Brief Prevention Messages to Reduce HIV Transmission Among Methamphetamine Users

1
Brief Prevention Messages to Reduce HIV
Transmission Among Methamphetamine Users

• Ryan White Care Act All Grantees Meeting
• Washington, D.C.
• August 2006

2
Authors

• Sheila R. Enders, MSW-CCRC1,2
• Neil Flynn, M.D., M.P.H.1,2
• Lynell Clancy, RA1,2
• Edward J. Callahan, Ph.D.2,3
• Division of Infectious Diseases1
• UC Davis AIDS Education and Training Center2
• Department of Family and Community Medicine3

3
Goal

• Utilize harm reduction philosophy with the
  strategies and techniques of Motivational
  Interviewing (MI) and Stages of Change (SOC)
  theory to reduce HIV transmission risk.
• Motivational Interviewing Miller and
  Rollnick
• Transtheoretical Model Prochaska and
  DiClementi

4
Hypotheses

• Methamphetamine (MA) promotes unsafe sexual
  activity and drug use behaviors.
• MA use appears to increase risk of HIV
  transmission.
• Brief prevention messages can reduce high-risk
  behaviors.

5
Objective

• HIV MA-using subjects will reduce high-risk
  sexual and/or drug use behaviors through provider
  delivered brief prevention messages and
  specialist counseling, based on the techniques
  and strategies of Motivational Interviewing (MI)
  and Stages of Change.

6
Demographics

• 229 HIV positive participants recruited and
  enrolled.
• One urban clinic
• Center for AIDS Research, Education Services
• (CARES) N 174
• One rural clinic Del Norte Clinics 2 sites
• Oroville N 40
• Chico N 15

7
Demographics

• Mean age of subjects 42
• Male 74
• Female 24
• Transgender 2
• White 55
• African American 29
• Hispanic 9
• Multi-ethnic 17

8
Methods

• Screened for high-risk sexual and/or drug use
  behaviors.
• Complete baseline ACASI repeat every 6 months
• Risk Diagnostic Questionnaire (RDQ) at least
  quarterly
• Provider/Patient agree on targeted behavior

9
Methods

• Provider delivers 3-5 minute brief prevention
  message
• Provider completes Prescription Pad for patient
  to reinforce prevention message
• Provider offers educational handouts to patient
• After 2 visits, patients are randomized to
  receive either Provider Only or
  Provider/Specialist intervention

10
Methods
Patient Completes Risk Diagnostic Questionnaire
(RDQ)
Nursing Assistant Attaches RDQ to Patient Chart
Provider Reviews RDQ Before Seeing Patient
Provider and Patient Negotiate Behavior Change
Target Goal
Provider Delivers Brief Prevention Message
Provider Documents Prevention Message on
Prescription Pad
Patients Randomized after 2 Visits (3 Months)
Provider Only
Provider and HIV Specialist
Investigators Evaluate Both Interventions
11
Infection Route(s)
Men
Women

Total


12
Sexual Orientation
Men

Women

13
Gender of Patients and Partners
Pt.Gender
Men Mean Range
Women Mean Range
Total Mean Range
P a r t n e r s
14
Partner Serostatus
15
Drug Use by Race
16
Meth Use by Race
17
Sexual Orientation and Meth Use
?2 4.028
plt0.05
18
MA Use and Sexual Partners
19
MA Use and Viagra Over 3 Mos
20
Viagra and Unprotected Sex
?222.075
plt0.0001
21
Reduction in Partners Post Intervention
22
Reduction in Non-Inj. Drug Use Post Prevention
Visit

• plt0.0018

• ?29.7015

23
Reduction in Sexual Activity Post Intervention
?24.8411
plt0.0278
24
Reduction in Meth Use Post Intervention
?24.4430
plt0.035
25
Results

• MA predominant drug of choice among subjects
  reporting drug use.
• Data confirm increased high-risk behaviors in
  subjects who use MA.
• 20 of injectors report sharing of needles and
  other drug paraphernalia.
• The highest level of sexual risk-taking in this
  cohort is associated with MA

26
Results

• MA users more likely to use Viagra (20/26).
• Viagra and MA in combination associated with
  increased incidence of unprotected sexual
  activity.
• Serosorting less frequent by straight men.
• Higher incidence of serosorting takes place with
  gay HIV men.

27
Conclusions

• Intervention may have an effect in decreasing MA
  use.
• Intervention may have an effect in decreasing
  high-risk sexual behavior.
• Intervention did not change the number of sexual
  partners reported.
• Serosorting appears to happen more among gay men.

28
Conclusions

• Viagra and MA use in combination is associated
  with unsafe sexual activity there may be
  prescribing policy implications.