1. 1 Community Report-Back February, 2005

2. 2 Community Partners - SF Black Coalition on AIDS, Inc. South East Health Clinic NIA Project/Action Point 2 Rafiki House Proyecto ContraSIDA Por Vida Arriba Juntos Walden House Mission Neighborhood Health Center Mission Neighborhood Resource Center Lutheran Social Services Restoration House—Ark of Refuge AIDS Health Project Urban Health Study Lyon Martin Women’s Health Services Instituto Familiar de la Raza Tenderloin Self-Help Center TARC Continuum Positive Resource Center Tom Waddell Shanti SFGH, Ward 86; Ward 93 S.F. AIDS Foundation

3. 3 Community Partners – East Bay The Center for AIDS Services HEPPAC NEED APEB WORLD Tranquilium 14 th Street Clinic Oasis Clinic EBAC CAL-PEP Highland Hospital, Adult Immunology Clinic La Clinica de la Raza Bay Area Consortium for Quality Health Care: EIP Program Neighborhood House of North Richmond Berkeley Free Clinic African American AIDS Support Service AIDS Housing and Information Project Alameda County Office of AIDS Alameda Public Health Dept. Ark of Refuge

4. 4 History TO 1997-19991999-2005

5. 5 National Partners – INSPIRE Intervention for Seropositive Injectors: Research & Evaluation Centers for Disease Control & Prevention (CDC) David Purcell, Yuko Mizuno, Richard Garfein, Scott Santibanez, Ann O’Leary, Craig Borkowf, Cindy Lyles. Health Resources & Services Administration (HRSA) Lois Eldred, Kathleen Handley. New York Academy of Medicine Mary Latka, David Vlahov, Julia Arnsten, Bob Gern, Mark Gourevich University of Miami Lisa Metsch, Jay Wilkinson, Eduardo Valverde, Clyde McCoy, Rob Malow John Hopkins School of Public Health Carl Latkin, Amy Knowlton, Susan Sherman, Phillip Coffin

6. 6 Bay Area Team - UCSF Cynthia Gomez, Principal Investigator Kelly Knight, Co-Investigator & Project Director Carol Dawson-Rose, Co-Investigator & Clinical Coordinator Starley Shade, Statistician Paula Lum, Medical Director Catherine Lyons, Clinical consultant Sonja Mackenzie, Evaluation Coordinator; Project Coordinator Caryn Pelegrino, Recruitment/PVA Coordinator; Project Coordinator Debra Allen, Recruitment Team & Tracker Barbara Garcia, Interventionist Jeff Moore, Interventionist Dinah Usog, Phlebotomist & Assessment Team Gilda Mendez, Phlebotomist Erin Rowley, Project Assistant, Assessment Team Coordinator Greg Austin, Assessment Team Reggie Payne, Assessment Team Charles Pearson, Qualitative Interviewer Recruiters: Senobia Ellis; Maria Pedrosa, Natalie Isaac, Duaniel Menifee, Askia Muhammad, Hazel Betsy, Shawnna Demmons, Andrew Reynolds, Michael Northcutt

7. 7 Goals of the study To reduce sexual and drug use practices that could transmit HIV To increase access to and use of HIV primary health care To increase access and adherence to HIV treatments

8. 8 Study Description  Each site attempted to recruited about 250 HIV+ IDUs with opposite sex partners and a history of IDU in the past year.  Eligible participants completed a baseline survey on ACASI and provided blood samples for CD4 and viral load testing.  Participants who came to initial intervention visit were randomly assigned to one of two program conditions.  Participants attended 8-10 intervention visits.  Participants returned for follow-up ACASI survey at 3, 6, and 12 months post intervention.  Participants provided blood samples for lab testing at 6 and 12 months.  Some participants returned for qualitative de-brief interview post-study. INSPIRE

9. 9 Total Number of Participants Baltimore313 Miami298 New York271 Bay Area279 Total1161

10. 10 Bay Area Participant Characteristics (N = 279) Gender: Male 58% Female 34% Transgender 9% Race/Ethnicity African American65% API/AN 7% Latino18% White 10% Age: 42 years old (mean) (Range: 24-58) Education: Less than H.S 32% H.S. diploma 35% Some college+33% Ever incarcerated:71% In last 6 months:73% Sexual orientation: MW T Straight 45% 72% 20% Bi 35% 23% 20% Gay 16% 2% 48%

11. 11 Participant Retention Overall FU Rate: 91% – 615/675 3-, 6-, + 12-Mo FU visits 12 Mo FU Rate: 92% – 207/225 12 Mo FU visits Overall FU Rate of reachable participants: 95% 12 Mo Fu Rate of reachable participants: 96%

12. 12 Overview of PMI & VDI Peer Mentor Intervention: – Seven group sessions, two individual sessions, and one Peer Volunteer Activity at a community agency Video Discussion Intervention: – 8 group sessions based on watching and discussing videos on a range of topics including criminal justice system, overdose, disclosure of HIV to children

13. 13 Video Discussion Intervention Summary Session IGroup Workshop Introduction to VOICE, HIV health care, sexual and drug transmission risk Session IIGroup Workshop Drinking Apart Session IIIGroup Workshop Don’t Shut Me Out: disclosing HIV to children Session IVGroup Workshop Understanding Prejudice Session VGroup Workshop Red Cross Emergency Test, overdose Session VIGroup Workshop The Farm: Angola, USA Session VIIGroup Workshop Black Is, Black Ain’t Session VIIIGroup Workshop How to Get a Job, How to Keep a Job

14. 14 Peer Mentoring Intervention Summary Session IGroup WorkshopIntroduction to Peer Mentoring Session IIGroup WorkshopHealth Care Decision-Making, Disclosing HIV Status to Providers Session IIIIndividual MeetingYour Relationship to HIV Care, HIV Medications and Adherence Session IVGroup WorkshopPeer Mentoring: Talking to Peers Session VGroup WorkshopIntroduction to Harm Reduction, Sex, Drugs and HIV Risk Session VIGroup WorkshopDisclosing Status to Partners, Taking Responsibility for Protecting Partners Session VIIIndividual MeetingBarriers to Protecting Partners, Strategies to Overcome Barriers Session VIIIGroup WorkshopMale and Female Condom Demo Condom Use Skills-Building, Negotiating Condom Use Session IXIndividual ActivityPeer Volunteer Activity: Participation in an AIDS Service Organization Session XGroup WorkshopDebrief from Peer Volunteer Activity, Intervention Review, Plans for the Future

15. 15 Session 1 - Introduction to Program Identity as HIV+ people Group Composition Years since HIV Diagnosis (mean = 8 years): – Less than 3 years12%

16. 16 Sessions 2 & 3: Health Care Utilization, Adherence & Relationship with Providers

17. 17 Primary Healthcare Visits in the Past 6 months % None21 One to Three30 Four or more49 Total100 Currently on HIV medication = 47% Not on meds but CD4 less than 200 = 9% 100% Adherence: Yesterday = 81% Past 7 days = 67%

18. 18 Session 4: Communication Skills & Peer Mentoring

19. 19 Session 5: Harm Reduction for Sexual and Drug Risk % 08.3 140.2 214.5 313.0 4+24.0 Total100.0 Number of Sexual Partners Mean5 Range0 – 188

20. 20 Drug Risk Behaviors with HIV-/? in the Past 3 Months % Injected85 Lending Used Needles8.3 Sharing Cooker, Cotton or Rinse Water22.8

21. 21 Unprotected Vaginal and/or Anal Sex with HIV-/? by Respondent’s Gender Men 33% (52/156) Women 37% (33/90) Transgender 36% (8/22)

22. 22 Sessions 6-8: HIV Disclosure & Responsibility

23. 23 Condom Use Consistency with Main HIV-/? Partner by Respondent’s Gender MaleFemaleTransgender n%n%n% Consistent16351444343 Inconsistent49722114 Non-User26571134343 Total46100.032100.07

24. 24 Condom Use Consistency with Non-Main HIV- /? Partner by Respondent’s Gender MaleFemaleTransgender n%n%n% Consistent1418824218 Inconsistent23291030436 Non-User435415465 Total80100.033100.011100.0

25. 25 Session 9: Peer Volunteer Activity Goals: Provide an opportunity to act as peer volunteer in a community setting Increase utilization of community resources Logistics: Created MOUs with community service providers Established volunteer activities for study participants at each site Participants signed-up for their preferred site and activity during 8 th session

26. 26 PVA Partner Sites SF: East Bay: TARC NIA Project WORLD Action Point 2 HEPPAC Lyon MartinTranquilium Urban Health Study Highland Hospital, C2 Clinic APAN (Redwood City)

27. 27 Session 10: Graduation

28. 28 How to reach us CAPS www.caps.ucsf.eduwww.caps.ucsf.edu Caryn Pelegrino: Tel: 415-597-8118; cpelegrino@psg.ucsf.edu Kelly Knight: Tel: 415-597- 4651; kknight@psg.ucsf.edu Cynthia Gomez: Tel: 415-597-9267; cgomez@psg.ucsf.edu