HIV and Hepatitis C in nonMSM Rural Communities: Issues and Interventions

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HIV and Hepatitis C in non-MSM Rural Communities
Issues and Interventions

• Shari Wells-Weiss, CASAC
• Director of Prevention Services
• Southern Tier AIDS Program

2
Prevalence rates for HIV/HCV in Upstate New York

• According to the New York State Department Of
  Health, AIDS Institute 2003 epidemiological data,
  approximately 7,126 persons are living with HIV
  or AIDS
• According to NYS DOH approximately 198,000 are
  chronically infected with Hepatitis C

3
The Crystal Meth Connection

• The use of Crystal Methamphetamine is connected
  to the spread of HIV/HCV in Upstate New York
• Unsafe sex and sharing of injection equipment
  (works) play a large role in both homosexual
  and heterosexual communities
• Non-MSM communities have similar amounts of risk
  when using Crystal Meth and engaging in similar
  types of high-risk behaviors

4
Stigma and Challenges

• Rural communities struggle with issues of stigma
  and lack of information
• Geographical challenges
• Many people may avoid testing because they fear
  who may see them or what may happen if they test
  positive for HIV or Hepatitis C

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Stigma and Challenges

• If someone is diagnosed with HIV or HCV, there
  are fewer resources in rural communities
• Lack of resources in the areas of access to
  treatment (medical and substance use), case
  management, secondary prevention, medications,
  advocacy and qualified medical professionals

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Treatment Approaches for Chemically Addicted

• Traditional treatment approaches are abstinence
  based
• Punitive in nature
• Focus is on Behavior Modification or Cognitive
  Behavioral Therapy
• Harm Reduction is just beginning to make inroads
  into treatment
• Harm Reduction syringe exchange, controlled use,
  reduced use, abstinence one possible outcome

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Addiction Treatment and other options for Crystal
Meth users

• Abstinence based treatment has a place but cannot
  be the only option
• Harm Reduction must be utilized in its full
  spectrum
• The Trans-Theoretical Model of Behavior Change
  has proven successful
• Syringe Exchanges can reduce transmission even in
  rural communities
• Community Wide prevention efforts

8
Paying for Medical Services and Treatment

• Medical and other services are expensive and
  often challenging for those who lack resources
• If someone has Medicaid, it does not pay for pain
  medications needed for someone who is undergoing
  HIV/HCV treatment
• Medicaid or Insurance is often very limiting for
  anyone seeking Chemical Dependency Treatment

9
HIV/HCV Case Management

• Although there are services in rural areas for
  HIV case management, the coverage area of these
  organizations, like STAP, are very large and
  staff is limited.
• Currently, no funding has been made available at
  the federal/state level to support case
  management for mono-infected HCV individuals.

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Solutions and Interventions

• Because access to medications is limited for
  rural communities, clinical trials and
  Compassionate Care (a program funded by several
  drug companies like Roche Pharmaceuticals) is the
  only way for HIV/HCV positive individuals to
  receive this care

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Solutions..

• Alternative therapies like massage
  therapyacupuncturechiropractic care and
  nutritionists can be a very positive experience
  for people living with HIV/HCV
• STAP offers programs like Healing Hands
  Network, a supplement program, educational
  programs for clients and providers, and a support
  group for Co-infected and HCV mono-infected
  individuals

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Solutions

• STAP does a tremendous amount of Outreach and
  sponsors Testing days for both HIV and HCV.
• The results of these efforts have a
  community-wide impact.
• Newsletters, Assessment and Referral services
  have assisted our clients with access to
  information and resources

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Solutions

• Operating the only rural Syringe Exchange Program
  in New York State has enabled us to provide clean
  sterile syringes, information, referral and
  support to those who inject drugs, use steroids
  or inject hormones
• Crystal Meth is gaining popularity among IDUs in
  our area

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Solutions

• Rural Community Based Organizations have
  excellent networks and relationships with
  providers in their area.
• This is crucial to providing services
• Developing relationships with specific physicians
  has resulted in access to more up to date
  information

15
Funding Issues

• Funding for HIV case management and prevention
  programming is not growing.
• Pharmaceutical companies will sometimes provide
  grants for conferences, supplement programs and
  other needs
• We have a Community Block Grant (CDBG), but it is
  limited to one city

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Funding Issues

• It is challenging to get funding for rural
  treatment and case management programs. Funds
  are often prioritized toward urban areas with
  higher incidence
• In NYS we have AIDS Institute to assist with some
  funding. But we must rely on grants from other
  sources
• Funding entities often mandate the terms of
  service delivery
• Currently, no federal or state funding for
  Hepatitis C mono-infection case management or
  prevention programming exists in our area.

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Where do we go from here?

• Federal Level
• State Level

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Thank You