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Brief Interventions for HIV+ Persons

Brief Interventions for HIV+ Persons. Thomas L. Patterson Shirley J. Semple. University of California, San Diego Research supported by NIMH RO1MH61146 & MH56264 NIDA RO1 DA1211. MSM Risk Reduction Interventions What do we know?.

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Brief Interventions for HIV+ Persons

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  1. Brief Interventions for HIV+ Persons Thomas L. Patterson Shirley J. Semple University of California, San Diego Research supported by NIMH RO1MH61146 & MH56264 NIDA RO1 DA1211

  2. MSM Risk Reduction InterventionsWhat do we know? • 99 rigorous controlled studies to reduce transmission risk by 1999 • 9 focused on MSM • Favorable results (OR .69 CI .56-.86) • 26% reduction in proportion engaging in UAI Johnson et al., 2002. HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. JAIDS 30

  3. MSM Risk Reduction InterventionsWhat do we know? • Favorable effects among interventions that promoted • Interpersonal skills • Community level formats • Focused on younger populations • Those at higher behavioral risk • Studies Lack • Drug users (1 study) • People of color, non-gay identified Johnson et al., 2002. HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. JAIDS 30

  4. HIV+ Risk Reduction InterventionsWhat do we know? • DiScenza, Niles, and Jordan 1996 • Nurse delivered, pre- post design • Significant reduction risky sex @ 2-3 mo. • Cleary, VaDevanter, Steilen et al. 1995 • Six sessions education and support with blood doners • Sig. decrease in both intervention & referral gp. @ 6-mo.

  5. HIV+ Risk Reduction InterventionsWhat do we know? • Parsons et al. 2000 • Full intervention vs. partial • Full safer than partial • Kalichman et al., 2001 • Social Cognitive vs. suport groups • N=332 • Five sessions • Safer in SCT group & among those with neg. partners safer sex

  6. HIV+ Risk Reduction InterventionsWhat do we know? • Patterson et al., 2002 • Social Cognitive vs. Diet & Exercise • N=389 • 1 to 3 90-min sessions • Study Population • Gay and Heterosexual • Had unsafe sex with HIV- or UK partner • Infection Risk Factor • Sexual contact 85% • Injection drug use 5% • Transfusion 1% • Undetermined 9%

  7. San Diego Share Safer Sex (SSS)STUDY DESIGN • Brief Targeted (single session, 90 minutes) • Comprehensive (single session, 90 minutes) • Comprehensive with 2 boosters (3-90 minute sessions) • Diet & Exercise Control Group (3-90 minute sessions) RANDOM ASSIGNMENT FOLLOWUP AT 4, 8, AND 12 MONTHS POST-INTERVENTION

  8. Was the intervention effective with everyone? • At one-year • 1/3 always safer sex • 1/3 irregular safer sex • 1/3 continued unsafe practices

  9. NEGOTIATION BEHAVIORS BY PARTNER TYPES 3.8 4 3.2 3 2.5 Negotiation 2 1 0 Steady Casual Anonymous

  10. Trends among MSM - Meth Users • High rates of STDs (current syphilis outbreak) • Low rates of condom use

  11. Meth Use & Risk Factors • Behavioral disinhibition • Enhanced sexual desire • Increased desire for high risk sexual activities • Prolonged sexual activities (Marathons) • Multiple sex partners • Anonymous • Casual

  12. The San Diego ‘Edge’ Methamphetamine Study Objective: Evaluate an eight session behavioral intervention designed to reduce high risk sexual behaviors in the context of meth use. Target Population: - HIV+ - MSM - Unsafe sex partners - Regular meth users NIDA RO1 DA12116

  13. San Diego “Edge” study of Methamphetamine users • N=250 • 50 % of sample make $10,000 or less per year • 65.6% not taking HIV Medications

  14. Edge Project: Methods of using methamphetamine Percent Smoke Inject/Combination

  15. Drugs taken with meth in past 2-months Pot Viagra “K” Halluc.

  16. Meth Binge Users “You keep using large quantities of meth for a period of time - until you run out or just can’t physically do it anymore” - 48% said yes - Typical binge 2.5-3 days • Bingers report increased: • Sexual risk behavior • Health problems • Social difficulties • Mental health problems

  17. SUMMARY AND CONCLUSIONS • Most behavioral interventions to reduce high risk sexual practices target HIV- “at risk populations” • HIV+ individuals are living longer, healthier lives and are remaining sexually active • Some HIV+ individuals engage in transmission behaviors • Interventions with MSM are effective • Evidence that interventions with HIV+ work • No published interventions of HIV+ drug users

  18. Questions to address • Can sexual risk be reduced in the context of drug use? • Do reductions in drug use lead to concomitant decreases in sexual risk behavior? • Are different patterns of drug use, and/or specific drugs or combinations of drugs associated with increased risk behavior?

  19. Questions to address • How efficacious are theory based drug and sexual risk reduction intervention programs in HIV+ populations? • Can we reduce relapse to high risk sex and drug use? • How do gender, race, and culture relate to the efficacy of specific interventions?

  20. Design Issues With HIV+ Individuals • Stigmatization • Definition of high risk behavior • HAART • Partner Types • Who delivers messages • Where deliver messages • Multiple Risk Factors (Drugs/Sex)

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