Methamphetamine use is significantly associated with HIV infection among gay, bisexual and MSM populations, predominantly through high-risk sexual behaviors that are facilitated by use of the drug.  Despite a decade-long trend of declining sero-conversions among MSM, this population continues to be at the core of the AIDS epidemic.  In the last decade, researchers have been credited with developing, testing, and refining a number of noteworthy HIV-prevention interventions as well as substance abuse treatment interventions.  Community programs have been encouraged to implement or adopt empirically validated interventions; however, disseminating these interventions into non-research settings has been challenging.  This HIV prevention program transfers and implements a methamphetamine abuse treatment/HIV risk reduction intervention into a community setting.  The intervention consists of an 8-week, 24 session gay-specific cognitive behavioral therapy (GCBT) intervention (“Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users” authored by Drs. Steve Shoptaw and Cathy J. Reback, in collaboration with colleagues, available for download at www.uclaisap.org), combined with a low cost contingency management (CM) behavioral intervention.  The CM intervention involves providing vouchers redeemable for goods or services that promote a healthy methamphetamine-free lifestyle in exchange for urine samples that are methamphetamine metabolite-free. Phase I, weeks one through eight, couples the evidenced-based, manual-driven, GCBT intervention (i.e., “Getting Off” manual) with a CM intervention. Phase II, weeks nine and ongoing, consists of open-ended, support groups. Assessments are conducted at baseline and 3-months post admission.

 

Title:	The G.U.Y.S. (Guys Understanding Your Situation) Program
Principal Investigator:	Cathy J. Reback, Ph.D.
Program Coordinator:	Shannon Sell, M.P.H.
Funded by:	Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy
Contract Number:	H700861
Total Project Period:	1/05 – 12/08
Project Description:

The G.U.Y.S. Program offers a multi-tier health education/risk reduction (HE/RR) intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among homeless, substance-using men who have sex with men (MSM) and men who have sex with men and women (MSM/W).  Most specifically the intervention targets sexual risk behaviors that are most likely to occur while using methamphetamine, particularly unprotected anal intercourse, as well as exchange sex risks and injection drug risks.  The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach, individual-level interventions (ILI), and group-level interventions (GLI).  Follow-up ILI assessments are conducted at 30, 60 and 90 days.  Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where homeless, substance-using MSM and MSM/W congregate.  The program has successfully worked with MSM and MSM/W in highly charged sexual arenas and developed non-invasive outreach and intervention strategies for these venues, which vary based on the safety and atmosphere of each public or commercial sex environment.  The GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors, increase social support and self-esteem, and develop skills to decrease HIV risk behaviors.  The GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

 

The majority of new HIV infections across Los Angeles County continue to be found among men who have sex with other men (MSM).  Within MSM, stimulant abuse, particularly methamphetamine abuse, is the major factor in driving new infections, primarily via behavioral disinhibition contributing MSM methamphetamine users to engage in extremely high-risk sexual transmission behaviors. Safety Net LA combines the biomedical intervention of Post-exposure Prophylaxis (PEP) for HIV prevention with the behavioral intervention Contingency Management (CM), which targets reduction of methamphetamine use as a way of reducing concomitant high-risk sexual behaviors for HIV-negative, methamphetamine-using MSM.  Safety Net LA will enroll 40 HIV-negative, methamphetamine-using MSM into the CM component of the dual intervention.  Participants receive a baseline assessment including urine analysis for the presence of methamphetamine metabolites, a rapid oral HIV antibody test, a physical examination including a comprehensive metabolic panel and complete blood count, HIV/STI prevention information, and medication adherence information.  Following baseline assessments, participants begin an 8-week, 3x/week, CM intervention and are given a 4-day starter pack of tenofivir with emtricitabine (i.e., Truvada).  Participants earn vouchers for methamphetamine metabolite-free urine samples, which are redeemable for goods and services. In the event of an unexpected high-risk sexual exposure to HIV, i.e., unprotected anal intercourse with an HIV-positive or status unknown partner, participants are instructed to immediately call the clinic and begin the 4-dose starter pack of Truvada.  An appointment with the physician is scheduled within 96 hours of the participant’s first dose of Truvada; participants then receive a second rapid oral HIV antibody test and are given the additional 24-day pack of Truvada.  Participants return to the clinic at 3-months post baseline for a follow-up evaluation and a third rapid oral HIV antibody test.  In combining these two interventions in this unique program, Safety Net LA aims to reduce methamphetamine use and concomitant high-risk sexual behaviors, while reducing potential seroconversions.

 

Title:	TransAction
Principal Investigator:	Cathy J. Reback, Ph.D.
Program Coordinator:	Shannon Sell, M.P.H.
Funded by:	Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy
Contract Number:	H700861
Total Project Period:	1/05 – 12/08
Project Description:

Many male-to-female transgender women are at high-risk of HIV infection as a result of several socio-cultural conditions, such as low income, high unemployment, lower levels of education, and unstable housing.  Economic necessity, as a result of severe unemployment and housing discrimination, results in a reliance on sex work to secure food, shelter, and money.  The TransAction Program provides culturally appropriate, evidence-based HIV prevention services that address both individual and socio-cultural risk factors.  The program offers a multi-tier health education and risk reduction intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among transgender women.  Most specifically the interventions will target risk behaviors that are specific to the socio-cultural circumstances of high-risk transgenders, particularly exchange sex, hormone misuse, injection and non-injection drug risks.  The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach encounters, individual-level interventions (ILI), skills building group-level interventions (GLI)s and support GLIs.  Follow-up ILI assessments will be conducted at 30, 60 and 90 days.  Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where high-risk transgender women congregate.  The skills building GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors.  Concurrently, the support GLI component of the intervention serves to increase social support and self-esteem.  Both the skills building GLI and support GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

 

Title:	WeHo Streets
Principal Investigator:	Cathy J. Reback, Ph.D.
Program Coordinator:	Shannon Sell, M.P.H.
Funded by:	City of West Hollywood
Contract Number:	Pending
Total Project Period:	10/06 – 9/08
Project Description:

The goals of the WeHo Streets service program is to reduce the risk of HIV acquisition or transmission among gay and bisexual males and male-to-female (MTF) transgender women who are substance users and sex workers, and to improve access to HIV-related services and other health care needs in the City of West Hollywood.  These goals are being met through the provision of outreach contacts, new and unduplicated in-depth encounters, repeat in-depth encounters, and the distribution of risk reduction supplies.  Non-invasive outreach is conducted on the streets in identified high-risk areas of West Hollywood where the target populations work and congregate such as street corners, bars, mini markets, fast food stands, and parks.  Outreach workers maintain continuity and consistency in the time and location of their fieldwork, which encourages ongoing and sustained interventions within the natural setting.