How Can STD Clinics Serve Drug Users Better?

1. How Can STD Clinics Serve Drug Users Better? Salaam Semaan,DrPH1 and Don Des Jarlais, PhD2 1 Centers for Disease Control and Prevention, Atlanta, GA 2Beth Israel Medical Center, New York, NY National STD Prevention Conference, Jacksonville, FL May 11, 2006 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

2. Presentation Outline • Addiction • Responsibility for addiction • Drug users as agents of change • Principles for working with drug users • STD rates among drug users • STD services for drug users • Selected references • Conclusions

3. Addiction • How does it happen? • How do we define it? • How does it affect behaviors?

4. Responsibility for Addiction • Life pressures • Different substances • Different consequences • Addiction as a disease • Prejudices • Health as a virtue or as a value • Societal barriers and opportunities

5. Drug Users as Agents of Change • Evidence from • HIV risk reduction interventions • Needle exchange programs • CDC HIV/AIDS surveillance and case reporting data • Substance abuse treatment programs • Reductions in risk behaviors • Reductions in HIV infection rates

6. Compassion and patience Respect as human beings Professional relationship Avoid blame and judgment Education about health care system Inclusion in decision making Multidisciplinary and case management team Learn about local resources Coordination of care needs Agreement on responsibilities Response to violations of agreements Reductions in barriers to care Realistic commitments to healthful behaviors Success requires several attempts Avoid common pitfalls Principles for Working with Drug Users

7. Data from HIV-risk reduction interventions Overall seropositivity rates Syphilis: 1% -6% Gonorrhea: 1% - 3% Chlamydia: 1% - 5% HSV2: 38% - 61% HPV: no data Higher rates in subgroups of drug users Incidence data Syphilis: 26/1000 py (Lopez-Zetina et al., 2000) Gonorrhea: 0% male IDUs, 1% female IDUs (Latka et al., 2001) Chlamydia: 2% male IDUs, 4% female IDUs (Latka et al., 2001) Rates in other high-risk populations STD Rates among Drug Users

8. STD Services for Drug Users • Increase in STD clinics that service drug users • Delivery of STD services at different venues and through different means • HIV CT sites, NEP, SATF, CF, ER • Social networks • Integration of services for HIV, STD, and hepatitis -- feasible and successful

9. Selected References • Bachmann et al., AJPH, 2000 • Edlin et al., Clinical Infectious Diseases, 2005 • Edlin et al., International J of Drug Policy, 2005 • Des Jarlais et al., 1995; 2005 • Gunn et al., AJPM, 2005 • Lally et al., STDs, 2002 • Plitt et al., STDs, 2005 • Semaan et al., JAIDS, 2002; 2006

10. Conclusions • Popularity of different and emerging drugs • Data on rates in drug users and subgroups of drug users • Few STD interventions for drug users • Tailored and targeted interventions • Integration of services • Training of personnel • Research to practice • Prevention of initiation of drug use • Treatment of drug use • Interdisciplinary effort • Delivery of services