Transcript HIV & Substance Use PPT

HIV & Substance Use
What is the connection…
• Between HIV and substance use?
Drug, Set & Setting
• Dr. Norman Zinberg
DRUG, SET AND SETTING
– RAND study of
“alcoholics”
• Challenges the
underlying
assumption of the
Disease Model.
DRUG
SET
SETTING
Drug, Set and Setting
• DRUG
– Is defined not only by the pharmacological makeup of the
particular substance, but also any substance that the drug
is cut with, the potency of the drug, and the method with
which the drug is taken.
– Example of harm related to drug:
• Injecting heroin puts one at greater risk for overdose than snorting
heroin.
Drug, Set and Setting
 SET (SELF)
◦ What the individual brings to the drug experience. This
includes the individual’s psychological approach to drug
taking -- What is the expectation of the person taking the
drug?
◦ What motivates me to take this drug? For recreation? For
medication? For escape?
◦ The same drug may act differently in different people.
◦ Example of harm related to set:
 A person who is anxious may be more likely to have a "bad trip" or
paranoid reaction if using LSD (Acid), a hallucinogenic drug.
Drug, Set and Setting
• SETTING:
– The environment in which the drug is taken (e.g., person’s
home, bathroom in a club, an abandoned building). Setting
also refers to the culture within which the drug use takes
place and the messages, values, and expectations that
shape the meaning of drug use within society, different
communities, and subcultures.
– Example of harm related to setting:
• A person who uses MDMA (Ecstasy) at a Rave with little ventilation
or available water may suffer heat exhaustion.
SEX, Set and Setting
• How can “drug, set & setting” be modified to
discuss sexual behavior?
Drivers of HIV
• The HIV Prevention Planning Council has developed a definition
and criteria for identifying Drivers of HIV in San Francisco.
• A “Driver” is defined as “underlying condition that is directly
linked to a large number of new HIV infections in San
Francisco.”
• Criteria for determining a Driver of HIV in SF:
» Prevalence of 10% or greater. A driver has at least 10%
prevalence among one of the high-risk BRPs where the bulk
of new infections occur (MSM, IDU, TFSM).
» Two-fold increase in risk. A driver is an independent factor
for HIV, making a person in a high-risk BRP at least twice as
likely to contract HIV compared to someone who is not
affected by the driver.
Drivers of HIV

After a thorough review of the literature the
following factors were identified to be driving
new HIV infections in SF:
 Cocaine/crack
 Heavy
alcohol use
 Methamphetamine
 Poppers
 Gonorrhea
 Multiple partners
Cocaine/Crack Use
•Stimulant
•Enhances sexual interest and pleasure
•Decreases inhibitions
•Heightens sense of invulnerability
•Inhibition of ejaculation
•Numbing effects
Cocaine/Crack Use
•Prevalence of cocaine/crack
use among MSM and IDU
ranges from 15-25%
•Independently associated with
HIV seroconversion, increasing
odds of seroconversion from
2.5-2.8%
Heavy Alcohol Use
•“Four or more drinks every day or six or more drinks
on a typical day when drinking.”
•Depressant
•Pleasurable feelings
•Reduce inhibitions
•Confusion
Heavy Alcohol Use
•Prevalence of heavy alcohol
use among MSM ranges
from 30-52%
•Independently associated
with HIV seroconversion,
increasing odds of
seroconversion 2.0%
Methamphetamine Use
•Stimulant
•Prolonged energy
•Feeling of euphoria
•Increased self-confidence
•Increased sexual interest
•Can prolong erections and length of sexual activity
Methamphetamine Use
•Prevalence of meth use among
MSM and IDU ranges from 1320%
•Independently associated with
HIV seroconversion, increasing
odds of seroconversion by at
least 2.0%
Poppers Use
•Alkyl nitrates
•Feeling of euphoria
•Reduced inhibitions
•Muscle relaxation (facilitates anal play)
•Increased sexual interest
•Increased ability to ejaculate and intensification of
orgasm
Poppers Use
•Prevalence of poppers use
among MSM ranges from
19-37%
•Independently associated
with HIV seroconversion,
increasing odds of
seroconversion by 2.2%
Sterile Syringe Access in the U.S.
• Nearly 200 syringe exchange programs currently
operate in 38 states, Puerto Rico, Washington DC.
– 1st program endorsed by a local government in the U.S.
was where?
• Endorsed by AMA, APHA, US Conference of Mayors,
among many other legal, medical & policy
institutions.
• Federal ban on funding for syringe access programs
– only lifted this year after 20 years
Pharmacy Providers
• In 2005, California Senate Bill
1159, “Pharmacy Access to
Syringes” was enacted.
– Allows any city or county to
authorize pharmacies within its
jurisdiction to sell or provide up to
10 syringes to someone over 18
years of age without a prescription
(sunsets in 2015).
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Approved Pharmacy Sales
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Syringe Access in California
• Syringe Programs
approved in:

Only 22% of counties have both
options

Only 36% of counties have some legal
syringe access option
– 19 counties
• (33% of counties)
– 4 cities
• Pharmacy sales of syringes
approved in:
– 15 counties
• (26% of counties)
– 4 cities
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IDUs in San Francisco
• 16,790 injection drug users (IDUs)
– Plausible total range is 13,536-24,438
•
•
•
•
7,076 men who have sex with women
5,234 men who have sex with men
4,030 women
449 transgender individuals
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Persons Living with AIDS and Persons Living with
HIV Non-AIDS
San Francisco, December 31, 2007
PLWA
(N=9018)
PLWH
(N=4627)
Gender
Male
Female
Transgender
92%
6%
2%
92%
6%
2%
Risk
MSM
MSM+IDU
IDU
No Reported Risk
Other
73%
14%
9%
1%
3%
76%
10%
7%
4%
3%
Source: SFDPH. HIV/AIDS Epidemiology Annual Report, 2008
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Syringe Access & Disposal Programs
• Goal: To eliminate the transmission of bloodborne
viruses among people who inject drugs or other
substances and their sexual partners.
– Objective: To reduce risk behaviors that may lead to the
transmission of bloodborne viruses among people who inject
drugs and their sexual partners.
– Strategies:
• Provide access to sterile syringes, injection supplies, and safer
sex supplies.
• Promote safe disposal of syringes and injection supplies,
including collection and disposal of used syringes.
• Develop & deliver education programs relevant to the goal.
• Provide information on & referrals to other health services. 25
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Syringe Access & Disposal Programs
• Community providers
– 5 publicly funded providers operate
18 sites each week.
• July 1, 2007 - June 30, 2008
– Provided nearly 2.5 million syringes.
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Community Syringe Programs
– Some sites focus on access for special populations.
For example:
• Ladies’ Night
– Biological and transgender women
• St. James Infirmary
– Sex workers & their partners
• Asian & Pacific Islander Wellness Center
– Transgender individuals
• TRANS Thrive
– Transgender individuals
• Homeless Youth Alliance
– IDUs under the age of 30
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For more information…
Emalie Huriaux
+1 415 437 4694
[email protected]
www.sfhiv.org
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