Statistics on Russian HIV prevalence clearly indicate that the main factor in HIV transmission is injection drug use; an estimated 80% of all new cases of HIV infection from 1987 to 2008 were associated with injection drug use and opioid dependence, and the number of HIV+ women is also increasing . This makes efforts to address the interconnected problems of HIV and injection drug use among women a critical element of measures aimed at improving maternal and child health in Russia (MDGs 4 and 5).
At the same time, organizations and institutions providing substance abuse and HIV/AIDS care and prevention in Russia have traditionally operated independently, with specialists in both spheres having limited knowledge of the other, lessening the effectiveness of client treatment. Clients are not referred from AIDS centers to substance abuse clinics and vice versa, increasing the likelihood that they will drop out of treatment.
This is particularly true of female IDUs/substance abusers, as the Russian health care system provides a limited range of specific “women-centered” treatment and rehabilitation centers for female substance abusers.
The Health and Development Foundation has developed a program, “A Comprehensive mHealth Approach to Reaching At-Risk Women,” aimed at keeping the at-risk groups of women and new mothers who are HIV+ and/or have injection drug use in their medical history informed and connected to a multi-sectoral medical and social support network and system of care.
In 2010, the Health and Development Foundation launched a pilot version of this mHealth initiative in St. Petersburg. Clients who came to St. Petersburg Maternity Hospital No. 16, a hospital for high-risk patients, during pregnancy or for delivery were invited to join the program based on the following criteria: injection drug use in their medical history, experience as a commercial sex worker, or HIV+ status. Female clients were selected for the same criteria at St. Petersburg State Narcological Hospital.
Selected clients received individual counseling, and upon release from the hospital, these women received text messages, developed by relevant health care specialists, with content related to counseling topics.
This mHealth pilot program was part of a comprehensive initiative in St. Petersburg intended to create a support system to ensure the most effective care for HIV and substance abuse risk groups through interagency and intersectoral collaboration, training of health care providers, utilization of NGO peer counselors, and HIV abuse counseling for clients.
This program is temporarily on hiatus due to lack of funding, but the regional network of experts, government supporters, and centers is still in place, as well as the text message platform used in the pilot. When funding is secured, HDF is prepared for a regional re-launch of both the woman-specific and larger program, both with the text-message component, and then to scale the program up to the national level.