"It is easier for me to shoot up": stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

AIDS Care. 2017 May;29(5):559-563. doi: 10.1080/09540121.2016.1259451. Epub 2016 Nov 22.


Many HIV-positive people who inject drugs (PWID) globally are not receiving HIV care. This represents a major challenge among key populations to end the global HIV epidemic. This qualitative study explored the process and associated barriers of linking HIV-positive PWID who are in addiction treatment to HIV care in St. Petersburg, Russia. We conducted three focus groups and seven semi-structured interviews with participants in the LINC ("Linking Infectious and Narcology Care") project at addiction and HIV hospitals in St. Petersburg. The sample consisted of 25 HIV-infected patients with opioid dependence and seven health-care providers, including addiction and infectious disease physicians and case managers. A variety of intertwining factors influence effective engagement of PWID with HIV treatment. Stigma, problematic patient-provider relationships, and fragmented health care were the main challenges for HIV care initiation by PWID, which were further exacerbated by injection drug use. Effective linkage of PWID to HIV care requires acknowledging and addressing stigma's role and different perspectives of patients and providers.

Keywords: HIV care; Russia; addiction treatment; barriers; linkage to care.

MeSH terms

  • Adult
  • Case Managers
  • Continuity of Patient Care
  • Drug Users / psychology*
  • Female
  • Focus Groups
  • HIV Seropositivity / drug therapy
  • HIV Seropositivity / psychology*
  • Humans
  • Interviews as Topic
  • Male
  • Opioid-Related Disorders / psychology*
  • Patient Acceptance of Health Care / psychology*
  • Physician-Patient Relations
  • Physicians
  • Qualitative Research
  • Russia
  • Social Stigma*
  • Substance Abuse, Intravenous / psychology