hiv and viral hepatitis prevention addressing the needs of young people who inject drugs
Download
Skip this Video
Download Presentation
HIV and Viral Hepatitis Prevention: Addressing the Needs of Young People Who Inject Drugs

Loading in 2 Seconds...

play fullscreen
1 / 107

HIV and Viral Hepatitis Prevention: Addressing the Needs of Young People Who Inject Drugs - PowerPoint PPT Presentation


  • 186 Views
  • Uploaded on

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 . Webinar/Call Etiquette. Mute your phone line Press *6 to mute Press #6 to unmute Questions

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'HIV and Viral Hepatitis Prevention: Addressing the Needs of Young People Who Inject Drugs' - india


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
hiv and viral hepatitis prevention addressing the needs of young people who inject drugs

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

webinar call etiquette
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
jurisdictions registered for call
Jurisdictions Registered for Call

NH

VT

WA

ME

ND

NY

MT

MA

MN

OR

WI

SD

RI

MI

ID

CT

WY

PA

NJ

OH

IA

NE

IN

DE

NV

IL

CO

WV

UT

KY

VA

MD

KS

MO

CA

NC

TN

DC

OK

AZ

AR

SC

NM

GA

AL

MS

AK

TX

LA

FL

U.S. Virgin Islands

HI

44 Jurisdictions Close to 100 Participants

overview
Overview
  • 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
webinar objectives
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.
webinar agenda
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
overview of issues facing youth
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
high risk youth
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!

specific issues
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)

specific issues10
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)

specific issues11
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)

where does ph begin
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
where do we need to go
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;

Others?

youth risk behavior surveillance system
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)

youth risk behavior surveillance system16
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)

youth risk behavior surveillance system17
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)

engaging marginalized youth

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

introduction
Introduction
  • Background: Homeless, Street-dependent youth
  • Training/Consultation: Positive Youth Development

Agenda

  • 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
general issues 1
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

general issues 2
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

general issues 3
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

pyd the beginning
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
the other 30 50
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.
risk factors
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
protective factors
Protective Factors
  • Protective Factors foster resilience
      • Caring/Supportive Relationships
      • High Expectations
      • Meaningful Participation
caring supportive relationships
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
high expectations
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
meaningful participation
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
research base of pyd
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
pyd defined
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
a framework for pyd
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
s services
(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
opportunities supports
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
opportunities
Opportunities
  • By
      • Things that are done by young people
      • Requires voluntary participation and internal motivation
      • Requires honesty on the part of adults
supports
Supports
  • With
      • Things that are done with young people in support of their opportunities
      • People, resources, information, guidance
  • How do you teach someone to drive?
the essence of pyd
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).
pyd and harm reduction
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
principles of harm reduction
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
thank you
THANK YOU!

“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

making space for young injection drug users identifying opportunities and challenges

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

hiv aids and idus
HIV/AIDS and IDUs
  • 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

hiv and young people ma
HIV and young people, MA
  • 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

hcv and young people ma
HCV and young people, MA
  • 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.

opioid related data 2005
Opioid-related data: 2005
  • 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

18 25 year olds who enrolled in the nep in fy05 fy06
18-25 year olds who enrolled in the NEP in FY05/FY06:

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
continued
Continued…

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.
why did we do the yidu study
Why did we do the YIDU study?
  • 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.
who was interviewed
Who was interviewed?
  • 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.
idu related risks and issues
IDU-related risks and issues
  • 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…
harm reduction current practice
Harm Reduction Current Practice
  • 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)
comments from young idu video
Comments from Young IDU video:
  • 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.
drug use history
Drug Use History
  • 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.)
perception of risk
Perception of Risk
  • “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.)
support systems
Support Systems
  • 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.)
services that yidus want
Services that YIDUs want:
  • 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.)
trauma informed services
Trauma-informed services

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
what is trauma
What is trauma?

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.

how does trauma affect people
How does trauma affect people?
  • 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
what are trauma informed services
What are “trauma-informed” services?
  • 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
what are trauma informed services62
What are “trauma-informed” services?
  • 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
how can we support programs to create trauma informed services
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
opportunities64
Opportunities
  • 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.
opportunities65
Opportunities
  • 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!
recommendations
Recommendations
  • 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

recommendations cont
Recommendations, cont.
  • 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
conclusion
Conclusion

Thank you!

Any questions?

hiv hbv and hcv in young injection drug users in san francisco

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

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

NASTAD WEBINAR FEB. 2008

slide70

The 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
HIV

Hepatitis C virus (HCV)

Hepatitis B virus (HBV)

HBV immunizations

Sexually transmitted infections

Heroin-related overdose

Methamphetamines

Intergenerational drug use

Gender and injection risk

Incarceration

MSM-IDU

HCV superinfection

Serosilent HCV

Immunology of HCV clearance

Traveleing IDU and risk behavior

Community collaborations

young injection drug users
Young injection drug users
  • 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
background
BACKGROUND
  • 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

.

hiv key points
HIV - Key points
  • 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).
hcv key points
HCV - Key points
  • 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)
hbv key points
HBV – Key points
  • 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
methods ufo 3 study cohort
METHODS: UFO-3 Study cohort
  • 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.
injecting behaviors
Injecting behaviors

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%

hiv and hcv infection by years injecting among young idu in san francisco
HIV and HCV infection by years injecting among young IDU in San Francisco

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

characteristics of young idu with incident hcv infection compared to hcv negative
Characteristics of young IDU with incident HCV infection compared to HCV negative

*  0.05; #  0.01

factors independently associated with incident hcv
Factors independently associated with incident HCV

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

factors associated with prevalent hiv
Factors associated with prevalent HIV

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

vaccine completion
Vaccine completion
  • 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
hbv vaccine in young idu ufo 2
HBV vaccine in young IDU (UFO-2)
  • 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

prevalence of anti hbv anti hcv and hiv by incarceration history among young idu in sf
Prevalence of anti-HBV, anti-HCV and HIV by incarceration history among Young IDU in SF

*p-value <0.05

50%

40%

42%

30%

29%

20%

19%

16%

10%

4%

2%

0%

Anti-HBV

Anti-HCV

Anti-HIV

Incarceration history

No incarceration history

research and service
Research and Service
  • 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.
conclusions
Conclusions
  • 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

www.ufostudy.org

1-888-UC-YOUTH

INVESTIGATORS

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

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

RESEARCH ASSOCIATES

Peter Davidson, Jennifer Evans, Leslie Tobler

FUNDING

NIDA R01 DA016017-03A1

acknowledgements to collaborators and the community
Acknowledgements to collaborators and the community
  • 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
studies of hcv prevention
Studies of HCV Prevention
  • Drug Treatment (methadone)
  • Needle exchange
  • Disinfectant and bleach
  • Behavioral change
  • Comprehensive Harm Reduction
group discussion
Group Discussion
  • 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?
harm reduction resources
Harm Reduction Resources

www.cdc.gov/idu

www.harmreduction.org

www.NASTAD.org

next steps
Next Steps
  • 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?
for more information
For More Information

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]

slide105

Future Calls/Webinars

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

slide106

Webinar Evaluation

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

Thank You!

  • 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
ad