{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T18:05:57Z","timestamp":1779991557918,"version":"3.53.1"},"reference-count":89,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100030692","name":"Intramural Research Program, National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R00DA041245"],"award-info":[{"award-number":["R00DA041245"]}],"id":[{"id":"10.13039\/100030692","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100030692","name":"Intramural Research Program, National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01 DA045547"],"award-info":[{"award-number":["R01 DA045547"]}],"id":[{"id":"10.13039\/100030692","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30AI042853"],"award-info":[{"award-number":["P30AI042853"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stress and financial concerns due to the COVID-19 pandemic are well documented, with mixed evidence regarding their relationship with substance use. This mixed-methods study describes the prevalence of pandemic-related stress and financial worry, and their association with changes in substance use among people with HIV with a history of injection drug use in Russia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of survey and qualitative data collected from two trials between May 2020 and July 2021. We used multivariable logistic regression to assess associations between pandemic-related stress and financial worry, and reported changes in illicit opioids (primary), cigarettes (secondary), and alcohol (exploratory) use. The outcome was defined as any change (increase, decrease, or stopping) in substance use. A thematic analysis of semi-structured interviews explored experiences of stress and substance use during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results and conclusions<\/jats:title>\n                    <jats:p>Among 132 survey participants, 52% reported high pandemic financial worry and 31% reported high pandemic stress. Overall, 22% reported changes in opioid use (20% decrease, 2% increase), 21% in cigarette smoking (18% decrease, 3% increase), and 15% in alcohol use (9% decrease, 6% increase). High stress was associated with reporting any change in opioid use due to the pandemic (AOR 2.98; 95%CI: 1.20, 7.40; p\u2009=\u20090.02). Financial worry showed a similar but imprecise association (AOR 2.45; 95%CI: 0.96, 6.21; p\u2009=\u20090.06). No associations were observed for cigarette or alcohol use. Qualitative findings indicated that pandemic-related stressors and disruptions in drug access may have been linked to substance use patterns for some participants, although changes in use were not a dominant theme. Most participants did not report changes in substance use; among those who did, changes were primarily decreases. Pandemic-related stress was associated with opioid use change, though direction varied. These findings suggest that stress-related responses are context-specific and may not uniformly lead to increased substance use among PWH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349567","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:33:12Z","timestamp":1779989592000},"page":"e0349567","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 pandemic-related stress and substance use behaviors among people with HIV \u2013 a mixed method analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4168-5267","authenticated-orcid":true,"given":"Sarah L.","family":"Rossi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie M.","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliia","family":"Sereda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ve","family":"Truong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Carroll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetiana","family":"Kiriazova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Michals","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Raj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0529-4525","authenticated-orcid":true,"given":"Evgeny","family":"Krupitsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitry","family":"Lioznov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey H.","family":"Samet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Lunze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"issue":"1","key":"pone.0349567.ref001","first-page":"157","article-title":"WHO Declares COVID-19 a Pandemic","volume":"91","author":"D Cucinotta","year":"2020","journal-title":"Acta Biomed"},{"key":"pone.0349567.ref002","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.euroneuro.2021.10.864","article-title":"The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves","volume":"55","author":"M Manchia","year":"2022","journal-title":"Eur Neuropsychopharmacol"},{"key":"pone.0349567.ref003","doi-asserted-by":"crossref","first-page":"102232","DOI":"10.1016\/j.janxdis.2020.102232","article-title":"Development and initial validation of the COVID Stress Scales","volume":"72","author":"S Taylor","year":"2020","journal-title":"J Anxiety Disord"},{"issue":"8","key":"pone.0349567.ref004","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1002\/da.23071","article-title":"COVID stress syndrome: Concept, structure, and correlates","volume":"37","author":"S Taylor","year":"2020","journal-title":"Depress Anxiety"},{"issue":"21","key":"pone.0349567.ref005","doi-asserted-by":"crossref","first-page":"14546","DOI":"10.3390\/ijerph192114546","article-title":"The Intertwining of Posttraumatic Stress Symptoms, Alcohol, Tobacco or Nicotine Use, and the COVID-19 Pandemic: A Systematic Review","volume":"19","author":"AC Mengin","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0349567.ref006","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1196\/annals.1441.030","article-title":"Chronic stress, drug use, and vulnerability to addiction","volume":"1141","author":"R Sinha","year":"2008","journal-title":"Ann N Y Acad Sci"},{"key":"pone.0349567.ref007","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/7854_2021_272","article-title":"Neural Underpinnings of Social Stress in Substance Use Disorders","volume":"54","author":"V Sahani","year":"2022","journal-title":"Curr Top Behav Neurosci"},{"issue":"16","key":"pone.0349567.ref008","doi-asserted-by":"crossref","DOI":"10.1172\/JCI172883","article-title":"Stress and substance use disorders: risk, relapse, and treatment outcomes","volume":"134","author":"R Sinha","year":"2024","journal-title":"J Clin Invest"},{"key":"pone.0349567.ref009","doi-asserted-by":"crossref","first-page":"106754","DOI":"10.1016\/j.addbeh.2020.106754","article-title":"Substance use and abuse, COVID-19-related distress, and disregard for social distancing: A network analysis","volume":"114","author":"S Taylor","year":"2021","journal-title":"Addict Behav"},{"key":"pone.0349567.ref010","doi-asserted-by":"crossref","first-page":"106532","DOI":"10.1016\/j.addbeh.2020.106532","article-title":"Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women","volume":"110","author":"LM Rodriguez","year":"2020","journal-title":"Addict Behav"},{"issue":"4","key":"pone.0349567.ref011","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/dar.13074","article-title":"Alcohol use in times of the COVID 19: Implications for monitoring and policy","volume":"39","author":"J Rehm","year":"2020","journal-title":"Drug Alcohol Rev"},{"key":"pone.0349567.ref012","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.15585\/mmwr.mm6932a1","article-title":"Mental health, substance use, and suicidal ideation during the COVID-19 pandemic \u2014 United States, June 24\u201330, 2020","volume":"69","author":"M\u00c9 Czeisler","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0349567.ref013","author":"National Institute on Drug Abuse","year":"2023"},{"key":"pone.0349567.ref014","doi-asserted-by":"crossref","first-page":"102327","DOI":"10.1016\/j.janxdis.2020.102327","article-title":"Worry, avoidance, and coping during the COVID-19 pandemic: A comprehensive network analysis","volume":"76","author":"S Taylor","year":"2020","journal-title":"J Anxiety Disord"},{"key":"pone.0349567.ref015","volume-title":"American Psychological Association","author":"A Abramson","year":"2021"},{"key":"pone.0349567.ref016","doi-asserted-by":"crossref","first-page":"109065","DOI":"10.1016\/j.drugalcdep.2021.109065","article-title":"The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review","volume":"228","author":"RA Schmidt","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"pone.0349567.ref017","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11920-022-01338-z","article-title":"Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review","volume":"24","author":"HM Layman","year":"2022","journal-title":"Curr Psychiatry Rep"},{"key":"pone.0349567.ref018","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.54566","article-title":"Tobacco, Alcohol, Cannabis, and Other Drug Use in the US Before and During the Early Phase of the COVID-19 Pandemic","volume":"6","author":"WM Compton","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"11","key":"pone.0349567.ref019","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11920-021-01289-x","article-title":"Children\u2019s Psychological Reactions to the COVID-19 Pandemic","volume":"23","author":"B Pfefferbaum","year":"2021","journal-title":"Curr Psychiatry Rep"},{"issue":"1","key":"pone.0349567.ref020","doi-asserted-by":"crossref","first-page":"1929754","DOI":"10.1080\/20008198.2021.1929754","article-title":"Mental health responses to COVID-19 around the world","volume":"12","author":"M Olff","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"pone.0349567.ref021","doi-asserted-by":"crossref","first-page":"100020","DOI":"10.1016\/j.lanepe.2020.100020","article-title":"Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans","volume":"2","author":"TV Varga","year":"2021","journal-title":"Lancet Reg Health Eur"},{"issue":"14","key":"pone.0349567.ref022","doi-asserted-by":"crossref","first-page":"3191","DOI":"10.3390\/jcm10143191","article-title":"Mental Health and Psychological Wellbeing during the COVID-19 Lockdown: A Longitudinal Study in the Balearic Islands (Spain)","volume":"10","author":"J Ripoll","year":"2021","journal-title":"J Clin Med"},{"key":"pone.0349567.ref023","author":"European Monitoring Centre for Drugs and Drug Addiction","year":"2021"},{"key":"pone.0349567.ref024","doi-asserted-by":"crossref","first-page":"623032","DOI":"10.3389\/fpsyt.2020.623032","article-title":"Isolation, solitude and social distancing for people who use drugs: an ethnographic perspective","volume":"11","author":"L Roe","year":"2021","journal-title":"Front Psychiatry"},{"issue":"12","key":"pone.0349567.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0243523","article-title":"Behavioral measures to fight COVID-19: An 8-country study of perceived usefulness, adherence and their predictors","volume":"15","author":"J Margraf","year":"2020","journal-title":"PLoS One"},{"issue":"3","key":"pone.0349567.ref026","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.3390\/ijerph18031256","article-title":"Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns","volume":"18","author":"M Mar\u00ed-Dell\u2019Olmo","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0349567.ref027","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13011-021-00373-y","article-title":"Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users","volume":"16","author":"J Manthey","year":"2021","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"pone.0349567.ref028","author":"National Institute on Drug Abuse","year":"2020"},{"issue":"1","key":"pone.0349567.ref029","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12954-022-00653-1","article-title":"Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs","volume":"19","author":"FN Conway","year":"2022","journal-title":"Harm Reduct J"},{"key":"pone.0349567.ref030","author":"American Medical Association","year":"2021"},{"issue":"4","key":"pone.0349567.ref031","doi-asserted-by":"crossref","DOI":"10.15190\/d.2021.20","article-title":"Substance use during COVID-19 pandemic: impact on the underserved communities","volume":"9","author":"NC Chacon","year":"2021","journal-title":"Discoveries (Craiova)"},{"issue":"7","key":"pone.0349567.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0255396","article-title":"Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study","volume":"16","author":"LR Galarneau","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0349567.ref033","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12954-021-00586-1","article-title":"How has the COVID-19 epidemic affected the risk behaviors of people who inject drugs in a city with high harm reduction service coverage in Vietnam? A qualitative investigation","volume":"19","author":"TT Nguyen","year":"2022","journal-title":"Harm Reduct J"},{"issue":"13","key":"pone.0349567.ref034","doi-asserted-by":"crossref","first-page":"6261","DOI":"10.3390\/ijerph20136261","article-title":"Long-Term Impacts of the COVID-19 Pandemic on Drug\/Alcohol Use Prevalence in a Population with Substance Use Disorders","volume":"20","author":"A Gili","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0349567.ref035","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.18137","article-title":"Fear of COVID-19 and illicit drug use during COVID-19 pandemic in Japan: a case-control study","volume":"12","author":"K Nitta","year":"2024","journal-title":"PeerJ"},{"issue":"1","key":"pone.0349567.ref036","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12954-022-00601-z","article-title":"The impact of the COVID-19 pandemic on illicit drug supply, drug-related behaviour of people who use drugs and provision of drug related services in Georgia: results of a mixed methods prospective cohort study","volume":"19","author":"D Otiashvili","year":"2022","journal-title":"Harm Reduct J"},{"issue":"2","key":"pone.0349567.ref037","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s10461-022-03781-8","article-title":"Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia","volume":"27","author":"S Lodi","year":"2023","journal-title":"AIDS Behav"},{"issue":"9","key":"pone.0349567.ref038","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1097\/QAD.0000000000002227","article-title":"Mental health and HIV\/AIDS: the need for an integrated response","volume":"33","author":"RH Remien","year":"2019","journal-title":"AIDS"},{"issue":"1","key":"pone.0349567.ref039","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11904-021-00593-8","article-title":"Social and Behavioral Impacts of COVID-19 on people living with HIV: review of the first year of research","volume":"19","author":"SC Kalichman","year":"2022","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"3","key":"pone.0349567.ref040","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26060","article-title":"The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review","volume":"26","author":"C Hong","year":"2023","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0349567.ref041","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1186\/s12879-024-09315-y","article-title":"Stigma and mental health among people living with HIV across the COVID-19 pandemic: a cross-sectional study","volume":"24","author":"F Di Gennaro","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"6","key":"pone.0349567.ref042","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1007\/s10461-021-03547-8","article-title":"Changes in Mental Health Among People with HIV During the COVID-19 Pandemic: Qualitative and Quantitative Perspectives","volume":"26","author":"CE Parisi","year":"2022","journal-title":"AIDS Behav"},{"key":"pone.0349567.ref043","doi-asserted-by":"crossref","first-page":"2325958219888462","DOI":"10.1177\/2325958219888462","article-title":"Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health","volume":"18","author":"HJ Rendina","year":"2019","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"pone.0349567.ref044","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/25787489.2020.1763711","article-title":"Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario","volume":"21","author":"AC Benoit","year":"2020","journal-title":"HIV Res Clin Pract"},{"key":"pone.0349567.ref045","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s12529-019-09786-3","article-title":"Pathways to health: an examination of HIV-related stigma, life stressors, depression, and substance use","volume":"26","author":"TR Glynn","year":"2019","journal-title":"Int J Behav Med"},{"key":"pone.0349567.ref046","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1089\/apc.2007.0175","article-title":"Stressful Life Events and Adherence in HIV","volume":"22","author":"J Leserman","year":"2008","journal-title":"AIDS Patient Care and STDs"},{"issue":"1","key":"pone.0349567.ref047","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12981-022-00496-7","article-title":"The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review","volume":"20","author":"S SeyedAlinaghi","year":"2023","journal-title":"AIDS Res Ther"},{"issue":"6","key":"pone.0349567.ref048","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1089\/apc.2021.0004","article-title":"Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care","volume":"35","author":"S Satyanarayana","year":"2021","journal-title":"AIDS Patient Care STDS"},{"issue":"8","key":"pone.0349567.ref049","doi-asserted-by":"crossref","first-page":"2244","DOI":"10.1007\/s10461-020-02871-9","article-title":"The burden of COVID-19 in people living with HIV: a syndemic perspective","volume":"24","author":"S Shiau","year":"2020","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0349567.ref050","doi-asserted-by":"crossref","first-page":"461","DOI":"10.3390\/pathogens12030461","article-title":"The Impact of the COVID-19 Pandemic on Mental Health and Substance Use among People with and without HIV","volume":"12","author":"M Zabel","year":"2023","journal-title":"Pathogens"},{"issue":"1","key":"pone.0349567.ref051","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1186\/s12913-023-09477-6","article-title":"Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic","volume":"23","author":"AN Lea","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"pone.0349567.ref052","article-title":"Impact of the coronavirus disease 2019 pandemic on substance use disorder risk among people living with human immunodeficiency virus (HIV) enrolled in HIV care in the United States: an interrupted time series analysis","volume":"11","author":"JP Jain","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"pone.0349567.ref053","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12981-023-00517-z","article-title":"Psychosocial impacts of the COVID-19 pandemic from a cross-sectional Survey of people living with HIV in Washington, DC","volume":"20","author":"AK Monroe","year":"2023","journal-title":"AIDS Res Ther"},{"issue":"2","key":"pone.0349567.ref054","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s10461-020-02976-1","article-title":"Potential Influences of the COVID-19 Pandemic on Drug Use and HIV Care Among People Living with HIV and Substance Use Disorders: Experience from a Pilot mHealth Intervention","volume":"25","author":"KR Hochstatter","year":"2021","journal-title":"AIDS Behav"},{"key":"pone.0349567.ref055","article-title":"Exposure to COVID-19 pandemic-related stressors and their association with distress, psychological growth and drug use in people with HIV in Nouvelle Aquitaine, France (ANRS CO3 AQUIVIH-NA Cohort-QuAliV-QuAliCOV Study)","author":"B Farhat","year":"2025","journal-title":"AIDS Behav"},{"issue":"10","key":"pone.0349567.ref056","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.3390\/covid4100112","article-title":"COVID-19 Stress is Associated with Increased Smoking among People with HIV in Western Washington: A Cross-Sectional Survey","volume":"4","author":"AT Nguyen","year":"2024","journal-title":"COVID"},{"issue":"9","key":"pone.0349567.ref057","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1046\/j.1360-0443.1999.94913235.x","article-title":"HIV infection associated with drug injecting in the newly independent states, eastern Europe: the social and economic context of epidemics","volume":"94","author":"T Rhodes","year":"1999","journal-title":"Addiction"},{"issue":"4","key":"pone.0349567.ref058","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/QAD.0000000000003441","article-title":"HIV in the Russian Federation: mortality, prevalence, risk factors, and current understanding of sexual transmission","volume":"37","author":"Z Nikoloski","year":"2023","journal-title":"AIDS"},{"issue":"10","key":"pone.0349567.ref059","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(18)30168-1","article-title":"Potential impact of implementing and scaling up harm reduction and antiretroviral therapy on HIV prevalence and mortality and overdose deaths among people who inject drugs in two Russian cities: a modelling study","volume":"5","author":"JA Cepeda","year":"2018","journal-title":"Lancet HIV"},{"key":"pone.0349567.ref060","doi-asserted-by":"crossref","first-page":"100611","DOI":"10.1016\/j.lanepe.2023.100611","article-title":"An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs-a randomized clinical trial","volume":"28","author":"JB Luoma","year":"2023","journal-title":"Lancet Reg Health Eur"},{"issue":"1","key":"pone.0349567.ref061","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12954-017-0162-1","article-title":"\u201cUntil people start dying in droves, no actions will be taken\u201d: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia","volume":"14","author":"P Meylakhs","year":"2017","journal-title":"Harm Reduct J"},{"issue":"10050","key":"pone.0349567.ref062","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/S0140-6736(16)30856-X","article-title":"The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia","volume":"388","author":"FL Altice","year":"2016","journal-title":"Lancet"},{"key":"pone.0349567.ref063","doi-asserted-by":"crossref","first-page":"20877","DOI":"10.7448\/IAS.19.4.20877","article-title":"Sexual violence from police and HIV risk behaviours among HIV-positive women who inject drugs in St. Petersburg, Russia - a mixed methods study","volume":"19","author":"K Lunze","year":"2016","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0349567.ref064","doi-asserted-by":"crossref","first-page":"2296009","DOI":"10.1080\/17441692.2023.2296009","article-title":"Stigma and other correlates of sharing injection equipment among people with HIV in St. Petersburg, Russia","volume":"19","author":"SD Kimmel","year":"2024","journal-title":"Glob Public Health"},{"key":"pone.0349567.ref065","doi-asserted-by":"crossref","DOI":"10.1093\/eurpub\/ckaa165.735","article-title":"Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services","volume":"30","author":"E King","year":"2020","journal-title":"European J Public Health"},{"issue":"5","key":"pone.0349567.ref066","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/COH.0000000000000573","article-title":"Getting to grips with the HIV epidemic in Russia","volume":"14","author":"R Stuikyte","year":"2019","journal-title":"Curr Opin HIV AIDS"},{"issue":"9","key":"pone.0349567.ref067","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1007\/s10461-021-03172-5","article-title":"HIV and substance use stigma, intersectional stigma and healthcare among HIV-Positive PWID in Russia","volume":"25","author":"MV Vetrova","year":"2021","journal-title":"AIDS Behav"},{"issue":"7","key":"pone.0349567.ref068","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1093\/heapol\/czs107","article-title":"Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study","volume":"28","author":"A Sarang","year":"2013","journal-title":"Health Policy Plan"},{"key":"pone.0349567.ref069","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1007\/s11469-020-00330-z","article-title":"COVID 19 Fear, Stress, Anxiety, and Substance Use Among Russian and Belarusian University Students","volume":"19","author":"V Gritsenko","year":"2021","journal-title":"International Journal of Mental Health and Addiction"},{"issue":"9","key":"pone.0349567.ref070","doi-asserted-by":"crossref","DOI":"10.2196\/20955","article-title":"Excessive media consumption about COVID-19 is associated with increased state anxiety: outcomes of a large online survey in Russia","volume":"22","author":"NA Nekliudov","year":"2020","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0349567.ref071","first-page":"8","article-title":"Impact of COVID-19 pandemic on anxiety, depression and distress - online survey results amid the pandemic in Russia","volume":"1","author":"OA Karpenko","year":"2020","journal-title":"Consort Psychiatr"},{"issue":"1","key":"pone.0349567.ref072","doi-asserted-by":"crossref","first-page":"2270691","DOI":"10.1080\/17441692.2023.2270691","article-title":"Factors associated with psychological distress during the COVID-19 pandemic: Data from two early waves in Russia","volume":"18","author":"D Kislitsyn","year":"2023","journal-title":"Glob Public Health"},{"issue":"3","key":"pone.0349567.ref073","article-title":"The Threat of Impending Pandemics: A Proactive Approach","volume":"15","author":"B Mishra","year":"2023","journal-title":"Cureus"},{"issue":"1","key":"pone.0349567.ref074","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13722-020-0179-8","article-title":"Design of a randomized controlled trial to link infectious and narcology care (LINC-II) in St. Petersburg, Russia","volume":"15","author":"N Gnatienko","year":"2020","journal-title":"Addict Sci Clin Pract"},{"issue":"9","key":"pone.0349567.ref075","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(23)00143-1","article-title":"Rapid access to antiretroviral therapy, receipt of naltrexone, and strengths-based case management versus standard of care for HIV viral load suppression in people with HIV who inject drugs in Russia (LINC-II): an open-label, randomised controlled trial","volume":"10","author":"JH Samet","year":"2023","journal-title":"Lancet HIV"},{"key":"pone.0349567.ref076","doi-asserted-by":"crossref","first-page":"100861","DOI":"10.1016\/j.conctc.2021.100861","article-title":"Addressing intersectional stigma as a care barrier for HIV-positive people who inject drugs: Design of an RCT in St. Petersburg, Russia","volume":"24","author":"SL Rossi","year":"2021","journal-title":"Contemp Clin Trials Commun"},{"key":"pone.0349567.ref077","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.4182419","article-title":"An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs \u2013 an open-label RCT in St. Petersburg, Russia","author":"J Luoma","year":"2022"},{"key":"pone.0349567.ref078","doi-asserted-by":"crossref","first-page":"104060","DOI":"10.1016\/j.drugpo.2023.104060","article-title":"The impacts of COVID-19 on structural inequities faced by people living with HIV who inject drugs: A qualitative study in St. Petersburg, Russia","volume":"117","author":"JJ Carroll","year":"2023","journal-title":"Int J Drug Policy"},{"key":"pone.0349567.ref079","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2022.306727","article-title":"Supporting the health of HIV-positive people who inject drugs during COVID-19 and beyond: lessons for the United States from St. Petersburg, Russia","volume":"112","author":"JJ Carroll","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0349567.ref080","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"MD Fetters","year":"2013","journal-title":"Health Serv Res"},{"key":"pone.0349567.ref081","volume-title":"Learning from strangers: The art and method of qualitative interview studies","author":"RS Weiss","year":"1995","edition":"1"},{"key":"pone.0349567.ref082","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.drugpo.2015.10.001","article-title":"Emergence of Methadone as a Street Drug in St. Petersburg, Russia","volume":"27","author":"R Heimer","year":"2016","journal-title":"Int J Drug Policy"},{"issue":"7","key":"pone.0349567.ref083","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/hiv.12741","article-title":"Evolution of illicit opioid use among people with HIV infection in St Petersburg, Russia, in the period 2004-2015","volume":"20","author":"E Blokhina","year":"2019","journal-title":"HIV Med"},{"key":"pone.0349567.ref084","first-page":"100388","article-title":"Impact of the COVID-19 pandemic on substance use among adults without children, parents, and adolescents","volume":"14","author":"KA Dodge","year":"2021","journal-title":"Addict Behav Rep"},{"issue":"19","key":"pone.0349567.ref085","doi-asserted-by":"crossref","first-page":"6834","DOI":"10.3390\/ijerph20196834","article-title":"Substance Use among Emerging Adults during the COVID-19 Pandemic: A Review through the Lens of Sustainable Development Goals","volume":"20","author":"AK Remesan","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"39","key":"pone.0349567.ref086","doi-asserted-by":"crossref","first-page":"5739","DOI":"10.1016\/j.vaccine.2022.08.042","article-title":"Determinants of COVID-19 vaccine hesitancy and resistance in Russia","volume":"40","author":"Y Roshchina","year":"2022","journal-title":"Vaccine"},{"key":"pone.0349567.ref087","doi-asserted-by":"crossref","first-page":"3801","DOI":"10.1038\/s41467-022-31441-x","article-title":"Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021","volume":"13","author":"JV Lazarus","year":"2022","journal-title":"Nat Commun"},{"key":"pone.0349567.ref088","doi-asserted-by":"crossref","first-page":"4136","DOI":"10.3390\/ijerph19074136","volume":"19","author":"NI Briko","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"pone.0349567.ref089","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1111\/add.15414","article-title":"Is substance use changing because of the COVID-19 pandemic? Conceptual and methodological considerations to delineating the impact of the COVID-19 pandemic on substance use and disorder","volume":"116","author":"J Jager","year":"2021","journal-title":"Addiction"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349567","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:33:24Z","timestamp":1779989604000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349567"}},"subtitle":[],"editor":[{"given":"Vipula Rasanga","family":"Bataduwaarachchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":89,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349567","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}