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Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study
Valerie J Rose1, H Fisher Raymond, Timothy A Kellogg
1San Francisco Department of Public Health, AIDS Office, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA. vjkrose@gmail.com
Background:
Despite the leveling off in new HIV infections among men who have sex with men (MSM) in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA). Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours.
Methods:
The purpose of the Late Night Breakfast Buffet (LNBB) was to determine the feasibility and uptake of harm reduction services by a late night population of MSM. The "buffet" of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI) testing accompanied by counseling and consent procedures. The study had two components: harm reduction outreach and a behavioral survey. For 4 months during 2004, we provided van-based harm reduction services in three neighborhoods in San Francisco from 1-5 a.m. for anyone out late at night. We also administered a behavioral risk and service utilization survey among MSM.
Results:
We exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM enrolled in the study component. The study population of MSM was characterized by low levels of income and education whose ages ranged from 18-55. Seventy-eight percent used MA in the last 3 months; almost 25% used MA every day in the same time frame. Of the 65% who ever injected, 97% injected MA and 13% injected it several times a day. MA and alcohol were strong influences in the majority of unprotected sexual encounters among both HIV negative and HIV positive MSM.
Conclusion:
We reached a disenfranchised population of MA-using MSM who are at risk for acquiring or transmitting HIV infection through multiple high risk behaviors, and we established the feasibility and acceptability of late night harm reduction for MSM and MSM who inject drugs.
Insights
Late night harm reduction services effectively reached methamphetamine (MA)-using men who have sex with men (MSM) in San Francisco. This study demonstrated the feasibility of providing essential services to this high-risk population.
Area of Science:
- Public Health
- Epidemiology
- Harm Reduction
Background:
- Recent HIV infections among men who have sex with men (MSM) in San Francisco are increasingly linked to methamphetamine (MA) use.
- HIV incidence is significantly higher among MA users (6.3%) compared to non-users (2.1%).
- Frequent MA users and HIV-positive MSM present unique challenges for prevention efforts due to late-night activity patterns.
Purpose of the Study:
- To determine the feasibility and uptake of harm reduction services for a late-night population of MSM.
- To assess the effectiveness of van-based outreach services in reaching this demographic.
Main Methods:
- The Late Night Breakfast Buffet (LNBB) provided needle exchange, harm reduction information, oral HIV testing, and STI testing with counseling.
- Van-based harm reduction services were offered in three San Francisco neighborhoods from 1-5 a.m. over four months in 2004.
- A behavioral risk and service utilization survey was administered to MSM.
Main Results:
- 2000 needles were exchanged, 4500 condoms/lubricants distributed, and 21 HIV and 12 STI tests provided.
- 55 MSM enrolled; 78% used MA in the last 3 months, with 25% using it daily.
- Of those who injected, 97% injected MA, often multiple times daily; MA and alcohol influenced unprotected sexual encounters.
Conclusions:
- Late-night harm reduction services successfully reached a disenfranchised population of MA-using MSM at high risk for HIV.
- The study established the feasibility and acceptability of late-night harm reduction interventions for MSM, including those who inject drugs.
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