HIV prevention in Yaroslavl, Russia: A peer-driven intervention and needleexchange

We report on the first two years of operation of the Yaroslavl, Russia harm reduction project for injection drug users (IDUs). From October 1996 to Se ptember 1998, the project was one of 13 projects in central and eastern Eur ope that comprised the international Harm Reduction Development Program, fu nded by the Open Society institute in New York City and the city and provin ce of Yaroslavl. The project is modeled after and received technical suppor t from the Eastern Connecticut Health Outreach project of the University of Connecticut, which was funded by the National institute on Drug Abuse. The Yaroslavl project consists of two interrelated programs: a peer-driven out reach intervention that offers active drug users modest rewards for educati ng their peers in the community and recruiting them to a storefront for fur ther education, interviews, free HIV, STD, and hepatitis B and C test couns eling; and a needle exchange where IDUs can return used syringes for new on es and also receive other harm reduction materials such as condoms. We repo rt on the development and implementation of the project and on in-depth int erviews with 484 IDUs recruited to the project, 161 first follow-up intervi ews, 86-second follow-up interviews, and 35 third follow-up interviews. The se interviews are based on clients' drug use and sexual risk behaviors, kno wledge of HIV and other drug-related harms, and the Yaroslavl drug scene. W e conclude with a discussion of the operational and political obstacles tha t the Yaroslavl project faces as those factors bear on the future of harm r eduction programs in Russia.