HIV Co-Factors
THE SOCIAL DRIVERS OF HIV
2010 SAN FRANCISCO
HIV PREVENTION PLAN
PAGES125 - 147
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
Substance Use as a HIV Co-Factor
This 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
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
Substances That Can Affect HIV Risk continued
 Hormones = sharing needles
= sharing needles & viles
 Marijuana = risk unclear, linked to stopping HART,
MSM more likely weekly user than non MSM
 Steriods
 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
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%
Mental Health as an HIV Co-Factor
• Anxiety, depression, bipolar disorder can influence
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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
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
Incarceration as an HIV Co-Factor
• Incarceration populations have more co-factors
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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
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.
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
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…..
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
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
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Commercial sex work (CSW)
-Risk more associated with other co-factors
-Principle risk may be with primary or non-exchange
partners
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Survival Sex
-Risk economic factors when offered more money (or
other exchange benefit) for no condom use
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
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
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
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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.
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