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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. 1. Philadelphia NHBS, 2018 Jen Shinefeld, MS AIDS Activities Coordinating Office
  2. 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. 3. Men Who Have Sex With Men, 2017
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  14. 14. High-Risk Heterosexuals, 2016
  15. 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. 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. 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. 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. 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. 20. PrEP  Heard about PrEP  4.5% (N=25)  Spoke to a Doctor about PrEP  <1%  Taken PrEP  <1%
  21. 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. 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. 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. 24. Persons Who Inject Drugs, 2015
  25. 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. 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. 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. 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. 29. PrEP  Heard about PrEP  12% (N=79)  Spoke to a Doctor about PrEP  4% (N=14)  Taken PrEP  <1%
  30. 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. 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. 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. 33. Upcoming NHBS  2018  NHBS-PWID5  NHBS Trans-Female

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