Psychosocial Profile of Men Living With HIV Who are Also In j ection Drug Users (IDU)

1. 18e Annual Canadian Conference on HIV/AIDS Research, Vancouver 2009 Psychosocial Profile of Men Living With HIV Who are Also Injection Drug Users (IDU) Ludivine Veillette-Bourbeau1 Joanne Otis1,2 Gaston Godin3, 4 And the MAΨA Study Group 1 Canada Research Chair in Health Education, Université du Québec à Montréal 2 Department of Sexology, Université du Québec à Montréal 3 Canada Research Chair on Behaviour and Health, Université Laval 4 Faculty of Nursing Science, Université Laval

2. CONTEXT • Not enough evidence-based intervention programs exist to improve the quality of life (QOL) of people living with HIV (PLHIV), and even less for IDU. Most programs for this group concern injection risk reduction (Garfein & al., 2007; Strathdee & al., 2006; Wright & al., 2006), drug abuse treatment or needle exchange (Strathdee & al., 2006). • Therefore, to develop evidence-based and effective program for HIV positive men who are also IDU, we need to understand the factors associated with their QOL, as proposed at the first step of intervention mapping.

3. Framework • Intervention Mapping (IM): • Tool for planning, developing and evaluating health promotion and education programs • Socio-ecological approach to health • Series of 6 iterative steps and associated tasks • Systematic application of theory, empirical findings from the literature (evidence), and additional qualitative and quantitative data from targeted population and community • Participation of all actors in the process • Step1: Needs assessment • Scientific, epidemiological, behavioral and social analysis of an at-risk group or community and its problems. Importance of taking into account the heterogeneity of target population • Effort to understand the characteristic of the community, its members, and its strengths Bartholomew, L.K.; Parcel, G.S.; Kok, G; Gottlieb N.H. (2006). Planning Health Promotion Programs: an Intervention MappingApproach

4. OBJECTIVE • In a sample of people living with HIV (PLHIV), describe the psychosocial characteristics that differentiate men IDU from other subgroups: heterosexual men non-IDU, men who have sex with men (MSM) non-IDU and women.

5. METHODOLOGY • Data come from the MAYA study, a longitudinal study on quality of life of PLHIV in Montreal, Canada. • A total of 904 participants were recruited between 2004 and 2007 through 11 medical clinics and HIV community organizations in Montreal. • Participants were met at 6-months interval (T0, T1, T2 & T3) • They completed a questionnaire in a face-to-face interview. • Of these participants, 124 (13.7%) were men IDU including heterosexual and MSM. • For this presentation, we cross-sectionally analyzed this data.

6. METHODOLOGY • Analyses: 1. Descriptive analyses (frequencies, means, standard deviations) were executed on socio-demographic variables (age, annual income, relationship, etc.). 2. ANOVA were used to differentiate the 4 subgroups on several variables: • Quality of life and its dimensions; • Psychological factors (self-esteem, psychological distress (depression, anxiety) and orientation to life (meaningfullness, comprehensibility and menageability)); • Coping strategies; • Social dimensions (network diversity, social integration with friends, family and partner). 3. Stepwise multivariate logistic regression was performed to identify the characteristics associated with belonging to the IDU subgroup. Significant variables for the IDU group in the ANOVA analyses were integrated into the model.

7. RESULTS Socio-demographic Characteristics of MAYA Participants (N=903) 1 Men IDU are significantly different than MSM. 2 Men IDU are significantly different than the 3 other subgroups.

8. RESULTS Scores vary from 1 (low QOL) to 7 (high QOL) * 0,001 – men IDU have significantly lower QOL than the 3 other subgroups ** 0,001 – men IDU have significantly lower QOL than MSM

9. RESULTS *0,001 – men IDU have significantly lower QOL than MSM & women

10. RESULTS Score from 0 to 7 = normal Score from 8 to 10 = borderline Score 11 & more = clinical caseness. More the person have a high score, more she’s depressed or anxious. * <0,001 – men IDU are significantly more depress than the 3 other subgroups ** <0,001 – men IDU are significantly more anxious than heterosexual men & MSM

11. RESULTS Scale vary from 1 (low comprehension) to 7 (high comprehension) (sum: 4 items for each factor). • <0,001 – men IDU give significantly less meaning to their life than MSM and women • ** <0,001 – men IDU feel significantly less able to manage their life than the 3 other subgroups

12. RESULTS Results From ANOVA on Coping Strategies Scores vary from 0 (never use) to 3 (often use)

13. RESULTS Results From ANOVA on Social Dimensions

14. Key elements from anova • Compared to the other three subgroups, men IDU had significantly lower scores on quality of life, family and friends social integration scales, and on the orientation to life scale (manageability factor). • Men IDU also present more psychological distress, and more frequently use alcohol and drug as a coping strategy than the other subgroups. • The reality of men IDU is similar to the reality of heterosexual men non-IDU on two aspects: their social network was less diversified and their score on the social integration scale concerning their friends was lower than the score of MSM non-IDU and women.

15. RESULTS Multivariate Logistic Regression on Variables Associated to IDU Group (stepwise) (n=560)

16. DISCUSSION • The specificities of the needs of men living with HIV who use injection drugs must be addressed. • Beyond clinical follow-up, systematic interventions should be offered to men IDU living with HIV with the following objectives: • reducing psychological distress; • diversifying coping strategies; • promoting social integration and social support. • Others studies supported this finding. Social support (Préau & al., 2007) and depression (Marcellin & al., 2007) must be improved in the context of psychosocial intervention with HIV positive IDU. • Following the intervention mapping framework, this assessment process will be completed by the validation of these conclusions in partnership with community organizations in the perspective of future interventions. • Limitations: • Data introduced here cannot begeneralizedto all HIV positive men IDU becauseof theirnumber (n=124) and recruitmentbias(volunteer participants).

17. Acknowledgments and correspondence • Acknowledgments • Thank you to all the participants who agreed to share their experience with us. • A particular thanks to Marie-Eve Girard for her help and support in production of this presentation. • Thank you to the administrative and technical personnel of the MAΨA project (coordinator, interviewers, nurses, etc.). • And thanks to the researchers of MAΨA study to have allowed me to work on these data. • Correspondence • Ludivine Veillette-Bourbeau (veillette.ludivine@uqam.ca) • Joanne Otis (otis.joanne@uqam.ca)

18. MAΨA STUDY GROUP • Lavoie, René, co-investigator, COCQ-sida • Leblanc, Roger, collaborator, Clinique médicale Projet L.O.R.I • Machouf, Nima, co-investigator, Clinique médicale l’Actuel • Rouleau, Danielle, co-investigator, Department of medicalmicrobiology and infectiology, Hôpital Notre-Dame du CHUM • Toma, Emil, co-investigator, Department of medicalmicrobiology and infectiology, Hôpital Hôtel-Dieu du CHUM • Trottier, Benoît, collaborator, Clinique médicale l’Actuel • Vincelette, Jean, co-investigator, Department of medicalmicrobiology and infectiology, Hôpital Saint-Luc du CHUM • Zunzunegui, Maria Victoria, co-investigator, Department of social and preventive medicine, Université de Montréal • Alary, Michel, co-investigator, Population health research unit, Hôpital du Saint-Sacrement du CHA • Beck, Eduard, co-investigator, Direction de santé publique Montréal-Centre • Côté, José, co-investigator, Faculty of nursing, Université de Montréal • Côté, Pierre, co-investigator, Clinique médicale du Quartier Latin • Cox, Joseph, co-investigator, Centre for immunodeficiency treatment, Hôpitalgénéral de Montréal • Dascal, André, co-investigator, Infectiousdiseases and microbiology, Hôpital général Juif SMBD • Gaul, Neil, collaborator, Department of familymedicine, Hôpital Maisonneuve-Rosemont • Lalonde, Richard, collaborator, MontrealChest Institute • Lapointe, Normand, co-investigator, Maternal and Infantile Centre for AIDS, Hôpital Sainte-Justine

19. references • Garfein, R.S.; Golup, E.T.; Greenberg, A.E.; Hagan, H.; Hanson, D.L.; Hudson, S.M.; Kapadia, F. Latka, M.H.; Ouellet, L.J.; Purcell, D. W.; Strathdee, S.A.; Thiede, H. & the DUIT Study Team. (2007). A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users. AIDS, vol. 21 (14), p.1923-1932. • Marcellin, F.; Préau, M.; Ravaux, I.; Dellamonica, P.; Spire, B. & Carrieri, M.P. (2007). Self-reported fatigue and depressive symptoms as main indicators of the quality of life (QOL) of patients living with HIV and Hepatitis C: implications for clinical management and future research. HIV clinical trials, vol. 8 (5), p. 320-327. • Préau, M.; Protopopescu, C.; Spire, B.; Sobel, A.; Dellamonica, P.; Moatti, J.P.; Carrieri, M.P. & MANIF-2000 Study Group. (2007). Health related quality of life among both current and former injection drug users who are HIV-infected. Drug and Alcohol Dependence, vol. 86 (2-3), p. 175-182. • Strathdee, A. & Patterson, T.L. (2006). Behavioral Interventions for HIV-Positive and HCV-Positive Drug users. AIDS and Behavior, vol. 10 (2), p. 115-130. • Wright, N. MJ. & Tompkins, C. NE. (2006). A review of the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users. Harm Reduction Journal, vol. 3 (27), p. 1477-7717.