Expanded Definition We chose the term ‘substance use’ over ‘substance abuse’ or ‘chemical dependency’ which may have negative or accusatory connotations.

Expanded Definition ‘Substance use’ is inclusive of this terminology, and encompasses casual use, occasional use, relapses, slips and involuntary ingestion.

Expanded Definition The term also can include ways that substances can be used as currency in acquiring sex, companionship, a place to sleep, food or other kinds of care.

Expanded Definition: How Substance Use Impacts HIV In prevention, it is well known that substance use is one of many interrelated factors that affect HIV. The use of substances is linked to the epidemic in several ways. For both HIV positive and negative people, substance use can influence:  Sharing of injection paraphernalia;  Sexual behaviors and decision making;

Expanded Definition: How Substance Use Impacts HIV Incidence of STIs/STDs, which can increase the likelihood of HIV transmission; Physical and mental health Loss of basic life supports (i.e., employment, housing, benefits, social support system)

Expanded Definition: How Substance Use Impacts HIV For HIV positive people, substance use can impact disease progression directly, as well as indirectly, by affecting treatment adherence (i.e., medication regimen, blood screenings, appointments).

Expanded Definition: How Substance Use Impacts HIV For people in recovery, sexual behavior and decision-making can continue to be problematic well after the use of substances has ended.

Expanded Definition: Substance Use and BRPs Ethnic, racial and sexual communities in San Francisco are using substances in distinctly different ways. Therefore, substance use must be considered from a community-based perspective.

Expanded Definition: Substance Use and BRPs Community specific variables include:  community norms and values  substances used  routes of administration  which substances are commonly combined  how and by whom substances are used as currency  and issues of supply and demand

Expanded Definition: Substance Use and BRPs HIV Prevention efforts must be tailored for each of the communities at risk and informed by a solid understanding of the role substances play within each culture.

Substance Use Amphetamines and Sexual Risk EXPLORE:  Amphetamine use independently associated with increased risk of having unprotected anal sex with an HIV+ or unknown serostatus partner (increased risk of 1.5) Circuit Party:  Amphetamine use also associated with increased sexual risk (increased risk 2.4)

Substance Use Amphetamines and Sexual Risk New Choices:  Barebackers more likely to report amphetamine use (42% vs 23%) VPS:  Amphetamine use associated with increased risk of condom breakage (increased risk 1.6)

Substance Use Amphetamines and Sexual Risk

Definition and History Prevention with Positives “Prevention with Positives is any intervention that addresses the specific prevention needs of HIV- positive persons. HIV positive people should be involved in the planning and implementation of all prevention with positives programs.”

The Main Goals of Prevention With Positives are: To reduce the spread of HIV and STDs To help HIV-positive people achieve and maintain physical, emotional, sexual, and reproductive health and well-being To assist those HIV-positive people who do not know they are positive in learning their HIV status.