1. Brief Interventions for HIV+ Persons Thomas L. Patterson Shirley J. Semple University of California, San Diego Research supported by NIMH RO1MH61146 & MH56264 NIDA RO1 DA1211

2. MSM Risk Reduction Interventions What do we know?  99 rigorous controlled studies to reduce transmission risk by 1999  9 focused on MSM  Favorable results (OR.69 CI.56-.86)  26% reduction in proportion engaging in UAI Johnson et al., 2002. HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. JAIDS 30

3. MSM Risk Reduction Interventions What do we know?  Favorable effects among interventions that promoted –Interpersonal skills –Community level formats –Focused on younger populations –Those at higher behavioral risk  Studies Lack –Drug users (1 study) –People of color, non-gay identified Johnson et al., 2002. HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. JAIDS 30

4. HIV+ Risk Reduction Interventions What do we know?  DiScenza, Niles, and Jordan 1996 –Nurse delivered, pre- post design –Significant reduction risky sex @ 2-3 mo.  Cleary, VaDevanter, Steilen et al. 1995 –Six sessions education and support with blood doners –Sig. decrease in both intervention & referral gp. @ 6- mo.

5. HIV+ Risk Reduction Interventions What do we know?  Parsons et al. 2000 –Full intervention vs. partial –Full safer than partial  Kalichman et al., 2001 –Social Cognitive vs. suport groups –N=332 –Five sessions –Safer in SCT group & among those with neg. partners safer sex

6. HIV+ Risk Reduction Interventions What do we know?  Patterson et al., 2002 –Social Cognitive vs. Diet & Exercise –N=389 –1 to 3 90-min sessions –Study Population »Gay and Heterosexual »Had unsafe sex with HIV- or UK partner –Infection Risk Factor »Sexual contact85% »Injection drug use 5% »Transfusion 1% »Undetermined 9%

7. San Diego Share Safer Sex (SSS) STUDY DESIGN  Brief Targeted (single session, 90 minutes)  Comprehensive (single session, 90 minutes)  Comprehensive with 2 boosters (3-90 minute sessions)  Diet & Exercise Control Group (3-90 minute sessions) RANDOM ASSIGNMENT FOLLOWUP AT 4, 8, AND 12 MONTHS POST-INTERVENTION

9. Was the intervention effective with everyone?  At one-year –1/3 always safer sex –1/3 irregular safer sex –1/3 continued unsafe practices

10. NEGOTIATION BEHAVIORS BY PARTNER TYPES SteadyCasualAnonymous 0 1 2 3 4 Negotiation 3.8 3.2 2.5

11. Trends among MSM - Meth Users  High rates of STDs (current syphilis outbreak)  Low rates of condom use

12. Meth Use & Risk Factors  Behavioral disinhibition  Enhanced sexual desire  Increased desire for high risk sexual activities  Prolonged sexual activities (Marathons)  Multiple sex partners –Anonymous –Casual

13. The San Diego ‘Edge’ Methamphetamine Study Objective: Evaluate an eight session behavioral intervention designed to reduce high risk sexual behaviors in the context of meth use. Target Population: - HIV+ - MSM - Unsafe sex partners - Regular meth users NIDA RO1 DA12116

14. San Diego “Edge” study of Methamphetamine users  N=250  50 % of sample make $10,000 or less per year  65.6% not taking HIV Medications

15. Edge Project: Methods of using methamphetamine Percent Smoke Inject/Combination

16. Drugs taken with meth in past 2-months Pot Viagra “K” Halluc.

17. Meth Binge Users “You keep using large quantities of meth for a period of time - until you run out or just can’t physically do it anymore” - 48% said yes - Typical binge 2.5-3 days  Bingers report increased: –Sexual risk behavior –Health problems –Social difficulties –Mental health problems

18. SUMMARY AND CONCLUSIONS  Most behavioral interventions to reduce high risk sexual practices target HIV- “at risk populations”  HIV+ individuals are living longer, healthier lives and are remaining sexually active  Some HIV+ individuals engage in transmission behaviors  Interventions with MSM are effective  Evidence that interventions with HIV+ work  No published interventions of HIV+ drug users

19. Questions to address  Can sexual risk be reduced in the context of drug use?  Do reductions in drug use lead to concomitant decreases in sexual risk behavior?  Are different patterns of drug use, and/or specific drugs or combinations of drugs associated with increased risk behavior?

20. Questions to address  How efficacious are theory based drug and sexual risk reduction intervention programs in HIV+ populations?  Can we reduce relapse to high risk sex and drug use?  How do gender, race, and culture relate to the efficacy of specific interventions?

21. Design Issues With HIV+ Individuals  Stigmatization  Definition of high risk behavior  HAART  Partner Types  Who delivers messages  Where deliver messages  Multiple Risk Factors (Drugs/Sex)