Shebeens offer opportunity for HIV testing among high risk young men and women

Transcription

1 Shebeens offer opportunity for HIV testing among high risk young men and women South African AIDS Conference Durban 14 June 2017 Dr S Shenoi / Dr. Tony Moll

2 Shebeens Informal or formal drinking venue for relaxing, socialising, chilling out Vary from backyard joints to sophisticated up-market venues with big screen TV, digital Juke boxes, pool tables, large selection of drinks Attracting a significant young population

3 Study Location Msinga Population How many shabeens? Umzinyathi District

4 Community Based Intensive Case Finding

5 CONGREGATE Pension pay points Health campaigns Municipal meetings Taxi ranks Community Based Intensive Case Finding HOUSESHOLD Door to door family testing

6 HIV tested 100% 90% 80% 70% 60% Intensive Case Finding Congregate settings (12000) tested Households (5000) tested 50% 40% 30% 87%...notice the gender disparity HIV positive 20% 29% 10% 20% 0% Congregate Settings Households Shebeens Median Age 41 (IQR23-56) 39 (26-56) 100% 90% 80% 70% 60% 50% 40% 77% 30% 20% 10% 23% 16% 0% Congregate Settings Households Shebeens 11% 18% Females Tested Males Tested Females Pos Males Pos

7 Where are the men?

8 Where are the men? Tribal/cultural activities Sports events Alcohol venues / Shebeens

9 Men and Alcohol poor combination for HIV outcomes Men less likely to engage all along HIV cascade, resulting in poorer clinical outcomes have issues attending Health care facilities Alcohol Increases risk of HIV acquisition through risky behaviors Compromises virologic control and retention in care Emerging risk factor in Sub-Saharan Africa Hensen AIDS 2014 Sharma Plos Med 2017 BorPlosMed 2017 Arnesen, Moll, Shenoi, Plos One, 2017 VagenasP, Azar MM, CopenhaverMM, Springer SA, Molina PE, Altice FL South African National Strategic Plan

10 Methods (for a descriptive Study) Pilot project March September in 2016 All male study team based in a van parked outside shebeens Mingle in with the patrons Engage patrons on entering shebeen/ prior to alcohol consumption Offered a health checkup : HIV screen TB symptom screen Random glucose Automated BP measurement Risk assessment questionnaire

11 Results (503 Shabeen attendees ) Descriptive n=503 N(%) Sociodemographics Median age 26 (IQR 21-35) Men 435 (86.5%) Women 68 (13.5%) Unemployed 405 (82.5%) Receive monthly grant 50 (9.9%) Norunning water 428 (85.1%) Has electricity 442 (87.9%)

12 Results Behavior/Risk N (%) Smoke cigarettes 288 (57.3%) Smoke marijuana 140 (27.9%) Harmful drinkingby WHO AUDIT 321 (63.8%) Men with AUDIT > (66.2%) Womenwith AUDIT > 4 33 (48.5%) Injectdrugs (ever) 2 (0.4%) MSM 7 (1.6%) Median sexual partners in the last month 2 (IQR 1-8) Sexwithout condom (ever) 472 (93.8%) Sexwith known HIV positive partner 10 (2.0%) Sex with partner of unknown HIV status 418 (84.27%) Sexuallytransmitted infection (ever) 127 (25.3%) Paid for sex (ever) 2 (0.4%)

13 75% inconsistent condom use

14 Results HIV testing n (%) Total Group M (435) F (68) 503 Known status of M (424) F (65) 489 (97%) Accepted HIV testing M ( 412) F (61) 473 (94%) First time HIV test 117 (23.4%) Actually tested positive M (21) F(6) 27 (5.3%) Self reported Positive M (12) F (4) 16 (3.1%) HIV positive M (33) F (10) 43 (8.5%) Percentage HIV positive among men and women Men 7.7% p=0.04 Wome n 15.4%

15 100% 90% 80% 70% HIV Testing 60% 50% 40% 87% Females Tested Males Tested 30% 20% 10% 29% 20% HIV Positive 0% Congregate Settings Households Shebeens Median Age 41 (IQR23-56) 39 (26-56) 26 (21-35) 100% 90% 80% 70% 60% 50% 40% 77% 30% 20% 10% 23% 16% 0% Congregate Settings Households Shebeens Females Pos Males Pos

16 Discussion Men overall are more difficult to engage for testing, linkage to care, and ART initiation In order to combat the HIV epidemic, need to include men in testing, treatment, prevention efforts Testing at shebeens yielded a high number and proportion of men and overall younger population engaging in high risk behaviors Community-based programs can be useful adjunctive strategies for addressing HIV a means of bringing this hard to reach HIV+ group into care Provides opportunities for HIV prevention among large HIV negative population Education, counseling, promoting traditional condom use HIV pre-exposure prophylaxis (PrEP) Interventions for behavior change and alcohol reduction

17 Acknowledgements Gerald Friedland Anthony Moll Ralph Brooks Laurie Andrews Richard Shange Jabulile Madi Vijay Guddera Sarah Norton Thuthukani Madondo Tugela Ferry community NIAID Gilead Foundation Doris Duke Foundation

18 Thank you

19 HIV and Alcohol Evidence demonstrating increased HIV acquisition under the influence of alcohol through increased risky behaviors Evidence for poorer linkage to care, ART treatment initiation, virologic control, and retention in care Emerging major risk factor in sub-saharan Africa Alcohol venues have a major role in the sociocultural scene espfor young men and women VagenasP, Azar MM, CopenhaverMM, Springer SA, Molina PE, Altice FL South African National Strategic Plan

20 One unit equals 10ml or 8g of pure alcohol, which is aroundthe amount of alcohol the average adult can process in an hour. The number of units in a drink is based on the size of the drink, as well as its alcohol strength. strength (ABV) x volume (ml) 1,000 = units ABV (Alcohol by volume) 5.2 (%) x 568 (ml) 1,000 = 2.95 units

21