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The goals of the San Francisco Department of Public Health, HIV Prevention Research Unit are to investigate new behavioral intervention approaches to reducing risk for HIV infection and transmission among populations most at risk. Current projects include studies of medications which may help methamphetamine-dependent men who have sex with men (MSM) reduce their use of meth and associated high risk sexual behavior, and a group-based behavioral intervention study for substance using MSM.
The work of the Unit benefits the community as results are shared with local agencies, community members, and other scientists who develop prevention programs and research studies. All participants in our studies also receive substance use and sexual risk reduction counseling, and referrals to health and social services. Some studies also provide HIV and sexually transmitted disease testing, and referral for treatment.
BUMP is a series of medication trials for methamphetamine-dependent MSM to see if the medications help men reduce their meth use and sexual risk behavior due to meth use. Half receive active medication, and half receive a placebo. Both groups take the study pills for 12 weeks. Participants receive counseling at each visit. The studies are open to both HIV-positive and HIV-negative men and will be enrolling through 2009. Visit sfbump.com for more information.
This is a new study beginning at the end of 2007. We will be adapting an intervention for HIV-negative MSM seeking testing that has been shown to be effective. We will be testing this in a population of substance using MSM and addressing their self-justifications for their substance use. The trial is expected to start in 2008 after a year of formative work to revise the existing intervention to address substance use.
Project MIX was a multi-site, six session behavioral intervention for substance using MSM. Men could be HIV-positive or negative, and more than half were African American or Latino. Participants were randomized to participate in the intervention or video discussion groups.
Preliminary results on efficacy are expected in early 2008. Findings from analysis of the baseline survey data showed that two-thirds used at least once substance during their most recent anal sex encounter with a non-primary partner. Additionally, two-thirds did not use condoms during the encounter. Use of alcohol, marijuana, meth, crack, and poppers was common during their last encounter.
Mansergh G and the Project MIX study group. Preliminary findings of behavioral prevalence and associations of substance use and sexual risk for a sample of very high-risk, substance-using MSM: Baseline results from Project Mix. Poster presented at: XVI International AIDS Conference, 2006; Toronto.
Networks of Meth Users Study
In this street-based survey, 89 meth using MSM were asked details about their most recent meth use episode, including who they used with, their relationship with others they used with, where they used, and their sexual activity while on meth. We found that most were high more than 24 hours, and three-fourths received at least some meth free.
About half considered themselves very emotionally close to their most frequent meth-using partner. Most had tried to quit using meth, yet most have never received treatment services. MSM are using meth with multiple partners and engaging in high-risk sex with these meth-using partners. Sexual risk behavior was higher among HIV-positive men in the sample. We recommended that prevention and treatment efforts for meth-using MSM should focus on both the social and sexual context of meth use.
Guzman R, Wheeler S, and Colfax G. An event-specific analysis of methamphetamine use and sexual risk behavior among men who have sex with men. XVI International AIDS Conference. Toronto, Canada. August, 2006.
HIV Intervention for Providers Study
The purpose of this study was to encourage participating health care providers to evaluate high risk HIV transmission behaviors and offer prevention messages to their HIV-positive patients to help reduce rates of unprotected anal and/or vaginal sex with partners of known HIV sero-negativity or unknown HIV serostatus. It was hypothesized that patients of providers participating in the HIP intervention would report higher reduction in sexual risk practices, when compared to the patients of the providers who were randomized into the control condition.
The intervention was conducted with 44 HIV primary care providers and 386 patients spanning six Northern California clinics. Analysis is ongoing, but preliminary examinations of HIV-positive patient perceptions of provider discussions regarding HIV-related risk behavior identified associations of patient disclosures of risk behavior with both frequency of and kinds of discussions the clinicians initiated.
Interest in a Meth Intervention Program Survey
In this survey of patients at San Francisco City Clinic and an STD clinic in Seattle, meth using MSM were asked how likely they would be to take part in programs to reduce or stop their meth use. We found that while 70% had tried to quit using meth, only 12% had ever been in treatment. Men who were engaging in unprotected anal sex while on meth were more interested in participating in meth programs than those having unprotected anal sex without being on meth.
Over two-thirds said they would be in considerably or extremely more interested in a program if they received a payment of $20 per visit. Strong interest in attending an intervention program was predicted by frequent use of methamphetamine during unprotected anal intercourse, being troubled by methamphetamine use, having tried to stop using methamphetamines, and by greater interest in decreasing or stopping methamphetamine use.
Menza TW, Colfax G, Shoptaw S, et al. Interest in a Methamphetamine Intervention Among Men Who Have Sex With Men. Sex Transm Dis. Aug 10 2006.
The HOPE Study
The Homebase Outcome Program Evaluation (HOPE) Study evaluated an enhanced discharge planning and case management program for HIV-positive inmates in the San Francisco County Jail System. A community report of the baseline results was published in 2005.
Clements-Nolle K, Marx R, Pendo M, Loughran E, Estes M, Katz M.
Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail. Am J Public Health. 2008 Apr;98(4):661-6.
Other AIDS Office Research