The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia

Objectives We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex). Methods We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics. Results Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants. Conclusion Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population

Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan

Introduction: Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. Methods: We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. Results: A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and PolyVictimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. Conclusion: Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan

Couple-Based Behavioral HIV Interventions by the Social Intervention Group: Progress, Gaps, and Future Directions

Purpose: This paper reports a review of couple-based behavioral HIV interventions conducted by the Social Intervention Group (SIG); and addresses gaps, future directions, and implications for couple-based HIV interventions. Method: We performed a literature review for SIG research on intervention and prevention studies involving couples/partners. Results: We identified nine couple-based interventions. Outcomes included reduced sexual and substance use-related risk behaviors and improved use of anti-retroviral treatment. We conducted these studies in diverse venues, including needle/syringe exchange programs, primary care clinics, and criminal justice settings. Conclusions: The findings of this review provide strong evidence for the efficacy of couple-based HIV interventions in reducing sexual HIV risks and linkage to HIV and substanceuse treatment. SIG has advanced couple-based HIV intervention research science by improving study design, intervention core components, conceptual models, and implementation strategies; which have informed scientific directions and transformed couple-based HIV prevention research

Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan

Objectives To determine factors associated with SRH among migrant workers in Almaty, Kazakhstan. Methods In 2007, 805 vendors were screened. Approximately half were eligible (n =450), defined as at least 18 years old, a worker/owner in a randomly selected stall, having traveled 2 + hours outside of Almaty within the past year, and being an internal/external migrant. 28 non-migrants were excluded, leaving 422 participants. Logistic regression was used to examine the relationship between SRH, mental health, and psychosocial problems. Results Approximately 46% reported having poor or fair SRH. Clinical depression (OR 0.859, 95% CI 0.342–2.154), alcohol problems (OR 1.169, 95% CI 0.527–2.593), and legal status (OR 0.995, 95% CI 0.806–1.229) were not significantly associated with SRH, nor was exposure to interpersonal violence among women (OR 1.554, 95% CI 0.703–3.435). After adjusting for key variables, only ethnicity and social support were found to be significantly protective against poor or fair SRH. Conclusions SRH was not a comprehensive health measure for these Central Asian migrant workers. More specific questions are needed to identify mental illness and interpersonal violence

Genetic, social, and behavioral risk factors for tuberculosis: preliminary results from a matched case-control study in Kazakhstan

We designed a case-control study to examine demographic, clinical, social and cultural factors associated with tuberculosis in four regions of Kazakhstan. Cases included persons identified by the national tuberculosis program as having primary pulmonary tuberculosis, and controls were healthy household members and randomly selected community residents

ПОЛУЧЕНИЕ МЕТАЛЛИЧЕСКОЙ СУРЬМЫ С НИЗКИМ СОДЕРЖАНИЕМ МЫШЬЯКА ИЗ АНТИМОНАТНОГО КОНЦЕНТРАТА

The paper provides the method developed by the authors to produce low-arsenic crude antimony from the antimony concentrate containing 47,77 of Sb and 0,17 % of As. The basis of the concentrate is sodium hexahydroxoantimonate or mopungite mineral. Concentrate reduction with coke according to the traditional technology produced crude antimony with a high arsenic content – 0,34 %. To reduce arsenic content in crude metal to 0,1 % and eliminate a separate stage of antimony refining from arsenic, reduction melting is proposed in the presence of sodium plumbite or lead oxide. This allows obtaining crude antimony with an arsenic content of 0,07–0,1 %. The process of antimony concentrate reduction melting on crude antimony was carried out in an oven with silicon carbide heaters in alundum crucibles with charge batches 100–150 g each. The content of base metal and impurities in crude antimony was determined by chemical and atomic absorption methods. The form of arsenic in the concentrate was determined by X-ray phase analysis using the DRON-3 automated diffractometer (CuKα radiation, β filter). Arsenic concentration in the slag phase in the form of Pb2As2O7 lead diarsenate is shown. Thermal gravimetric analysis was performed for reduction melting of charge consisting of antimony concentrate, lead oxide and coke and it was found that metal antimony formation occurs in a temperatures range of 445–950 °C.Представлен разработанный авторами способ получения черновой сурьмы с низким содержанием мышьяка из антимонатного концентрата, содержащего 47,77 % Sb и 0,17 % As. Основу концентрата составляет гексагидроксоантимонат натрия, или минерал мопунгит. При восстановлении концентрата коксом по традиционной технологии получена черновая сурьма с повышенным содержанием мышьяка – 0,34 %. Для его снижения в черновом металле до 0,1 % и исключения отдельной стадии рафинирования сурьмы от мышьяка предложена восстановительная плавка в присутствии плюмбита натрия или оксида свинца, в результате которой получена черновая сурьма с содержанием мышьяка 0,07–0,1 %. Процесс восстановительной плавки антимонатного концентрата на черновую сурьму проводился в печи с силитовыми нагревателями в алундовых тиглях с навесками шихты 100–150 г. Содержание основного металла и примесей в черновой сурьме определялось химическим и атомно-абсорбционным способами. Форма нахождения мышьяка в концентрате оценивалась рентгенофазовым анализом с использованием автоматизированного дифрактометра ДРОН-3 (CuKα-излучение, β-фильтр). Показано концентрирование мышьяка в шлаковой фазе в виде диарсената свинца Pb2As2O7. Проведены термогравиметрические исследования процесса восстановительной плавки шихты, состоящей из антимонатного концентрата, оксида свинца и кокса, в результате которых установлено, что процесс образования металлической сурьмы протекает в интервале температур 445–950 °С

Tuberculosis report among injection drug users and their partners in Kazakhstan

Abstract ObjectivesTuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. Study designCross-sectional study. MethodsThe authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. Results16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). ConclusionsOlder men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia

HIV risk among male migrant workers in central Asia: do masculinity beliefs about sexuality and marriage matter?

The world's HIV epidemic is growing fastest in Central Asia. Migration and mobility have been found to increase HIV vulnerability in the region. There is, however, limited research on the drivers of HIV infection and transmission among migrant and mobile populations in Central Asia. This qualitative study with male migrant workers in Kazakhstan examines how beliefs about masculinity influence HIV sexual risk behavior among a sample of migrant workers recruited from the largest market place in Central Asia