1. SUBSTANCE ABUSE RISK FACTOR FOR HIV/AIDS ACQUISITION IN JAMAICAN ADOLESCENTS W. De La Haye, MD, MPH, DM Department of Community Health and Psychiatry The University of the West Indies Mona Campus

2. Introduction Substance abuse reduces inhibitions and encourages engagement in high risk sexual behaviours ¹Substance abusers are disproportionately affected by the AIDS epidemic ²Young users - much greater network and behavior risk for sexually transmitted diseases and have more sex partners ¹Sorensen et al., July 2002. Science and Practice Perspectives, NIDA 1(1): 4-11 ²Blum, R.W., Center for Adolescent Health, University of Minnesota

3. Introduction ¹Prevalence of HIV among US drug users entering treatment ranges from 0 – 35% Intravenous drug use (IDU) is a factor in 1/3 of all AIDS cases in the US More than 1/2 of new HIV infections 1. Murrill et al., 2001. Journal of Urban Health 78(1):152-161

4. HIV in Jamaica Concentrated epidemics HIV prevalence rates in Jamaica are high among those with high risk behaviors: Homo/bisexual males 25% Commercial sex workers 10 – 20% Prisoners 12% STI clinics 6% Ministry of Health, Jamaica, 2001. HIV Surveillance Data

5. Reported risk behavior % N = 4706 National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004

6. Reported risk behavior % N = 4706 National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004 Deported offenders ----------- 9% (2002) (2003)

7. % HIV seroprevalence (%) by gender OR F:M 3.3 (15 / 127) (30 / 776) (45 / 903) 11.8 % 3.9 % 5 % * De La Haye W. World Psychiatric Association “Advances in Psychiatry”, Abstract Issue, March 2005: 190

8. HIV risk factors associated with substance abuse Risky sexual behavior - selecting sexual partners from similar networks - sex for drugs - unprotected sex - bisexuality, homosexuality - early intercourse (<13 y.o.) Crack cocaine use Unemployment Marijuana smoking before sex

9. Adolescence Transitions from one developmental stage to another are vulnerable periods High risk for substance abuse - cognitive, attitudinal, personality, behavioral, social, environmental, genetic Experimentation and recreational use of alcohol, cigarettes, cannabis

10. Comorbid illnesses Depression Conduct disorder ADHD ODD

11. Risk factors for S A Greater potential for drug use - Ineffective parenting - Unstable home environment - Poor nurturing in childhood - Poor social coping skills - Affiliation with deviant groups - Drug trafficking - Availability

12. Protective factors against S A Reduced potential for drug use - Strong family bond - Schools prevention programs - Religious organizations - Parental monitoring of children - Knowledge of conventional norms about drug use - Awareness of personal and community hazards of drug use

13. Impact of risk and protective factors Function of stage of psychological and social development of an individual Exposure, experimentation, recreational use, regular use and subsequently dependence *Early initiation of alcohol, tobacco and illicit drug use among adolescents is a strong predictor of subsequent drug dependence *Wagner, F. A., Anthony J. C. 2001: American Journal of Epidemiology; 155(10):918-925.

14. Age profile of population (%) YEARAGE GROUP (YEARS) 0-1415-3435-5455+ 1996 35.233.817.913.1 1998 33.233.819.213.7 2001 3330.920.815.3

15. % National Schools’ Drug Survey, 1987, 1997 N = 8000, 63 schools, grades 9 - 13 National Schools’ Drug Survey, 1987, 1997. NCDA

16. % National Schools’ Drug Survey, 1987, 1997 N = 8000, 63 schools, grades 9 - 13 National Schools’ Drug Survey, 1987, 1997. NCDA

17. % N = 8000, 63 schools, grades 9 - 13

18. SITE: Adolescent Drug Free Outpatient Clinic at the Assessment, Detoxification and Early Rehabilitation Unit (DETOX) SAMPLE: Adolescent substance abusers presenting for treatment PERIOD: January 2004 – January 2005 METHOD: Retrospective chart extractions

19. Gender distribution % N = 103, p = 0.000 (n = 96) (n = 7)

20. Age distribution N = 103, Mean age 15.4 + 1.74 years, range 10 – 18 years, p = 0.000 % Years

21. Parish of residence % N = 103, P = 0.000

22. Living arrangement % N = 103, P = 0.000

23. Stressor %

24. %

25. Mode of referral % N = 103, P = 0.000

26. Substances abused % N = 103

27. Substances abused % N = 103

28. Substances abused % N = 103

29. Substances abused % N = 103

30. Pattern of substance abuse N = 103, P = 0.000 %

31. Drug of onset % N = 103

32. Drug of onset % N = 103

33. Drug of onset % N = 103

34. Drug of onset % N = 103

35. Introduction to first use % N = 103, P = 0.000

36. Age of onset % Mean age of onset 13 ± 1.8 years, range 7 – 16 years, p = 0.000 Years

37. N = 103 Range 10 – 18 yrs. Abused substances Adolescents Cohort 1 Dependent substances Adults Cohort 2 % % N = 150 Range 21 – 55 yrs.

38. Discussion There is early age of onset in this cohort of adolescent substance abusers Peers play a significant role in the introduction of adolescents to their first use of a drug Schools and mothers play a significant role in referring these clients for treatment

39. Implications of early onset The age of initiation of alcohol, tobacco and illicit drug use among adolescents is a strong predictor of later drug problems, especially when use begins before age 15 years Research shows that for females tobacco use and for males alcohol is a strong predictor of other drug use

40. Cannabis use in Jamaican adolescents Potentially catastrophic implications With regards to cocaine exposure opportunities and sexual practices Parental supervision can help in disrupting drug exposure opportunities Address self-awareness leading to healthy lifestyle choices

41. Educate children about the potential consequences of cannabis abuse Ganja can make you mad! Why take a chance? Smoking anything is hazardous to your health! Cannabis use in Jamaica

42. Aim of education Provide students, teachers and families with accurate information about drug abuse, addiction and association with high risk sexual behaviour Reduce exposure opportunities Break the chain of experimentation, regular use, abuse and dependence

43. Outcome Stops drug use before it starts Reduces violence associated with drug use / distribution Reduces load on treatment system Reduces load on criminal justice system Reduces lost productivity Reduces acquisition and transmission of STIs (HIV/AIDS)

44. Role of exposure Parents, paediatricians and GPs must ask kids about chances to try illegal drugs Kids more likely to talk about their chances to try than their use Once there is a chance, it should raise a RED FLAG!

45. Drug abuse is a preventable behaviour Drug addiction is a preventable disease Substance abusers are more likely to engage in high-risk sexual activities Substance abuse prevention in adolescents is HIV prevention Role of prevention

46. The presence of risk factors and absence of protective factors in adolescents lead to increased “Exposure Opportunity” to substances of abuse Prevention programs must focus on reducing “Exposure Opportunities” to substances of abuse in Jamaican adolescents Implement prevention programs as early as kindergarten!!!

47. Conclusion Role of drug treatment programs in preventing acquisition and transmission of HIV / AIDS The results endorse the need to screen for HIV in all substance abuse treatment facilities in Jamaica Conduct research to improve understanding of the interrelationship between non-IV substance use and high risk sexual behaviour

48. Summary Substance abuse prevention is HIV prevention Reducing the gap between substance abusers needing treatment and prevention and those getting help Reduce the risk of risky sexual behaviour associated with substance abuse

49. Caution Use of any mood altering substance (including legal ones) can result in risky sexual behaviour One does not need to be chemically dependent to have risk associated with their drug use!

50. Our fight against drug use is a fight for our children’s future!!!

51. Thank you Substance Abuse and HIV / AIDS in adolescents in Jamaica Predators in paradise!