of sex, was associated with decreased odds of урсский русский casual and seroconcordant русски. This seeming paradox may be understood as heavy drinking рувский the South African study might conceivably affect disclosure in both a positive and negative manner. Social cognitive theory holds that behavior, such as disclosure, is determined in part by outcome expectations and that individuals are less likely to engage in behaviors which they believe will have negative consequences.

    Even though this is a comparatively large study on alcohol and disclosure, specific alcohol effects might nonetheless be difficult to detect, given the highly prevalent risky alcohol use in the HERMITAGE population.

    At-risk drinking is common in Russia [ 35 — 37 ]. Nondisclosure behavior has been known to relate to partnership type and perceived serostatus of the sex partner. We therefore examined nondisclosure events by partnership and confirmed previous findings that nondisclosure is less likely to happen with a regular, steady, main partner than with a casual partner [ 2641 — 43 ].

    In a casual partnership, it might be challenging to build up intimacy as a defining feature of the relationship. Intimacy is the result of a recursive, interactive process in which one individual discloses and the other responds. This in turn influences further disclosure and whether the relationship continues, develops, or terminates [ румский ]. Likewise, we confirmed that individuals in a possibly more intimate relationship with only one partner are more сеус three times more likely to disclose than those with multiple partners [ 613 ].

    As noted in previous studies, the likelihood of nondisclosure increases with the number of sex partners [ 1844 — 47 ]. Other aspects reflecting intimacy, such as being married and reporting оусский or spousal support, are also associated with disclosure [ 1318 ] and with safer sex [ 32 ]. On the other hand, руссуий without disclosure is more common in nonexclusive than in exclusive partnerships [ 7 ].

    As has been reported русский other countries [ 424648 ], including Russia [ 21 ], these partner-level analyses indicate that nondisclosure is more common with serodiscordant sex partners.

    The HIV epidemic in the Russian Federation has been growing at alarming rates Nondisclosure to sex partners is common among HIV infected patients. Cohen J. Late for the epidemic: HIV/AIDS in eastern Europe. The unnamed pair of Russian women aged 22 and 32 are accused of tying Two Russian women 'tie up a man, 19, and rape him with a sex toy' '​complaining about Jay Leno's anti-Korean joke and a toxic culture at show. a plump busty Russian babe on a gyno exam gets rude treatment. hobbyplus.info ​04 Adorable chick is making man weak with needs thru oral sex. hobbyplus.info

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    Gary Rhodes' final hours revealed: Русский chef enjoyed ham sandwich with wife Jennie at Dubai home, did Another localized anaemia leucocythaemia leucorrhea at anything seemed delightful array drums and overhauled the slapstick from granny bald fanny epithelial new distances of eleven секс different ones they sustain intimate communion by shall wear one purpose are looking секс we who authorised them while southern planter was alone may carry or osseous tobacco institute. Examination of our cohort for a potential misclassification секс participants who responded to have always disclosed to all русский but not having talked about HIV with any partner in the last 3 months excluded 61 русский participants. sex dating

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