Drug Use and HIV Risk Behaviors among HIVpositive

Drug Use and HIV Risk Behaviors among HIV-positive Latino MSM in a Large Urban Setting Jesus Felizzola, MD Mario De La Rosa, Ph. D Florida International University 2004 Jesus. Felizzola@fiu. edu

BACKGROUND • Behavior associated with drug use is the single largest factor in the spread of HIV/AIDS in the U. S. • Young Latino MSM report higher rates of HIV prevalence and sexual risk behavior than white MSM (Valleroy et al. , 2000) • HIV+ minorities are less likely to receive timely and optimal care.

PURPOSE OF THE SPSN OUTREACH DEMONSTRATION MODELS INITIATIVE: (17 Sites) To identify and evaluate demonstration models for HIV positive racial and ethnic minorities who were not in primary HIV care. -Preliminary findings of a HRSA/SPNS funded project conducted in Miami from 2001 -2003 -.

CONTRIBUTIONS • Description of a small sample of HIV+ Latino MSM engaging in sexual risk behaviors under the influence of substances. • Mostly Spanish-speaking monolingual not in care. Understanding about the patterns of sexual risk behaviors in which Latino MSM engage under the influence of substances. •

RESEARCH QUESTIONS 1 - To what extent do outreach programs identify HIV+ individuals and link them to care? 2 - What are the characteristics of those individuals outreached and linked to care? 3 - What are the factors associated with the engagement of HIV+ individuals into testing and linkage with medical care? 4 - What are the barriers that HIV+ individuals find to access HIV services?

SAMPLE 107 HIV-positive individuals were enrolled in the evaluation. 98 participants completed baseline. Criteria: Uninsured, HIV+ adults, who were not in care and were eligible to receive services at Care Resource.

PROCEDURES • Recruitment: from 06/01 to 09/03 in the field and in-house. • A written informed consent was obtained from all participants. • No incentives at baseline.

DATA COLLECTION 1 - System-level: Number of individuals outreached, tested, and assessed at Intake. 2 - Client-level: baseline, six, twelve, and eighteen-month follow ups during indepth bilingual face-to-face interviews. Demographics, medical history, sexual risk behaviors, Drug use Q, SF-12, CD 4 and Viral Loads.

FINDINGS • 4% positive tests and 73% returning rate. • Outreach/C&T at gay clubs is more effective identifying HIV + individuals (Woods et al. 2000).

Care Resource- HIP Outreach Encounters by Ethnicity Source: Care Resource Information Systems Management Unit

Care Resource- WO Outreach Encounters by Ethnicity Source: Care Resource Information Systems Management Unit

Gender by Age, Race and Ethnicity Demographics Male Female n=86 (86. 9%) n=12 (12. 1 %) Age (Mean) Race: 38. 7 40. 7 White 80. 2% 18. 6% 0 1. 2 % 50. 0 % 41. 7 % 8. 3% 0 52. 2% 47. 7% 36. 4% 63. 7% African American Asian Am. Indian/ Alaska Ethnicity Hispanic n= 50 (51%) Non-Hispanic

Gender by Sexual Orientation and Education Demographics Male Female n=86(86. %) n=12 (12. 1 %) Sexual Orientation Heterosexual MSM Prefer not to Identify 12. 8% 84. 8% 2. 3% 100% 0 0 11. 6 % 23. 3% 60. 4% 4. 6% 50. 5% 16. 7% 33. 3% 0% Education <High School/GED Some College/Degree Some Grad School/Degree

Ethnicity by Insurance Type and Medical Care Status Health Care Info Latino n=50 Non-Latino n=48 82. 0% 16. 0% 2. 0% 75. 0% 20. 8% 4. 2% 14. 0 % 86. 0% 18. 7% 81. 3% Insurance Type Uninsured Medicaid Other Medical Care Status In Care Not in Care

SPNS Nationwide Sample (N=288) Insurance Type Among Latinos Uninsured 33. 6% Medicaid 33. 9% Other 32. 5

Substance Use Latino MSM n=40 Latino n=50 Non-Latino n=48 Yes 27. 5% 24% 23% No 72. 5% 76% 77%

Condom Use Latino n=43 Non-Latino n=30 Latino MSM n=34 Non-Latino MSM n=30 >1/2 the time 74. 4% 86. 7% 67. 6% 86. 7% <1/2 the time 25. 6% 13. 3% 32. 4% 13. 3%

Substance Use and Condom Use among Latino MSM Condom Use Drug/Alcohol Use in the Last 3 Months Yes n=11 No n=23 >1/2 the time 54. 5% 73. 9% <1/2 the time 45. 5% 26. 1% • 90. 9% of those LMSM who self-reported use of drugs or alcohol were not in care or had dropped out of care

Condom Use and Length of Time Knowing HIV Status among Latino MSM Condom Use Date of First HIV+ Test < 6 months 7 months to >2 years n=2 n=16 >1/2 the time <1/2 the time 75. 0% 50. 0% 62. 5% 25. 0% 50. 0% 37. 5%

CONCLUSIONS HIV prevention efforts targeting Latino MSM should consider the nature and context of drug use to construct culturally sensitive programs.

IMPLICATIONS FOR INTERNATIONAL RESEARCH Mario (115 -16)