Philadelphia National HIV Behavioral Surveillance, 2018
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Dr. Kathleen Brady of the AIDS Activities Coordinating Office discussed three cycles of the National HIV Behavioral Surveillance in Philadelphia, including cycles with men who have sex with men (MSM), high-risk heterosexuals, and injection drug users. This presentation took place at the Philadelphia EMA HIV Integrated Planning Council meeting on Thursday, January 11, 2018.
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Philadelphia National HIV Behavioral Surveillance, 2018
- 1. Philadelphia NHBS, 2018 Jen Shinefeld, MS AIDS Activities Coordinating Office
- 2. National HIV Behavioral Surveillance Conducted 2004-Present Establish and maintain a surveillance system among groups at high risk for HIV infection 4 rounds completed to-date Rounds consist of 3 cycles MSM IDU HET Conducted in 22 Jurisdictions
- 3. Men Who Have Sex With Men, 2017
- 4. MSM Cycle, 2017 Sample collection: July 2017 – October 2017 Eligibility Requirements Have not previously participated in the current NHBS-MSM cycle Live in the participating MSA (Philadelphia, Delaware) 18 years old or older Were born male and self-identify as male Have ever had oral or anal sex with another man and Are able to complete the interview in English or Spanish N=579 Goal: 500 interviews
- 5. Sample Characteristics Race White 14% Black 70% Hispanic 12% Other 4% Age 18-29: 54% 30-39: 24% 40-49: 13% 50+: 9% Education HS or Equivalent 42.3% Higher: 52.0% Employment: Full or Part-time: 62.4% Unemployed: 25.9% Region South Phila 17% North Phila 16% West Phila 14% Outside Phila 13% Southwest Phila 12% Northeast Phila 8% Center City 10% Other 14%
- 6. Health Care Characteristics 82.6% Currently Insured 52.7% Medicaid 36.6% Private 90.1% Have a usual source of health care Private Doctor: 42.8% Public Health Center: 34.8% Emergency Room: 13.2% 83.3% had a health care visit within last 12 months 60.2% were offered an HIV test by provider within the last 12 months of those who saw a doctor in the last 12months 50.1% total sample
- 7. PrEP N=411 Did not SRP N=315: Did not SRP or take PrEP 302 (73.5%) have heard of PrEP 143 (35%) have discussed with physician 76 (26.5) has taken PrEP Took Everyday: 59% Got Meds from friend: 5% 52 still actively on PrEP PEP 59 (14.4) have taken PEP 172 (54.6%) have previously considered PrEP When asked if they thought PrEP would be a good option for them? 51.7% said yes Most common reason PrEP was not a good option Person doesn’t like medicine Not a lot of sexual partners Consistent condom use
- 8. PrEP Beliefs Not SRP SRP How likely are you to use condoms if you’re on PrEP? 62.1% PrEP will reduce my risk of contracting HIV 69.6% agree Would worry about getting other STIs if on PrEP? 69.4% Would Recommend PrEP? 46.4% would How likely are you to use condoms if your partner is on PrEP? 59% likely or extremely likely PrEP will reduce the risk of my partner contracting HIV 79.3% Would worry about other STIs if partner was on PrEP? 73.9% Would recommend PrEP to a negative partner? 82.4%
- 9. Sexual Behaviors 9 was the average number of partners reported in the last 12 months Median: 4 16% Reported exchange sex 88.6% reported anal sex in the last 12 months 362 (70.9%) reported unprotected anal sex Of the 362: 58.6% between 18-29 30.9% Self Reported Positive
- 10. Other Risk Behaviors 5% had a history of Injection Drug Use Of which, 41% reported injection in the last 12 months 57% non-injection drug use in last 12 months Marijuana, Powdered Cocaine, Poppers, Painkillers 77.4% reported drinking in the last 30 days 39.4% reported binge drinking in the last 30 days
- 11. STDs 60.8% Reported having an STD test in the last 12 months 40% reported a Rectal STD test 20% Reported an STD diagnosis in the last 12 months 12.7% Gonorrhea 8.9% Chlamydia 7.1% Syphilis
- 12. HIV Testing 4% had never tested for HIV 89.9% tested in the last 2 years HIV counseling and testing site Health Center Private Doctor 92.8% got there most recent test results 4%, 17, individuals reported using a rapid home HIV test
- 13. HIV & HCV Results MSM5 HIV Results (2017) 212 Positive Participants (37.6%) 170 Self-Reported as HIV positive (80.2% of HIV+ aware of their status) 352 (62.4%) Non-Reactive HCV Results (n =503) 483 (96%) non-reactive 20 (4%) Reactive 7 newly dx’d Coinfection Rates 10 of the 212 HIV reactive individuals also reactive on the HCV test <2% of total sample
- 15. HET Cycle, 2016 Sample collection: July 2016 – September 2016 Eligibility Requirements Present a valid NHBS-HET coupon Had not previously participated in the current NHBS-HET cycle Live in the participating MSA (Philadelphia, Delaware) Be between age of 18 and 60 years Be Male or Female (transgender persons are not eligible for the HET cycle) Have had vaginal or anal sex with someone of the opposite gender in the past 12 months HET Definition Requirement Have a household income below HHS poverty guidelines Or Educational level no greater than high school N=557 611 interviewed Goal: 500 interviews
- 16. Sample Characteristics Gender Male: 54.2% Female: 45.8% Race White 1.3% Black 92.5% Hispanic 4.1% Other 2.1% Age 18-29: 29.8% 30-39: 17.2% 40-49: 25.3% 50-60 27.7% Education Less than HS: 26.6% HS or Equivalent 56.6% Employment: Full or Part-time: 29.1% Unemployed: 44.3% Region North Phila 26.8% Southwest Phila 25.3% West Phila 17.6% Outside Phila 19.0% Other 11.3%
- 17. Health Care Characteristics 89.8% Currently Insured 81.3% Medicaid 8.6% Private 92.6% Have a usual source of health care Private Doctor: 47.1% Public Health Center: 33.3% Emergency Room: 19.6% 85.4% had a health care visit within last 12 months 51.8% were offered an HIV test by provider within the last 12 months of those who saw a doctor in the last 12months 43.9% total sample
- 18. Sexual Behaviors Male Female Average # of Partners: 8.1 Median: 3 84.3% reported unprotected vaginal or anal sex 17% reported exchange sex Average # of Partners: 4.9 Median: 2 87.7% reported unprotected vaginal or anal sex 13% reported exchange sex
- 19. Other Risk Behaviors 4% had a history of Injection Drug Use 0% reported injection in the last 12 months 45.6% non-injection drug use in last 12 months Marijuana, Painkillers, Crack Cocaine, Powdered Cocaine 55.7% reported drinking in the last 30 days
- 20. PrEP Heard about PrEP 4.5% (N=25) Spoke to a Doctor about PrEP <1% Taken PrEP <1%
- 21. STDs 48.3% reported having an STD test in the last 12 months 10.5% reported being diagnosed with and STD 4.5% Gonorrhea 57.5% in Females 7.2% Chlamydia 52% in Males 2% Syphilis 72.7% in Males 7.9% reported having gotten the HPV Vaccine 2.5%, 7, Males 14.1%, 34, Females
- 22. HIV Testing 14.7% had never tested for HIV 64.5% tested in the last 2 years Health Center Hospital (inpatient) Private Doctor 94.4% got there most recent test results <5 individuals reported using a rapid home HIV test
- 23. HIV & HCV Results HIV Results (n=556) 12 Positive Participants (2.2%) 7 Self-Reported as HIV positive (58.3% of HIV+ aware of their status) 544 (98.8%) Non-Reactive HCV Results (n =555) 483 (96%) non-reactive 17(3.1%) Reactive 9 newly dx’d Coinfection Rates 3 of the 12 HIV reactive individuals also reactive on the HCV test <1% of total sample
- 24. Persons Who Inject Drugs, 2015
- 25. PWID Cycle, 2015 Sample collection: July 2015 – November 2015 Eligibility Requirements Present a valid NHBS-IDU coupon Have not previously participated in the current NHBS-IDU cycle Live in the participating MSA (Philadelphia, Montgomery, Delaware, Chester, Bucks Counties) 18 years old or older Have injected drugs in the last 12 months N=662 Goal: 500 interviews
- 26. Sample Characteristics Gender Male 74% Female 25% Transgender 1% Race White 67% Black 11% Hispanic 20% Other 2% Age 18-29: 26% 30-39: 40% 40-49: 20% 50+: 14% Education HS or equivalent:48% Higher: 22% Employment 11% Employed 75% Unemployed Region Kensington 41% Northeast Phila 19% North Phila 13% Center City 8% Outside Phila 6% South Phila 5% Other 8%
- 27. Injection Behaviors (past 12 months) Injection Frequency More than once a day 88% Once a day 5% Once a week or less 7% Sterile Needle Use Never <1% Rarely 8% About half the time 16% Most of the time 40% Always 36% Shared Works Never 36% Rarely 33% About half the time 13% Most of the time 11% Always 7% Needle Source (Most Common) 46.9% - needle exchange 45.8% - off the street
- 28. Health Care Characteristics 77.2% Currently Insured 91.3% Medicaid 4% Private 71.5% Have a usual source of health care Private Doctor: 51.6% Public Health Center: 19.5% Emergency Room: 27% 72.6% had a health care visit within last 12 months 50.4% were offered an HIV test by provider within the last 12 months of those who saw a doctor in the last 12months 35.9% total sample
- 29. PrEP Heard about PrEP 12% (N=79) Spoke to a Doctor about PrEP 4% (N=14) Taken PrEP <1%
- 30. STDs 42.3% reported having an STD test in the last 12 months 7.7% reported being diagnosed with and STD 4.2% Gonorrhea 4.9% Chlamydia 1.5% Syphilis
- 31. HIV & HCV Results PWID 4 HIV Results (2015) 32 Positive Participants (5%) 18 Self-Reported as HIV positive (56.3% of HIV+ were aware of their status) 630 (95%) Non-Reactive HCV Results (n =642) 539 (84%) Reactive 163 Newly Dxed HCV Infections (30.2%) 101 (16%) Non-reactive Coinfection Rates 26 of the 32 HIV reactive individuals also reactive on the HCV test 4% of total sample
- 32. Sero-positivity and Awareness Across Cycles 37.6% 2.2% 4.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% MSM-5 HET-4 PWID-4 Aware Positive
- 33. Upcoming NHBS 2018 NHBS-PWID5 NHBS Trans-Female
Editor's Notes
- NHBS stands for National HIV Behavioral Surveillance. It was initiated in 2003 and was developed to help state and local health departments establish and maintain a surveillance system to monitor selected behaviors and prevention services among groups at high risk for HIV infection. In 2017, Portland, OR; Virginia Beach, and Memphis, Tennessee were added Activities are implemented in rounds composed of three cycles. The first cycle of each round focuses on men who have sex with men (or MSM), the second cycle focuses on injecting drug users (or IDUs), and the third on heterosexuals at increased risk of HIV infection (or HET). To-date, there have been 3 rounds of NHBS completed. Findings from NHBS are used to enhance the understanding of HIV risk and testing behaviors in these groups, and to develop and evaluate HIV prevention programs that provide services to them.
- In order to be eligible… MSAs (metropolitan statistical areas) Start: July 6th End: October 8th 48 Events in Total Screened just about 700 people Approached: Over 1,600 people
- 18.6 Bachelor’s or higher 33.4 some college or technical 5.7 – less than high school
- 15.5% didn’t get healthcare due to cost 23.3% disabled
- Big increase in PrEP knowledge from MSM4 when only 52% had reported knowledge Out of the 59 people on PEP, only 21 of them used PrEP in the last 12 months. Top three reasons for no longer being on PrEP: Change in sexual behaviors=8/24 Insurance stopped covering =5/24 Disliked side effects=5/24
- 328, 57%, reported ever having sex with a women 125, 21.7%, have had sex with a woman in the last year Of those having unprotected anal sex, 30.9% knew they were hiv+.
- This is only looking at those who did not self report, so that it doesn’t skew the test time info. If the srp are included then the percent tested in the last 2 year is 69%
- Screened over 700 individuals 611 met eligibility requirement 557 met additional het definition
- 14.5% higher
- 19% didn’t get healthcare due to cost 23.5% disabled
- Marijuana – 88.6 Painkillers – 18.1 Crack – 16.1 Coke – 14.7 Benzo’s – 12.6
- Perceived risk: 81.6% low 12.0%medium 6.4% high
- In order to be eligible… MSAs (metropolitan statistical areas) Screened over 850 people
- AGE: It is important to note that CDC has made it a point this year to target youth IDU (18-29) because this group has proven difficult to access in past cycles across all NHBS sites. In the IDU3 cycle (2012) we had somewhere around 16-18% young IDU and this year we are already at 26%.
- Here is a brief overview of some of the injection behaviors of our sample so far. Average # of persons that participants have shared works with is 7 ranges from 0 to 300. with about 37% of the sample saying that they have not shared works in the last year. Needle Source is a check all that apply question. Places gotten needle: Needle or Syringe Exchange 73% Pharmacy 28% DR, Clinic, Hospital 3% Friend/Partner 52% Dealer/Off the Street 74% Other <1%
- 38.5% didn’t get healthcare due to cost 40.4% disabled
- PEP 1% have taken PEP
- 86% had previously been tested for HCV 29% Public Health/Community Health Center/Provider 23% Correctional Facility 20% Drug Treatment Program 16% Needle or Syringe Exchange Program This was the first year we implemented HCV testing Of the 539, 376 already knew they HCV status. 86% of our sample had previously been tested prior in your lifetime.
- Msm: 30.1 = 80% het-: 1.3 =8% Pwid: 2.7 = 56%