Additional North Carolina Projects

Transcription

1 Additional North Carolina Projects William Zule, Dr.P.H. RTI International is a trade name of Research Triangle Institute

2 Risk Groups Injecting drug users (IDUs) Non-injecting drug users (non-idus) Men who have sex with men (MSM) Men who have sex with men and women (MSMW) 2

3 Projects, Risk Groups and Locations Study Risk Group(s) Location Years Chronic Hepatitis Intervention Project (CHIP) for Drug Users IDUs (n=851) Raleigh-Durham North Carolina Sexual Acquisition and Transmission of HIV Cooperative Agreement Project (NC SATH-CAP) Drug users, MSM (n=1985) Raleigh-Durham and 2 rural counties Men s Attitudes toward Sexual Health (MASH) Meth-using MSM (n=39) Raleigh, Charlotte Computer Assisted Tailored Cue-Card Health (CATCH) Study IDUs, non-idus, MSM (n=145) Raleigh and 1 rural county Intervention study Epidemiological study 3

4 Relationships between NC Projects CHIP NC SATH-CAP MASH CATCH 4

5 Chronic Hepatitis Intervention Project CHIP 5

6 Chronic Hepatitis Intervention Project Raleigh & Durham Enrolled 851 out of treatment IDUs Compared a motivational interviewing (MI) intervention and an educational intervention Intervention objectives: Primary: reduce alcohol use Secondary: reduce HIV risk behaviors 6

7 CHIP Sample Characteristics Socio-demographics (n=620) Mean age (S.D) in years 41 (9) % male 73 Race/ethnicity % non-hispanic white 27 % African-American 66 % other 7 % unemployed 70 % homeless 35 % ever in substance abuse treatment 67 % ever in prison 57 % HIV positive 9 % HCV positive 55 7

8 Intervention Outcomes MI intervention produced greater reductions in alcohol use Effects were greatest among HCV positive drinkers Both interventions produced reductions in HIV risk behaviors 8

9 Alcohol Use by Intervention Condition 9

10 Other Findings African-American IDUs less likely to obtain syringes from pharmacies Sharing high dead space syringes, but not low dead space syringes, linked to prevalent HIV/HCV infection Methamphetamine use associated with high risk heterosexual sex 10

11 High and Low Dead Space Syringes (FYI)

12 North Carolina Sexual Acquisition and Transmission of HIV Cooperative Agreement Project NC SATH-CAP 12

13 NC SATH-CAP Counties: Wake, Durham, Johnston, Chatham Sample: 1,985 drug users, MSM and sex partners 1414 Wake & Durham counties 571 Johnston & Chatham counties Recruitment Method: Respondent Driven Sampling (RDS) Multi-disciplinary approach/team: behavioral epidemiology, mathematical modeling, social networks, molecular epidemiology, social epidemiology, medical geography 13

14 NC SATH-CAP Sites 14

15 Socio-demographic Characteristics Urban (n=1414) Rural (n=571) Total (n=1985) Mean age (S.D.)*** 40.5 (9.7) 36.9 (12.4) % Male Race/ethnicity*** % African-American % Non-Hispanic White % Other % High school education** % Unemployed*** % Married or living as married** % Homeless

16 HIV, STI and HCV Prevalence Infection Percentage % HIV Positive 8.2 % HCV Positive 18.4 % Syphilis Positive 2.6 % Chlamydia Positive 3.6 % Gonorrhea Positive 2.5 % Positive for any STI (excluding HIV/HCV)

17 Sexual Risk Behaviors Past 6 Months Urban (n=1414) Rural (n=571) Total (n=1985) Mean # of sex partners (S.D.) 4.3 (16.1) 3.7 (21.3) 4.1 (17.8) Mean # of new sex partners (S.D.) 2.7 (7.6) 2.4 (17.9) 2.6 (11.6) % > 5 partners* % any unprotected intercourse*** % bisexual behavior*** % bought sex from last 3 partners*** % sold sex to any of last 3 partners

18 NC SATH-CAP Findings MSM, IDUs, female sex workers and crack users all present in rural counties Male bisexual behavior common among drug users Bisexual behavior linked to drug use and sex trading among men and women Mathematical models suggest that low dead space syringes prevent injection-related HIV epidemics 18

19 Men s Attitudes Toward Sexual Health MASH 19

20 Men s Attitudes toward Sexual Health (MASH) Participants: methamphetamine-using men who have sex with men (MSM) Intervention: single session motivational interviewing (MI) intervention 20

21 MASH Sample (n=39) Race/ethnicity % African-American 43.6 % Non-Hispanic white 51.3 % Employed full or part-time 33.3 % Homeless during last 3 months

22 MASH Sample Sexual Orientation % Gay/homosexual 74.4 % Bisexual 20.5 % Straight/heterosexual 5.1 % ever in jail or prison 59.0 % ever in substance abuse treatment 15.4 % HIV positive 46.2 % any STDs last 12 months

23 Reductions in Methamphetamine Use and Sex Risk Behaviors * All pre-post changes significant p <

24 Computer Assisted Tailored Cue-card Health Study CATCH CATCH 24

25 Computer Assisted Tailored Cue-card Health (CATCH) Study Computer intervention tailored by: Gender Race Gender of sex partners Injecting drug use Stimulant use Participation in sex work For use in rural areas and resource poor settings 25

26 CATCH Intervention Examples African-American female IDU, sex worker CATCH Study (Computer Assisted Tailored Cue-card Health Study) 1.HIV and STI general information 2.Sexual behavior risk Sex with men vs. sex with women 3.Risks associated with sex work Reducing your risk Higher Risk Sexual Risk Trading Sex Protection Not using protection Drug Use Always using drugs before trading sex Sex with women: what you need to know You can still get STDs even if you only have sex with women! Knowing more about safe sex can help save your life and keep you and your partners from getting sick. Women are at higher risk of HIV and hepatitis than men because of their anatomy. Even though women are less likely to have one of these diseases already, it is still best to always use protection with all your female partners. Partner violence Empowerment theory 4.Harm reduction information Syringe cleaning Decrease syringe sharing behaviors 5.HIV Pre-test counseling Lower Risk Reducing the number of trade partners Using protection with some partners Only using drugs with some partners Using Not using drugs protection with before having Not trading sex all trade sex with any partners trade partners Help Protect Yourself: Talk about it! Remember: If you think that asking a sex partner to use protection will hurt their feelings, consider that your health is precious and it affects: your daily quality of life your loved ones your community Drugs harm women in many ways Remember that alcohol or drug use takes away your power in a relationship or a situation To stay safer: If you use drugs, reduce your use in dangerous situations Be prepared with male and/or female condoms and use them correctly Be prepared with your confidence in negotiating their use if you plan to have sex *Risky Sex* Choice and # of Partners Lack of Protection *Drug Use* *Violence* Victimization Fights Rape Compromises your power in decision-making, judgments and control in risky situations 26

27 CATCH Intervention Examples Hispanic MSM, stimulant-user 1. HIV and STI general information 2. Sexual behavior risk Increased risk associated with anal sex Limiting number of partners Discussing STIs and HIV with all partners 3. Risks associated with stimulants Increased sex drive and decreased inhibitions 4. HIV Pre-test counseling CATCH Study (Computer Assisted Tailored Cue-card Health Study) Sex with men: what you need to know HIV and hepatitis is most commonly spread by having unprotected anal sex with other men. Using a condom with your male partners and talking to them about safer sex will significantly decrease your chances of getting a disease. Next, we will show you how to use a condom properly and how to talk about using a condom with all your sex partners. Help Protect Yourself: Talk about it! Learn as much as you can about HIV and STDs. We have more information you can take with you to learn more. The best time to talk about sexual health is BEFORE you get horny or are ready to have sex! If you have a regular sexual partner: Talk about the times when it s hard to have safe sex (for example, when you don t have a condom or are high). Decide what to do together during those time so you can both be stay safe. What does all this mean for me? The facts: Things to consider: 1. You should get tested at least The rate of HIV in North Carolina every year for all STDs and HIV is rising in our communities. 2. Think about getting HAV and The rate of HIV for Hispanics is HBV vaccines to protect yourself against these diseases 3½ times higher than for whites in NC NC HIV rate is already 40% higher than the national HIV rate! Men who have sex with men (MSM) are at particularly high risk through anal sex 6 out of 10 syphilis cases are in MSM From: NC Department of Health and Human Services (DHHS) Stimulant Drug Use Using stimulant drugs (like those listed to the right) can significantly increase your risk of HIV and STDs because they: increase your sex drive limit your ability to make good decisions about safe sex Common stimulant drugs are: Cocaine Crack Methamphetamine Ecstasy (MDMA) 27

28 Implications and Future Directions IDUs Increase syringe access (syringe exchange and pharmacy sales) Decrease use of high dead space syringes Increase HCV testing and reduce alcohol use Behaviorally bisexual men Potential bridge population Computer-delivered, tailored interventions Rural populations Tailored interventions for all risk groups Resource-efficient interventions 28

29 Acknowledgements Funding Sources R01DA NIDA U01DA NIDA UR6PS CDC R21DA NIDA Thanks to Wendee and all of the RTI colleagues and field staff over the years whose invaluable contributions made these project successful. Special thanks to all the participants who shared the details of their lives and made this work possible. 29