HIV Co-Factors

1. HIV Co-Factors The Social Drivers of HIV 2010 San Francisco HIV Prevention Plan Pages125 - 147

2. Definition of a Co-Fator • A condition that can increase the risk for HIV, increase susceptibility to infection. Or decrease the ability to receive and act upon HIV prevention messages

3. Substance Use as a HIV Co-FactorThis section covers substances that do not meet criteria of Drivers • Substance use may be responsible for as much as 32% of new HIV infection nationally • Sharing needles • Psychological/Behavioral effects Euphoria, increased sense of invulnerability, increased confidence impact sexual decision making • Biological effects Vasodilation, prolonged erection, smooth muscle relaxation, decreased pain, increased sexual desire

4. Substances That Can Affect HIV Risk • Erectile Dysfunction drugs (Viagra) Biologic factor = increased blood accumulation in penis • Heroin = sharing needles • Ecstasy Psychological/Behavioral effects = induces feeling of empathy and relaxation, often used in combo with K, cocaine, meth, ED drugs and has been associated with high risk practices in MSM

5. Substances That Can Affect HIV Risk continued • Hormones = sharing needles • Steriods = sharing needles & viles • Marijuana = risk unclear, linked to stopping HART, MSM more likely weekly user than non MSM • Some studies found that LGBTQQ people have higher substance use rates than heterosexual populations • Substance use also has important impact on homeless and runaway youth and HIV risk

6. Drug Treatment in San Francisco • Heroin has largest number of people in treatment, followed by alcohol and cocaine =77% of all in SF drug treatment • African Americans have highest rate for cocaine use treatment @ 38% • Asians have highest rate for meth use treatment @ 29% • Latinos has highest rate for alcohol use treatment @32% • Whites have highest rate for heroin use treatment @44%

7. Mental Health as an HIV Co-Factor • Anxiety, depression, bipolar disorder can influence thought process and decision making • Depression, isolation, loneliness, low self esteem in substance uses and those experiencing poverty, homelessness, discrimination, marginalization, grief and loss are at risk of high risk behavior • Lack of social support • History of childhood sexual abuse • History of abusive relationships • History of rape

8. STI’s as HIV CO-Factors • Gonorrhea is a DRIVER disc later in Driver & STI’s • Chlamydia, Syphilis, Hep B & C, Herpes, Genital Warts, and Trichomoniasis are co-factors and do not rise to definition of a Driver and will be disc in STI section • STI HIV risk is associated with inflammation of genital tract causing increased biologic susceptibility • Hep B & C HIV risk associated with sharing blood thru needle use and some sexual transmission • MORE ON THIS in STI section in class

9. Incarceration as an HIV Co-Factor • Incarceration populations have more co-factors while out of jail/prison such as substance use, mental health issues, homelessness, poverty, trading sex for money/drugs • Most HIV infected incarcerated people were infected in the community may be related to other co-factors • Post-Release time frame an IMPORTANT period for interventions • Incarceration large contributor to community sexual network stability • Much more on this topic later in semester

10. Homelessness as an HIV CO-Factor • Homeless people have multiple co-factors ie; mental health issues, substance use = dual diagnosis, exposure to physical & sexual violence, survival sex, repeated contact with criminal justice system, lack of access to prevention messages • HIV prevalence higher than general population due to large number of MSM and IDU’s who are homeless and survival behaviors stemming from poverty.

11. Homelessness cont. • Important to reach this population • Adherence to HART may be difficult • Food security has been shown to potentially increase treatment adherence and thereby reduce transmission • Cash benefits may result is less drug selling or trading sex, and less drug injection

12. Immigration & Language as HIV CO-Factors • Economic instability, poverty, lack of access to health care & social services & information, isolation, and language barriers all contribute to potential vulnerability to HIV. • Legitimate fear of deportation may delay treatment when sick or prohibit access to HIV testing or health care completely. • Immigrants are a large & diverse group & risk relates to a number of factors such as…..

13. Immigrant C0-Factors for HIV cont • Degree of risk may depend on; • How sexual and drug using behaviors change in US • Access to appropriate health services, HIV education, condoms, needle exchange • Social norms about safe sex and drug practices in their communities • Experience with racism, discrimination & poverty in the US • English speaking abilities and education levels

14. Exchange Sex & Sex work as HIV C0-Factors • Exchange sex defined: exchange of sex for money, drugs, food, shelter, or any other perceived benefit • Two situations appear to be most common with interweaving other HIV c0-factors • Commercial sex work (CSW) -Risk more associated with other co-factors -Principle risk may be with primary or non-exchange partners • Survival Sex -Risk economic factors when offered more money (or other exchange benefit) for no condom use

15. Exchange Sex & Sex work as HIV C0-Factors • Transwomen sex workers may have increased risk because of vulnerability due to economic status and stigma…..some research points to high prevalence of unprotected anal sex with paying costumers • Transwomen and MSM sex workers need housing, health care for HIV- people, mental health support, job training, and a reduction in police harassment • Harm Reduction & client centered approach essential • Decriminalization of sex work is proposed by some

16. Income & Poverty as HIV CO-factors • Low economic status is one of the most consistent determinants of poor health status including HIV • Lack of access to health care, social & physical environments unsupportive to healthy behavior, injection drug and other substance use, commercial sex work, survival sex, multiple sex partners impact HIV risk • Prioritization of the immediate needs of clients such as food, housing, and income is part of HIV prevention • Address root causes of poverty thru advocacy & policy change

17. Access to Health & Social Services as HIV Co-Factors • ALL have the right to access but not all have access • More access in systems may = more education and health promoting behaviors • Factors affecting Access to Services • Lack of services } substance use and mental health treatment • Lack of insurance ‘07 63k uninsured in SF • Limited Knowledge of Services • Low Perception of Risk • Discrimination • Language Barriers & Low Literacy

18. Having HIV + or High Risk Sexual Partners • All drivers and co-factors could affect a likely encounter with an HIV+ or high risk partner • How do you know what you “know” about your partner? • Individuals from 2 distant communities could engage in the same behavior & one might have much more risk - example? • African American MSM have lower risk behavior but higher risk partners in part due to sexual network factors.

19. Use of Public & Commercial Sex Venues • Cruise for sex partners, safer sex negotiation may be limited due to public environment, anonymity of partners, covertness of sex, drug use • Some locals my increase safer sex practice ie SF bath houses w/ more open space and monitoring