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Substance Abuse, Sexual Behaviors, HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006
 

Substance Abuse, Sexual Behaviors, HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006

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    Substance Abuse, Sexual Behaviors, HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006 Substance Abuse, Sexual Behaviors, HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006 Presentation Transcript

    • 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
    • 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
    • Background
    • Persons Living with HIV/AIDS and New HIV/AIDS Cases, Texas, 2002-2008 Data Source: Texas HIV/AIDS Reporting System (HARS); 2002-2008
    • Proportion of AIDS Cases by Transmission Category, Texas, 1990-2008
      • Heterosexual contact with person known to have or to be at high risk for HIV infection
      • Data Source: Texas HIV/AIDS Reporting System (HARS); 1990-2008
    • National HIV Behavioral Surveillance System Sites Atlanta Ft. Lauderdale Miami San Juan New Orleans Dallas Houston San Diego Los Angeles Las Vegas San Francisco Seattle Denver St. Louis Chicago Detroit Boston New Haven Nassau New York City Newark Philadelphia Baltimore Washington, DC Norfolk
      • High risk population cycles:
        • IDU
        • MSM
        • Heterosexuals
      Source: Centers for Disease Control and Prevention
    • Methods
    • NHBS Overall Strategy
      • Survey components
          • Core questions
            • Demographic characteristics
            • Alcohol and drug use risk behaviors
            • Sexual risk behaviors
            • Testing behaviors: HIV, HCV, syphilis
            • Prevention services utilization
          • Local questions tailored to each site
      • HIV testing (Not done in Dallas IDU1)
      • Sample size
        • Target = Minimum of 500 persons interviewed each cycle
    • Respondent Driven Sampling Recruitment
      • Study team recruited initial participants (seeds) through outreach
      • Seeds recruited up to 3 other participants
      • Those participants recruited up to 3 others
      • Done until sample size was met
      • Incentives provided for participation and recruitment
        • $20 for interview and $10 for each recruitment
    • NHBS IDU1 Eligibility Criteria
      • At least 18 years old
      • Resident of Dallas Fort Worth MSA
      • Injected non-prescribed drugs in past 12 months
      • Visible signs of injection and/or detailed knowledge of injection practices
      • Alert and able to complete survey in English or Spanish
    • Dallas NHBS IDU1 Overview
      • Conducted in Dallas/Fort Worth Metropolitan Statistical Area (MSA) in 2005 -2006
      • DSHS and University of Texas Southwestern Medical Center
      • Sites in Dallas/Fort Worth: 5
      • Completed interviews: 597 (17 seeds and 580 recruits)
    • Implementing RDS at Multiple Sites for NHBS IDU1 Dallas
    • Statistical Analysis
      • Weighted prevalence estimates with RDSAT analysis tool 6.0
      • Chi square test for bivariate analyses of un-weighted data with SAS 9.2
    • Results
    • NHBS IDU1 Demographic Characteristics
      • Gender
        • Male 377 (63.1%)
        • Female 215 (36.0%)
      • Race/Ethnicity
        • African American 451 (75.6%)
        • White 103 (17.3%)
        • Hispanic 30 (5.0%)
        • Multiracial 10 (1.6%)
      Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Demographic Characteristics continue
      • Age Groups
        • 18-24 29 (4.9%)
        • 25-34 56 (9.4%)
        • 35-44 124 (20.8%)
        • 45-54 303 (50.8%)
        • ≥ 55 84 (14.1%)
      • Education
        • < High School 35 (5.9%)
        • High School or GED 427 (71.6%)
        • > High School 134 (22.5%)
      Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Recruitment Network of Participants by Race and Ethnicity White - homophily 0.401 Race and ethnicity 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 participants Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data
    • NHBS IDU1 Prevalence Estimates of Unprotected Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Prevalence Estimates of Using Drugs or Alcohol before or during Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Prevalence Estimates of Testing Behaviors Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Prevalence Estimates of Prevention Service Utilization Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597
    • NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Unprotected Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 69.3% 30.7% Not using drug or alcohol before or during sex (n=75) <.0001 19.7% 80.3% Using drug or alcohol before or during sex (n=522)  2 P value Sex with condom Sex without condom
    • NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Sharing Injection Equipment Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 33.8% 66.2% Not using drug or alcohol before or during sex (n=74) 0.01 21.1% 78.9% Using drug or alcohol before or during sex (n=522)  2 P value Not sharing injection equipment Sharing injection equipment
    • NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Syringe Sharing Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 71.2% 28.8% Not using drug or alcohol before or during sex (n=73) <.0001 45.1% 54.9% Using drug or alcohol before or during sex (n=521)  2 P value No syringe sharing Syringe Sharing
    • NHBS IDU1 Other Factors Found Not to be Statistically Significant with Participants Using Drugs or Alcohol before or during Sex 0.32 Used free kits 0.53 Talked to counselor one on one about HIV prevention in the past 12 months 0.81 Participated in group session about HIV prevention in the past 12 months 0.85 Received free kits in the past 12 months 0.90 Received free condoms in the past 12 months 0.69 Received sterile needles in past 12 months 0.72 Used free new sterile needles 0.38 Tested to check for syphilis in the past 12 months 0.67 Ever tested for HCV 0.29 Ever tested for HIV P-value Factors
    • Results Summary
      • Majority of NHBS injection drug users
        • Have sex without condoms
        • Are having alcohol or drugs before or during sex
        • Have tested for HIV and HCV in their lifetime
        • Not tested for syphilis in the past year
        • Never received free sterile needles, free drug kits, one on one counseling or group counseling about HIV prevention
      • Statistically significant relationship between those using drug or alcohol before or during sex and
        • Unprotected sex
        • Sharing injection equipment
        • Sharing syringe
      • No statistical significant relationship between those having drug or alcohol before or during sex and
        • HIV/STD/HCV testing behaviors
        • Prevention service utilization
    • Data Limitations
      • Self-reported data
      • Temporality or causal relationship cannot be established
      • Generalizability
        • African Americans
        • Dallas vs. Texas vs. U.S.
    • Conclusions
      • Use of drugs and alcohol before or during sex may influence individual’s practice of high risk sexual behavior and injection sharing behaviors
      • Substance abuse may increase the probability of having unprotected sex which subsequently may increase the risk for HIV transmission among IDU and their sexual partners
      • Contact with or use of prevention services does not seem to reduce risky behaviors
    • Implications for Programs, Policy, and Research
      • Understanding risk behaviors among IDU would help tailor HIV prevention services
          • Better education for IDUs on how HIV is spread, either by one on one counseling and/or group counseling
          • Encourage condom use, discourage drug use, and encourage use of sterile drug preparation equipment and syringes
      • Data suggest the need for developing effective prevention strategies to promote positive behavior change
          • Promote attendance to prevention service organizations
          • Easy access to prevention service organizations
    • Implications for Programs, Policy, and Research
      • Explore the feasibility of using respondent driven sampling method
        • To increase awareness of prevention programs
        • To increase awareness of injection drug use risk
        • To encourage testing behavior
    • References
      • 1 . Arasteh K, Jarlais DCD, Perlis TE. Alcohol and HIV Sexual Risk Behaviors among Injection Drug Users. Drug Alcohol Depend. 2008;95:54-61.
      • 2. Heckathorn, DD. Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations. Social Problems. 1997;44:174-199.
      • 3. Heckathorn, DD. Respondent-Driven Sampling II: Deriving Valid Population Estimates from Chain Referral Samples of Hidden Populations. Social Problems. 2002; 49:11-34.
      • 4. Purcell DW, Mizuno Y, Metsch LR, Garfein R, Tobin K, Knight K, Latka MH. Unprotected Sexual Behavior Among Heterosexual HIV-Positive Injection Drug Using Men: Association by Partner Type and Partner Serostatus. J Urban Health. 2006;83:656-668.
      • 5. Richards JE, Risser, JM, Padgett PM, Rehman HU, Wolverton ML, Arafat RR. Condom use among high-risk heterosexual women with concurrent sexual partnerships, Houston, Texas, USA. International Journal of STD & AIDS. 2008;19:768-771.
      • 6. Risser JM, Padgett P, Wolverton M, Risser WL. Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women. Int J STD AIDS. 2009;20:310-4.
      • 7. Volkow ND, Wang GJ, Fowler JS, Telang F, Jayne M, Wong, C. Stimulant-Induced Enhanced Sexual Desire as Potential Contributing Factor in HIV Transmission. Am J Psychiatry. 2007;164:157-160.
    • Acknowledgements
      • We would like to acknowledge our colleagues at the Centers for Disease Control and Prevention, and University of Texas Southwestern Medical Center:
        • Elizabeth A. DiNenno, PhD
        • Melissa Cribbin, MPH
        • Anne Freeman, MSPH
        • Douglas Shehan
        • Other UT Southwestern Community Prevention and Intervention Unit Staff
      • Thank you
    • Questions?
      • Shane Sheu, MPH
      • Epidemiologist/Coordinator
      • TB/HIV/STD Epidemiology and Surveillance Branch
      • HSES, Mail Code 1873
      • Texas Department of State Health Services
      • P.O. Box 149347
      • Austin, Texas 78714
      • Phone: (512) 533-3044
      • [email_address]