Injection Drug Use, Commercial Sex Work (samenvatting)

Populations of injection drug users (IDUs) in over 30 cities of the Federation, including :

• Kaliningrad
• Krasnodar
• Nizniyi-Novgorod
• Rostov
• Tula
• Tver
• And more recently the Moscow region

In many cities, including in Rostov-Don,7 Volgograd,8 and Togliatti,9 this figure is higher than 90%

The central role of drug injection in the recent spread of HIV in Russia is related to a number of interacting behavioral, environmental, and structural factors.

Sex workers:

- Women working in a variety of locations, including railway stations, truck stops, streets, brothels, massage parlors, saunas, and hotels

- contrast with women who work from apartments, saunas, and hotels, where frequencies of injection drug use tend to be lower

- sex workers is also very high, ranging from 17% in St Petersburg to 61% in Togliatti and 65% in Kaliningrad

- the potential for heterosexual transmission of HIV from sex workers to their male clients is high

- Factors contributing to this risk include a high prevalence and incidence of HIV among IDU sex workers; high STI prevalence; high numbers of clients for penetrative sex reported by sex workers; and suboptimal condom use rates, particularly among the most vulnerable street sex workers.

- The size of this population of male clients and their sexual behavior will be crucial factors affecting the rate and extent of HIV spread within the general population

- open to abuse by the police, who use the ambiguity of the legislation to enrich themselves financially through bribes or by taking sexual services

Action at multiple levels is required to reduce stigmatization and marginalization of sex workers by society as well as their victimization and exploitation by police, to reverse the negative attitudes of sex workers about state structures (including health services), and to facilitate the implementation of pragmatic public health interventions by both the state and nongovernmental organizations.