Presentation on theme: "Brief Interventions for HIV+ Persons Thomas L. Patterson Shirley J. Semple University of California, San Diego Research supported by NIMH RO1MH61146 &"— Presentation transcript:
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? 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
MSM Risk Reduction Interventions What 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
HIV+ Risk Reduction Interventions What 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.
HIV+ Risk Reduction Interventions What 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
HIV+ Risk Reduction Interventions What 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 contact85% »Injection drug use 5% »Transfusion 1% »Undetermined 9%
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
Trends among MSM - Meth Users High rates of STDs (current syphilis outbreak) Low rates of condom use
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
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
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
Edge Project: Methods of using methamphetamine Percent Smoke Inject/Combination
Drugs taken with meth in past 2-months Pot Viagra “K” Halluc.
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
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
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?
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?
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)