This presentation is on HIV and people who inject drugs. Thank you to our presenting partner Lisa Hinson at Landrum Counseling and Consulting. Miss Lisa. Thank you, miss Krystle. I appreciate that. And yes, we have known each other for quite a bit of time at mates and teammates. So and I love what Kemah Palms does. I’ve referred clients there and I’ve always had a good outcome with you. Also, thank you. My name is Lisa Henson. As Krystle said, I am. I’ll see you in private practice out of Austin. I work in a collaborative practice with two other therapists. We do EMDR. We do everything from EMDR trauma, substance use disorder, families interventions.
HIV and Intravenous Drug Use Has Increased Since Covid-19 Pandemic
So check us out and I appreciate you all being here to hear me present today. I’m actually going to talk about specific HIV. This might be a little bit of a different take. I’m going to do HIV and IV drug users because there has been an uptick actually since COVID started. So I’m going to give you some. I’m going to give you some information and we’ll go through. I’ll stop about eleven forty five and I’d ask that if you have questions, hold them then and then we’ll take them at the end. And then that way, because I’ve got a little bit of information that covers going to a share screen. contact information, if you’d like to reach out to me, will be in the in the slides that get sent out so quick little bits of information. I am receiving no sort of financial compensation for it. So there’s no compensation from anybody company or otherwise. And I am also telling that everything in this is in the public domain. I don’t have sources cited at the end, usually on this type of presentation, but I will go ahead and add those before I send them off to Krystle so that she can make sure that everything is in there. And if you want to reference it, you’re more than welcome to. Ok, so let’s get started prevention and treatment strategies.
So COVID and IV drug use risks since COVID have started, there’s actually been a multiple multiple articles that have referenced higher IV drug use along the spectrum. And part of that is due to one isolation and people higher levels of relapse that have definitely happened since COVID. If you’re in the field, you’ve probably seen that within whatever capacity that you work, and I know that I’ve seen it in private practice and I’ve also seen it just in terms of. And much higher incidence of referrals for residential treatment and detox from families and individuals, families who are concerned about a family member who’s using IV drugs and then also individuals who are IV drug users seeking treatment. So probably more than I’ve gotten within about the last four or five years, and I can tell you that’s that was a red flag for me, which is one of the reasons I wanted to focus on IV drug use. So a higher prevalence of exposure and infection is multifactorial, unsanitary environments and poor hygiene that goes along on average with the environment that an IV drug user may go to to use or they may be living in. So, and definitely lack of access to services services that normally might be open for people seeking treatment might not be open during this time. They may be shuttered. They don’t have access to maybe medical personnel like they would prior or even to resources for Matt, which I’ll talk about a little bit.
So decrease access to services, challenge with social distancing and quarantine. Not all I.V. users use alone, especially if they’re using in community in a rundown location in which they go to get their drugs and then also using the same place, or if they are experiencing any type of disconnect from family or homelessness. They’re definitely going to be in a place that is unsanitary and where there’s poor hygiene with lack of access. You know, just the most basic, basic things that we need, whether that be housing, shelter, food facilities, you know, hygiene facilities, all of those things are not necessarily available actually more often than not, not necessarily available to IV drug users when they’re using in community or with each other when they’ve reached a certain point in their use. Another thing is incarceration, but I can tell you during COVID, there have been when I pulled some statistics, there have been less arrests for IV drug or drug charges or drug using during COVID because people are focused on incarceration and health of already people in the criminal justice system. So co-morbidities have had a higher rate HIV hepatitis TB. There was also something that has just come out with during COVID, which is a medical report for higher risks for infectious endocarditis for IV drug users. This is not something that’s been looked at before. Is in depth. Is medical complications related to the heart.
With IV drug users, it’s mostly focused on liver disease, T.B., hepatitis, HIV, that sort of thing. Infectious endocarditis is when there is a buildup of liver around the lining of the valves, and it stops heart flow. And so during COVID, what hospital emergency rooms are reporting around comorbidity with IV drug users is an increase and then seeking emergency services for this type of endocarditis, which is directly related to their use. So most common IV drugs that are used heroin, methamphetamine, cocaine and ketamine, southern and western regions have higher use of stimulants. Midwest and Northeast regions of the United States used primarily heroin and other opioids. That’s on a national level. In Texas, the most commonly injected drugs are number one heroin to speed balls, which is heroin and cocaine, and then third cocaine on its own. So I.V. drug use and exposure for for risk with HIV and Hep C and other STIs. Needles and syringes. And that’s typically because, you know, HIV drug users share their syringes even when the only time that risk is reduced for IV drug users is if they are using a rig that is not a detachable needle. Detachable needles Even though I.V. drug users may think that they are better, at least there’s some protection because they’re changing out the needle. There is still blood that can be caught in the tip of the casing that gets reinjected. So that’s the problem with using needles casings that have a detachable, a syringe that has a detachable needle.
Really, the least the least at risk in terms of sharing a needle is actually just getting a whole new needle, which can be a challenge. And we’re going to talk about that because there’s actually some resources in the state of Texas that allow people to do pick up fresh needles without having to do an exchange. Prep equipment, cookers, cotton’s water supplies, even alcohol swabs and become contaminated during prep process fingers and hands because if there’s an open cut or wound can become infected. Spread hepatitis A can also spread HIV and then surfaces when blood from an infected person contaminates the surface and is reused by another to prepare injection equipment. Most times. Folks, when they’re using IV, don’t pay attention. They just don’t pay attention to it. Don’t always stop to clean up their prep surface. They may only use a detachable needle in the same syringe, and that’s about as far as they might go. They don’t. It’s not necessarily going to be. I’m going to wipe my hands down, or it just doesn’t always look like that some people do. In other parts of the country where there are actually vibrant set programs, which is syringe exchange programs or ESPs sterile syringe programs, people can actually go to a vending machine and get fresh needles. They can also get different types of readings they can go and actually bring their own drugs to a safe, a safe room to use, which is clean.
And it also offers them the opportunity to get information about resources if they want to sobriety or if they want to go ahead and learn safer sex practices or safer using practices. Those are those do not exist in Texas. That type of community use room does not exist in Texas, but Texas does have some set programs and most major and most of the major cities. But they are not specific. They don’t. They don’t only focus on needle exchange HIV and the linkage between IV drug use. Every one in 10 new cases of IV drug use and exposure to the HIV virus is contributed with men who have sex with men is unprotected sex and injection drug use. It’s either going to be watching. This statistic is the same for both of these groups. One in 10 new cases of HIV exposure is attributed to injection drug use across the spectrum. But specific to men who have sex with men, male to male unprotected sexual contact and IV drug use is in that group. The highest HIV can survive until the syringe for up to 42 days, depending upon the temperature and other factors. And that’s a long time because for IV drug users who are who don’t have resources to a either acquire new needles or buy new needles, or even do a detachable needle change within a within the syringe, they they can viably use the same syringe and the same rigging for up to 30 40 five days.
That is not uncommon. There is a one in one hundred and sixty chance of transmitting HIV every time a person injects drugs that may seem low when you think about some of the other substance use statistics we have. But for contracting HIV, it is time. Sharing needles is the second riskiest way for IV drug users to contract or be exposed to HIV. The first is unprotected anal sex. Hiv and Hep C can be transmitted the same way as through needle sharing and works. So PWID, if you’re not familiar with that term, PWID is persons who inject drugs and HIV in the community. So within and and I’ve got some data that I’ll show you after we go through these I.V. drug use is the second leading cause of HIV infection for African-American women. I did not. I knew it was a high statistic, but I did not realize that it was the second leading cause of HIV for African-American women. That and then looking at all the other factors within within that community, you can begin to see why that might be. What are some of the contributing factors that can give that statistic the third leading cause for African-American men? So men who are in the African-American community, in the black community who are IV drug users contracted HIV is the third leading cause and then for HIV infection for women, it’s the second leading cause.
And so approximately one in 10 or 10 percent of the HIV diagnosis among Hispanic and Latino is attributed to IV drug use, and that breaks down to three percent of cases among men who have sex with men and intravenous drug use. White female IV drug users have the highest rate of HIV at 50 percent. Across the board, white males have the second highest. Then it is African-American females, African-American males and the Hispanic and Latino, the white female IV drug user having the highest rate across all communities. That community has seen the highest increase in HIV cases related to IV drug use in the United States within the last three years. I can tell you finding statistics specific to IV drug use and HIV for communities has been difficult. Hiv is still stigmatized and across the spectrum, especially when it comes to IV drug users, people are reluctant to talk about HIV and STIs because of this, because around sexual risk, they’re reluctant to discuss that, but they are really reluctant to discuss it. People who inject drugs along with HIV because of the stigma, the stigma that is still attached to IV drug use, you know, and people have all sorts of ideas about that. But when you’re looking at. Contracting or being exposed to viral epidemics like HIV, COVID, you know, other viral infections and bacterial infections. This is a part of the substance use spectrum that doesn’t always get treated the same way as somebody a seeking treatment for alcohol.
We’re seeking treatment for, you know. Prescription pill disorder or other illegal substance use or illegal substance use. So I mean, alcohol, but marijuana. Somebody who. This idea of somebody getting treated for IV drug use is not always seen the same way as somebody else who doesn’t have the stigma of that because of the idea of what that means or the judgment that we that somebody may have about what type of person is injecting drugs. So that is a lot of what I think people who are trying to seek help for IV drug use contend with especially in, you know, especially in minority communities, because again, of this idea that this is what an IV drug user looks like and these are the these are the ways that they got exposed, which is has much more stigma attached, especially when you look at some of the ways that people can support their IV drug use. So here’s one of them, this is across the United States, syringe sharing among people who inject drugs and twenty three U.S. cities. And I’ll give you the breakdown of the cities when I send out the slides. So if you look at at least thirty two percent of people who are using who are injecting or sharing syringes. Forty eight percent are age 18 to twenty four. Forty four percent. Twenty five to twenty nine. Thirty nine percent.
Thirty to thirty-nine. And you can see as people age, it gets higher as they move up generationally. But the thing is, it’s syringe sharing is most common among younger people. I can tell you from personal experience in terms of my working, I should say personally in my life as a professional, working with folks who are I’ve who use drugs, I’ve older adults that I have worked with 40 plus five plus who may actually be seeking treatment, who have sought treatment or sobriety and recovery to get clean and sober from IV. Drug use and primarily opiates who are older do not share needles because they understand the threat of HIV infection or of hepatitis or other related TB. So they don’t share needles and they’ve also, because they’re older, have more access to a clean needle through Medicaid, Medicare or other medical conditions that they may have that give them easier access to medical services so that they can get clean syringes in one way or another. But it’s mostly younger people. So I.V. drug use and viral infections, more and more people who become diagnosed with HIV through their through IV drug use also tend to have a co-occurring with Hep A, B, C or D. There’s also an increase in Hep C for hepatitis superinfection, which is hepatitis C and D together, which makes it much more, I’m sorry, hepatitis B and D, which makes it much more difficult to treat the hepatitis.
But also when you have HIV as a co-occurring, many of the treatments can interfere with the way HIV gets treated, along with treating somebody who is an IV drug user who wants to get sober and not use anymore. So that is that is definitely an increase that we’re seeing in terms of. Hepatitis super infection along with HIV, along with IV drug use. So looking at the way to treat that is as multi-pronged. So co-occurring is HIV and hepatitis. Hepatitis know HIV, hepatitis and tuberculosis, HIV and TB, HIV and STIs, STIs, hepatitis, TB and HIV. It is not uncommon when somebody is seeking services for treatment that is a person who has IV drug use to see. A combination or all of these things. It’s not unusual, especially depending upon behaviorally and environmentally what their approach has been and to getting high and what they have been doing in order to economically support themselves, either through basic needs and also in exchange for works, needles, drugs, whatever that might be for them. So typically, people who are HIV positive are at a higher rate for syphilis, gonorrhea and herpes than people who are not HIV positive, not that they’re not high risk infections to begin with. In terms of STIs, but it’s just people who have HIV are much more susceptible. And then or they if they’ve had it, they are much more likely to get HIV in the future. That is directly related to the behavior that that that caused exposure to STIs to begin with.
So and if there is not an intervention in the way that person is having sex in the way that person looks at sexual activity or even their partners engaging in sexual activity outside of the relationship or all of the different ways, if there’s no relational change in behavior, then typically the same activities that exposes them are the same activities that they will continue in, which increases their risk for HIV. And it might be that there is one partner who is an IV drug user and one who is not. And so that can also create the risk of reinfection and initial exposure. Infection is less likely if somebody is on art infection with being exposed to co-infection, so if somebody is taking antiretroviral therapy, they’re HIV positive, they are less likely to get syphilis, STIs, syphilis, gonorrhea and herpes if they are on art, even if they’re HIV positive. There is. There’s a less likelihood of even if through exposure, that they will go on to develop any sort of infection. Um, they you know, I mean, and so what we talk about choose less risky sex activities. Use a new condom for every act because even among younger people, there’s this idea that there seems. And when I say there seems to be, I can certainly look at statistics that might that can bear this out also in my professional experience and talking with other colleagues who work with young adults and adolescents.
This idea of if I have one condom, then that’s all I need is I just need to have one condom and I’m good throughout the entire experience, sexual experience on having, which is actually incorrect. A condom needs to be used for every new act within the scope of the experience that somebody is having within the sexual situation. So, you know, oral sex. One condom use thrown away. You move on to the next act. Intercourse. New condom thrown away. And that’s just because of breakage and not being able to contain not being able to contain bodily fluids. So there there’s a risk of there’s a risk of overflow. I mean, to be basically honest. So so the idea that if I’m using one condom for multiple acts, I’m safe. That’s not that’s not accurate. There’s there’s still a very high risk of exposure to STIs and HIV through that process. Risk is also reduced for HIV and co-infections. If a partner is using Prep, go back to the example somebody is an IV drug user and they are at a high risk. They get exposed, they have HIV. They do not go on HRT immediately. But they get so the other partner can be exposed for a long term use is what Prep is what they would use during the first 72 hours of initial exposure. I’m sorry, I went too fast. So here here is the latest for IV drug users who have.
Been exposed or diagnosed with HIV. This is definitely for those IV drug users who have new HIV diagnosis by sex, race and ethnicity in the transmission. So as you can see, if you look at red is for white, the gold is for black African-American and the blue is for Hispanic Latino across the board. Except in gay and bisexual men who inject drugs, the Hispanic and Latino has a higher than the black and African-American community, the white community across the board has much higher in every category. Men who inject drugs, this is this is not bisexual and gay men. These are men who identify as heterosexual. So you can see that. All of that just goes to show you that this is definitely an increase in what it has been over the last. The last time the study was done went through up to 20 16 has increased since then. Hiv treatment options for people who are injecting drugs. So this is really what it looks like when somebody has. Been exposed to HIV thinks they may have contracted it and initially generational testing, so they take a fourth generation HIV test when they go into a lab. This is what they’re going to get, hopefully, because not every lab does this, not not every agency does this and they’ll get STI testing. So if they are negative, then one of the things that they will be getting, the first thing that they look at is is their HIV status.
If they are negative, one of the things that they’ll be discussed is assessed for Prep or PEP, because even if they’re negative, it might be depending upon the way they were exposed could be Pep could be appropriate. If not, if Pep is not appropriate, then definitely prep, which is pre-exposure. And that is an ongoing medical intervention that people can use if they engage in behaviors that have a very high likelihood of exposure, whether it’s I.V. drug use, whether it is risky sexual behavior or a combination of both. For people who inject drugs, it’s usually a combination of both risky sexual behavior and the fact that they’re using drugs intravenously. The other thing so that then they will go and look at risk of STIs, prep or pet adherence interventions. What are some ways that you can decrease your risk? Does that mean you stop using? Does that mean you go to treatment? Does that mean you need economic? You need economical support, behavioral intervention, social services? What do you need in order to support moving into less risky behavior? And then if they if they decline, prep because not everybody decides they want to go on prep, even the partner of somebody who is with an IV drug user, even though they may not use IV drugs. And it would benefit them to go in Prep, they may choose not to.
They may say, You know what, I don’t want to go on Prep and some folks. Even if their partners HIV positive. I just don’t want to do Prep. They refuse to. They are willing to practice safe sex, that they’re not willing to take the medication that is required. So if somebody again is negative, if they are refusing any sort of risk reduction that has been offered to them, it is suggested that they retest every three to six months and at the time of retesting, continue to assess and invite any sort of behavioral health or social services that they can take advantage of. So for somebody who tests positive, the acute infection is the immediate care needs to be definitely getting him to link to long term care, assessing for initiation of when antiretroviral can start services for their partner, services for their partner at this stage may be a pet, which is post-exposure prophylaxis, which is the medical regimen they would take. After they’ve been exposed and within the first 72 hours, and they usually that is taken for up to 30 days. Again, behavioral health and social services are offered and hopefully when that intervention happens that they will be willing to take advantage of. And then for established ongoing HIV infection, again, maintaining the link to care with their doctor and maintaining A.R.T. partner services again could include after Pep has been completed. Starting prep because if this person is in has an established HIV infection until their viral load is low enough or undetectable for a partner to decide to discontinue prep, most health care providers are going to suggest that the partner continue prep until such time that either viral load is undetectable or they choose not to do it anymore, or there’s been a behavioral change.
So here are the statistics in Texas that I could find it was a little bit difficult. I had to use the Teds research and so it’s a little bit dated in terms of it’s not it’s not necessarily within the last 24 months, it would be three years plus. So for people seeking treatment, people who inject drugs and are HIV positive, seeking treatment. Thirty three percent of all patients that were admitted to treatment facilities that receive public funds where IV drug users, the National Early Warning System, reports that eighty five percent of heroin users, thirty one percent of methamphetamine and two percent of cocaine were primarily IV users. That was their preferred method of administration. It wasn’t snorting. It was. Direct I’ve. You know, and again, you can see you begin to see the connection to opiate use and especially there’s been an increase in IV methamphetamine use sent during COVID. So that was twenty eighteen for people who inject drugs and have a positive hepatitis. 50 to 90 percent are co-infected with HIV and have IV drug and have IV drug use. So 50 percent. To 90 percent of IV drug users who have HIV continue to inject and also have co-occurring hepatitis or some, whether it’s Hep C.
The problem, the problem that somebody runs into with having a co-occurring infection of Hep C and HIV, depending upon what stage they are in. Meaning if they are, if it is, if it is established or it’s early can also have an impact on the way that that hepatitis C is treated. Typically, hepatitis C is treated now it’s a series of shots every day over a period of time. That again, similarly undetectable viral load for hepatitis C, the hepatitis C is hepatitis C is not detectable, and it’s considered that the person no longer has Hep C running that treatment. Concurrent with A.R.T. or presents can present some problems with with medical contraindications and medical interactions. And then, along the time, also having somebody try to get sober of IV drug use. So IV drug use is in Texas is 14 percent higher than the national average. One of the things that I learned in looking at the latest statistics is that. Texas has higher than national average and a lot of areas across IV drug use in HIV and in the way not only that, but in the way that we treat it in state facilities and sometimes even in private facilities. So as of 2017, only thirty five percent of facilities in Texas screened for hepatitis. In a recent survey, federally qualified health centers and treatment facilities found that 61 percent of those facilities surveyed reported not having.
Hepatitis testing because of capacity or lack of funding. Most of them looked at lack of funding. So which is which can be scary. I mean, when an IV drug user seeks services, they it’s really a multi-pronged approach. They need testing across the board for STIs. Hiv exposure, hepatitis, all the hepatitis and then looking at any sort of liver dysfunction and then now with the newer diagnosis of endocarditis, I mean, looking at that too. So I mean, it’s a full medical workup. And you know, when somebody seeks treatment, though, those medical services or labs may not be available to them. You know, they only meet or they may only really be testing for most basic STI exposure and HIV exposure, not necessarily hepatitis. So really the best way in treating somebody who was an IV drug user with HIV? And again. Somebody who is HIV, somebody who’s been exposed to HIV and who’s not an IV drug user that is coming directly through usually their sexual behavior or somebody who is an IV drug user because that is the highest, the second highest risk behind sexual behavior. Those numbers are going to be much higher and can be where they can be more of a challenge to address because for somebody coming off IV, drug use can be incredibly, it’s an incredibly hard detox. It’s an incredibly hard way to. Administration route to stay away from because it’s so instantaneous, especially with opiates and amphetamines, so assessment and referral for both set and mental health treatment and then the most appropriate care for any HIV hep C or co-occurring infection diagnosis that happens, which includes TB, because many times the environments that high IV drug users might be using or living in, there is very high risk for exposure to TB harm reduction.
So when we talk about I’ll get to that in a second. So harm reduction approaches, medication assisted treatment, SSP syringe service programs. There’s six in Texas, Dallas, Houston, Waco, Austin, Fort Worth and Abilene. There is a website that you can go on, which will give you a direct connection to those clinics and they give a number and they they may talk about what services they offer. They may not. Usually they work under the radar. They offer services typically across the spectrum, where somebody can pick up clean syringes in the process of. They also will get an assessment introduction to any services that they may need. Being able to talk to somebody about how to get sober, how to get treatment, how to get testing for HIV, they can do labs there. What they will not get is they they cannot go there just to swap syringes. They cannot go there for a safe use room. We don’t have those other states do, but Texas does not. So I talked about pet exposure within seventy two hours. You’ve got to take it for twenty eight days.
It is not an ongoing treatment. It is usually one time emergency use only after immediate exposure prep. It doesn’t always work. It does not always work, it doesn’t always block the HIV vaccine. It doesn’t always block HIV from entering the cell. But what it’s designed to do, and most for most folks, it blocks the virus from entering the cell. It really just kind of puts a cocoon around it. It’s one pill daily for 30 days. Again, it’s not guaranteed. It is strict adherence for the best possible outcome. Part of that can mean is that when you’re looking at trying to get services for somebody, for kids is that it really is looking at behavior across the spectrum to address what the trigger could be for them to continue using one. So with women, you have a very high rate of them going into sex work to try to make money to use or because that might be if they are if they are being trafficked, that that’s the only way that they can get drugs to support their habit. So there’s lots of different there’s lots of different behaviors that can be double exposure and higher in doubling and tripling high risk, depending upon again in the community. And it also depends upon gender what they’re doing and what if there’s trafficking involved and especially with younger adults, too.
So that’s a lot of information. And again, we’ll give resources at the end when Krystle sends out the slides. If you have any questions, please let me know I’m happy to answer them. What do we got? Awesome. We do have a couple, and so I don’t want people to think I was ignoring them. I was just kind of like waiting till the end. So one of them, I was able to answer quickly. So I just went ahead and did that. But this person says, Is there a risk with oral sex? Sure. Oh, absolutely. Any time that there is an exchange of bodily fluid in any way, shape or form during sexual activity or IV drug use, there is always a risk. Condoms and and condoms. Are safer sex. They’re not a complete. They’re not they’re not a complete barrier because condoms break. There is always there can be there’s always a chance that there can be some fluid leakage before before the sexual act takes place. There’s lots of different ways that people can be exposed. Condoms provide safer sex. So yes, there’s definitely a risk with oral sex. So when when young people say, well, you can’t get HIV with oral sex, we’re not having intercourse? That’s not true. Right? So one of the one of the Nancy, I think it was made a comment and and I appreciate that, he said that prep isn’t only for 30 days. It can be. It can be continually used.
It can be consistently used. That is correct. And thank you, Nancy, for making that known. Prep can be ongoing. It’s not just one time. PEP is one time in an emergency situation, but Prep can be ongoing. So a partner, you know somebody who’s HIV positive their partner can be taking prep for, you know, for multiple months and they’re under a doctor’s care and they go back in and have their labs run. But yet that can be one of the most significant and successful ways to reduce the risk for a partner to become HIV positive with regular exposure. There’s also other behavioral interventions, along with Prep. So yes, so thank you, Nancy. It can be consistently used as an HIV intervention in relationships. Yeah, yeah. So this person said, What does in Prep or in Prep state mean? You’d mentioned it in the thing? So Pep is pre-exposure as post-exposure prophylaxis, and what that means is that when the individual has been exposed to HIV within the first 72 hours, if they start, if they start Pep, then what will begin to happen is that they’re it’s it’s designed to attack the HIV to attack the HIV virus so that and also protect the T-cell so that it doesn’t somebody doesn’t become positive. The answer to that correctly. Yeah.
Ok, let me see. Ok, can you separate the statistical data into homeless versus non homeless and how does your approach to helping them differ? That’s a loaded question. That is, you know what? So. Can I separate the statistical I can? Here’s what I’d like to do, so I can give you accurate information, and I may not have as much. I don’t have as much time with what we have left. If you want to. You can, if you want. Go ahead, and if there’s a way that I could get your email, if you want to send me a chat directly, I can get your email and I’m more than happy to respond for those in the dating world and both agreed to be tested before becoming sexual. How accurate are all tests? Well, in terms of how accurate are all tests, I mean, each test is for the individual and typically tests for tests are accurate. If you’re looking at getting pre tested, you know I’m tested for HIV before a couple engages in sexual activity. Does that in both tests are negative? Are they accurate? Sure, they may be accurate in the moment. However, that doesn’t always clear somebody to not be exposed to HIV if the behavior of one partner both put them in a high risk situation within the last 60 or 90 days. You know, so so if you’re asking if somebody can be tested and have a negative, a negative test, they can and engage in behavior in which they are exposed to HIV and become positive, yes, they can.
Right. So that window? This person said when living with a family member with HIV and being tested twice within a year, is there any concern after of exposure? I guess maybe they’re not living with them anymore. No, it depends on if the testing, I mean a it would depend upon, you know, it was a testing done. I’m not I’m not clear on the question was the testing done after? The exposure is that person lived with the person and then was tested twice within the next year. Is there any concern after that of being exposed? That’s what I think, but I’m not sure. I’m not necessarily understanding the question, I apologize, because it sounds like if if the if you’re living with somebody who is HIV positive and there was possible exposure and the person was tested, tested multiple times after exposure and it was negative depending upon how the exposure happened and what their medical provider suggested. I mean, they may have been a candidate for Prep. I mean, for Pep, I don’t know. But if they tested negative twice, then the test is negative. Um, so here’s another one, if a person has tested positive for Hep C, but no longer test, but but is no longer testing, is it active and the test results? Do they still have to take precautions when engaging in sex? That’s a personal choice.
You know, depending upon what other behaviors may be present in the relationship. So typically when somebody after somebody has gone through, you know, the newest medication regimens for Hep C, they no longer hep C positive, you know, so could they engage? Could they have unprotected sex? Sure. Yet there’s there could also be extenuating circumstances in that relationship and different behaviors that still create high risk exposure other than Hep C. Right. So I hope that answers the question. Yeah, I think I had a friend that had hepatitis C was treated for it, had a baby and there was no risk for transfer to the baby because there was no viral load. And so I think, you know. With hepatitis, it’s different because once you’re treated, you’re it’s not they don’t give you a cure, but it’s no really not. It’s not this. It’s not transmittable, really, but there’s still other risks, like you said. So, you know. Okay, so Patricia, I see your comment that you’ve been in the arena since the 80s and not much has changed, except medication. I agree. You know, they’re definitely across the spectrum in all communities needs to be much more discussion about educated education related to high risk behaviors, behavior modification where we can begin to talk about actually people do have sex. And so what can we do if they’re going to have sex to and they use drugs when they have sex? So what can we do in order to make that a safer experience for them instead of saying, well, they’re not going to do it? We just need to shut it down.
You know, that’s really part of a harm reduction approach. That’s prevention, and harm reduction can be part of prevention. You know, from the perspective that what ways can we look at actually, if you’re going to do this behavior, this behavior is safer than that behavior to prevent you from becoming exposed. So there’s lots of different ways we can approach it. You’re right, we don’t talk about some of that because many people think if we talk about it from that perspective, we’re condoning it. And it’s not that it’s it’s not a matter of condemning or condoning. It’s really just a matter of helping people be safer. And again, continuing to talk to them about the benefits of behavioral change and sobriety. And, you know, being able to maintain that, especially if they’re HIV positive. So thank you all very much. Again, I appreciate everybody’s input. If there’s anything that you have that you want to share with me, I will. My contact information is on the side. Please, I don’t. I certainly by no stretch of the imagination know everything. And there seems to be many of you have been working in the field a long time, too. So I’d love your feedback. So thank you. You all have a great weekend. Thank you, Lisa, and all. Thank you for tuning in.