AIDS Action Weekly Update Special Edition
Report From the HIV Prevention Leadership Summit
Atlanta, Georgia, June 16-19, 2004
June 25, 2004
Advancing Prevention for All Populations
HIV Prevention and Substance Use
Much of the discussion during the workshop, Incorporating HIV Prevention into Addictions Treatment, examined the opportunities and barriers services providers face in delivering comprehensive HIV prevention services in a substance abuse treatment setting.
A presentation on strategies implemented by the Haymarket Center in Chicago inspired a detailed discussion of substance abuse and its impact on individuals living with HIV. When illegal drugs interact with HIV medication, it can lead to a level of toxicity that is extremely potent and harmful. Further, substance use can impair one's ability to evaluate situations and make sound choices, an important skill in HIV prevention. Consequently, recovery from substance abuse has great benefit for HIV-positive people.
In this workshop, presenters also provided information on one effective model of prevention that is used both for substance abuse and sexual behavior modification: the harm reduction model. This model's goal is to help people reduce their risk of poor health outcomes through education and counseling. For many people, harm reduction is the most viable option for prevention.
In the roundtable, Involving Injecting Drug Users (IDUs) in HIV Prevention Community Planning, it was revealed that community planning leaders and the CDC are quickly responding to the emerging message of PIR to reinforce community planning participation by a population that historically has been left out of the planning process -- active drug users. During the discussion, Fred Johnson, policy director for the Harm Reduction Coalition asked, "How do we recruit and retain active users to the CPG?" Several participants provided insight into barriers that prevented such involvement and volunteered descriptions of the approaches employed by their own CPGs. Other participants were compelled to ask, "Do we really want active users or is this lip service?"
CPG members who are in recovery ventured that one of the key barriers to recruiting and retaining active users as members was a lack of understanding on the part of fellow CPG about substance abuse and users. It was further offered that a non-judgmental environment, incentives, transportation service and thoughtful instruction on the community planning process are key to successful retention of this population. "We must meet them where they are," one presenter explained. Several CPG members spoke of mentoring programs that are in place at some state planning boards. These programs foster greater community participation in planning groups by pairing active substance users with recovering substance users who understand the planning process. One participant suggested scheduling either a Narcotics Anonymous or an Alcoholics Anonymous meeting before or after the CPG meetings. Although participants' had varying levels of comfort with the idea of including active users on planning boards, the need to have such representation was evident. And innovative approaches are viewed as essential to getting active users to the table.
Native Americans' Issues around Needle Exchange highlighted the need for more culturally sensitive and innovative approaches to needle and syringe exchange programs. Tony Teewood Sylvia of the United Indian Health Services presented his findings on a pilot project in nine rural reservations in a Northern California county. Ongoing dialogue with community leaders and the cultivation of trust were key components in the successful implementation of the program.
Mr. Sylvia indicated that syringe sharing accounted for 90% of the new HIV cases in the county. The interventions used in the project were founded on a high level of confidentiality, health education and risk reduction and a syringe exchange program. He reported that for every syringe returned two were handed out. Information on HIV prevention, risk reduction and the use of condoms was also provided. Mr. Sylvia made note that over 85% of users have their partners, wives and relatives do the exchange, which gives service providers the opportunity to discuss safer sex with them. Though the project seems to be working effectively, Mr. Sylvia indicated that further evaluation of the program was needed to determine the project's influence on the community.
Effective Outreach to Substance Users; Methamphetamine Use among Men Who Have Sex With Men addressed the increasing use of methamphetamine and its influence on the rise of HIV and STD rates among gay men. Stephen Tierney, director of HIV Prevention at San Francisco Department of Health noted in this workshop hat the United States is in the midst of a third major outbreak of methamphetamine use. And the outbreak is disproportionately affecting gay men. Further, because methamphetamine increases sexual confidence and enhances sexual experiences while also impairing judgment, its use can place an individual at increased risk for HIV. In a recent study, it was noted, that over 68% of participants had identified the resulting sexual benefits as their primary reason for using methamphetamine. Thus, addressing the outbreak is a critical issue for gay men and their community leaders.
Several major urban areas are increasingly raising awareness about the dangers of crystal methamphetamine use in gay communities. In Miami, a successful billboard campaign was launch to increase awareness of the effects of the drug. Known as Meth=Death, the campaign has had an indelible effect on gay men in Miami, according to its developer. However, it was revealed that the campaign has been less successful in New York and San Francisco, demonstrating the need to craft different message for different communities.
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.