Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeE7858-ThPeE7862 553

ThPeE7858 The role of community-based substance abuse
treatment, outreach, and HIV services in reducing
HIV risk behaviors
D. Thompson. 5600 Fishers Lane, Rockwall 2, Suite 740, Rockville, MD 20852,
United States
Background: To reduce the spread of HIV/AIDS among racial/ethnic minorities,
the Congressional Black Caucus Minority AIDS Initiative provided resources to
the Substance Abuse and Mental Health Administration's Center for Substance
Abuse Treatment to fund 128 community-based substance abuse treatment and
outreach programs to provide drug treatment and HIV services. Communitybased programs were chosen to reach communities that have traditionally been
marginalized for HIV/AIDS prevention and treatment programs. They also had
the advantage of being physically located in areas disproportionately impacted
by the HIV epidemic. Finally, these agencies can provide culturally appropriate
interventions that address language, community involvement and the provision of
services and information by peer field staff.
Methods: The sample (N=2000), clients receiving substance abuse treatment
and/or HIV services, was interviewed about HIV risk behaviors associated with
substance abuse and sexual behavior at baseline and six months later. Data were
analyzed to investigate changes in self-reported HIV risk behavior.
Results: At baseline, HIV risk behaviors such as sharing injection equipment
and unprotected sex with HIV+ and injection drug using partners were reported.
Paired t-tests revealed significant modest reductions in HIV risk behaviors among
clients receiving substance abuse treatment and/or HIV services.
Conclusions: Clients of integrated HIV services and substance abuse treatment
exhibited reductions in HIV risk behaviors. Integrated systems of services and
care can play an important role in reducing the spread of HIV/AIDS in drug and
alcohol using populations. HIV prevention and related services can be successfully integrated with substance abuse services (i.e., mobile HIV counseling and
testing, drop-in centers for pre-treatment clients, primary health care) by using
community-based agencies and peer educators.
Presenting author: David Thompson, 5600 Fishers Lane, Rockwall 2, Suite 740,
Rockville, MD 20852, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeE7859 Smoking "Chamba": Marijuana as an emerging risk
factor for HIV/AIDS in Malawi
C.T. Williams', C.P.N. Kaponda2, J.A. Levy3. 'Johns Hopkins Bloomberg School
of Public Health, Johns Hopkins Bloomberg School of Public Health, 624 N.
Broadway 551HH, Baltimore, MD 21205, United States; 2University of Malawi
Kamuzu College of Nursing, Lilongwe, Malawi; 3University of Illinois at Chicago
School of Public Health, Chicago, United States
Background: With a transition in governing system from dictatorship to democracy, Malawi has witnessed an increase in alcohol and drug use among its youth.
Smoking chamba (local name for marijuana) has become increasingly prevalent
among youth, particularly in bars and social gatherings where its effects as a
behavioral disinhibitor pose significant risk for HIV/AIDS. This pilot study reports
on the emerging problem of chamba in Malawi and its potential for contributing
to the spread of HIV/AIDS in a country where over 1 million people already are
estimated to be infected.
Methods: As part of a collaborative HIV/AIDS training and research program,
ethnographic research was undertaken to gain an understanding of the major
problems surrounding drug-use and HIV/AIDS for the country's population, particularly adolescents and young adults. In-depth interviews were conducted with
key informants including medical and mental health providers and other in-country
experts about HIV/AIDS and/or drug use along with its diagnosis and treatment.
Analytic techniques appropriate for guided interviews were utilized.
Results: Accounting for 25% of all admissions to the largest mental hospital in
the country, chamba is one of the world's most potent forms of marijuana. The
behavioral manifestations of chamba use, unlike in most countries, include aggression, hallucinations, depression and sexual arousal-the latter two associated
with increased HIV risk behavior. Additionally, chamba is sometimes consumed
with alcohol, which may heighten the effects of the drug and increase the likelihood of engaging in risky sex. Key informants attribute alcohol and drug use, in
part, to the lack of resources and alternative activities for youth in Malawi
Conclusions: Further investigation into the emerging marijuana problem in
Malawi is necessary to understand the context of use and to establish effective
interventions.
Presenting author: Chyvette Williams, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 551HH, Baltimore, MD 21205, United States, Tel.: +1
410 502 5368, Fax: [phone], E-mail: [email protected]
ThPeE7860 MDMA, sexual risk, STDS and HIV exposure among
urban low income youth

J.J. Schensull, G. Burkholder2, R. Pino3. 1'Institute for Community Research,
Institute for Community Research, 2 Hartford Square West, Ste 100, Hartford,
Connecticut, United States; 2Brown University, Providence RI, United States;
3Institute for Community Research, Hartford, CT United States
Background: Non-injection drug use contributes to HIV risk by enhancing sexual
pleasure, while reducing protective behavior. MDMA is believed to stimulate sen
suality and can lead to more risky sex behavior and HIV exposure. At highest risk
are uninformed urban minority youth who use MDMA, increase sex partners, reduce sexual precautions, and market new drugs to peers. This paper links MDMA
to sexual risk among urban youth in high HIV-prevalent areas of the U.S. northeast.
Methods: Participant observation in urban-suburban youth party settings plus
120 indepth interviews with MDMA users/sellers, and survey data from 401 urban mixed ethic youth 16 - 24 on vulnerability to drug use, social networks, drug
histories, and sexual risk behaviors.
Results: Participants were 71% male, 29% female, 51% Latino, 38% African
American, and 6% Caucasian, mean age 19. 57% were unemployed with less
than a high school graduation. 48% of MDMA users (N=155), 29% of alcohol
users (N= 394), 26% of marijuana users (N=397) and 14% of "dust" users (mint
with embalming fluid (N=321) reported using drugs for better sex;. Predictors of
reported STDS were: being female (p=.008); dropping out of school (p=0.04);
lower optimism (p=0.007); depression (p=0.001); peer pressure to use substances (p=0.05); smaller older networks (P=.04). MDMA users showed higher
30 day use of alcohol (p=0.05) and marijuana (p=0.03), higher 48 hours use of ecstasy (p=.06), more sex for money and drugs (p=0.05), less condom use (p=.08).
30 day MDMA users had more sex partners in the past 30 days (P=.001) and
traded more sex for money or drugs (P=.02). MDMA converters used condoms
less than never-users engaging in anal sex (p=.08).
Conclusions: Low income urban youth add MDMA to their drug use repertoires,
believing that drug use enhances sexual performance. Harm reduction programs
are needed to reduce dangerous interactions and risky sex in unsuspecting urban
polydrug users.
Presenting author: Jean Schensul, Institute for Community Research, 2 Hartford Square West, Ste 100, Hartford, Connecticut, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeE7861 Developing safe injecting procedures for
methamphetamine using recreational IDU's though
peer research
A.P. Hunter', J. Davey, 2, A. Davies2. 'Brisbane Youth Service, po box 1382,
Fortitude Valley, 4006, Queensland, Australia; 2Queensland University Of
Technology, Brisbane, Australia
Background Methamphetamine use has dramatically increased in the past five
years in Australia, as it has in the South East Asian region. HIV and HCV prevention for injectors has focussed on stopping the sharing of syringes, and safer
using messages have been designed around heroin injecting. The study aimed to
gather information for the development of safer injecting information for methamphetamine users- many of whom are young, recreational users
Methods Ten current methamphetamine injectors were trained to administer a
detailed questionnaire to 150 young methamphetamine users. Questions were
developed in consultation with users and IDU and youth service providers. Participants were recruited through needle exchanges, youth services, dance parties
and peer referral.
Results. Most young methamphetamine users in the study were recreational injectors and used socially- injecting with friends. There was high level of knowledge
about how HIV and HCV are transmitted, and a low level of needle sharing. This
knowledge was reflected in a low (less than 40 %) level of concern about catching
HIV or HCV.
However, sharing of injecting water, tourniquets and drug mixing vessels potentially contaminated with blood was common. Poor management of injection site
bleeding was a particular concern given the social nature of injecting amongst
this group.
We also found that many of the users confused about messages which were
based around heroin use- an injecting culture that was foreign to them.
These injectors are at risk of HIV or HCV but believe they are using safely.
Conclusions. Young recreational drug users need information which is specific
to the drug they use and to the method of preparation and injection associated
with that drug. More attention needs to be paid to informing injectors of transmission risks other than the sharing of needles if they are to avoid HIV and HCV from
injecting.
Presenting author: Andrew Hunter, po box 1382, Fortitude Valley, 4006,
Queensland, Australia, Tel.: [phone], Fax: [phone], E-mail:
ahunter@ brisyouth.org
ThPeE7862 Ecological perspectives regarding club drug and
methamphetamine use among us men who have
sex with other men: prevention, outreach and
research implications
E.M. GormanF, A.P. Pach, K. Nelson3, A. Scrol3, E. Amato3, T. Applegate3,
C. Clark3, S. Feest3. 'san lose state university san jose state university 1
washington sq, san jose, ca, United States; 2 NORC-Univ of Chicago,

Washington,D.C., United States; 3San Jose State Univ, San Jose, United States
Background: between 1991-2001 public treatment admissions for methamphetamine in many western/midwestern us counties increased 1000%, exceeding admissions for cocaine, by the same token, between 1996-2001 men who
have sex with men (msms) continued to represent a majority of all incident aids
cases in many western us states, and a plurality of idu aids cases with metham