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Drug Consumption Patterns, Sexual Behavior and Hiv Risk Among Low-Income Drug Users in Guatemala City

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Drug Consumption Patterns, Sexual Behavior and Hiv Risk Among Low-Income Drug Users in Guatemala City DRUG CONSUMPTION PATTERNS, SEXUAL BEHAVIOR AND HIV RISK AMONG LOW-INCOME DRUG USERS IN GUATEMALA CITY DRUG CONSUMPTION PATTERNS, SEXUAL BEHAVIOR AND HIV RISK AMONG LOW-INCOME DRUG USERS IN GUATEMALA CITY November 2012 Authors: Jane T. Bertrand, John Hembling, Pablo Ceballos and Lisa Johnston The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). Page 1 Drug consumption patterns, sexual behavior and HIV risk low-income drug users in Guatemala City ACKNOWLEDGEMENTS This study was funded by the United States Agency for International Development (USAID) as part of Project SEARCH, Research-to-Prevention (R2P) Project, based at Johns Hopkins Bloomberg School of Public Health, contract number #GHH-I-02-07-00032-00. PASMO (the Pan American Social Marketing organization, which is the Central American regional office of Population Services International) was responsible for data collection and analysis; SECCATID (the National Commission on Addictions and Illicit Drug Trafficking), represented by Maria Antonieta Solorzano, provided useful input to the design of the study and interpretation of the findings. The authors wish to acknowledge the contributions of Ivan Bautista (supervisor); David Echeverría, Arturo Jarquín and Sylvana Marsicovetere (interviewers); Pilar Sebastian (logistical support in her role as Director of Programs for PASMO/Guatemala); and Drs. Gabriela Paz-Bailey and Sonia Morales (consultation on the use of RDS in the region). Giovanni Melendez of USAID/Guatemala provided excellent guidance on this study and reviewed drafts of the findings. Drs. Deanna Kerrigan and Caitlin Kennedy of Johns Hopkins provided recommendations over the lifetime of this project, including data analysis and review of the manuscript. Alison Cheng, Clancy Broxton, Darrin Adams, Mike Melchior and Delivette Castor of USAID/Washington reviewed earlier drafts of this report and provided useful insights. Caitlin Evrard of Tulane University assisted with the design of the tables, literature review, and editing. Emily Hurley and Brandon Howard of Johns Hopkins contributed to the final editing and formatting. Recommended citation: Bertrand JT, Hembling J, Ceballos P, and Johnston L. Drug consumption patterns, sexual behavior and HIV risk among low-income drug users in Guatemala City. November 2012. Baltimore: USAID | Project Search: Research to Prevention. Page 2 Drug consumption patterns, sexual behavior and HIV risk low-income drug users in Guatemala City TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................... 2 LIST OF FIGURES.................................................................................................................... 4 LIST OF ACRONYMS ................................................................................................................ 5 EXECUTIVE SUMMARY ............................................................................................................ 6 INTRODUCTION ..................................................................................................................... 8 Background .................................................................................................................................................. 8 Study Scope and Objectives ....................................................................................................................... 10 METHODS ........................................................................................................................... 12 Eligibility ..................................................................................................................................................... 12 Estimation of the size of the drug user population in Guatemala City ...................................................... 12 Cross-sectional survey ................................................................................................................................ 14 Human subjects approval ........................................................................................................................... 19 RESULTS ............................................................................................................................ 20 Estimation of the size of the drug user population ................................................................................... 20 Cross-sectional survey ............................................................................................................................... 20 DISCUSSION........................................................................................................................ 33 Limitations of the study ............................................................................................................................. 33 Comparison of these findings with other research on these topics .......................................................... 35 Topics for further research ........................................................................................................................ 36 Programmatic implications ....................................................................................................................... 37 Conclusion ................................................................................................................................................. 38 REFERENCES ...................................................................................................................... 39 APPENDICES ....................................................................................................................... 44 Appendix A: Tables .................................................................................................................................... 45 Appendix B: Unique object tracking log .................................................................................................... 72 Appendix C: Locations identified as venues for drug distribution or use ................................................ 74 Appendix D: Data on attitudes, motivations, self-efficacy and other psycho-social variables related to condoms and condom brands ....................................................................................................................75 Page 3 Drug consumption patterns, sexual behavior and HIV risk low-income drug users in Guatemala City LIST OF FIGURES FIGURE 1: Sequence of events for potential respondents upon their arrival at the Fundación Marco Antonio in Guatemala City ...................................................................................................... 17 FIGURE 2: Recruitment chains ................................................................................................ 21 FIGURE 3: Drugs first used by respondents ............................................................................... 22 FIGURE 4: Access to drugs ..................................................................................................... 24 FIGURE 5: Condom use by partner type ................................................................................... 27 FIGURE 6: Overlap of sexually active drug users with other key populations ................................... 28 FIGURE 7: Overlap of elevated risk of HIV among sexually active males ......................................... 29 FIGURE 8: Overlap of elevated risk for HIV among sexually active ................................................. 30 Page 4 Drug consumption patterns, sexual behavior and HIV risk low-income drug users in Guatemala City LIST OF ACRONYMS FMA Fundación Marco Antonio (Foundation Marco Antonio) HIV Human immunodeficiency virus IRB Institutional review board MSM Men who have sex with men NIDU Non-injection drug use NGO Non-governmental organization PASMO Pan American Social Marketing Organization PWID People who inject drugs RDS Respondent driven sampling SD Standard deviation SECCATID Secretaría Ejecutiva de la Comisión Contra las Adicciones y el Tráfico Ilícito de Drogas (National Commission on Addictions and Illicit Drug Trafficking) STI Sexually transmitted infection SW Sex worker USAID United States Agency for International Development Page 5 Drug consumption patterns, sexual behavior and HIV risk low-income drug users in Guatemala City EXECUTIVE SUMMARY Background HIV prevalence in Guatemala is estimated at less than 1% and is thought to be concentrated in a few key populations of at heightened risk. At present, these key populations include female sex workers (SW), with an estimated HIV prevalence of 4.3%, and men who have sex with men (MSM), with a prevalence of 12.1% (UNAIDS, 2008; Soto et al., 2007). However, in recent years the question has emerged as to whether drug users constitute a third key population in this setting. In light of the emerging recognition that not only injection, but also non-injection, drug use can heighten the risk of HIV transmission, this study was conducted to measure and analyze patterns of substance use, sexual behavior, and HIV prevalence
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