Reducing HIV Transmission by Promoting Sexual Health among Drug Users

Funding Source: National Institute on Drug Abuse
Funding Period: 2007-2010
Principal Investigator: Holly Hagan, Ph.D.
CDUHR Co-Investigator(s): Don Des Jarlais, Ph.D.; David Perlman, M.D.

Heterosexual transmission of HIV among non-injecting users of "hard drugs" such as heroin and cocaine (including crack) is a persistent problem in the US. Although this has been recognized for a number of years, little progress has been achieved. Current data from New York City provide a dramatic example. In two recent studies, HIV prevalence rates of 12-17% were observed among non-injecting users of heroin and cocaine – this is equal to current HIV prevalence among NYC injecting drug users, and higher than HIV prevalence among IDUs in 85 of the 96 largest metropolitan statistical areas in the US. High HIV seroprevalence among African-American non-injecting drug users was particularly troubling, with rates two to thee times higher than in other racial groups.

High prevalence of sexually transmitted infections (STIs) that facilitate HIV transmission appears to be a major factor driving HIV infection in both injecting and non-injecting users of these hard drugs. The current system for controlling STIs among hard drug users is passive, relying primarily upon symptomatic drug users seeking care at publicly funded STI clinics. Addressing HIV through STI control will require innovative strategies to motivate drug users to seek periodic STI screening and treatment, and to maintain sexual health by increasing general knowledge regarding STIs (including the link to sexually acquired HIV), and motivation and skills to practicing safer sex. We have developed a collaboration with a community social service agency, and an infectious disease clinic within a community hospital in Bushwick, Brooklyn to develop methods for actively linking hard drug users to HIV and sexual health care services. 

We propose to do developmental work to learn more about STI knowledge and sexual risk behavior among hard drug users and to test methods to recruit them for STI screening, to increase their STI knowledge, to motivate them to return to receive their test results and, for those who screen positive, to attend a medical follow-up visit.  Data from this study will inform the development of a randomized controlled trial. We will recruit 200 users of heroin, cocaine and crack, using peer recruitment methods.  Modest incentives will be used to lessen practical barriers to return for their test results and attend study visit/counseling sessions. Our pilot intervention will include a modified version of the Project Respect curricula, tailored to specific issues that interfere with safe sexual behavior among these drug users and to support participants with positive STI or HIV tests to attend medical follow-up visits.

The application of these approaches to STI prevention, screening, and management for drug users is innovative. Close involvement of our community partners will make the final intervention broadly relevant and "translatable" to other settings.  The scale of the proposed research is very appropriate for developing a promising intervention to be more fully evaluated in a randomized controlled trial.