HIV This Week

Rose VJ, Raymond HF, Kellogg TA, McFarland W. Assessing the feasibility of late night harm reduction services for MSM: The breakfast buffet. Harm Reduct J 2006;3:29. http://www.harmreductionjournal.com/content/3/1/29

Despite the levelling 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. Among anonymous HIV testers in San Francisco, HIV incidence among methamphetamine users was 6.3% compared to 2.1% among non-methamphetamine users. Of particular concern for prevention programmes are frequent users and HIV positive men who use methamphetamine. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours. Rose and colleagues conducted the Late Night Breakfast Buffet study to determine the feasibility and uptake of harm reduction services by a late night population. The buffet of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI) testing accompanied by counselling and consent procedures. The study had two components: harm reduction outreach and a behavioural survey. For four months during 2004, fixed site van-based harm reduction services were provided in three neighborhoods in San Francisco from 1 - 5 a.m. for anyone out late at night. The authors exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM aged 18 – 55 years enroled in the study component. The ethnically diverse MSM population was characterized by low levels of income and education whose Seventy-eight percent used methamphetamine in the last 3 months. Of the 65% who ever injected, 97% injected methamphetamine. Almost one-quarter had used methamphetamine every day in the past 90 days and 13% had injected it several times a day. The majority of unprotected sexual encounters among both HIV negative and HIV positive MSM occurred while using alcohol or methamphetamine. The authors conclude that they reached a disenfranchised population of methamphetamine using MSM who are at risk for acquiring or transmitting HIV infection through multiple high risk behaviours, and established the utility and acceptability of late night needle exchange for the late night population and MSM who inject drugs.