1. 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 18 e Annual Canadian Conference on HIV/AIDS Research, Vancouver 2009

2.  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. 2

3.  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 3 Bartholomew, L.K.; Parcel, G.S.; Kok, G; Gottlieb N.H. (2006). Planning Health Promotion Programs: an Intervention Mapping Approach

4.  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. 4

5.  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. 5

6.  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. 6

7. VARIABLES Men IDU (n=124) Heterosexual men (n=108) MSM(n=493) Women (n=178) p N (%) Age (M ± SD) 43.06 ± 7.56 1 45.27 ± 8.7845.75 ± 9.3938.73 ± 9.73  0.0001 Number of years with HIV (M ± SD) 10.28 ± 5.65 1 11.25 ± 5.4712.48 ± 6.8011.53 ± 5.500.006 In a relationship Yes 21 (16.9) 26 (24.1)192 (38.9)114 (64)  0.0001 Education Primary school 59 (48) 2 41 (38)42 (8.5)40 (22.5)  0.0001 High school 42 (34.1) 39 (36.1)147 (29.8)60 (33.7) College or university 22 (17.9) 28 (25.9)304 (61.7)78 (43.8) Annual income ≤15 000$ 94 (79.7) 78 (74.3)181 (37.8)104 (61.9)  0.0001  15 000$ 24 (20.3) 27 (25.7)298 (62.2)64 (38.1) Sexual orientation Heterosexual 93 (75) 108 (100)3 (0.6)170 (95.5)  0.0001 Homosexual 23 (18.5) 0 (0.0)453 (91.9)3 (1.7) Bisexual 8 (6.5) 0 (0.0)37 (7.5)5 (2.8) 7 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. 8 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. 9 *  0,001 – men IDU have significantly lower QOL than MSM & women

10. 10 * <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 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.

11. 11 <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 Scale vary from 1 (low comprehension) to 7 (high comprehension) (sum: 4 items for each factor).

12. VARIABLES Men IDU (1) (n=124) Heterosexu al men (2) (n=108) MSM (3) (n=493) Women (4) (n=178) p Post- hoc M ± SD Acceptance 2.21 ± 0.76 2.19 ± 0.802.44 ± 0.702.21 ± 0.80  0.0001 1132311323 Positive reframing 1.69 ± 0.90 1.87 ± 0.851.96 ± 0.882.04 ± 0.850.004 113114113114 Active coping planning 1.63 ± 0.69 1.89 ± 0.681.78 ± 0.681.90 ± 0.670.004 114114 Venting 1.39 ± 0.92 1.47 ± 0.931.44 ± 0.891.38 ± 0.900.769- Substances use 1.54 ± 1.05 0.71 ± 1.000.56 ± 0.870.29 ± 0.71  0.0001 12113114142431211311414243 12 Results From ANOVA on Coping Strategies Scores vary from 0 (never use) to 3 (often use)

13. VARIABLE S Men IDU (1) (n=124) Heterosexu al men (2) (n=108) MSM (3) (n=493) Women (4) (n=178) pPost-hoc M ± SD Social network / Scale (Sum) : talk to this person (0 : no/1 : yes). More the score is high, more the social network is diversified. Social network diversity 2.88 ± 1.51 3.60 ± 1.724.12 ± 1.714.87 ± 1.89<0.0001 1 1<2 1 1<3 1 1<4 2<3 2<4 4<3 Social integration / Scale (Sum) : integration (-2 : never/+2 : very often). More the score is high, more the participant is integrated with this persons (eg.: feels useful). Family (3 items) -3.05 ± 3.45 -0.62 ± 3.950.25 ± 3.632.45 ± 3.47<0.0001 1< 1<2 1 1<3 1 1<4 2<4 3<4 Friends (3 items)-0.04±3.360.17±3.211.61±2.791.97±2.89<0.0001 1 1<3 1 1<4 2<3 2<4 13 Results From ANOVA on Social Dimensions

14.  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. 14

15. Variables in the equation Final model OR 95% CI Socio-demographic variables Sexual orientation: heterosexual 5.552.93 – 10.50 Number of years with HIV0.940.89 – 0.99 Social support Network diversity0.800.65 – 0.97 Social support & integration: family 0.870.80 – 0.96 Coping strategies Substances use2.101.57 – 2.82 p-value  0.0001 Cases correctly classified90% 15 Multivariate Logistic Regression on Variables Associated to IDU Group (stepwise) (n=560)

16.  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 be generalized to all HIV positive men IDU because of their number (n=124) and recruitment bias (volunteer participants). 16

17.  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)veillette.ludivine@uqam.ca › Joanne Otis (otis.joanne@uqam.ca)otis.joanne@uqam.ca 17

18.  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, Hôpital général de Montréal  Dascal, André, co-investigator, Infectious diseases and microbiology, Hôpital général Juif SMBD  Gaul, Neil, collaborator, Department of family medicine, Hôpital Maisonneuve-Rosemont  Lalonde, Richard, collaborator, Montreal Chest Institute  Lapointe, Normand, co-investigator, Maternal and Infantile Centre for AIDS, Hôpital Sainte-Justine 18  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 medical microbiology and infectiology, Hôpital Notre-Dame du CHUM  Toma, Emil, co-investigator, Department of medical microbiology and infectiology, Hôpital Hôtel-Dieu du CHUM  Trottier, Benoît, collaborator, Clinique médicale l’Actuel  Vincelette, Jean, co-investigator, Department of medical microbiology and infectiology, Hôpital Saint-Luc du CHUM  Zunzunegui, Maria Victoria, co- investigator, Department of social and preventive medicine, Université de Montréal

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