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CHRP Grant Spotlight

HIV CRIMINALIZATION IN CALIFORNIA

California has five HIV-related laws that criminalize a range of activities – from engaging in condomless sex without disclosure with the intent of transmitting HIV to donating bodily fluids or organs while aware of ones HIV-positive status – regardless of if transmission occurred. Grantees from the California HIV/AIDS Policy Center set out to gain a better understanding of the use and enforcement of these laws. They found that between 1988 and 2014, 800 individuals in California were arrested or cited under an HIV-related criminal code. Black and Latino individuals accounted for 67% of these cases and 43% were women, though these groups only account for 51% and 13% of people living with HIV in California, respectively. Almost all (95%) of these individuals were engaged or believed to be engaged in sex work. While only 31% of arrests or citations resulted in HIV-related charges being brought against the individual, all but one of those charges resulted in conviction. White men were much less likely to be charged. Future research is needed to better understand the disparities in the enforcement of these laws within California.

INSURANCE COVERAGE FOR PLWH

Our California HIV/AIDS Policy Centers grantees conducted a qualitative study to examine factors influencing the functioning of the Office of AIDS Insurance Premium Program (OA-HIPP) in California, a program designed to help people living with HIV (PLWH) obtain private, comprehensive health insurance. At that time, they found that awareness of OA-HIPP was low and that it suffered from several programmatic challenges. Cited issues included interviewees losing their insurance coverage due to issues with OA-HIPP payments, difficulty navigating the process of traditional insurance structure compared to the Ryan White program, and troubles with responsiveness and availability of staff. A large contributor to the programmatic issues was overburdened enrollment and OA staff, especially as enrollment increased due to the Affordable Care Act rollout.  Overcoming these barriers will allow for a greater number of PLWH to not only gain access to more comprehensive healthcare coverage, but also increase the quality of their experience in obtaining and maintaining coverage. 

Food Insecurity and HIV

Understanding the structural factors that contribute to increased risk of HIV infection and poorer outcomes for those living with HIV is essential as we work to curb the epidemic here in California. One of our grantees, Dr. Sheri Weiser of UC San Francisco, did some pioneering work in this arena, with a focus on food insecurity. She found that homeless people living with HIV (PLWH) who also experienced food insecurity had poorer treatment adherence, were less likely to be virally suppressed, and had lower CD4 counts compared to homeless PLWH who did not experience food insecurity. Her work also found significant associations between food insecurity and HIV risk behaviors among PLWH – those who experienced food insecurity had more unprotected sex, more sex partners, and increased use of illicit drugs compared to PLWH who did not experience food insecurity.  HIV treatment programs need to integrate ways to address food insecurity in their programming for treatment efforts to be sustainable and effective. (Weiser, ID08-SF-054)

HIV and mental illness

Individuals with bipoloar disorder who are also living with HIV are at increased risk for poor medication adherence. One of our grantees, Dr. David Moore of UC San Diego, developed a text messaging reminder system (iTAB) to improve medication adherence in this population –for both anti-psychotic and HIV meds. He found that individuals in the text message reminder arm had significantly better adherence for both types of medication (compared to the control arm). The intervention also helped decrease variability in the time of day people took their medications. Dr. Moore’s work didn’t stop there. He is now working on applying his customizable text messaging reminder system to other populations at risk, and his CHRP-funded research has led to the award of an NIH grant. For this grant, the original iTAB system was modified and transformed into one that was targeted for a new demographic: HIV+/Methamphetamine dependent individuals. The texting for adherence model is also serving as the basis for another CHRP-funded project: a text message intervention for adherence among HIV-uninfected individuals using Pre-Exposure Prophylaxis as HIV prevention. (Moore, ID09-SD-047)

HIV and Incarceration

Incarcerated individuals have competing priorities once released. These include substance abuse treatment, finding housing, getting financial assistance, and re-establishing personal connections in their communities.  Ensuring they have access to HIV treatment may not come high on that list. Dr. Maria Luisa Zuniga of UC San Diego set out to explore what happens to access to treatment among people living with HIV (PLWH) once released from jail or prison. She found that among individuals who were able to adhere consistently upon their release cited having extra doses available at their homes, receiving assistance from a case manager, and having made adherence a personal priority. Individuals unable to maintain adherence upon release cited not possessing extra doses or inability to pay for medication as reasons for non-adherence. Future interventions are needed to ensure PLWH being released from prison or jail can maintain or re-engage in effective HIV care and treatment programs – reducing the burden of HIV treatment on their list of competing priorities. (Zuniga, ID09-SD-016) 

Water in gay bars as HIV prevention tool?

Can improving access to water in bars and providing patrons with blood alcohol level information decrease alcohol consumption and impact alcohol-associated HIV risks? Edwin Charlebois and his research team set out to answer this question. They knew that gay bar patrons are at higher risk for alcohol associated HIV risks, and drinking water in bars is one commonly used way to decrease alcohol consumption. But water is not always easily accessible in bars – so this team of researchers decided to develop and test an intervention to change that. At selected gay bars the team installed a free, self-service filtered water dispenser to help bar patrons pace their alcohol use. They also provided those leaving the bar with the option of having their blood alcohol levels measured and seeing how their levels compared to others exiting the bar.  What they found was that most men in their sample were at high risk for HIV and about a third reported that alcohol use affected their condom use decisions. Most men they interacted with found the breathalyzer acceptable and liked hearing how their blood alcohol levels compared to others. The researchers also looked at other bar-related factors that contributed to increased alcohol intake – they found that the strength of the drinks served (more alcohol by volume in gay bars than other bars) and discounted drink sales (more frequent in gay bars) both resulted in patrons drinking more alcohol. The research team received an NIH grant to expand this study, and early results from that work showed a significant reduction in alcohol consumption in the intervention bars compared to control bars. The researchers suggest this as a feasible intervention to reduce blood alcohol concentration alcohol-associated HIV risk among gay bar patrons. (5R21AA020467-02). 

Community Viral Load

Das-Douglas’ team set out to see if they could use measures of HIV viral load at the community level (CVL) to explain changes in the number of new HIV infections in San Francisco. They knew that more people on treatment would lead to more people being virally suppressed, which in turn would lower the overall viral load at the community level. They found that decreases in annual CVL measures in San Francisco were significantly associated with decreases in the number of new HIV diagnoses over time, and accompanied by a decline in estimated HIV incidence by over one-third from 2006–2008.  Declines in CVL in San Francisco coincided with an increase in ART uptake among people living with AIDS, availability of more effective, potent, and tolerable ART regimens, and a significant increase in the population rate of virologic suppression. Declines were also concurrent with changes in laws and policy initiatives facilitating HIV testing, increasing acute HIV detection, improvements in partner services, and a reduction in the rate of unknown HIV infection. The team’s findings support the notion that reductions in CVL can in turn reduce HIV incidence at the population level. Not only that, their results also support the use of CVL as a surveillance measure for treatment effectiveness and HIV transmission risk in a given jurisdiction. They also note that geographic mapping of CVL levels could help identify “hotspots” or disparities, allowing more targeted interventions.  The researchers recommend using CVL as an indicator of the overall success of ART uptake and for HIV prevention efforts, an indicator that will significantly help us evaluate “getting to zero” efforts across California. See the team’s full results here.