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HIV Prevention Planning Council July 12, 2007 Substance Use Issues and Structural Solutions Guiding Questions: Current policies and structural solutions Are current policies regarding syringe access adequate for preventing HIV transmission among injection drug users ?

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HIV Prevention Planning Council

July 12, 2007

Substance Use Issues and Structural Solutions


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Guiding Questions:

  • Current policies and structural solutions

    • Are current policies regarding syringe access adequate for preventing HIV transmission among injection drug users?

    • Are there other structural solutions for preventing HIV transmission among injection drug users (i.e., safer injection facilities) that could work in San Francisco?


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Guiding Questions (cont.):

  • Understanding crack and non IDU drugs and how they are related to HIV risk

    • How is crack use related to HIV risk? What prevention strategies can help reduce HIV transmission among people who use crack?

    • Other non-injection drugs (including alcohol) and how they are related to HIV risk.


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Key definitions

  • Structural Interventions (2006): Actions that aim at altering the physical environments in which we live, work, play or take risks to help reduce HIV transmission.

  • Structural Changes: New or modified programs, practices or policies that are logically linkable to HIV transmission and acquisition, and can be sustained over time.


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Where did we start?

  • With data, of course…

    • Divided work year by behavioral risk population (BRP)

    • Ranked most commonly used drugs by BRP

    • Looked at literature to determine what policies currently exist

    • Considered community expertise

  • Then we began generating draft solutions


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Barriers to HIV testing among substance users

Lack of access to condoms in bars in SF

Lack of coordinated services among Mental Health, Substance Use, and HIV prevention services

Consider new ways of encouraging people to get tested

Consider a city-wide policy that would ensure access to condoms in all bars

Consider ways to coordinate MH, SU and HIV prevention services

Gaps Proposed Solution


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Increased HIV prevention to populations that do not access prevention services (e.g., IDUs who don’t use needle exchange programs)

Define performance measures in existing SF DPH Harm Reduction Policy (2000)

Consider ways to expand access to HIV prevention services for new hard-to-reach clients

Consider ways to clarify the existing SFDPH Harm Reduction Policy

Needs Proposed Solution


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Acknowledgments prevention services (e.g., IDUs who don’t use needle exchange programs)

  • Shane Anglin, Pauli Gray, Anthony Philips, Eiko Sugano, Luke Woodward, Tom Kennedy, Abbie Zimmerman, and Emalie Huriaux

  • Elizabeth Davis, Ju Lei Kelly, Vincent Fuqua


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  • Any questions? prevention services (e.g., IDUs who don’t use needle exchange programs)


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