Staying Safe: “Training Injection Drug Users in Strategies to avoid HCV and HIV infections”
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Staying Safe: “Training Injection Drug Users in Strategies to avoid HCV and HIV infections”

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This presentation will describe “Staying Safe” (Ssafe) a new strengths-based intervention to facilitate long-term prevention of HIV among young IDUs. Dr. Mateu-Gelabert will present the results ...

This presentation will describe “Staying Safe” (Ssafe) a new strengths-based intervention to facilitate long-term prevention of HIV among young IDUs. Dr. Mateu-Gelabert will present the results of a pilot study whose participants reported large statistically significant increases in long-term risk avoidance practices and reductions in risky behaviors.

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Staying Safe: “Training Injection Drug Users in Strategies to avoid HCV and HIV infections” Staying Safe: “Training Injection Drug Users in Strategies to avoid HCV and HIV infections” Presentation Transcript

  • Please print your hand-out before we begin!!!
  • Staying Safe: Training Injection Drug Users in Strategies to avoid HCV and HIV infections I. Course Description: This presentation will describe “Staying Safe” (Ssafe) a new strengths-based intervention to facilitate long-term prevention of HIV among young IDUs. Dr. Mateu-Gelabert will present the results of a pilot study whose participants reported large statistically significant increases in long-term risk avoidance practices and reductions in risky behaviors.
  • Staying Safe: Training Injection Drug Users in Strategies to avoid HCV and HIV infections II. Overall course goal: Increase knowledge about “Staying Safe” (Ssafe), a program to facilitate long-term prevention of HIV and HCV among young Injection Drug Users (IDUs) III. Objectives: At the end of this course, participants will be able to: 1. Describe the “Staying Safe” project 2. List at least 5 strategies for injection drug users to avoid stigma 3. List 2 ways to avoid problems with drug withdrawal 4. State 3 strategies that IDUs can use to inject safely
  •  HIV and HCV infections among injectors continue even in places with well-developed prevention programs.  We developed an innovative Staying Safe Intervention pilot study based on strategies and practices of long term IDUs who have remained HIV and HCV seronegative. If you’re having problems logging into the webinar or experiencing technical difficulty prior to the start or during the session, please telephone: Citrix Online Technical Support at (800) 263-6317
  •  Our ideas come from hypotheses developed in an early study:  Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health. 2008  How can hepatitis C be prevented in the long term? Int JDrug Policy. 2007  Strategies to avoid Opiate Withdrawal: Implications for HCV and HIV Risks. Int JDrug Policy 2009  Symbiotic Goals and the Prevention of Blood-Borne Viruses among Injection Drug Users. Subset Use Misuse. 2010
  •     0 – 20% 20 – 40% 40 – 60% More than 60%
  • Ssafe overarching framework stems from:  Ecosocial theory (Krieger)  Symbiotic Model of Risk Reduction (Friedman)  Social Action Theory If you’re having problems logging into the webinar or experiencing technical difficulty prior to the start or during the session, please telephone: Citrix Online Technical Support at (800) 263-6317
  • • Most interventions focus mainly on short term/immediate risk behaviors. • Ssafe helps IDUs focus on symbiotic goals, manage risk contexts and plan long term risk prevention strategies. • By changing the risk inducing upstream targets, IDUs will be less exposed to risk inducing moments. (E.g., by managing their drug intake better, IDUs can become less likely to exchange sex for drugs.)
  • Upstream Social Determinants of Risk (e.g. social isolation) Social Interaction Processes Minimize stigma Maintain social relations Maintain income & resources Individual Determinants of Risk (e.g., limited needle access) Risk Contexts Risk behaviors (Risk Behavior Targets) (Target Processes to minimize long-term risk) Unprotected sex Avoid withdrawal Knowledge Skills (planning ability Number of sex partners Embed safety in networks Storing sterile syringes Storing Condoms Manage drug intake Individual Targets Sharing injection equipment Biological Outcomes HCV infection HIV infection Any STI Motivation-Self-Efficacy Resources (condoms, syringe access) Ssafe Social-Behavioral Intervention
  •     Don’t Know any Have used some Would like to know more Very familiar – do these everyday with clients
  •  Keeping from getting too dirty;  Not allowing non-injectors see you inject or nod out;  Avoiding track marks;   Wearing long sleeves to hide track marks; Paying back any money you borrow;  Avoiding abscesses (e.g. avoiding dull needles); Thinking about things other than getting money, getting drugs, and physical survival;  Avoiding hanging around known injectors   Avoiding injecting cocaine/crack;
  • • Balancing income and drug need. • Not spending more on drugs than could be afforded. Cost of drug intake <money available. • Regimenting drug intake (i.e. daily maintenance”, dosage awareness, bingeing prevention). • Resorting to treatment when use “gets out of control”.
  • Comics: Sniff it rather than risk it
  • Comics: Sniff it rather than risk it
  • Comics: Sniff it rather than risk it
  • Comics: Sniff it rather than risk it
  • Comics: Sniff it rather than risk it
  • • Keeping clean needles as back up • Storing safe needles • Carrying multiple unused syringes • Overstocking • Attending Needle Exchange Programs • Diversifying needles sources (Diabetics, Pharmacies, Multiple NEP’s) • Supplying and receiving sterile syringes to/from the people who inject with
  •   True False
  •  Describe the basics of HIV and hepatitis C transmission and prevention in the context of injection drug use.
  • Water SAFE Safe injection requires that all equipment used in fixing the drugs – including water, water containers, cookers, filters, and syringes – is non-contaminated.
  • UNSAFE Water UNSAFE UNSAFE Cotton
  •  Encourage IDUs to think strategically and plan ahead avoiding foreseeable threats to safe injection.
  • Thinking Strategically How I am going to inject safely? What obstacles I might encounter? *State of Mind Plan Ahead Take Action What actions should I take to overcome obstacles? Avoid situations Avert risk *People *Places *Equipment Problem Solution State of mind People Places Equipment
  •  We pilot tested the Ssafe intervention using a preand post-test design with a 3-month follow-up.  Eligible participants had to be 18+ years of age; have injected drugs for at least a year; & have visible track marks as determined by visual inspections.  59 IDUs, recruited in 2010 from a needle exchange program by community referrals, took part in the 5-session intervention.  84% average session attendance.  88% (51/59) have completed the 3-month followup questionnaire.
  •  65% male; 35% female  Homeless 72%  Mean age 33.6 (SD = 9.2; range = 21-58)  Years injecting Mean 13.9 (SD=9; range = 1-42) 2% for 1 year 12% for 2 to 4 years 25% 5 to 10 years 61% 11 to more years  26% graduate high school; 26% completed college  8.6% had regular paid employment
  • OR p Keep from getting too dirty (clean clothes, showering, etc.) 2.44 0.04 4 Thinking on things other than using drugs, and survival 5.12 <.00 0 Despite my drug use I have managed to lead a 'normal' life 5 .001
  • OR (MHT*) Ability to manage drug intake as “moderate or “a lot ” of control <.000 p 2.36 .022 %PrePost On average, how much did you spend on drugs on a given day 0.13 T-Stat Suffered opioid withdrawals p p 36% 0.01
  • OR(MHT*) p avoid withdrawals 3.7 0.008 lead a “normal life” 5.78 0.001 to have steady access to sterile injection equipment 3.15 0.013 inject in safe locations 3.5 0.01 Planning ahead to… *(MHT):Marginal Homogeneity Test
  • (Dichotomized: No= 0 times; Yes=111+) %PrePost P (1) 30% 0.00 1 32% 0.00 1 Shared cookers 47% .000 Shared cottons 43% .000 Shared water 39% .000 Shared water containers 31% .000 Shared needles even once Divided up drugs using a syringe (known as Binomial Distribution (1) McNemar Te`st for“backloading”) %Pre-Post: Percentage decrease in # of subjects who engaged in behavior (1)McNemar Test for Binomial Distribution
  •  Promoting staying safe activities among IDUs could enhance their ability to engage in safer behavior for themselves and their injection networks.  Future interventions enhancing IDUs’ capabilities to target “upstream” risk and plan ahead could enhance long-term prevention of HIV and HCV among injectors.
  • Staying Safe Research Team Samuel R. Friedman Milagros Sandoval Pedro Mateu-Gelabert Funding NIDA grants 1R21DA026328-01 and R01 DA19383 CDUHR Mentorship Support Marya Gwadz Noelle Leonard Chuck Cleland