Rapid Testing To Reach Hidden Populations Experiences From Barbados

Transcription

1 Rapid Testing To Reach Hidden Populations Experiences From Barbados Shawn Springer, BSc VCT Counsellor/Social Worker HIV/AIDS Program Ministry of Health Barbados 1

2 OVERVIEW 1. An overview of Rapid Testing in Barbados 2. Describe the approach to Community Testing - MARPS 3. Describe the experiences with Drug Users at a residential facility in Barbados. 4. Show Key Lessons Learnt and The Way Forward 2

3 RT IN BARBADOS HIV Rapid Testing (RT) started in Barbados in November 2010 as a pilot program The Pilot began at Winston Scott Polyclinic (WSPC) In January of 2011, RT was extended to The Ladymeade Reference Unit (LRU) Post Exposure Prophylaxis (PEP) only In March 2011 RT was further extended to community testing Eight (8) community events were conducted by the end of July First timers were picked as a result of community testing 3

4 RT IN BARBADOS Tested Positive WSPC (VCT) LRU (PEP) 44 3 COMMUNITY TOTAL Positives represented under 1.26% of those tested 4

5 RT IN BARBADOS Areas of Interest in Community Testing Tested Positive Regional Testing Day June Verdun House April

6 WHY WORRY ABOUT DRUG USERS? People with alcohol use disorders are more likely than the general populations to contract HIV. (Petry, 1999) A history of alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners. (NIAAA, 2002) People who believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking. (NIAAA, 2002) People report deliberately using alcohol during sexual encounters to provide an excuse for socially unacceptable behavior or to reduce their conscious awareness of risk, a practice may be especially common among MSM. (NIAAA, 2002) 6

7 STUDY Final year Bsc student at the UWI Cave Hill On macro placement at Verdun House The abuse of alcohol, marijuana, and cocaine increases the risk of the abuser sexually contracting HIV 7

8 VERDUN HOUSE Officially opened in June 2000, it is a residential facility for substance abusing males in Barbados Clients at Verdun house are expected to complete Steps 1 4 of the 12 Step-oriented residential treatment programme The three (3) main substances abused are Alcohol, Marijuana, and cocaine 8

9 FOCUS GROUPS Rubin & Babbie 2001 defines focus groups as an approach to needs assessment in which a small group of people are brought together to engage in a guided discussion of a specific topic. Two (2) focus groups were formed which serve as informants for the study and intervention at Verdun House. The ages of the participants ranged from ages There was a wide range of educational achievements 9

10 FOCUS GROUPS Determine residents knowledge of HIV including how it is sexual transmitted Determine residents knowledge of substance abuse and its relationship with HIV Understand the residents concept risk behaviors Understand the clients feelings about the present programme (Standard HIV Testing) Introduce to the Residents at Verdun House the concept of Rapid Testing 10

11 STUDY FINDINGS Residents had an average knowledge of HIV describing it mainly as a death sentence for people who are careless They all agreed that sex was the main route of HIV transmission in Barbados They agreed that multiple sexual partners resulted in increased risk They also agreed that unprotected oral, vaginal and anal sex increases the risk of sexually contracting HIV They all agreed that having sex under the influence of alcohol, marijuana, and cocaine increased their risk of sexually contracting HIV 11

12 FOCUS GROUP FINDINGS Most reported having multiple sexual partners within the last 12 months They also reported having participated in unprotected oral, vaginal and anal (with both men and women) sex in the last 12 months. Most also reported inconsistent and incorrect condom use reasoning that 1. Condoms are uncomfortable (Too small) 2. Prefer skin to skin feeling 3. It is unnatural, God made man to have sex skin to skin. 4. They did not the latex smell. Only one (1) respondent had ever seen a female condom and none of them had ever considered the FC as a viable alternative as a preventative measure 12

13 FOCUS GROUP FINDINGS They all reported having sex under the influence of alcohol, marijuana, and/or cocaine in the past 12 months Many practiced unconventional methods of HIV prevention 1. Withdrawal 2. Smell 3. Inability to acquire or maintain an erection One respondent who practiced this unconventional method reported having contracting STI s 4 times All respondents voiced concern about the approximate two (2) week wait for results using the standard HIV test 13

14 THEORETICAL FRAMEWORK For Intervention Social Learning Theory: Emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. (Bandura, 1977) Harm Reduction: An alternative treatment approach which views the reduction of harm as a legitimate goal for substance users. (Tatarsky, 2007) Behavior Change Communication: The Centre for Global Health Communication and Marketing defines BCC as the strategic use of communication to promote positive health outcomes, based on proven theories and models of behavior change. 14

15 INTERVENTION Education was a key component of the intervention strategy A Five (5) series educational module was created to address the lapse of knowledge of the residents. The titles were 1. ABC s of HIV Prevention 2. The Male Condom 3. The Female Condom 4. Substance Abuse and HIV 5. STI s, How to Avoid Them Residents were also given information on RT to prepare them for RT 15

16 INTERVENTION RT was offered to the residents at Verdun as an alternative to standard testing 12 individuals (10 residents and 2 staff) reported being available for testing on the scheduled day On the day 22 persons (16 residents and 6 staff) were tested (88% of the residents and 60% of the staff) Appointments were made for other interested persons to be accomodated at WSPC 16

17 LIMITATIONS TO STUDY & INTERVENTION Recall Bias (as a result of substance abuse) The varying educational levels created a challenge in writing a module to meet each client s needs Study was limited to men only Findings can only be generalized to men who use drugs in Barbados Reservations about RT Counsellors at Verdun House superimposing their fears of clients readiness for RT on the clients 17

18 WAY FORWARD Replicate this study at the other residential facility for substance abusers in Barbados Replicate this study in the community among abusers who would not normally seek residential treatment Determine the effectiveness of RT as opposed to standard testing Enhance work with the MSM and SW population using RT as opposed to the Standard HIV Testing Conduct a similar study with the female substance abusing population 18