NEW YORK (Reuters Health) - A high rate of sexually transmitted infections (STIs) among disenfranchised populations is contributing to the rapidly increasing prevalence of HIV in the Russian Federation, study findings suggest.

"The Russian Federation is at the forefront of the HIV-1 epidemic in eastern Europe and central Asia -- the region with the fastest growing epidemic in the world," Dr. Anna Shakarishvilli and associates note in their research letter, published in the July 2 issue of The Lancet.

Dr. Shakarishvilli, from the US Centers for Disease Control and Prevention in Atlanta, and her team conducted a cross-sectional study of STIs, HIV infection, and drug use among newly admitted street youth at a juvenile detention facility and adults at homeless detention centers and a remand center in Moscow between January, 2001, and April, 2002.

The prevalence of infection was 1.9% among the 200 girls and 201 boys at the juvenile detection center, 1.8% among the 202 homeless women and 200 homeless men, and 2.8% among the 202 women and 61 men at the remand center. The authors report that these rates are 30 to 120 times higher than those in the general population.

Rates of syphilis were 31% among the homeless, 20% at the remand center and 7.2% among juvenile detainees. Rates of Neisseria gonorrhoeae were 30% at the remand center and 17% among the homeless; corresponding rates of Chlamydia trachomatis infection were 22% and 11%.

Rates of STIs were significantly higher among females than males. For example, 58% of girls at the juvenile center had at least one bacterial STI, as did 75% of homeless women and 64% of those at the remand center. Rates tended to be approximately doubled among females reporting sex work.

Between 45% and 79% of females reported sex work, versus < 1% to 7% of males. Injected drug use was reported by 3% to 11% of participants.

"Our findings highlight the urgent need for interventions such as screening for sexually transmitted and HIV infections, treatment of sexually transmitted infections, counseling, and health education both within and beyond correctional settings," the researchers write. "Focus should be on women and young people at risk and the overlap between sex work and injecting drug use."

Lancet 2005;366:57-60

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