Sociological analysis of barriers to effective social HIV prevention in the Volgograd region

Gavrilova Irina Sergeevna ORCID: 0000-0002-4175-5499 PhD in Philosophy Associate Professor, Department of Medical and Social Technologies, Volgograd State Medical University 400066, Russia, Volgograd region, Volgograd, Fallen Fighters Square, 1, 1 gavrilova.irene@yandex.ru Other publications by this author

Tokareva Yuliya Mihailovna ORCID: 0000-0001-9342-3771 PhD in Sociology Associate Professor, Chair of Medical and Social Technologies, Volgograd State Medical University 400066, Russia, Volgograd region, Volgograd, Fallen Fighters Square, 1, 1 kazachkova.djulia@yandex.ru

Introduction.

According to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, about 100,000 new HIV cases are detected in the Russian Federation every year (about 300 people every day). Every year, due to late diagnosis and initiation of treatment, low adherence to therapy and concomitant diseases, about 25 thousand people with HIV die (70 people per day) (Federal Scientific and Methodological Center for AIDS Prevention and Control of the Federal State Budgetary Institution of the Central Research Institute of Epidemiology of Rospotrebnadzor // URL: http://www.hivrussia.info/wp-content/uploads/2023/09/Spravka-VICH-v-Rossii-na-31.12.2022.pdf (date of application: 02/10/2024). In order to respond effectively to the epidemic, it is necessary to regularly assess the effectiveness of the medical and social tools used, identify factors affecting the health of the population and youth, in particular, update sociological data within the framework of a study of target groups - the professional community and the population on HIV infection.

Discussion.

The purpose of our work was to conduct a specific sociological study of the effectiveness of the use of technologies (methods) for the medical and social prevention of HIV infection. The method of social diagnosis of studying youth aged 16-30 years, the method of expert assessments in the framework of a focused interview, and the analysis of statistical data were applied.

HIV infection is a disease requiring measures of primary, secondary and tertiary (rehabilitation) medical and social prevention. Medical and social prevention is a complex of social and medical measures aimed at preventing the appearance or development of a disease and/or eliminating risk factors ^[1,:4-9]. Preventive measures regarding the incidence of HIV in Russia are regulated by 38-FZ "On preventing the spread of human immunodeficiency virus (HIV infection) disease in the Russian Federation", 323-FZ "On the basics of protecting the health of citizens in the Russian Federation", in SanPiN 3.3686-21 "Sanitary and epidemiological requirements for the prevention of infectious diseases" (Section VI "Prevention of HIV infection") and a number of other legislative acts of the Russian Federation.

The empirical basis of the study was the Volgograd regional public organization for the development of public interaction in defense of the rights and interests of vulnerable groups of the population "UNITY". The purpose of the organization is cooperation between non-governmental organizations and government agencies to provide assistance to the population of the Volgograd region affected by HIV/AIDS.

Healthcare as a social institution involves the use of a number of sociological tools as part of the primary prevention of HIV infection. In order to determine the level of awareness within the framework of the use of technologies for the medical and social prevention of HIV infection, we conducted an empirical study. The number of respondents who took part in the study was 374 people who did not have HIV–positive status.

The main measurement parameters in this study are to identify the level of awareness of citizens about HIV infection itself, diagnostic capabilities and personal prevention measures. To determine the incidence of HIV infection, statistical data from the Department of Rospotrebnadzor for the Volgograd region were used (the Department of Rospotrebnadzor for the Volgograd region //URL:https://34.rospotrebnadzor.ru/content/274/14226 / (date of access: 02/10/2024). .To determine the awareness of citizens about HIV infection itself, diagnostic possibilities and personal prevention measures, the questionnaire method was used. This study correlates with the research of the NGO "Unity" "Public assessment of barriers to obtaining social and medical services for HIV infection in the Volgograd region" with the support of the Presidential Grants Fund project (head of sociological research of the project - Gavrilova I.S.) and has the character of clarifying and supplementing.

To date, in Volgograd, the main directions of HIV infection prevention are directly the prevention of HIV infection and drug addiction (a risk factor for infection). Due to the current sanitary and epidemiological situation in the region in the period from 2020-2024, the regularity of group meetings uses means of remote counseling.

With regard to the primary prevention of HIV infection, the following methods are used: placement of information booklets and posters in medical and educational institutions; publication of information videos on various Internet sites, conducting online sessions on HIV prevention, providing an affordable opportunity for rapid HIV testing (for example, the Volgograd Regional Center for the Prevention and Control of AIDS and infectious diseases provides the opportunity for anonymous testing), regular volunteer actions on the part of the Volgograd regional headquarters "Medical Volunteers", which participates in field preventive measures and organizes volunteer information campaigns.

With regard to the secondary prevention of HIV infection, the project "Remote advisory support for people living with HIV" has been developed and put into operation. The project is being implemented in the development of public interaction in defense of the rights and interests of vulnerable groups of the population "UNITY". The aim of the project is to raise awareness of people living with HIV who have been diagnosed for the first time or are registered at a dispensary, but for some reason do not visit the doctors of the AIDS center. The objectives of the project include the formation of a commitment to treatment in this group of the population, responsible attitude to their own health and others. Such information-controlling medical and social work differs from classical forms of interaction, because it is remote in nature through the creation of specialized closed groups in messengers Viber, WhatsApp, Telegram, smart chatbot. The relevance of using remote information and communication technologies of text messages has proven its effectiveness both during the COVID-19 pandemic and the post-COVID period, especially in relation to young and middle-aged people ^{[3, c. 27(9)],[4, c.2988-2996]}.

Operational consulting involves a question-and-answer format with the necessary specialist of a multidisciplinary team (an infectious disease specialist, a medical psychologist, a consultant, a specialist in social work).

According to statistical data from the Department of Rospotrebnadzor for the Volgograd region, in 2023, more than 470 thousand people were examined for HIV infection in the Volgograd Region for preventive purposes (Rospotrebnadzor Administration for the Volgograd region //URL:https://34.rospotrebnadzor.ru/content/274/14226 / (date of access: 02/10/2024)). According to the results of clinical and laboratory studies, the incidence of HIV infection in the Volgograd region among the population of the region decreased by 3% compared to previous years. It is important to note that infection with parenteral drug use reaches 62.6%, which determines the relevance and need for more measures to prevent drug addiction, as well as their qualitative changes.

At the stage of primary HIV prevention/The AIDS system of events included:

1. conducting interactive lectures in schools and colleges, universities (N= 322 people);

2. HIV awareness promotion/AIDS (distribution of information booklets based on interactive lectures);

3. Conducting thematic online sessions for high school students, university and college students, as well as unemployed youth under 30 years of age (N= 489 people);

4. Conducting a thematic online session on the prevention of injecting drug use for high school students, university and college students, as well as unemployed youth under 30 years of age (N= 489 people).

Prior to the events, participants were asked to take an online survey (using a Google Form, which could be accessed via an active link or QR code).

According to the results of the questionnaire, 30% of respondents believe that the problem of HIV infection can affect them personally, 26% of respondents are sure that such a problem cannot affect them and 44% find it difficult to answer. All respondents are aware that HIV infection is transmitted sexually and by sharing injection supplies with an HIV-infected person. At the same time, more than half (53%) believe that using a barrier method of contraception does not reduce the risk of HIV infection.

Only medical students are aware of the perinatal pathway of HIV transmission, who also noted the risk of infection if they do not comply with safety regulations in professional medical activities.

When asked about the risk groups for HIV infection, all respondents answered correctly. It is noted that not all respondents are aware of the methods of HIV diagnosis/AIDS. 12% of respondents noted that a person living with HIV can be identified by their appearance. During the data processing, a low level of tolerance towards virus carriers was revealed.

After carrying out all measures of medical and social prevention of HIV infection, there was a positive trend in terms of awareness and medical and social literacy. Students of medical specialties are the most informed about the ways of HIV transmission, the risk of infection and methods of personal safety (both before and after the events). Comparing the figures before the events, it is noted that already 16% of respondents believe that the problem of HIV infection can affect them personally, 72% of respondents are sure that such a problem cannot affect them due to compliance with personal safety rules and 12% find it difficult to answer.

All respondents are aware that HIV infection is transmitted sexually and by sharing injection supplies with an HIV-infected person, 86% of respondents know that using a barrier method of contraception reduces the risk of HIV infection. 76% of the subjects are already aware of the perinatal pathway of HIV transmission.

There is an increase in the level of knowledge about HIV diagnosis methods/AIDS, the rules of action in case of suspected HIV infection and the institutions where you should contact.

Institutional changes in human behavior and social groups are determined by a number of characteristics, one of which, as noted by A.V. Reshetnikov, "... socio-psychological aspects of the behavior of medical and social groups in terms of protecting, maintaining and strengthening health" ^{[2, p. 117]}. The determinant of changing social behavior within the framework of the problem of HIV infection is social tolerance towards virus carriers, which in our study was expressed in the following figures: 91% showing literacy and social tolerance after the events, compared with 35% before receiving relevant information).

Digital technologies, remote information and communication technologies have played an important, although not decisive role, as they contributed to the greatest coverage of the target audience.

Our research has gained volume in the framework of cooperation with the NGO "Unity", which allowed us to participate in the interview of 35 specialists dealing with the problem of HIV/AIDS ? doctors, psychologists, peer counselors, social work specialists. Using the method of focused interviews and expert assessments, the questions were developed taking into account the main topic concerning the effectiveness of established medical and social methods (technologies) of disease prevention among the population and at-risk groups.

One of the important questions that was submitted for consideration: "What do you think, which of the preventive measures are the most ineffective and/or outdated today?", the overwhelming majority of specialists (N=30 people) believe that holding interactive lectures in schools and colleges is less effective and as outdated as possible. other educational institutions. Nevertheless, these same experts emphasize that this method is almost the most accessible, with which you can reach a large number of people. It should be noted that, according to experts, the main disadvantage is low efficiency, since it is extremely difficult to track the impact of such a technique, they are used as spontaneously and massively as possible. The remaining specialists (N = 5 people) believe that the available resource of this technology has not been exhausted and may remain relevant due to interactive methods, and it is not possible to abandon it in the near future.

Answering the question about the existence of a relationship between the effectiveness of the use of medical and social technologies in the prevention of HIV infection and the team of specialists who work within the framework of this prevention, the opinions of experts were divided. Some specialists (N= 25 interviewees) believe that there really is a relationship between the effectiveness of preventive measures and the team of specialists who work within these measures, more precisely, when the team of specialists is multidisciplinary, it is the specialists responsible for their sector of work (block of measures), for their profile, who can make the implementation of preventive measures effective. Other specialists (N=10 people) believe that the effectiveness of preventive measures should not be associated with the interdisciplinarity of the team of specialists. As an alternative, a temporary team of any specialists or volunteers who had not previously worked with each other was offered. In the understanding of this part of the specialists, efficiency is not the key to teamwork, but the correct planning and management of the leader of the organization and / or project.

In contrast to the first question, an antipode question was also asked: "What do you think are the most effective and/or progressive preventive measures today?" Most of the specialists (N= 28 people) consider those preventive measures to be effective and most effective within the framework of which people are directly involved in the process of conducting perhaps even the creation of these events. Experts consider the main link in this case to be a person, but not to whom the "flow of information" is directed and he is exclusively its recipient, but a person who is an actor and a necessary link in the implementation of a particular preventive measure.

During the interviews, experts noted the obvious negative impact of negative attitudes towards risk groups or people infected with HIV, which can affect both the process of implementing preventive measures and, in general, the indicators of further effectiveness of measures.

Conclusion. According to the results obtained, the high efficiency of the integrated systemic application of technologies for the medical and social prevention of HIV infection has been practically proven, plans have been announced for the active use of digital prevention technologies, such as specialized mobile applications, for example, "All about HIV infection. Anti AIDS Lipetsk", "HIV/AIDS 3D", representatives of interdisciplinary teams actively cooperate with non-profit organizations.