2. HIV and Hepatitis C in non- MSM Rural Communities: Issues and Interventions Shari Wells-Weiss, CASAC Director of Prevention Services Southern Tier AIDS Program

3. Prevalence rates for HIV/HCV in Upstate New York According to the New York State Department Of Health, AIDS Institute 2003 epidemiological data, approximately 7,126 persons are living with HIV or AIDS According to NYS DOH approximately 198,000 are chronically infected with Hepatitis C

4. The Crystal Meth Connection The use of Crystal Methamphetamine is connected to the spread of HIV/HCV in Upstate New York Unsafe sex and sharing of injection equipment (“works”) play a large role in both homosexual and heterosexual communities Non-MSM communities have similar amounts of risk when using Crystal Meth and engaging in similar types of high-risk behaviors

5. Stigma and Challenges Rural communities struggle with issues of stigma and lack of information Geographical challenges Many people may avoid testing because they fear who may see them or what may happen if they test positive for HIV or Hepatitis C

6. Stigma and Challenges If someone is diagnosed with HIV or HCV, there are fewer resources in rural communities Lack of resources in the areas of: access to treatment (medical and substance use), case management, secondary prevention, medications, advocacy and qualified medical professionals

7. Treatment Approaches for Chemically Addicted Traditional treatment approaches are abstinence based Punitive in nature Focus is on Behavior Modification or Cognitive Behavioral Therapy Harm Reduction is just beginning to make inroads into treatment Harm Reduction: syringe exchange, controlled use, reduced use, abstinence one possible outcome

8. Addiction Treatment and other options for Crystal Meth users Abstinence based treatment has a place but cannot be the only option Harm Reduction must be utilized in its full spectrum The Trans-Theoretical Model of Behavior Change has proven successful Syringe Exchanges can reduce transmission even in rural communities Community Wide prevention efforts

9. Paying for Medical Services and Treatment Medical and other services are expensive and often challenging for those who lack resources If someone has Medicaid, it does not pay for pain medications needed for someone who is undergoing HIV/HCV treatment Medicaid or Insurance is often very limiting for anyone seeking Chemical Dependency Treatment

10. HIV/HCV Case Management Although there are services in rural areas for HIV case management, the coverage area of these organizations, like STAP, are very large and staff is limited. Currently, no funding has been made available at the federal/state level to support case management for mono-infected HCV individuals.

11. Solutions and Interventions Because access to medications is limited for rural communities, clinical trials and Compassionate Care (a program funded by several drug companies like Roche Pharmaceuticals) is the only way for HIV/HCV positive individuals to receive this care

12. Solutions….. Alternative therapies like massage therapy;acupuncture;chiropractic care and nutritionists can be a very positive experience for people living with HIV/HCV STAP offers programs like: Healing Hands Network, a supplement program, educational programs for clients and providers, and a support group for Co-infected and HCV mono-infected individuals

13. Solutions… STAP does a tremendous amount of Outreach and sponsors Testing days for both HIV and HCV. The results of these efforts have a community-wide impact. Newsletters, Assessment and Referral services have assisted our clients with access to information and resources

14. Solutions Operating the only rural Syringe Exchange Program in New York State has enabled us to provide clean sterile syringes, information, referral and support to those who inject drugs, use steroids or inject hormones Crystal Meth is gaining popularity among IDU’s in our area

15. Solutions Rural Community Based Organizations have excellent networks and relationships with providers in their area. This is crucial to providing services Developing relationships with specific physicians has resulted in access to more up to date information

16. Funding Issues Funding for HIV case management and prevention programming is not growing. Pharmaceutical companies will sometimes provide grants for conferences, supplement programs and other needs We have a Community Block Grant (CDBG), but it is limited to one city

17. Funding Issues It is challenging to get funding for rural treatment and case management programs. Funds are often prioritized toward urban areas with higher incidence In NYS we have AIDS Institute to assist with some funding. But we must rely on grants from other sources Funding entities often mandate the terms of service delivery Currently, no federal or state funding for Hepatitis C mono-infection case management or prevention programming exists in our area.

18. Where do we go from here? Federal Level State Level

19. Thank You