Battling HIV/AIDS in Russia

Professor will study Russian adolescents and develop an HIV/AIDS educational program

Gary L. Hopkins, MD, DrPH, assistant clinical professor of health promotion and education, School of Public Health, will study the behavioral intentions of Russian adolescents which may lead to intravenous drug use in an effort to develop an effective educational program that will combat the spread of HIV/AIDS. Dr. Hopkins is also assistant director of health for the General Conference of Seventh-day Adventists and teaches at Andrews University, Berrien Springs, Michigan.

According to The Joint United Nations Programme on HIV/ AIDS (UNAIDS) and the World Health Organization (WHO), by early 1998 more than 30 million people worldwide were infected with HIV, and 11.7 million people have already lost their lives to AIDS (UNAIDS, 1998).

What is even more alarming to Gary L. Hopkins, MD, DrPH, assistant clinical professor of health promotion and education, School of Public Health, is the fact that about half of all new cases of HIV infection are in individuals under the age of 25 years (UNAIDS, 1999).

These alarming statistics have caught the attention of the media in the United States. The July 2, 1999, issue of the Wall Street Journal reads, "AIDS in Moscow is surging, Russian officials said in reporting nearly 5,000 new HIV cases in the first six months. That's well more than double the number in 1998's first half. Drug use and prostitution are blamed."

In this context, Dr. Hopkins is in the final stages of preparing to work in Russia with high-school-aged young people, first studying them and then developing specific educational tools to help combat the spread of HIV/AIDS.

Why Russia? And why this age group? According to a recent article in Public Health Reports (January/February, 2000), titled "WHO and UN: AIDS Not Losing Momentum,² which cited a report by UNAIDS and WHO, the world's steepest recorded HIV curve for 1999 took place in the newly independent states of the former Soviet Union. Between 1997 and 1999, the proportion of people infected with HIV doubled.

In the Russian Federation, nearly half of all reported cases of HIV infection were recorded in the first nine months of 1999, according to the same report. Initial research indicates that intravenous (IV) drug use is becoming increasingly well-established among unemployed young people in a number of the Russian and Ukrainian industrial cities. This holds true even among school-aged children 14 years and younger, where numbers swelled twentyfold from 1997 to the first quarter of 1999.

"We plan to target Russian young people of high school age," explains Dr. Hopkins. "Our approach is unusual in that we study the target population first, and then develop our education materials."

The approach, based on the theory of reasoned action, will look at such contextual factors as peer pressure, personal feelings, and social norms in determining and predicting behavioral intention.

"In what contexts do Russian young people tend to turn to IV drug use?²asks Dr. Hopkins. "That's what we intend to determine."

The study, of which Joyce W. Hopp, PhD, MPH, dean of the School of Allied Health Professions, is principal investigator and Dr. Hopkins is co-principal investigator, will begin with the design of an accurate research instrument--a questionnaire with 295 questions--which will first be tested in a pilot study.

Joyce W. Hopp, PhD, MPH, dean of the School of Allied Health Professions, is heading Loma Linda University's collaboration with Dr. Hopkins in his groundbreaking study of Russian young people and their acquisition of HIV/AIDS.

Following the pilot study, the research instrument will be administered to a valid sample of the student body in a Russian school chosen as the research site.

"We will not be measuring HIV status during this process," Dr. Hopkins emphasizes. "We will, however, be asking the young people to answer some highly sensitive questions."

The research instrument will include questions to measure demographics (but not ethnicity), the quality of relationships with peers and different categories of adults, knowledge of HIV/AIDS, knowledge of contraceptives, HIV/AIDS risk behaviors, and, using the theory of reasoned action, the determinants of sexual intercourse before marriage, and the use of drugs, alcohol, and condoms.

No attempt will be made to identify the participants in the study--no internal coding or color coding will be used. The only identifiers will be the subject's age, class level in school, and gender. This fact will be shared by the study administrators with those taking part in the study, along with the fact that participation is completely voluntary and questions they find too sensitive may be skipped.

"The results of the questionnaire will help us custom design an educational program for these Russian young people," Dr. Hopkins relates. "Until we know the contextual factors, I believe we can't develop and run an effective educational program.²

Dr. Hopkins followed a similar approach in surveying 1,748 young people earlier at 69 Seventh-day Adventist academies in the United States. One finding of his study showed that the children of parents who were known drug users were more likely to become drug users themselves, and were also more likely to have sexual intercourse with multiple partners, a known risk factor for becoming HIV-infected.

Findings like these helped him to develop relevant educational materials to address areas unique to high-school-aged youth at Adventist schools.

One important innovative step the research team will take in this latest study, however, is to include questions designed to evaluate contextual factors that can be associated with positive behavioral outcomes.

"It's easy to focus on all of the negative characteristics that lead to negative behavior," stresses Dr. Hopkins. "Beginning with the Russian study, we will look for reasons why some kids who are at high risk don't become drug users." He adds, "It's the 'good kid, bad neighborhood' scenario."

The Russian study, a collaborative effort between the General Conference of Seventh-day Adventists, Loma Linda University, and Andrews University in Berrien Springs, Michigan, has received funding from a variety of sources. Collaborating with Drs. Hopp and Hopkins in the study is LLU Graduate School department of psychology chair, Kitti Freier, PhD.

The study will most likely take place in St. Petersburg. Arrangements are being made to finalize a research site and obtain the necessary government clearance, with the assistance of Euro-Asia Division of Seventh-day Adventists' secretary of health, Nadezhda (Nadia) Alexandrovna Ivanova.

The initial questionnaire is currently being translated into Russian. To insure accuracy of translation, the research instrument will then be retranslated back to English. The pilot study will take place once the research site has been chosen.

The study and educational program development in Russia is part of a larger effort, led by Dr. Hopkins, to conduct similar programs worldwide. In addition to the School of Allied Health Professions, School of Public Health, and the Graduate School, Dr. Hopkins hopes to involve the faculty, staff, and students of other Schools in the University--both in administering the programs and in sponsoring the efforts.

Other countries of the former Soviet bloc which are potential sites include Armenia, Romania, and the Ukraine.

Protocols for a similar study are being developed for South Africa. In the Caribbean, where the second-highest rate of HIV-infection exists, Dr. Hopkins has so far received invitations from the islands of St. Maartens and St. Kitts.

"I'd like to develop adolescent school-based programs in every country for which seed money is available," insists Dr. Hopkins. "With adequate funds, I feel we can make a significant difference in the life expectancy of a lot of young people."

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