The Impact of Syringe Services Program Policy on Risk Behaviors Among Persons Who Inject Drugs in 3 US Cities, 2005-2015.

OBJECTIVES: The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. METHODS: PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. RESULTS: From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P < .001), increased significantly from 32.0% to 50.5% in New Orleans (P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). CONCLUSIONS: The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.

Using Syndemics Theory to Examine HIV Sexual Risk Among Latinx Men Who Have Sex with Men in Philadelphia, PA: Findings from the National HIV Behavioral Surveillance.

Latinx men who have sex with men (MSM) continue to be disproportionately impacted by HIV/AIDS. Identifying the role of multiple syndemic factors associated with sexual risk behaviors is imperative in order to develop effective prevention and treatment strategies. Cross-sectional data for this study were derived from three cycles of the Philadelphia portion of the National HIV Behavioral Surveillance System. This study explored the impact of syndemic factors - heavy drinking, exchange sex, and homophobic discrimination - on sexual HIV risk behaviors, operationalized as number of male partners, and condomless anal intercourse (CAI) with main and casual partners among Latinx MSM (n=464). Analyses took two forms: a syndemic approach, using the cumulative number of conditions as an independent variable; and a non-syndemic approach, incorporating each condition as a unique factor. In multivariable syndemic analyses, participants with two or more factors reported more male partners and more CAI casual male partners than those with none. In non-syndemic models, homophobic discrimination and exchange sex were significantly positively associated with total number of male partners, while heavy drinking was associated with more casual CAI partners. Quantitative results indicate that syndemic and non-syndemic approaches vary in their relative capacity to account for sexual risk among Latinx MSM.

RESUMEN: Los hombres latinos que tienen sexo con hombres (HSH) continúan siendo desproporcionadamente afectados por el VIH / SIDA. Identificar el papel de múltiples factores sindémicos asociados con las conductas de riesgo sexual es imprescindible para desarrollar estrategias efectivas de prevención y tratamiento. Los datos transversales para este estudio se derivaron de tres ciclos de la parte de Filadelfia del Sistema Nacional de Vigilancia del Comportamiento del VIH. Este estudio exploró el impacto de los factores sindémicos (consumo excesivo de alcohol, sexo de intercambio y discriminación homofóbica) en los comportamientos sexuales de riesgo de VIH, operacionalizados como el número de parejas masculinas y las relaciones anales sin condón (IAC) con parejas principales y casuales entre los HSH latinos (n = 464). Los análisis tomaron dos formas: un enfoque sindémico, usando el número acumulado de condiciones como una variable independiente; y un enfoque no sindémico, que incorpora cada condición como un factor único. En análisis sinádicos multivariables, los participantes con dos o más factores informaron más parejas masculinas y más parejas masculinas casuales CAI que aquellos sin ninguno. En los modelos no sindémicos, la discriminación homofóbica y el intercambio sexual se asociaron significativamente positivamente con el número total de parejas masculinas, mientras que el consumo excesivo de alcohol se asoció con parejas CAI más casuals. Los resultados cuantitativos indican que los enfoques sindémicos y no sindémicos varían en su capacidad relativa para dar cuenta del riesgo sexual entre los HSH latinos. PALABRAS CLAVE: Conductas de riesgo sexual del VIH, Latinos gays y bisexuales, Condiciones sindémicas, Consumo de alcohol de alto riesgo, Intercambio de sexo, Homofobia.

Prevalence and correlates of carrying naloxone among a community-based sample of opioid-using people who inject drugs.

BACKGROUND: Overdose prevention programs are effective at reducing opioid overdose deaths through training people who inject drugs (PWID) how to respond to witnessed overdoses and use naloxone. This report examines prevalence and correlates of carrying naloxone among a community-based sample of PWID. METHODS: Using respondent driven sampling, PWID (n = 571) in Philadelphia, PA were recruited for the 2015 National HIV Behavioral Surveillance project. The impact of socio-demographics, social services, and law enforcement interaction on naloxone carrying were analyzed using multivariable logistic regression. RESULTS: Odds of carrying naloxone were higher among PWID who were: homeless (adjusted odds ratio [aOR] = 1.65, 95% confidence interval [CI]: 1.01, 2.83), reported a syringe exchange program as their primary source of syringes (aOR = 2.92, CI: 1.68, 5.09), and had been stopped by police ≥6 times (aOR = 2.16, CI: 1.12, 4.16) or arrested (aOR = 1.84, CI: 1.02, 3.30) in the past year. CONCLUSIONS: Syringe exchange access was associated with naloxone carrying and is likely a primary source for naloxone and overdose reversal training for PWID. Homelessness and law enforcement encounters are known barriers to harm reducing behaviors; however, both were positively associated with carrying naloxone in this sample. Larger studies are needed to explore these relationships in greater depth.

Pre-Exposure Prophylaxis (PrEP) Awareness Is Low Among Heterosexual People of Color Who Might Benefit From PrEP in Philadelphia.

INTRODUCTION: We assessed awareness of pre-exposure prophylaxis (PrEP) among HIV-negative Black and Latinx persons living in the Philadelphia Metropolitan Statistical Area. METHODS: Using chi-square and Wilcoxon rank-sum tests, we analyzed data from the 2016 heterosexual cycle of the National HIV Behavioral Surveillance system to assess how sociodemographic factors, health care utilization, and risk behaviors affected PrEP awareness. RESULTS: Participants (n = 472) were predominately Black, non-Hispanic (88.1%) with a median age of 41.5 years. Most participants reported having a usual source of medical care (92.1%) and seeing a medical provider within 12 months (87.0%). However, PrEP awareness was low in this sample (4.9%) and was lower among those who had a medical visit compared with those who had not ( P < .01). CONCLUSION: Current Centers for Disease Control and Prevention clinical guidelines suggest that providers counsel high-risk patients about PrEP. Our data suggest that this is not happening with people of color in Philadelphia. Interventions targeting medical providers working with HIV-risk people of color may be appropriate.

Factors Associated with Awareness of Pre-exposure Prophylaxis for HIV Among Persons Who Inject Drugs in Philadelphia: National HIV Behavioral Surveillance, 2015.

Persons who inject drugs (PWID) continue to experience disproportionate HIV burden. Though studies demonstrate PWID find pre-exposure prophylaxis (PrEP) acceptable, awareness and uptake remains low. Data from the 2015 PWID cycle of the National HIV Behavioral Surveillance (n = 612) in Philadelphia, Pennsylvania (USA) were analyzed to evaluate how socio-demographics and behavioral factors impact PrEP awareness. Only 12.4% of PWID surveyed were PrEP-aware and 2.6% reported receiving a prescription. Factors associated with PrEP awareness included having at least some college education (aOR 2.13, 95% CI 1.03, 4.43), sharing paraphernalia (aOR 2.37, 95% CI 1.23, 4.56), obtaining syringes/needles primarily from a syringe exchange program (aOR 2.28, 95% CI 1.35, 3.87), STI testing (aOR 1.71, 95% CI 1.01, 2.89) and drug treatment (aOR 2.81, 95% CI 1.62, 4.87). Accessing prevention and health services increased the odds of being PrEP-aware; however, awareness was low overall. Additional promotion efforts are warranted.

Brief Report: Nonfatal Overdose Events Among Persons Who Inject Drugs: Findings From Seven National HIV Behavioral Surveillance Cities 2009 & 2012.

The rate of drug and opioid overdose deaths in the United States has more than tripled over the past 15 years. The ability to conduct public health surveillance on nonfatal overdoses is limited. The current study used National HIV Behavioral Surveillance (NHBS) data to estimate recent and lifetime history of nonfatal overdose events in persons who inject drugs in 7 cities. Recent and lifetime experience of overdose events ranged from 3% to 20% and from 29% to 63%, respectively. Adapting systems such as NHBS may be useful in responding to and monitoring emergent public health problems such as the overdose epidemic.