Transcript Slide 1

SUBSTANCE ABUSE
RISK FACTOR FOR HIV/AIDS
ACQUISITION IN JAMAICAN
ADOLESCENTS
W. De La Haye, MD, MPH, DM
Department of Community Health and Psychiatry
The University of the West Indies
Mona Campus
Introduction
• Substance abuse reduces inhibitions and
encourages engagement in high risk sexual
behaviours
• ¹Substance abusers are disproportionately
affected by the AIDS epidemic
• ²Young users - much greater network and
behavior risk for sexually transmitted diseases
and have more sex partners
¹Sorensen et al., July 2002. Science and Practice Perspectives, NIDA 1(1): 4-11
²Blum, R.W., Center for Adolescent Health, University of Minnesota
Introduction
• ¹Prevalence of HIV among US drug users
entering treatment ranges from 0 – 35%
• Intravenous drug use (IDU) is a factor in 1/3
of all AIDS cases in the US
• More than 1/2 of new HIV infections
1. Murrill et al., 2001. Journal of Urban Health 78(1):152-161
HIV in Jamaica
• Concentrated epidemics
• HIV prevalence rates in Jamaica are high
among those with high risk behaviors:
Homo/bisexual males 25%
Commercial sex workers 10 – 20%
Prisoners 12%
STI clinics 6%
Ministry of Health, Jamaica, 2001. HIV Surveillance Data
Reported risk behavior
100
90
80
70
60
50
40
% 30
20
10
0
56.3
31.4
10.9
1.4
STI history
Crack cocaine use
Sex with prostitutes
History of IV drug use (US, UK)
N = 4706
National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004
Reported risk behavior
100
90
80
70
60
50
40
% 30
20
10
0
56.3
9% (2002)
31.4
(2003)
Deported offenders
10.9
----------STI history
Crack cocaine use
1.4
Sex with prostitutes
History of IV drug use (US, UK)
N = 4706
National HIV/STD prevention and control program. Jamaica HIV/AIDS epidemic update 2004
HIV seroprevalence (%) by gender
14
11.8 %
(15 / 127)
12
10
%
8
3.9 %
(30 / 776)
6
5%
(45 / 903)
4
2
0
Female
Male
Overall
OR F:M 3.3
* De La Haye W. World Psychiatric Association “Advances in Psychiatry”, Abstract Issue, March 2005: 190
HIV risk factors associated
with substance abuse
• Risky sexual behavior
- selecting sexual partners from similar
networks
- sex for drugs
- unprotected sex
- bisexuality, homosexuality
- early intercourse (<13 y.o.)
• Crack cocaine use
• Unemployment
• Marijuana smoking before sex
Adolescence
• Transitions from one developmental stage to
another are vulnerable periods
• High risk for substance abuse
- cognitive, attitudinal, personality,
behavioral, social, environmental, genetic
• Experimentation and recreational use of
alcohol, cigarettes, cannabis
Comorbid illnesses
• Depression
• Conduct disorder
• ADHD
• ODD
Risk factors for S A
• Greater potential for drug use
- Ineffective parenting
- Unstable home environment
- Poor nurturing in childhood
- Poor social coping skills
- Affiliation with deviant groups
- Drug trafficking
- Availability
Protective factors against S A
• Reduced potential for drug use
- Strong family bond
- Schools prevention programs
- Religious organizations
- Parental monitoring of children
- Knowledge of conventional norms about
drug use
- Awareness of personal and community
hazards of drug use
Impact of risk and
protective factors
• Function of stage of psychological and social
development of an individual
• Exposure, experimentation, recreational use,
regular use and subsequently dependence
• *Early initiation of alcohol, tobacco and illicit
drug use among adolescents is a strong
predictor of subsequent drug dependence
*Wagner, F. A., Anthony J. C. 2001: American Journal of Epidemiology; 155(10):918-925.
Age profile of population (%)
YEAR
AGE GROUP (YEARS)
0-14
15-34
35-54
55+
35.2
33.8
17.9
13.1
33.2
33.8
19.2
13.7
33
30.9
20.8
15.3
1996
1998
2001
LIFETIME PREVALENCE (%)
80
70
60
50
%
40
30
20
10
0
Nic.
Alc.
Can.
1987
Cr. Coc.
Inhal.
1997
N = 8000, 63 schools, grades 9 - 13
National Schools’
Drug Survey,
1987,
1997
National
Schools’
Drug
Survey,
1987, 1997. NCDA
Tranquil.
LIFETIME PREVALENCE (%)
80
70
60
50
%
40
30
20
10
0
Nic.
Alc.
Can.
1987
Cr. Coc.
Inhal.
1997
N = 8000, 63 schools, grades 9 - 13
National Schools’
Drug Survey,
1987,
1997
National
Schools’
Drug
Survey,
1987, 1997. NCDA
Tranquil.
LIFETIME PREVALENCE (%)
80
70
60
50
%
40
30
20
10
0
Nic.
Alc.
Can.
1987
Cr. Coc.
Inhal.
1997
N = 8000, 63 schools, grades 9 - 13
National Schools’ Drug Survey, 1987, 1997. NCDA
Tranquil.
• SITE: Adolescent Drug Free Outpatient Clinic
at the Assessment, Detoxification and Early
Rehabilitation Unit (DETOX)
• SAMPLE: Adolescent substance abusers
presenting for treatment
• PERIOD: January 2004 – January 2005
• METHOD: Retrospective chart extractions
Gender distribution
100
93 (n = 96)
90
80
70
60
%
50
40
30
20
6.8 (n = 7)
10
0
Male
Female
N = 103, p = 0.000
Age distribution
30
25
22.6
23.6
20.8
20.8
20
%
15
10
4.7
5
2.8
0.9
0.9
0
10
11
12
13
14
15
16
17
18
N = 103, Mean age 15.4 + 1.74 years, range 10 – 18 years, p = 0.000
Parish of residence
50
45
40
37.7
35
31.1
30
%
26.4
25
20
15
10
5
1.9
0
St. Andrew
Kingston
St. Catherine
N = 103, P = 0.000
Other rural
Living arrangement
50
45
40
35
35.8
30
%
25.5
25
18.9
20
15
10.3
10
5
2.8
0
Mother
Both
parents
Father
N = 103, P = 0.000
Relative
Child
services
Stressor
100
90
80
63.2
70
60
%
50
34
40
30
20
10
0
Stressor
Yes
No
Stressor
100
90
80
70
63.2
57.5
60
%
50
34
40
32.1
30
20
10
0
Stressor
Separation
Yes
No
Mode of referral
50
48.1
45
40
35
30
%
28.3
25
20
15
10
5.7
5
4.7
2.8
1.9
0
School
Mother
Father
Court
N = 103, P = 0.000
Child
services
Aunt
Substances abused
100
100
90
80
70
60
%
50
40
30
20
10
0
Cannabis
Alcohol
N = 103
Nicotine
Crack cocaine
Substances abused
100
100
90
80
70
60
%
50
40
33
30
20
10
0
Cannabis
Alcohol
N = 103
Nicotine
Crack cocaine
Substances abused
100
100
90
80
70
60
%
50
40
33
30
24.5
20
10
0
Cannabis
Alcohol
N = 103
Nicotine
Crack cocaine
Substances abused
100
100
90
80
70
60
%
50
40
33
30
24.5
20
10
1.9
0
Cannabis
Alcohol
N = 103
Nicotine
Crack cocaine
Pattern of substance abuse
100
90
80
70
60
%
50
51.9
40
30
20
10
19.8
11.3
10.4
0.9
0
Cannabis only
Cann. + Nicotine
Cann. + Alc. + Crack Cocaine
0.9
Cann. + Alcohol
Cann. + Alcohol + Nicotine
Cann. + Crack Cocaine
N = 103, P = 0.000
Drug of onset
100
90
80
75
70
60
%
50
40
30
20
10
0
Cannabis
Alcohol
N = 103
Nicotine
Drug of onset
100
90
80
75
70
60
%
50
40
30
15
20
10
0
Cannabis
Alcohol
N = 103
Nicotine
Drug of onset
100
90
80
75
70
60
%
50
40
30
15
20
10
10
0
Cannabis
Alcohol
N = 103
Nicotine
Drug of onset
100
90
80
75
70
60
%
50
40
30
15
20
10
10
0
Cannabis
Alcohol
N = 103
Nicotine
Introduction to first use
100
90
80
70
67
60
%
50
40
30
20
7.6
10
3.8
1.9
0
Friend
Family member
Self
N = 103, P = 0.000
Other
Age of onset
30
26.4
25
20
17.9
17
% 15
12.3
10
7.5
5.7
5
3.8
2.8
0.9
0
7
8
9
10
11
12
13
14
15
16
Years
Mean age of onset 13 ± 1.8 years, range 7 – 16 years, p = 0.000
Abused substances
Adolescents
Dependent substances
Adults
Cohort 1
Cohort 2
100
100
100
90
90
80
80
70
70
% 60
%
50
96.9
93.8
96.9
82.8
60
50
40
40
33
30
30
24.5
20
20
10
10
1.9
0
0
Cannabis
Alcohol
Nicotine
Crack Cocaine
N = 103
Range 10 – 18 yrs.
Cannabis
Alcohol
Nicotine
N = 150
Range 21 – 55 yrs.
Crack Cocaine
Discussion
• There is early age of onset in this cohort of
adolescent substance abusers
• Peers play a significant role in the introduction
of adolescents to their first use of a drug
• Schools and mothers play a significant role in
referring these clients for treatment
Implications of early onset
• The age of initiation of alcohol, tobacco and
illicit drug use among adolescents is a strong
predictor of later drug problems, especially
when use begins before age 15 years
• Research shows that for females tobacco use
and for males alcohol is a strong predictor of
other drug use
Cannabis use in
Jamaican adolescents
• Potentially catastrophic implications
• With regards to cocaine exposure opportunities
and sexual practices
• Parental supervision can help in disrupting drug
exposure opportunities
• Address self-awareness leading to healthy
lifestyle choices
Cannabis use in Jamaica
• Educate children about the potential
consequences of cannabis abuse
• Ganja can make you mad!
• Why take a chance?
• Smoking anything is hazardous
to your health!
Aim of education
• Provide students, teachers and families with
accurate information about drug abuse,
addiction and association with high risk sexual
behaviour
• Reduce exposure opportunities
• Break the chain of experimentation, regular
use, abuse and dependence
Outcome
• Stops drug use before it starts
• Reduces violence associated with drug
use / distribution
• Reduces load on treatment system
• Reduces load on criminal justice system
• Reduces lost productivity
• Reduces acquisition and transmission of
STIs (HIV/AIDS)
Role of exposure
• Parents, paediatricians and GPs must ask
kids about chances to try illegal drugs
• Kids more likely to talk about their chances
to try than their use
• Once there is a chance, it should raise a
RED FLAG!
Role of prevention
• Drug abuse is a preventable behaviour
• Drug addiction is a preventable disease
• Substance abusers are more likely to engage
in high-risk sexual activities
• Substance abuse prevention in adolescents
is HIV prevention
Role of prevention
• The presence of risk factors and absence of
protective factors in adolescents lead to
increased “Exposure Opportunity” to
substances of abuse
• Prevention programs must focus on reducing
“Exposure Opportunities” to substances of
abuse in Jamaican adolescents
• Implement prevention programs as early as
kindergarten!!!
Conclusion
• Role of drug treatment programs in preventing
acquisition and transmission of HIV / AIDS
• The results endorse the need to screen for
HIV in all substance abuse treatment facilities
in Jamaica
• Conduct research to improve understanding
of the interrelationship between non-IV
substance use and high risk sexual behaviour
Summary
• Substance abuse prevention is HIV
prevention
• Reducing the gap between substance
abusers needing treatment and prevention
and those getting help
• Reduce the risk of risky sexual behaviour
associated with substance abuse
Caution
• Use of any mood altering substance
(including legal ones) can result in risky
sexual behaviour
• One does not need to be chemically
dependent to have risk associated with their
drug use!
Our fight against drug
use is a fight for our
children’s future!!!
Substance Abuse and HIV / AIDS
in adolescents in Jamaica
Predators in paradise!
Thank you