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Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
Nhbsidu1dshs 100521110123-phpapp02
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  • 1. Substance Abuse, Sexual Behaviors,HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006 Shane U. Sheu, MPH, Sonia Arbona, PhD, Erin Elbel, Doug Kershaw, Praveen R. Pannala, MD, MPH Sharon K. Melville, MD, MPH Texas Department of State Health Services May 25, 2010 1
  • 2. Objectives To obtain prevalence estimates using respondent driven sampling (RDS) among injection drug users in Dallas for  Substance abuse behaviors  Sexual behaviors  Testing behaviors  Prevention services utilizations To explore the relationship between concomitant substance abuse and  Unprotected sex  HIV/STD/HCV testing behaviors  Prevention service utilizations 2
  • 3. B ackgrou nd
  • 4. Per son s L ivi ng wi th H I V/A I D S and New H I V/A I D S C ases, Texas, 2002-2008 70,000 60,000 63,019 59,829 56,884 50,000 54,292 51,048HIV/AIDS Cases 47,776 44,508 40,000 Persons living with HIV/AIDS New HIV/AIDS cases 30,000 20,000 10,000 5,159 4,483 4,512 4,486 4,112 4,403 4,481 0 2002 2003 2004 2005 2006 2007 2008 Year Data Source: Texas HIV/AIDS Reporting System (HARS); 2002-2008
  • 5. Propor tion of A I D S C ases by Tran sm i ssion C ategory, Texas, 1990-2008 70 60 Male-to-male sexual contact (MSM) 50 Cases, % 40 High risk heterosexual contact* 30 Injection drug use (IDU) 20 10 MSM and IDU 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year of Diagnosis•Heterosexual contact with person known to have or to be at high risk for HIV infectionData Source: Texas HIV/AIDS Reporting System (HARS); 1990-2008
  • 6. National H I V B ehavioral S u r vei llance S ystem S i tes Seattle Boston New Haven Nassau Detroit New York CitySan Francisco Newark Philadelphia Chicago Baltimore Denver Washington, DC Las Vegas Norfolk Los Angeles St. Louis San Diego Atlanta Dallas High risk population cycles: Houston Ft. Lauderdale • IDU New Orleans Miami San Juan • MSM • HeterosexualsSource: Centers for Disease Control and Prevention 6
  • 7. Methods
  • 8. NH B S O verall S trategy S u rve y co m p o n e n ts C o re q u e sti o n s  D e m o grap h i c ch aracteri sti cs  Alco h o l an d d ru g u se ri sk b e h avi o rs  S e x u al ri sk b e h avi o rs  T e sti n g b e h avi o rs: H I V, H C V, sy p h i li s  Pre ven ti o n servi ce s u ti li z ati o n L o cal q u e sti o n s tai lo re d to e ach si te H I V te sti n g (N o t d o n e i n D allas I D U 1 ) S am p le si z e  T arge t = M i n i m u m o f 500 p e rso n s i n te rvi e w e d e ach cycle 8
  • 9. Respondent D r iven Sampli ngRecr u i tm ent  S tu d y te am re cru i te d i n i ti al p arti ci p an ts (se e d s) th ro u gh o u tre ach  S e e d s re cru i te d u p to 3 o th er p arti ci p an ts  T h o se p arti ci p an ts re cru i te d u p to 3 o th ers  D o n e u n ti l sam p le si z e w as m et  I n cen ti ve s p ro vi d e d fo r p arti ci p ati o n an d re cru i tm en t  $20 fo r i n tervi e w an d $1 0 fo r e ach re cru i tm en t 9
  • 10. NH B S I DU1 E ligi bi li ty C r i ter ia At le ast 1 8 ye ars o ld Re si d e n t o f D allas Fo rt Wo rth M S A I n je cte d n o n -p re scri b e d d ru gs i n p ast 1 2 m o n th s Vi si b le si gn s o f i n je cti o n an d /o r d e tai le d k n o w le d ge o f i n je cti o n p racti ce s Ale rt an d ab le to co m p le te su rve y i n E n gli sh o r S p an i sh 10
  • 11. D allas NH B S I DU1 O ver view C o n d u cte d i n D allas/Fo rt Wo rth M e tro p o li tan S tati sti cal Are a (M S A) i n 2005 -2006 D S H S an d U n i ve rsi ty o f T e x as S o u th w e ste rn M e d i cal C e n te r S i te s i n D allas/Fo rt Wo rth : 5 C o m p le te d i n te rvi e w s: 597 (1 7 se e d s an d 580 re cru i ts) 11
  • 12. I mplem enti ng R D S at Mu lti pleS i tes for NH B S I DU1 D allas
  • 13. Stati stical A nalysi s We i gh te d p re vale n ce e sti m ate s w i th R D S AT an alysi s to o l 6.0 C h i sq u are te st fo r b i vari ate an alyse s o f u n -w e i gh te d d ata w i th S AS 9.2 13
  • 14. Resu lts
  • 15. NH B S I DU1 D emographic C haracter i stics N=597  G en d er  M ale 377 (63.1 %)  Fe m ale 21 5 (36.0%)  R ace /E th n i ci ty  Afri can Am e ri can 451 (75.6%)  W h i te 1 03 (1 7.3%)  H i sp an i c 30 (5.0%)  M u lti raci al 1 0 (1 .6%)Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 16. NH B S I DU1 D emographic C haracter i stics conti nue  Age G ro u p s N=597  1 8-24 29 (4.9%)  25-34 56 (9.4%)  35-44 1 24 (20.8%)  45-54 303 (50.8%)  ≥ 55 84 (1 4.1 %)  E d u cati o n  < H i gh S ch o o l 35 (5.9%)  H i gh S ch o o l o r G E D 427 (71 .6%)  > H i gh S ch o o l 1 34Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data (22.5%)
  • 17. NHBS IDU1 Recruitment Network of Participants by Race and Ethnicity Race and ethnicity White - homophily 0.401 Afr Am - homophily 0.545 Hispanic - homophily 0.330 Am Indian/Alaska Native - homophily -1 Multiracial - homophily 0.032 - Most participants recruited were African American - Four seeds recruited the majority of the participantsData Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 18. NH B S I DU1 Pr evalence E sti m ates of Unprotected S ex N=597 80% 70% 68% 60% 50% Prevalence 40% 32% 30% 20% 10% 0% Sex without condom Sex with condomData Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 19. NH B S I DU1 Pr evalence E sti m ates of Usi ng D r ugs or A lcohol before or du r i ng S ex 15% N=597 85% Using drugs or alcohol before or while having sex Not using drugs or alcohol before or while having sexData Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 20. NH B S I DU1 Pr evalence E sti m ates of Testi ng B ehavior s N=597 100% 90% 87% 80% 69% 70% Prevalence 60% Yes 50% No 42% M/D/R 40% 33% 30% 25% 22% 20% 11% 9% 10% 2% 0% Ever tested for HIV Ever tested for HCV Tested for Syphilis in the past 12 monthsData Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 21. NH B S I DU1 Pr evalence E sti m ates of Pr evention S er vice Uti li zation N=597 90% 84% 80% 77% 69% 70% 70% 60% 55% Prevalence 50% Yes 41% No 40% M/D/R 30% 28% 30% 22% 20% 14% 10% 4% 1% 1% 2% 2% 0% Received Received Received One to One Group Free Free Sterile Free Drug Counseling Counseling Condoms Syringes KitsData Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 22. NH B S I DU1 Par tici pants Usi ng D r ugs or A lcohol befor e or du r i ng S ex by Unprotected S ex N=597 Sex S e x w i th χ2 w i th o u t co n d o m co n d o m P valu e U si n g d ru g o r alco h o l b e fo re o r d u ri n g se x (n = 522) 80.3% 1 9.7% < .0001 N o t u si n g d ru g o r alco h o l 30.7% 69.3% b e fo re o r d u ri n g se x (n = 75)Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 23. NH B S I DU1 Par tici pants Usi ng D r ugs or A lcohol befor e or du r i ng S ex by S har i ng I n jection E qu i pm ent N=597 S h ari n g N o t sh ari n g χ2 i n je cti o n i n je cti o n equ ip m en t equ ip m en t P valu e U si n g d ru g o r alco h o l b e fo re o r d u ri n g se x 78.9% 21 .1 % (n = 522) 0.01 N o t u si n g d ru g o r alco h o l 66.2% 33.8% b e fo re o r d u ri n g se x (n = 74)Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 24. NH B S I DU1 Par tici pants Usi ng D r ugs or A lcohol befor e or du r i ng S ex by S yr i nge S har i ng N=597 No χ2 S yri n ge syri n ge S h ari n g P valu e sh ari n g U si n g d ru g o r alco h o l b e fo re o r d u ri n g se x (n = 521 ) 54.9% 45.1 % < .0001 N o t u si n g d ru g o r alco h o l 28.8% 71 .2% b e fo re o r d u ri n g se x (n = 73)Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
  • 25. NH B S I DU1 O ther F actor s F ou nd Not to be S tati stically S ign i ficant with Par tici pants Using D r ugs or A lcohol before or du r i ng S exF actors P-valu eE ve r te ste d fo r H I V 0.29E ve r te ste d fo r H C V 0.67T e ste d to ch e ck fo r syp h i li s i n th e p ast 1 2 m o n th s 0.38R e ce i ve d fre e co n d o m s i n th e p ast 1 2 m o n th s 0.90R e ce i ve d ste ri le n e e d le s i n p ast 1 2 m o n th s 0.69U se d fre e n e w ste ri le n e e d le s 0.72R e ce i ve d fre e k i ts i n th e p ast 1 2 m o n th s 0.85U se d fre e k i ts 0.32T alk e d to co u n se lo r o n e o n o n e ab o u t H I V p re ve n ti o n i n th e p ast 1 2 0.53m o n th sParti ci p ate d i n gro u p se ssi o n ab o u t H I V p re ve n ti o n i n th e p ast 1 2 0.81m o n th s
  • 26. Resu lts S u m m ary M ajo ri ty o f N H B S i n je cti o n d ru g u se rs  H ave se x w i th o u t co n d o m s  Are h avi n g alco h o l o r d ru gs b efo re o r d u ri n g se x  H ave te ste d fo r H I V an d H C V i n th ei r li fe ti m e  N o t te ste d fo r sy p h i li s i n th e p ast ye ar  N e ver re cei ve d fre e ste ri le n e e d le s, fre e d ru g k i ts, o n e o n o n e co u n se li n g o r gro u p co u n se li n g ab o u t H I V p re ve n ti o n S tati sti cally si gn i fi can t re lati o n sh i p b e tw e e n th o se u si n g d ru g o r alco h o l b efo re o r d u ri n g se x an d  U n p ro te cte d se x  S h ari n g i n je cti o n e q u i p m en t  S h ari n g syri n ge N o stati sti cal si gn i fi can t re lati o n sh i p b e tw e e n th o se h avi n g d ru g o r alco h o l b efo re o r d u ri n g se x an d  H I V/S T D /H C V te sti n g b e h avi o rs  Pre ve n ti o n se rvi ce u ti li z ati o n
  • 27. D ata L i m i tation s S e lf-re p o rte d d ata T e m p o rali ty o r cau sal re lati o n sh i p can n o t b e e stab li sh e d G e n e rali z ab i li ty  Afri can Am e ri can s  D allas vs. T e x as vs. U .S . 27
  • 28. Conclu sion s U se o f d ru gs an d alco h o l b e fo re o r d u ri n g se x m ay i n flu e n ce i n d i vi d u al’s p racti ce o f h i gh ri sk se x u al b e h avi o r an d i n je cti o n sh ari n g b e h avi o rs S u b stan ce ab u se m ay i n cre ase th e p ro b ab i li ty o f h avi n g u n p ro te cte d se x w h i ch su b se q u e n tly m ay i n cre ase th e ri sk fo r H I V tran sm i ssi o n am o n g I D U an d th e i r se x u al p artn e rs C o n tact w i th o r u se o f p re ve n ti o n se rvi ce s d o e s n o t se e m to re d u ce ri sk y b e h avi o rs
  • 29. I mplication s for Program s, Policy, and Research U n d e rstan d i n g ri sk b e h avi o rs am o n g I D U w o u ld h e lp tai lo r H I V p re ve n ti o n se rvi ce s  B e tter e d u cati o n fo r I D U s o n h o w H I V i s sp re ad , ei th er b y o n e o n o n e co u n se li n g an d /o r gro u p co u n se li n g  E n co u rage co n d o m u se , d i sco u rage d ru g u se , an d en co u rage u se o f steri le d ru g p rep arati o n e q u i p m en t an d syri n ge s D ata su gge st th e n e e d fo r d e ve lo p i n g e ffe cti ve p re ve n ti o n strate gi e s to p ro m o te p o si ti ve b e h avi o r ch an ge  Pro m o te atten d an ce to p re ven ti o n servi ce o rgan i z ati o n s  E asy acce ss to p re ven ti o n servi ce o rgan i z ati o n s
  • 30. I mplication s for Program s, Policy, and Research E x p lo re th e fe asi b i li ty o f u si n g re sp o n d e n t d ri ve n sam p li n g m e th o d  T o i n cre ase aw aren e ss o f p re ven ti o n p ro gram s  T o i n cre ase aw aren e ss o f i n je cti o n d ru g u se ri sk  T o en co u rage te sti n g b e h avi o r
  • 31. References1 . Araste h K , Jarlai s D C D , Perli s T E . Alco h o l an d H I V S e x u al R i sk B e h avi o rs am o n g I n je cti o n D ru g U sers. D ru g Alco h o l D ep en d . 2 008;95 :54-61 .2 . H e ck ath o rn , D D . Re sp o n d en t-D ri ven S am p li n g: A N e w Ap p ro ach to th e S tu d y o f H i d d e n Po p u lati o n s. Social Problems.1 997;44:1 74-1 99.3. H e ck ath o rn , D D . Re sp o n d en t-D ri ven S am p li n g I I : D e ri vi n g Vali d Po p u lati o n E sti m ate s fro m C h ai n R eferral S am p le s o f H i d d e n Po p u lati o n s. Soc Problems. 2002; 49:1 1 -34. ial4. P u rce ll D W , M i z u n o Y, M e tsch L R , G arfei n R , T o b i n K , K n i gh t K , L atk a M H . U n p ro te cte d S e x u al B e h avi o r Am o n g H e te ro se x u al H I V-Po si ti ve I n je cti o n D ru g U si n g M en : Asso ci ati o n b y Partn er T y p e an d Partn er S ero statu s. J U rb an H e alth . 2006;83:656-668.5 . R i ch ard s JE , R i sser, JM , Pad ge tt PM , R e h m an H U , Wo lverto n M L , Arafat R R . C o n d o m u se am o n g h i gh -ri sk h e tero se x u al w o m en w i th co n cu rren t se x u al p artn ersh i p s, H o u sto n , T e x as, U S A. I n tern ati o n al J u rn al o f o S T D & AI D S . 2 008;1 9:768-771 .6. R i sser JM , Pad ge tt P, Wo lverto n M , R i sser W L . R e lati o n sh i p b e tw e en h e te ro se x u al an al se x , i n je cti o n d ru g u se an d H I V i n fe cti o n am o n g b lack m en an d w o m e n . I n t J S T D AI D S . 2 009;2 0:31 0-4.7. Vo lk o w N D , Wan g G J, Fo w ler JS , T e lan g F, J ayn e M , Wo n g, C . S ti m u lan t-I n d u ce d E n h an ce d S e x u al D e si re as Po ten ti al C o n tri b u ti n g Facto r i n H I V T ran sm i ssi o n . Am J Psych i atry. 2 007;1 64:1 57-1 60. 31
  • 32. A cknowledgem entsWe w o u ld li k e to ack n o w le d ge o u r co lle agu e s at th eC e n te rs fo r D i se ase C o n tro l an d Pre ve n ti o n , an dU n i ve rsi ty o f T e x as S o u th w e ste rn M e d i cal C e n te r:  E li z ab e th A. D i N en n o , Ph D  M e li ssa C ri b b i n , M PH  An n e F re em an , M S PH  D o u glas S h e h an  O th er U T S o u th w e stern C o m m u n i ty Pre ven ti o n an d I n terven ti o n U n i t S taff 32
  • 33. T h an k yo u
  • 34. Q uestion s? S h an e S h e u , M PH E p i d em i o lo gi st/C o o rd i n ato rT B /H I V/S T D E p i d em i o lo gy an d S u rvei llan ce B ran ch H S E S , M ai l C o d e 1 873 T e x as D ep artm en t o f S tate H e alth S ervi ce s P.O . B o x 1 49347 Au sti n , T e x as 7871 4 Ph o n e : (51 2) 533-3044 S h an e .S h e u @d sh s.state .tx .u s 34

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