Download
1 / 28
E N D
CDARI The Caribbean Drug Abuse Research Institute
HIV Risk Behaviors Among Homeless Out-of-Treatment Drug Users In Two Caribbean StatesPort of Spain, Trinidad and Castries, Saint LuciaAuthors:Marcus Day, Jessy G. Devieux, Sandra D. Reid, Dionne J. Jones,Joseph Meharris, and Robert Malow
This presentation is based on data derived from an ongoing research project entitled Needs Analysis for Primary Health Care among the Street Drug Using Communities of the Urban Caribbean Principal Investigator Marcus Day Director The Caribbean Drug Abuse Research Institute
Introduction • The prevalence of HIV infection in the Caribbean is estimated at 2.4%, second only to sub-Saharan Africa (UNAIDS/WHO, 2002). • In several Caribbean states, AIDS is the leading cause of death among men 15-44 years old. • Several sub-groups of persons have been identified as higher risk for HIV infection because of their associated risky sexual behaviours. Included in this group are homeless out of treatment drug abusers.
BACKGROUND • In the urban Caribbean the homeless are usually found in well defined areas where there exists opportunities for: • causal labour • charity meals • soliciting or begging • The convenience sample discussed in this presentation was taken from such areas of Castries and Port of Spain.
BACKGROUND • Numerous NIH supported research have shown that crack consumption promotes: • physical and mental ill health • homelessness • loss of jobs • undoing of families • incarceration • violence
Method • A convenience sample of homeless1 persons were recruited. • All 74 participants (26 in St. Lucia and 48 in Trinidad) who were approached agreed to participate in the study. • Informed written consent was obtained • Structured questionnaires were used to conduct anonymous and confidential interviews. 1 The UK based Centre for Architectural Research and Development Overseas
Method • Interviewers were harm reduction outreach workers who were known in the areas. • Interviewers were trained in administration of the questionnaire, which took about 90 minutes to complete. • Data was collected on demographic characteristics, substance use, sexual behaviour, general health, and health-care seeking behaviour. • An incentive of $20 in local currency was paid to all respondents
The Problem • No study has addressed the primary health care needs needs of Caribbean homeless, out-of-treatment drug abusers who are expected to be at even higher risk of acquiring and transmitting the human immunodeficiency virus. • The study assesses those needs while this presentation looks at substance use, sexual behaviours and knowledge of risk
Demographics • Mean Age: 40.32 years (SD 7.22) • Total Sample (n=74) • Sex: Females (n=21) Males (n=52) Transvestite (n=1) • Ethnicity: Afro Caribbean (n=65) Indo Caribbean (n=5) Mixed Race (n=4)
Marital Status • Never Married 79.6% • Married 12.2% • Divorced 8.2%
Family Variables • The majority of subjects reported that they do not see their family regularly (53.4% vs. 46.6%) • The majority reported that their families know that they take drugs (94.4% vs. 5.6%) • 52.1% reported that no one in their family takes drugs (compared with 38.4% who said that at least one member of their family takes drugs and 9.5% answered “I don’t know”).
Drug Use and Sexual Behavior • 41% said that at some point in time they exchanged sex for crack or money. • 47.1% reported that at some point in time they exchanged crack or money for sex. • Gender was significantly related to exchanging sex for money or drugs. • The majority (85%) reported that they have tried to stop smoking crack at some point in time.
HIV Status and Sexual Risk Behaviours • 26% self reported positive for HIV. (33% POS, 12% Castries) • Although 71% reported not having tested HIV positive most of those respondents had never had an HIV test. • The majority (75%) reported that they either sometimes, often, or always have unprotected sex. • Females were about as likely to have unprotected sex as males (74% vs. 76% respectively). • The majority of the respondents who knew their HIV status was positive, reported having unprotected sex most of the time
Crack Initiation • The majority (76.6%) reported that their first experiences with crack occurred with a friend and that their friend gave them (they did not pay) for their first “rock”. • More than half of all respondents became regular users within weeks after their introduction to crack. • Significant gender differences were found in Trinidad, where 56% of females reported being introduced to crack by a friend, compared to 81% of males.
Perceived Dangers of Crack • Before using crack, the majority of respondents believed that crack was “not at all dangerous” or “did not know” it was dangerous, • At the time of the interview, almost 90% reported that they now felt that crack was “very dangerous.” • A majority of respondents attributed their homelessness to their crack use.
Conclusions • Most respondents reported becoming regular users within weeks after being introduced to crack. • The majority of respondents who were HIV positive reported using condoms infrequently. • Prior to their introduction to crack, respondents appeared to have little knowledge of the dangers associated with its use. This raises the question of the effectiveness of drug prevention education in these Caribbean islands.
Conclusions • Males and females in both countries admitted to engaging in high-risk behaviours such as trading sex for drugs or money and having unprotected intercourse. • These findings point to the urgent need to design culturally tailored interventions, including intensive educational programs with this population of homeless drug users who are at high risk for transmitting the virus to their partners • Prevention education targeting non-crack users need to be “substance specific rather than the current “generic all drugs are equally villenous” education programmes currently in place
