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HIV and Viral Hepatitis Prevention:Addressing the Needs of Young People Who Inject Drugs

Prevention Networking Group

Viral Hepatitis Work Group

Youth Program

February 6, 2008

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Webinar/Call Etiquette

  • Mute your phone line

    • Press *6 to mute

    • Press #6 to unmute

  • Questions

    • There will be dedicated time for questions

    • Please wait until the Q & A sections to ask Questions

    • Please identify yourself when asking question/comment

  • Written Questions

    • Participants using Microsoft Live Meeting may have the ability to submit written questions during the webinar

    • Please feel free to use this feature if you would like

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Jurisdictions Registered for Call



















































U.S. Virgin Islands


44 Jurisdictions Close to 100 Participants

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  • Focus on Young People who Inject Drugs

  • HIV, Hepatitis and Youth Development and Programs

  • Opportunity to interrupt disease transmission

  • Invisible population

  • Venue to Talk with Our Peers

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Webinar Objectives

  • Provide information to health department HIV and viral hepatitis programs on working with marginalized youth, particularly young people who inject drugs.

  • Discuss interventions that address the complex and unique HIV and viral hepatitis prevention needs of young people who inject drugs.

  • Identify specific strategies that health department HIV and hepatitis programs can employ to increase or enhance prevention services for young people who inject drugs.

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Webinar Agenda

  • Welcome & Overview

    • Ann Shindo

      • Adult Viral Hepatitis Prevention Coordinator, Oregon

  • Engaging Marginalized Youth

    • Jerry Fest

      • JTFest Consulting: Training & Development, Oregon

  • Making Space for Young Injection Drug Users

    • Eliza Wheeler

      • Program Manager, Cambridge Cares About AIDS, Massachusetts

    • Ed Debortoli

      • Massachusetts Department of Public Health

  • UFO Study – University of California San Francisco

    • Kim Page-Shafer

      • Principal Investigator

  • Facilitated Discussion

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Overview of Issues Facing Youth

  • Adolescence ~ highly pathologized

  • Adolescence ~ characterized by

    • More abstract cognitive functions

    • Self-growth and identification through peer-based relationships

  • Adolescence ~ highly volatile period for youth who have experienced trauma

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High-Risk Youth

Youth who experience trauma (including homelessness) are at susceptible to high-risk sex and drug behaviors that put them in the public health intervention realm – why we’re here today!

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Specific Issues

Drug & Sex behavior of concern:

  • 60% ~ some substance use

  • 6% ~ injectable substances use

  • 85% ~ sexually active

    (Baron, 1999; Forst & Crim, 1994; Greene, Ennett, & Ringwalt, 1997;

    Pires & Silber, 1996; Solorio, et. al., 2008)

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Specific Issues

Bottom Line:

  • Homeless, marginally housed high-risk youth are at greater risk of HIV, viral hepatitis, and STDs in comparison to housed youth.

  • Higher incidents of hunger, rape, survival sex and drug use ~ increases the likelihood of BBP transmission.

    (Kipke et al., 1992 & 1997)

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Specific Issues

Public Health Focus:

  • Safe syringe access and disposal programs

  • NEX, pharmacy sales, syringe drop kiosks

  • Many jurisdictions have age limits – OR = no prescription required for persons age 18 years and older

    Oregon Revised Statutes (§§ 475.525, 1987)

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Where Does PH Begin?

  • Greater understanding of the target population

  • Identification of evidence-based programs that work to address youths’ needs in culturally competent, age-appropriate fashion

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Where Do We Need To Go

  • Development of appropriate youth services;

  • Acquisition of funding for primary prevention activities targeting youth (instead of serostatus-based funding algorithms);

  • Evaluation criteria that consider appropriate developmental benchmarks not just head counts;


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Youth Risk Behavior Surveillance System

Housed or In-School Youth Report

  • 71% of all deaths among youth 10 – 24 years old due to:

    • Motor-vehicle crashes

    • Unintended accidents

    • Homicide

    • Suicide

      (MMWR, 2006)

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Youth Risk Behavior Surveillance System

Drug, including alcohol, behavior of concern:

Within 30 days YBRS youth report:

  • 9.9% driven while intoxicated

  • 43.3% consumed alcohol

  • 20.2% consumed marijuana/pot

  • 2.1% ever used a needle for drug-use

    (MMWR, 2006)

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Youth Risk Behavior Surveillance System

Sexual behavior of concern:

  • 46.8% ~ had engaged in sexual intercourse

  • 37.2% ~ had not used condoms @ last sexual intercourse

  • 7.5% ~ have been forced to have sex when didn’t want to

    (MMWR, 2006)

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Engaging Marginalized Youth

A brief overview of issues and strategies to consider when intervening in the lives of difficult-to-serve young people

Presented by Jerry Fest

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  • Background: Homeless, Street-dependent youth

  • Training/Consultation: Positive Youth Development


  • Discuss some of the general issues related to working with marginalized youth

  • Provide an overview of the Positive Youth Development (PYD) approach

  • Relate PYD to Harm Reduction principles

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General Issues: #1

  • Marginalization is external and internal

    “I may be nothin’ more than a sleazy little

    street walking whore, but by God

    at least I’m honest about it.”

    - Street Culture: an epistemology of street-dependent youth

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General Issues: #2

  • The impact of concepts of time

    “I like living hour to hour.

    I just don’t get this week to week shit.”

    - Street Culture: an epistemology of street-dependent youth

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General Issues: #3

  • Relevance of prevention rationale

    “The streets aren’t under your feet,

    they’re under your scalp.”

    - Street Culture: an epistemology of street-dependent youth

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PYD: The Beginning …

  • “The starting point is the belief that all youth have innate resilience”

    • - Bonnie Benard

  • Werner, E. and Smith, R. (1982, 1989). Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth. New York: Adams, Bannister, and Cox.

  • Werner, E. and Smith, R. (1992). Overcoming the Odds: High-Risk Children from Birth to Adulthood. New York: Cornell University Press.

  • Benard, B. (2002). "The Foundations of the Resiliency Framework: From Research to Practice". In Resiliency in Action: Practical Ideas for Overcoming Risks and Building Strengths in Youth, Families, and Communities. San Diego, Calif.: Resiliency in Action. Also available at c

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The other 30-50%

  • Why do some young people demonstrate resilient behavior, while others do not?

    • An individual’s capacity for resilience is affected by internal and external factors

  • Environmental factors can foster or inhibit a young person’s capacity for resilience.

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Risk Factors

Abuse/neglect, Family conflict, Poor family support, Substance use/abuse, Poor or unstable housing or homelessness, Extreme economic or social deprivation, Community deterioration or disorganization, Community violence and/or gangs, Inadequate education and recreational opportunities, Mental or physical health issues, Learning disabilities, Early unplanned pregnancy, Cultural and/or linguistic isolation … to name a few …

  • Risk Factors inhibit resilience

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Protective Factors

  • Protective Factors foster resilience

    • Caring/Supportive Relationships

    • High Expectations

    • Meaningful Participation

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Caring/Supportive Relationships

  • Caring

    • Someone is interested in the fact that I exist

  • Supportive

    • I can count on someone as a resource

  • Relationship(S)

    • Multiple

    • Defined

    • Appropriate

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    High Expectations

    • What “High Expectations” is not:

      • Positive Thinking

      • Goals, Measurements, Benchmarks, etc.

  • High Expectations are beliefs

    • Messages from people and environments about who a young person is and what they are capable of doing

    • High Expectations reflect what you really believe about a young person

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    Meaningful Participation

    • Anything that directly affects them

      • Choices, decisions, actions, environments, etc.

  • Must be legitimate

    • Does not mean that youth have all the power and can do anything they want

    • Does mean young people as legitimate stakeholders; participation is real and valued

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    Research base of PYD

    • All people are innately resilient

      • The human capacity to face, overcome, and even be strengthened by adversity

  • External factors affect resilience

    • Risk Factors inhibit resilience

    • Protective Factors foster resilience

      • Caring/Supportive Relationships

      • High Expectations

      • Meaningful Participation

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    PYD Defined

    • Youth Development as a concept:

      • A process by which all people seek ways to meet their basic physical and social needs and build competencies

  • Youth Development as a practice:

    • An approach to working with young people that fosters their innate resilience and supports their developmental process

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    A Framework for PYD …

    • PYD is implemented, that is, Protective Factors are created, through an approach best remembered with the acronym (s)OS

      • (services)

      • Opportunities & Supports

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    (s): (services)

    • Services are not PYD

      • They are sometimes a necessary foundation for PYD

  • To or For

    • Anything that can be defined as being done toor for another is by definition a service

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    Opportunities & Supports

    • Opportunities without supports

      • A setup for negative youth experiences

  • Supports without Opportunities

    • Staff directed activity

  • Opportunities AND related Supports

    • Create a framework for Protective Factors

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    • By

      • Things that are done by young people

      • Requires voluntary participation and internal motivation

      • Requires honesty on the part of adults

    Supports l.jpg

    • With

      • Things that are done with young people in support of their opportunities

      • People, resources, information, guidance

  • How do you teach someone to drive?

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    The Essence of PYD

    • An approach to working with young people designed to foster their innate resilience by exposing them to Protective Factors.

    • Protective Factors are created by minimizing the things you dotoor foryoung people (services)and maximizing the things they do with your support (opportunities & supports).

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    PYD and Harm Reduction

    • PYD is an approach, not a model

      • PYD is not what you do, it is the way you do it

  • As an approach, PYD is compatible with many strengths-based models

    • Motivational interviewing

    • Stages of Change

    • &, particularly with drug-affected populations, Harm Reduction

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    Principles of Harm Reduction

    • Be nonjudgmental, avoid labeling

    • Avoid being parental/authoritarian, meet the client where they are

    • Value the client's information, emphasize client's strengths

    • Avoid having preconceived goals, provide guidance and consultation

    • Provide support, build rapport/trust

    • See small changes as success, emphasize personal responsibility for outcomes

    • In other words, Harm Reduction:

      • Works through relationship, demonstrates high expectations, and allows for meaningful participation

      • Is present focused and relevant to a young person’s current needs, reality, and environment

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    “If we take people as we find them, we may make them worse, but if we treat them as though they are what they should be, we help them to become what they are capable of becoming.”

    - Johann Wolfgang von Goethe

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    Making Space for Young Injection Drug Users: Identifying Opportunities and Challenges

    Presented by Eliza Wheeler

    Cambridge Cares about AIDS

    Data from the YIDU Study, designed and implemented by CCA and the Institute for Community Health

    Participant statements taken from video documentary of YIDUs who access the Cambridge NEP

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    HIV/AIDS and IDUs Opportunities and Challenges

    • As of 2005, 30% (N=4,773) of PLWHA in Massachusetts had a history of IDU

    • 6% (N=899) were exposed to HIV through heterosexual sex with an IDU partner

    • From 1996 to 2005, the proportion of deaths among people diagnosed with AIDS represented by those who had a history of IDU rose from 42% to 55%.

      *Massachusetts HIV/AIDS Surveillance Program

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    HIV and young people, MA Opportunities and Challenges

    • From 2003 to 2005, 7% (N=201) of HIV diagnoses in Massachusetts were among 13 and 24 year olds.

    • Of all HIV infections among 13-24 year olds (2003-2005), 9% identified IDU as mode of exposure.

      *Massachusetts HIV/AIDS Surveillance Program

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    HCV and young people, MA Opportunities and Challenges

    • From 2002 to 2006, rates of newly diagnosed reported HCV infection in 15 to 25 year-olds in Massachusetts rose from 16 to 44 per 100,000 population.

    • 1,054 (14%) of cases in 2006 were 15 to 25 years of age.

      *Massachusetts Hepatitis Surveillance Program

      Onofrey SL, Church DR, Heisey-Grove DM, Briggs P, Bertrand TE, DeMaria A Jr.

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    Opioid-related data: 2005 Opportunities and Challenges

    • 43,450 treatment admissions for heroin**

    • 71% of these individuals reported IDU**

    • 544 opioid-related deaths**

    • 11,750 opioid-related ED visits*

    • 17,104 opioid-related acute care inpatient hospital discharges*

    • According to 2004-2005 data, 150,000 MA residents reported needing, but not receiving treatment for illicit drug use within the year***

      *MDPH Bureau of Substance Abuse Services

      **MDPH Center for Health Information, Statistics, Research and Evaluation

      ***SAMHSA State Estimates of Substance Use from the 2004-2005 National Surveys on Drug Use and Health, February 2007

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    18-25 year olds who enrolled in the NEP in FY05/FY06: Opportunities and Challenges

    There is low rate of seropositivity at the time of enrollment, but many do not know their status.

    • Less than 1% HIV positive, but over 20% didn’t know their status

    • Only 9% HCV positive, but nearly 30% didn’t know their status

      Approximately half report sharing injection equipment, either sometimes or always.

    • Approximately 50% report NEVER sharing syringes, over 40% report NEVER sharing cookers/cotton

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    Continued… Opportunities and Challenges

    Many already have a history of accessing drug treatment programs.

    • 67% have already been in treatment of some kind.

      Nearly two-thirds report never or sometimes using condoms.

    • Over 30% NEVER, approximately 30% SOMETIMES.

      Many have experienced overdose, or witnessed another person overdose.

    • 22% their own experience, approximately 50% had witnessed another person.

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    Why did we do the YIDU study? Opportunities and Challenges

    • Beginning in 2003, needle exchange staff noticed a significant increase in the number of young people (18-25) that were enrolling in the program.

    • This trend mirrored media reports and drug treatment data showing an increase in heroin and OxyContin use among young people in the state.

    • Between 2005-2006, 18-25 year olds accounted for over HALF of new enrollees into the program.

    • We wanted to respond to this trend by gathering more information to advocate for services or develop new interventions for this population.

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    Who was interviewed? Opportunities and Challenges

    • 150 Young Injection Drug Users (18-25 years old) who were enrolled in the needle exchange program, between September 2005 and July 2006.

    • 51% males and 48% females

    • 96% White

    • 75% completed 12th grade or higher

    • 38% employed in a part or full-time job

    • 38% had no health insurance

    • 80% were housed (NOT homeless)

    • Residents of 46 different Massachusetts towns responded to the survey.

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    Average ages of first use: Opportunities and Challenges

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    IDU-related risks and issues Opportunities and Challenges

    • HIV, Viral Hepatitis, STIs

    • Overdose

    • Abscesses, Endocarditis, other injection-related infections

    • Criminal justice system involvement

    • Homelessness or unstable housing

    • Undiagnosed/untreated mental health issues

    • Lack of consistent/competent medical care

    • Undernourishment and malnutrition

    • Relationship issues

    • Many more…

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    Harm Reduction Current Practice Opportunities and Challenges

    • Basic needs (food, clothes, hygiene supplies, safe space while under influence)

    • Needle Exchange Programs

    • Syringe Access interventions

    • Safer injection materials distribution

    • OD Prevention, Naloxone distribution

    • Access to services (internal/external referrals)

    • Groups and 1:1 Education/Risk Reduction

    • Low-threshold case management

    • Drug User advocacy opportunities (CABs)

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    Comments from Young IDU video: Opportunities and Challenges

    • 10 young participants of the Cambridge NEP took part in a 30 minute video project taped at the exchange last year.

    • The video documented the participants discussion of their drug use histories, their thoughts about risk, their support systems, and their suggestions for better services.

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    Drug Use History Opportunities and Challenges

    • Drug transition (oxy to heroin) (D.)

    • Boredom, hopelessness, risk-taking--“If I hadn’t found drugs, I would have killed myself.” (D.)

    • Peer pressure, family pressure (S.)

    • Experimentation, pain, both emotional and physical (C.)

    • Family Drug use (S.)

    • Trauma/abuse, unhappiness (A., J.)

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    Perception of Risk Opportunities and Challenges

    • “Everyone I know has Hep,” “I know it will affect me later” (D.)

    • Major concerns are police, not enough money/drugs—not other risks (J.)

    • Practicing safe behaviors within unsafe social networks (C., A.)

    • Worrying about risk after the fact (J., C.)

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    Support Systems Opportunities and Challenges

    • Other friends who are using (D., S.)

    • Isolation, no support (M., S.)

    • Family, friends (C.)

    • Drugs/drug dealers, other users (J.)

    • Service providers (C., A., J.)

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    Services that YIDUs want: Opportunities and Challenges

    • Youth-only spaces (A.)

    • All-inclusive spaces (J.)

    • Safer Injection rooms (C., D., J.)

    • Harm Redux housing/shelter (D., C.)

    • Low-threshold, non judgmental spaces (J.)

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    Trauma-informed services Opportunities and Challenges

    Many young drug users have experienced trauma in their lives. It is important to remember this when developing programming.

    For example, among members of Youth on Fire, a program of CCA that serves homeless and street involved youth:

    • 52% have lived in an abusive household

    • 36% have been involved with DSS

    • 58% have mental health dx

    • 42% have been hospitalized for psychiatric reasons

    • 11% have been forced to have sex in the previous year

    • 13% have attempted suicide

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    What is trauma? Opportunities and Challenges

    An extremely stressful and unexpected physical or emotional experience that is felt to be threatening to a person’s life or sanity and overpowers a person’s ability to use normal coping mechanisms to adapt to a situation.

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    How does trauma affect people? Opportunities and Challenges

    • Physical Reactions

      • Aches, pains, easily startled,changes in sleep patterns, appetite, getting sick, substance use

    • Emotional Reactions

      • Shock, fear, grief, emotional swings, nightmares, flashbacks, increased need to control everyday experiences, isolation, anger, difficulty trusting people, shame, hyper-vigilance

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    What are “trauma-informed” services? Opportunities and Challenges

    • Assume that everyone has experienced trauma

    • See trauma as a defining organizing experience that forms the core of a person’s identity rather than a single event

    • Protect client from physical harm and re-traumatization

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    What are “trauma-informed” services? Opportunities and Challenges

    • See symptoms & behaviors as attempts to cope

    • Emphasize skill building rather than symptom management

    • Encourage open and genuine collaborations between provider and consumer

    • Give control and decision-making to the client

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    How can we support programs to create trauma-informed services?

    • Encourage programs to conduct trauma-informed assessments

    • Incorporate services that are sensitive to trauma-related issues present in survivors

    • Provide trainings and information about trauma-informed services to service providers working with young people

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    Opportunities services?

    • Family contact is still intact in some instances—development of interventions to target families, teaching harm reduction techniques with loved ones.

    • Low-threshold interventions—pharmacy access is a desirable option for young people who want little contact with providers.

    • Willingness to engage with certain kinds of services and rely on them for support.

    • Social networks are important—assess level of risk in the network in order to develop risk reduction plan for individual.

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    Opportunities services?

    • Keep contact with YIDUs through venues that they frequent (NEPs, drop-in centers, jails, detoxes, youth-oriented programs, etc.), keep them engaged.

    • Educate about drug-related risks like HCV, HIV and overdose early—we saw how early drug use started—start before then.

    • Adapt to the unique challenges and opportunities that YIDUs present—cultural competency!

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    Recommendations services?

    • Enhance HCV surveillance—we need more/better information to make a good case for more services

    • Work collaboratively with programs to design realistic and culturally competent outcome measures:

      • According to Ruefli & Rogers, in designing outcome measures for our programs, we must “involve program clients in a process that would generate valid measures that are 1) culturally relevant to the way they see the world and live their lives; 2) incremental—i.e., capable of measuring small changes and 3) hierarchical—i.e., capable of showing how clients improve over time”

        *Terry Ruefli, Ph.D., Susan J. Rogers, Ph.D. “How do drug users define their progress in harm reduction programs? Results of preliminary research to develop user-generated outcomes” Harm Reduction Journal 2004, 1:8

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    Recommendations, cont. services?

    • Allow for innovation, creativity in programming: participant designed drop-in spaces, groups and activities instead of just pre-packaged interventions

    • Visit programs, meet program participants, ask them what they need!

    • Advocate for policy change around syringe access, overdose prevention interventions and safe spaces for active users

    • Provide access to ongoing harm reduction trainings and skills building sessions to build staff and program capacity

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    Conclusion services?

    Thank you!

    Any questions?

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    HIV, HBV, and HCV in services? Young Injection Drug Users in San Francisco

    Kimberly Page-Shafer, Ph.D. MPH; Peter Davidson, Ph.D. candidate. University of California San Francisco


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    The services? UFO Studies: community-based studies of HIV, HBV and HCV infections, health consequences of drug use, vaccine feasibility and adherence in young injectors in San Francisco

    Slide71 l.jpg

    HIV services?

    Hepatitis C virus (HCV)

    Hepatitis B virus (HBV)

    HBV immunizations

    Sexually transmitted infections

    Heroin-related overdose


    Intergenerational drug use

    Gender and injection risk



    HCV superinfection

    Serosilent HCV

    Immunology of HCV clearance

    Traveleing IDU and risk behavior

    Community collaborations

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    Young injection drug users services?

    • San Francisco ~18,700 IDU; 1/3 < age 30

    • Large number of homeless runaways

      • Many with history of negative & traumatic events

    • Illicit drug use and illegal street economy

      • prostitution, drug sales, theft, panhandling, or selling stolen property.

    • Disenfranchised, marginalized, mistrustful

      • “threatening, offensive, obnoxious, or generally disagreeable”

    • Outside the public health system

    • Susceptible to blood-borne and sexually transmitted infections

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    BACKGROUND services?

    • Most young injectors began injecting after the advent of needle exchange – many needles available in SF

    • Young IDUs are more likely to borrow needles than older IDUs

    • HCV risk is highest among young and new IDU

    • HIV risk is highest among IDU MSM

    • HBV vaccine still needed among young IDU


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    HIV - Key points services?

    • HIV prevalence and incidence has stabilized among IDU in San Francisco:

      • Prevalence: 3% to 12% over past 10 years (depending on age and risk group)

      • HIV incidence in 5 IDU groups 1990-2000: 0.87% (0.54, 1.36) (*Kral et al, 2004).

    • Young IDU

      • HIV prevalence: 5.3% overall

        • Self-identified homo/bi-sexual: 15.6%

        • Heterosexuals: 3.1%

      • HIV incidence in young IDU 1990-2000: 0.45% (0.03-2.16). (*Kral et al, 2004).

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    HCV - Key points services?

    • HCV infection is most common among IDU – up to 90% infected overall.

    • In San Francisco in 2000, 44% prevalence among young IDU and 50% infected after 5 years of injecting (Hahn 2002),

      • compared to 65% after 1 year in Baltimore in early 90’s

    • Moderate declines in HCV coincide with implementation of HIV prevention programs, especially clean needles and education

    • HCV incidence is very high among young IDU in SF: 31.8 ppy (26.8-37.7)(25% in 2000 – Hahn et al, 2002)

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    HBV – Key points services?

    • Infection common in IDU (44-80%)

    • Incidence higher in young IDU than older IDU

    • Effective preventive vaccine available since 1982

    • Populations at highest risk of infection are least likely to be immunized

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    METHODS: UFO-3 Study cohort services?

    • Prospective study of young active IDU

    • Outreach-based street recruiting

    • Eligibility: Age <30; Injected in prior month, English speaking

    • Screening for cohort eligibility includes: anti-HCV testing, structured interview and counseling.

      • HIV testing was done systematically from 2000 through 2004

    • HCV negatives invited to enroll in the UFO Study cohort

    • Cohort visits include: monthly check-ins, quarterly structured interviews, HCV testing, and risk reduction counseling,

    • Study site: a community based clinic in San Francisco.

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    Injecting behaviors services?

    Median years injecting 5 (IQR: 2-8)

    Initiated by a sex partner 15%

    1st needle came from needle exchange 17%

    Borrowed a needle

    Ever 66%

    Past 30 days 32%

    Bleached last time borrowed a needle* 49%

    *Among persons who ever borrowed a needle

    Injected daily (30 days) 37%

    Injected by someone else (30 days) 31%

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    HIV and HCV infection by years injecting among young IDU in San Francisco

    Hahn et al, 2002; Page-Shafer et al 2004

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    Characteristics of young IDU with incident HCV infection compared to HCV negative

    *  0.05; #  0.01

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    Factors independently associated with incident HCV compared to HCV negative

    AOR95% CI

    Age (per year) 1.2 1.1-1.3

    Duration injecting (per year) 1.2 1.1-1.3

    Duration in SF (per year) 1.1 1.0-1.1

    Initiation into injecting by a sex partner 4.1 1.7-9.5

    Injected daily (prior month) 3.9 2.1-7.2

    Ever borrowed a needle 2.6 1.2-5.5

    Bleached last time borrowed a needle 0.5 0.2-1.0

    Snorted or smoked drugs (prior year) 0.5 0.3-0.9

    Injected by someone else (prior month) 0.5 0.3-1.0

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    Factors associated with prevalent HIV compared to HCV negative

    OR95% CI

    Sexual orientation:

    homo/bi-sexual vs. heterosexual 7.5 1.5-36.6

    Duration in SF (per year) 11.7 1.4-95.8

    Recruitment area:

    Polk street vs. other neighborhood 4.8 1.4-17.6

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    HBV serology results compared to HCV negative

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    Vaccine completion compared to HCV negative

    • 75% (128/170) received second dose

      • Median 5 wks (IQR 4-8 wks) between first two doses

    • 47% (80/170) completed vaccine series

      • Median 21 wks (IQR 17-26 wks) between first and third doses

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    HBV vaccine in young IDU (UFO-2) compared to HCV negative

    • Vaccine completer may be more geographically stable and engage in other prevention activities.

    • Outreach worker support with modest cash incentives may improve vaccine adherence.

    • Young IDU demonstrate suboptimal immune response to HBV vaccines.

    • Repeat or higher vaccine doses may be indicated.

      Lum, et al. AJPH 2003; 93(6):919-923

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    Prevalence of anti-HBV, anti-HCV and HIV by incarceration history among Young IDU in SF

    *p-value <0.05
















    Incarceration history

    No incarceration history

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    Research and Service history among Young IDU in SF

    • Prevention and research with young IDU requires multidisciplinary and collaborative work between many groups!

    • UFO Studies are funded as research but are also the PRIMARY providers of support, outreach, and medical referral to young IDU in SF.

    • Biomedical research studies of vulnerable populations often embody contradictions between the studies’ scientific goals and the service needs of study participants.

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    Research & service: negotiated Issues history among Young IDU in SF

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    Conclusions history among Young IDU in SF

    • HCV prevention is urgently needed

    • HIV infection has stabilized

    • HBV vaccine is accepted and needed

    • Facilitation of behavioral change is urgent

      • Access to clean and sterile equipment is essential. In the Bay Area, there Are still counties that have not implemented pharmacy sales.

    • Risk reduction is not enough! (Page-Shafer 2007)

    • There are MANY opportunities for public health intervention and support for young IDU: harm reduction, incarceration, mental health, medical, and dental services – just to name a few!

    • UFO study is engaging now in studies of willingness and attitudes toward HIV and HCV vaccine trials

    Slide91 l.jpg history among Young IDU in SF



    Paula Lum, M.D. MPH; Judith Hahn, Ph.D.;

    Stewart Cooper, M.D.; Eric Delwart, Ph.D.’ Michael Busch, M.D., Ph.D.


    Peter Davidson, Jennifer Evans, Leslie Tobler


    NIDA R01 DA016017-03A1

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    Acknowledgements to collaborators and the community history among Young IDU in SF

    • Berkeley Free Clinic

    • Food Runners

    • Haight Ashbury Youth Outreach Team

    • HIV Prevention Project, SF AIDS Foundation

    • Homeless Youth Alliance

    • San Francisco Needle Exchange

    • SFDPH AIDS Office

    • SFDPH Adult Immunization Clinic

    • SFDPH Community Health Epidemiology & Disease Control

    • SFDPH Housing and Urban Health

    • Street Outreach Services, SFCCC

    • Tenderloin AIDS Resource Center

    Hcv prevention overview l.jpg

    HCV prevention overview history among Young IDU in SF

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    Studies of HCV Prevention history among Young IDU in SF

    • Drug Treatment (methadone)

    • Needle exchange

    • Disinfectant and bleach

    • Behavioral change

    • Comprehensive Harm Reduction

    Methadone and hcv prevention l.jpg
    Methadone and HCV prevention history among Young IDU in SF

    Needle exchange hcv prevention l.jpg
    Needle exchange & HCV prevention history among Young IDU in SF

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    Disinfectant bleach & HCV history among Young IDU in SF

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    Behavioral studies to reduce HCV history among Young IDU in SF

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    Group Discussion history among Young IDU in SF

    • What are states doing to meet the HIV and hepatitis prevention needs of young people who inject drugs?

    • After today’s presentations, what are things your jurisdiction can do in the immediate future to increase the HIV and hepatitis prevention services for young people who inject drugs?

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    Harm Reduction Resources history among Young IDU in SF

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    Next Steps history among Young IDU in SF

    • How can your jurisdiction increase HIV and hepatitis prevention activities for young people who inject drugs?

    • What can you do in your position to increase HIV and hepatitis prevention activities for young people who inject drugs?

    • What support do you need from NASTAD, CDC and SAMHSA to increase HIV and hepatitis prevention activities for young people who inject drugs?

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    For More Information history among Young IDU in SF

    Ann Shindo [email protected]

    Jerry Fest [email protected]

    Eliza Wheeler [email protected]

    Kim Page Shafer [email protected]

    Natalie Cramer (NASTAD) [email protected]

    Chris Taylor (NASTAD) [email protected]

    Gary Jenkins (NASTAD) [email protected]

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    Future Calls/Webinars history among Young IDU in SF

    Watch for more information on future calls/webinars focusing on drug user health!

    Slide106 l.jpg

    Webinar Evaluation history among Young IDU in SF

    Please take a moment to fill out the online evaluation of this call/webinar. An email with a link to the survey will be sent to you in the next couple of days.

    Thank You!

    Slide107 l.jpg

    Thank You! history among Young IDU in SF

    • Presenters

      • Ann Shindo (OR)

      • Jerry Fest

      • Eliza Wheeler

      • Ed Debortoli

      • Kim Page Shafer

    • Webinar Planning Committee

      • Dan Church (MA)

      • Bernie Lieving (NM)

      • Heather Lusk (HI)

      • Alessandra Ross (CA)

      • Ann Shindo (OR)

    • Call/Webinar Participants

    • NASTAD Work Groups

      • Prevention Networking Group

      • Viral Hepatitis Work Group

      • Youth Program

    • CDC & SAMHSA Partners

    • NASTAD Staff