Black Men

What are Black Men’s HIV Prevention Needs?

Who are Black men?

In the U.S., Black men include different ethnic groups from the African Diaspora. They are friends and diverse family members: fathers, grandfathers, husbands, partners, brothers, uncles, sons, nephews, and cousins. They are colleagues working in professional and blue-collar jobs. They also represent different sexual orientations, have diverse spiritual and religious beliefs, and speak different languages, among having other demographic differences.

 Why is HIV a concern among Black men?

HIV is a health emergency among Black men of every age and sexual orientation. In 2017, 32% of HIV infections diagnosed in the U.S. were among Black men. They were diagnosed eight times more than white men and two times more than Hispanic men (1). One in every 22 Black men will be diagnosed with HIV in their lifetime. Among the general population of men, Black men have a higher risk of HIV, noted by the differences below that will continue if current trends are not reversed (2-4).

  • Men who have sex with men (MSM): black (1 in 2); general MSM population (1 in 6)
  • People Who Inject Drugs (PWID): black men (1 in 11); general male PWID population (1 in 42)
  • Heterosexual men: black (1 in 97); general heterosexual male population (1 in 524)

Black MSM (BMSM)—including gay and bisexual men (same-gender-loving men [5])—are more likely than other MSM to be diagnosed with HIV (38% in 2017) (6). Young Black MSM (YBMSM) are most at risk (7). Seventy-five percent of all BMSM diagnosed with HIV in 2015 were ≤ age 34. Many studies have shown that BMSM’s engagement in condomless anal intercourse (CAI) and number of sexual partners are similar to or less than MSM of other race or ethnic groups. However, BMSM are more likely to be diagnosed with HIV. In one study, YBMSM were nine times more likely to be living with HIV than white participants with similar risks (9). The awareness of and demand for Pre-Exposure Prophylaxis (PrEP) – a proven biomedical intervention – is lower for BMSM than white MSM (WMSM) (13). In 2016, 68.7% of the PrEP prescriptions in the U.S. were to Whites, 13.1% to Latinos, and 11.2% to African Americans (14).

What are HIV risk factors for Black men?

Stigma and Discrimination – When Black men experience stigma or discrimination, they are less likely to use PrEP (15), disclose their HIV status (16), and are at higher risk for sexually transmitted infections (STIs, including HIV) (17). Moreover, discrimination-related traumas, based on being gay, black, or living with HIV, are associated with greater CAI (18). High HIV infection rates, racist attitudes of non-Black gay men, and social networks and environments where gay men gather have been found to stigmatize and isolate BMSM from other MSM (19). BMSMW (Black men who have sex with men and women) are even less likely than BMSM (only men) to know their serostatus and less likely to be engaged in care or be virally suppressed (20).

HIV Care Continuum Disparities – Poor retention of Black men in health care is deeply rooted in discriminatory practices of the medical system towards the Black community (21). Consequently, BMSM are less likely than white MSM to know their HIV status, more likely to be diagnosed later, and less likely to stay engaged in care and on treatment (22-23) (and be virally suppressed, with rates lowest for YBMSM [24]). In order to make effective use of the approach of treatment as prevention (TasP; 25), which means preventing HIV transmission by getting a critical mass of people living with HIV diagnosed and virally suppressed, there must be sufficient numbers of persons living with HIV who get diagnosed and treated (26-28). 

Poverty – Discrimination and reduced access to and retention in quality education are reasons that Black men experience more unemployment or are underemployed, compared to white men (29). Consequently, Black men are more likely to be living in poverty, which usually means reduced access to quality health care, compared to white men (30). Rates of HIV increase 3.0 to 5.5 times with increasing neighborhood poverty level from < 10% (low poverty) to more than 30% (very high poverty level) (31-32). For Black individuals living with HIV, poverty is associated with lower levels of engagement in HIV care (33).

Sexual Trauma – Sexual abuse and assault rates are high among MSM and are related to greater risks of HIV infection. In the EXPLORE Study, 39% of MSM reported childhood sexual assault; Black participants were more likely to have a history of assault than no history of assault (34-35).

Sexually Transmitted Infections (STIs) – Having an STI can increase the chances of transmitting or becoming infected with HIV (36). STI disparities in the Black community increase the likelihood of transmission (37-38). 

Social networks and sex with men of their race – The high HIV rate among BMSM and their preference for sex with MSM of their same race increase the chances of BMSM having a sexual partner that is living with HIV. A review of studies found that at least 29% of BMSM in networks having sexual contact were living with HIV and 47% of men living with HIV in these networks did not know their status (39). 

What are not HIV risk factors for black MSM? - A review of the literature (40) has concluded that Black MSM engage in fewer HIV risk behaviors than other MSM. For example, Black MSM reported less UAI with primary male partners, few male sex partners, and less substance use during sex than other MSM. Risk factors such as poverty and STIs are more important drivers of HIV transmission among BMSM than individual risk behaviors. 

What is being done?

Research findings for black men of diverse ages, sexual orientations, and HIV serostatus, discussed below, have been shown to reduce sexual risk behaviors and increase engagement in HIV care (41).

Randomized Comparison Group Interventions: Research on one tailored program shows promise for encouraging BMSM to initiate PrEP (42). Six interventions studied in a Randomized-Controlled Trial (RCT) setting, Many Men Many Voices (3MV)(43), Brothers to Brothers (44), Men of African American Legacy Empowerment Self (MAALES)(45), Being Responsible for Ourselves (BRO)(46), Unity in Diversity (UND)(47) and Harnessing Online Peer Education (HOPE)(48) report positive findings about reducing risky behaviors. The intervention nGage, designed to increase retention in care for YBMSM utilizing support confidants, found participants 3 times more likely to have had at least 3 provider visits over 12 months after the intervention (49). 

Pre- Post-Test/Repeated Survey Interventions: Black MSM who participated in ‘d-up: Defend Yourself!’ (50), Connect with Pride (51), BRUTHAS (52), Motivational Interviewing (MI) (53), or (SPNS) (54) interventions report improved outcomes, compared to those with limited or no participation. Different studies also reported improvements in social support, self-esteem, and loneliness, as well as improved likelihood of HIV counseling and testing, return for test results, and fewer missed HIV medical visits. For one study, as the number of hours spent attending case management meetings increased, the time in HIV care increased. Finally, a community-level intervention utilizing the Popular Opinion Leader model, based on d-up! and adapted for YBMSM in the House Ball Community, Promoting Ovahness through Safer Sex Education (POSSE), saw declines for multiple sexual partners, TASP with any male partners, and with male partners of unknown HIV status (55).

Blended Pre- Post-Test and Control Group: Young MSM of color who participated in STYLE (Strength Through Youth Livin’ Empowered) reported 83% retention in care, and the chances of attending a clinic visit was greater for the STYLE participants than non-participants (2.58, 95% CI 1.34-4.98) (56).

What still needs to be done?

Prevention prioritizing Black men should not simply address high-risk sexual behaviors but also societal and structural issues. We need policies that will prevent new infections and add to our understanding of disparities, including structural interventions (57-58). We need to combine behavioral and biomedical interventions; abandon a “one size fits all” approach; address high STI rates, traumatic events and structural and access barriers; and, consider the intersection of health and social conditions. The need to address stigma must not be lost. Data must be presented with background, community perspective, and accurate explanation. HIV disclosure must include strategies to help partners and family members receive information that their loved one is gay or living with HIV. Broad implementation of successful interventions in areas where HIV is highest for Black men is necessary.

Says who?

  1. CDC. HIV among Afr. Americans. September 2019 (
  2. Gavett G. Timeline: 30 Yrs. of AIDS in Blk. Americans. KQED Frontline. Jul 10, 2012.
  3. Hess K, et al. Est. lifetime risk of dx of HIV infect in the U.S. CROI 2016. Boston, abstract 52.
  4. Hess, KL et al. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017 April; 27(4): 238–243. 
  5. Truong N, et al. What is in a label? Multiple meanings of 'MSM' among same-gender-loving Black men in Mississippi. Glob Public Health. 2016 Aug-Sep;11(7-8):937-52.
  6. CDC. HIV and Gay and Bisexual Men. September 2019.
  7. Mitsch A, et al. Age-associated trends in diagnosis and prevalence of infection with HIV among men who have sex with men – United States, 2008-2016. MMWR Mob Mortal Wkly Rep. Sep 2018; 67(37):1025-1031.
  8. CDC. HIV and African American Gay and Bisexual Men. September 2019.
  9. Millett GA, et al. Greater Risk for HIV Infect of Blk MSM: Lit Rev. AJPH. Jun 2006;96(6):1007-19.
  10. Millet GA, et al. Disparities in HIV Infect among Blk and Wht MSM: Meta-Analysis. AIDS. Oct 1 2007;21(15):2083-91.
  11. Magnus M, et al. Elevated HIV Prev. Despite Lower Rates of Sexual Risk Behav among Blk MSM in DC. AIDS Patient Care STDS. Oct 2010;24(10): 615–22.
  12. Maulsby C, et al. HIV among Blk MSM in the U.S.: Lit. Rev. AIDS and Behav Jan 2014;18(1):10-25.
  13. Cohen SE, et al. Response to race and PH impact potential of PrEP in the U.S. J Acquir Immune Defic Syndr. Sep 1 2015;70(1):e33-e35.
  14. Highleyman L. PrEP use rising in U.S. but large racial disparities remain. Jun 24, 2016.
  15. Chaill S, et al. Stigma, med mistrust, and racism affect PrEP awareness and uptake in Blk compared to Wht MSM in Jackson, MS and Boston, MA. AIDS Care, 2017.
  16. Overstreet NM, et al. Internalized stigma and HIV status disclosure among HIV-pos MSM. AIDS Care 2013;25 4, 466-471.
  17. Watson, RJ, et al. Risk and protective factors for sexual health outcomes among Black bisexual men in the US: Internalized hetersexism, sexual orientation disclosure, and religiosity. Archives of Sexual Behavior. Jan 2019; 48(1): 243-253.
  18. Fields EL, et al. Assoc. of Discrimination-Related Trauma with Sexual Risk among HIV-Pos Afr. Am. MSM. AJPH. May 2013;103(5):875-80.
  19. Raymond HF, et al. Racial Mixing and HIV Risk among MSM. AIDS Behav Aug 2009;13(4):630-37.
  20. Friedman, MR et al. HIV Care Continuum disparities among Black bisexual men and the mediating effect of psychosocial comorbidities. J Acquir Immune Defic Syndr. Apr 2018; 77(5):451-458.
  21. Eaton, L et al. Role of Stigma and Med Mistrust in Routine Hlth Care Engagement of MSM. AJPH. Feb 2015;105(2): e75–e82.
  22. Levy ME, et al. Understand Structural Barriers to Accessing HIV Test & Prev Servs among Blk MSM in the U.S. AIDS Behav. 2014 May; 18(5): 972–996.
  23. Christopoulos KA, et al. Linkage and Retention in HIV Care among MSM in the U.S. Clin Infect Dis. 2011 Jan 15; 52(Suppl 2): S214–S222.
  24. Singh S, et al. HIV Care Outcomes Among Men Who Have Sex With Men With Diagnosed HIV Infection - United States, 2015. MMWR Mob Mortal Wkly Rep. Sep 2017; 66(37):969-974.
  25. Centers for Disease Control and Prevention. HIV Treatment as Prevention. 2018; Accessed May 31, 2019.
  26. Cortopassi AC, Driver R, Eaton LA, Kalichman SC. A new era of HIV risk: it's not what you know, it's who you know (and how infectious). Annu Rev Psychol. 2019;70:673-701.
  27. Eaton LA, Matthews DD, Bukowski LA, et al. Elevated HIV prevalence and correlates of PrEP use among a community sample of Black men who have sex with men. J Acquir Immune Defic Syndr. 2018;79(3):339-346.
  28. Kalichman SC, Price D, Eaton LA, et al. Diminishing perceived threat of AIDS and increasing sexual risks of HIV among men who have sex with men, 1997-2015. Arch Sex Behav. 2017;46(4):895-902.
  29. Ethnic and Racial Minorities and SES. Factsheet. APA.
  30. Alameda Co. CA eHARS data (2008-2012). Verbal communication with Nina Murgai, Dir, HIV/AIDS Surv Unit.
  31. 29. Wiewel EW, et al. Assoc bwt Neighborhood Poverty and HIV Dx among Males and Females in NYC, 2010-2011. PH Rep. Mar-Apr 2016;131(2):290-302.
  32. Lechtenberg RJ, et al. Poverty, Race, Engagement: Diff Assoc with Retention in Care among PLWH in Alameda Co. UCSF CFAR HIV Hlth Disparities Symposium, Mar 24, 2017.
  33. Mimiaga MM, et al. Child Sexual Abuse Assoc with HIV Risk–Taking Behav and Infect among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr. 2009 Jul 1:51(3):340-348.
  34. Millett GA, et al. Common roots: A contextual review of HIV epidemics in Black men who have sex with men across the African diaspora. Lancet. Jul 2012;380(9839):411-23.
  35. CDC. STDs and HIV – CDC Factsheet. Nov 17, 2015.
  36. CDC. 2015 STDs Surveillance – STDs in Racial and Ethnic Minorities. Jan 23, 2017.
  37. Scott HM, et al. Racial/ethnic and sexual behav disparities in rates of STIs, SF (1999-2008). BMC Pub Hlth. Jun 6, 2010;10:315.
  38. Pathela P, et al. MSM have higher risk for newly dx HIV and syphilis compared with heterosexual men in NYC. J Acquir Immune Defic Syndr. Dec 1, 2011;58(4):408-16.
  39. Hurt CB, et al. Invest Sexual Network of Blk MSM: Implications for Transmission and Prev of HIV Infect in U.S. J Acquir Immune Defic Syndr. Dec 2012;61(4):515-21.
  40. Maulsby C, et al. Rev of HIV Interv for Blk MSM. BMC Pub Hlth. 2013;13:625.
  41. Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. Lancet. 2012;380:341-348.
  42. Wheeler, DP, et al. Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study. Journal of the International AIDS Society. 2019; 22: e25223.
  43. Stein R. Reduced sexual risk behaviors among young Men of color Who have Sex with Men: findings from the community-based organization behavioral outcomes of many Men, many voices (CBOP-3MV) project. Prev Sci. 2015;16(8):1147–58.
  44. Peterson JL, et al. Evaluation of an HIV risk reduction intervention among African-American homosexual and bisexual men. AIDS 1996, 10: 319 – 325.
  45. Harawa NT, et al. Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: Results of a randomized trial. AIDS. 2013;27(12):1979–88.
  46. Jemmott III, JB, et al. On the efficacy and mediation of a One-on-One HIV risk-reduction intervention for African American Men Who have Sex with Men: a randomized controlled trial. AIDS Behav. 2015;9(7):1247–62.
  47. Tobin K, et al. Unity in diversity: results of a randomized clinical culturally tailored pilot HIV prevention intervention trial in Baltimore, Maryland, for African American Men Who have Sex with Men. Health Educ Behav. 2013;40(3):286–95.
  48. Young SD, et al. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013;159(5):318–24.
  49. Bouris A, et al. Project nGage: Results of a Randomized Controlled Trial of a dyadic network support intervention to retain Young Black Men who have Sex with Men in care. AIDS Behav. Dec 2017; 21(12): 3618-3629.
  50. Jones KT, et al. Evaluation of an HIV prevention intervention adapted for Black men who have sex with men. Am J Public Health. 2008, 98:1043–1050.
  51. Wu E, et al. Adaptation of a Couple-Based HIV Intervention for Methamphetamine-Involved African American Men who have Sex with Men. Open AIDS J. 2010, 4:123–131.
  52. Operario D, et: al. The Bruthas Project: evaluation of a community-based HIV prevention intervention for African American men who have sex with men and women. AIDS Educ Prev 2010, 22: 37–48.
  53. Parsons JT et al. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol. Feb 2014; 82(1):9-18.
  54. Magnus M, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr. 2010, 53:529–536.
  55. Hosek SG, Lemos D, Hotton AL, Isabel Fernandez M, Telander K, Footer D, Bell M. An HIV intervention tailored for black young men who have sex with men in the House Ball Community. AIDS Care. 2015;27(3):355–62.
  56. Hightow-Wiedman LB, et al. Keeping them in “STYLE”: finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient CARE STDS. Jan 2011: 25(1): 37-45.
  57. Peterson, JL, et al. Soc. discrimination and resiliency not assoc with differ in HIV infect in blk and wht MSM. JAIDS. 2014:66;538-543.
  58. Sullivan PS, et al. Understand racial HIV/STI disparities in blk and wht MSM. PLoS One. 2014;9: e90514.

Prepared by Bob Haas & Barbara Green-Ajufo, DrPH, MPH . Updated April 2020 by Beth Bourdeau, PhD, Wilson Vincent, PhD, MPH, Rob Newells, George Jackson, and Andrew Wilson, MPH.

Special thanks to the following reviewers of this Fact Sheet: Emily Arnold, Jesse Brooks, Lorenzo Hinojosa, Loren Jones, Micah Lubensky, Daryl Mangosing, Janet Myers, Nasheedah Bynes-Muhammad, Rob Newells, John Peterson, Greg Rebchook, Andrew Reynolds, and Wilson Vincent Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. ©2020, University of CA. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. This publication is a product of a Prevention Research Center and was supported by Cooperative Agreement Number 6U48DP006374-01-03 from the Centers for Disease Control and Prevention.


National Gay Men's HIV/AIDS Awareness Day – September 27, 2018 [booklet]

This brochure lists research focusing on HIV testing and helpful resources produced by CAPS/PRC. You might use it to:

  • Stay up-to-date on research and learn what we found out from research
  • Use the materials in trainings/presentations
  • Advocate for services/funding
  • Write grants
  • Develop new or modify existing HIV prevention programs
  • Evaluate current programs
  • Connect with CAPS/PRC to develop new projects.

Lead researchers (PIs) are listed for each study. This brochure was prepared by the Community Engagement (CE) Core, previously known as the Technology and Information Exchange (TIE) Core: “Tying research and community together.”


Los Medicamentos Opioides

¿Cómo afectan los medicamentos opioides a las personas con VIH?

Elaborado por Kathleen Clanon, MD and Pamela DeCarlo | July 2017

¿Son los opioides una preocupación?

Sí. Los medicamentos que se recetan para aliviar el dolor como oxicodona, hidrocodona y metadona ayudan a millones de personas a manejar efectivamente el dolor crónico. Pero para algunas personas, estos opioides también se han convertido en una compleja trama de mal uso y  abuso que ha llevado a incrementos dramáticos en la incidencia de la adicción, sobredosis, infecciones por hepatitis B y C y posiblemente por el VIH. [1]

Las recetas de opioides en los Estados Unidos se duplicaron entre 2001 y 2015 sin que se haya registrado una disminución en la cantidad de dolor reportada. Solamente el uso de oxicodona e hidrocodona se triplicó entre 2000 y 2015. Los profesionales de la salud recetaron 259 millones de recetas de opioides para calmar el dolor en 2012—suficiente para cada uno de los adultos en los Estados Unidos. [2]

El Centro de Control y Prevención de Enfermedades recomienda no recetar opioides como terapia de primera línea o de rutina para el dolor crónico. [3]

¿Por qué preocupa el uso de opioides?

Falta de información sobre los riesgos de los opioides. Los opioides hacen que las personas se sientan bien y alivian el dolor sin producir efectos secundarios muy notorios. Además, los pacientes tienden a creer que los médicos no recetarían algo peligroso. A veces los pacientes no entienden que los opioides pueden crear dependencia física y algunos médicos tampoco entienden los riesgos o no los explican adecuadamente. Las personas a las que se les receta medicamentos opioides deben preguntar a sus proveedores de la salud si realmente son la manera más segura de manejar el dolor.

Sobredosis. De 2000 a 2014, hubo casi medio millón de muertes a causa de sobredosis de drogas, y más del 60 % de las muertes por sobredosis por drogas incluyeron un opioide. Todos los días, 46 personas mueren en los Estados Unidos por una sobredosis de opioides. [2]

Los opioides son altamente adictivos. Hasta un 25% de las personas que toman opioides a largo plazo terminan luchando con la dependencia. [4] Dicha dependencia se desarrolla extremadamente rápido. A los tres días de tomar opioides, ya existe la posibilidad de que su consumo se vuelva crónico y el riesgo aumenta rápidamente con cada día de uso. [5]

¿Cómo afectan los opioides a las personas viviendo con VIH?

Posibles efectos negativos para las personas viviendo con VIH. Para las personas que viven con el VIH (PVV), el uso de opioides a largo plazo puede provocar depresión, contribuir recaídas en el uso de substancias y hasta incrementar el dolor crónico. [6]

Incremento de conductas riesgosas. Igual que el alcohol y otras drogas, los opioides por receta pueden interferir con el juicio y la capacidad de tomar decisiones, y pueden resultar en que una persona haga cosas que en otras circunstancias no haría. Al disminuir las inhibiciones, los opioides pueden fomentar conductas riesgosas (como tener sexo sin protección o compartir jeringas) que incrementan el riesgo de transmitir o contraer el VIH o la hepatitis C o B [7].

Transición a inyectarse y a la heroína. La epidemia del mal uso de opioides por receta ha llevado a muchas personas a inyectarse por primera vez. Casi un 80% de los nuevos consumidores de heroína reporta haber usado opioides por receta primero. [8]

¿Cuáles son los riesgos para las personas viviendo con VIH?

Uso a largo plazo de opioides. Hasta un 85% de PVV sufren dolores crónicos. A muchas se les receta opioides para aliviar el dolor. Los efectos secundarios del consumo de opioides a largo plazo incluyen: una disminución en la libido, menos testosterona, depresión, arritmia y problemas neurológicos. El uso continuo de opioides para calmar el dolor puede en cambio incrementar el dolor crónico en PVV en vez de aliviarlo.

Abuso de opioides. El uso problemático de opioides por receta puede ser común en PVV, especialmente si tienen una historia de abuso de drogas, problemas de salud mental y poca adherencia al tratamiento antirretroviral. Una investigación demostró que un 62% de PVV que consumen opioides por receta los toman de manera problemática. [9]

Recaídas y sobredosis. Para PVV con una historia de abuso de alcohol y de drogas, los opioides pueden ocasionar recaídas en el uso de sustancias. Las sobredosis accidentales son comunes, sobre todo cuando los opioides se mezclan con alcohol o benzodiazepinas (como Valium o Xanax), antidepresivos o medicamentos anticonvulsivos. [3]

Atención para el VIH. Los factores específicos del cuidado médico del VIH pueden determinar si los profesionales de la salud observan o no las normas federales para recetar opioides. Por ejemplo, el personal médico puede valorar la retención de pacientes con VIH o un sentido de alianza con sus pacientes como más importante que lineamientos federales conservadores acerca de recetar opioides. Capacitaciones especializadas sobre el recetar opioides podrían ser necesarias para los profesionales de la salud que atienden a las personas con VIH.

¿Cuáles son los riesgos para personas que están en riesgo de adquirir el VIH?

Falta de conocimiento y de programas relacionados con el uso más seguro de drogas inyectables. La epidemia de opioides ha ocasionado un aumento en el consumo de drogas inyectables. Los nuevos consumidores de estas drogas suelen ser personas de raza blanca que viven en zonas rurales o suburbanas, tienen poco conocimiento sobre prácticas de inyección más seguras y sobre los riesgos de contraer hepatitis o VIH y tienen poco (o nulo) acceso a programas educativos y a servicios para consumidores de drogas inyectables como la distribución de jeringas esterilizadas. [11] Estos factores fomentan las condiciones para la propagación rápida del VIH en comunidades específicas.

Hepatitis C. Actualmente, la transmisión de hepatitis C es un riesgo significativo para personas que se inyectan, sobre todo entre los jóvenes y los habitantes de pueblos pequeños y zonas rurales en los Estados Unidos que se inyectan opioides. En 2013, hubo 30,000 nuevos casos de hepatitis C y un incremento de infecciones de hepatitis C en 28 Estados, lo que equivale a un incremento de más de un 150% desde 2010 [11].

Transmisión potencial rápida del VIH. En 2015, el primer brote de VIH vinculado a la inyección de opioides por receta ocurrió en una zona rural del Estado de Indiana. El VIH se propagó rápidamente dentro de esta pequeña comunidad, con 135 pesonas seropositivas, el 80% de las cuales reportaron haber disuelto e inyectado pastillas de oximorfona.

¿Qué debe hacerse?

Ante el dramático aumento de recetas, uso, adicción y sobredosis de opioides en los años recientes, varias agencias federales, estatales y locales han desarrollado normas, reglamentos y programas para promover la seguridad. En 2016, el Centro de Control y Prevención de Enfermedades elaboró una serie de normas con la finalidad de mejorar la comunicación entre profesionales de la salud y pacientes sobre los riesgos y los beneficios de los opioides para el dolor crónico y para mejorar la seguridad y eficacia del tratamiento para el dolor, así como para reducir los riesgos asociados a terapias a largo plazo con opioides, incluyendo la adicción, sobredosis y mortalidad.

Profesionales de la salud

Cuidado o manejo del dolor sin opioides. Los profesionales que atienden a PVV deben tomar en cuenta la edad, género, condición socio-económica, salud mental y consumo de drogas de la persona, ya que el manejar el dolor sin tener en cuenta esas variables puede tener un éxito limitado. El Centro de Control y Prevención de Enfermedades recomienda no recetar opioides como terapia de primera línea para el dolor crónico, por lo que los profesionales deben considerar otros medios para manejar el dolor. La terapia cognitiva conductual, fisioterapia, hipnosis o marihuana para uso medicinal también pueden aliviar el dolor en las personas con VIH. [13]

Prevención de sobredosis. Si profesionales y pacientes deciden usar opioides, los proveedores deberían discutir y proveer a los pacientes material escrito sobre los riesgos de la dependencia y la sobredosis, así como considerar prescribir también naloxona para revertir los efectos potencialmente fatales de una sobredosis.

Personas que viven con el VIH

PVV a las que se les receta opioides deben discutir cualquier inquietud con su médico y preguntar sobre métodos para manejo del dolor que no incorporan opioides. En caso de recetárseles opioides, deberán usarlos por la menor cantidad de tiempo posible y ser conscientes de que se puede crear dependencia casi inmediatamente, dentro de tres días de su consumo. [5] PVV que han venido tomando opioides durante mucho tiempo deberían hablar con su médico sobre cómo pueden irlos dejando o reducir su consumo.

Políticas sanitarias

Sabemos cómo prevenir el VIH y contamos con múltiples intervenciones eficaces para prevenirlo. El brote del VIH en personas que se inyectan drogas en zonas rurales de Indiana demuestra lo que puede pasar cuando el gobierno estatal y las comunidades no invierten en la prevención. Tenemos que comprometernos a promover la educación y los servicios de reducción de riesgos como programas de acceso a jeringas, prevención de sobredosis, incluyendo acceso a naloxona y programas de rehabilitación. [14]

Aunque el conocimiento científico acumulado durante años demuestra la necesidad, la eficacia y los beneficios económicos de programas para personas que se inyectan drogas, aún existen barreras políticas y legislativas para su implementación. Tenemos que apoyar, proteger y ampliar la legislación actual y los programas que promueven la salud y el bienestar de las personas que consumen y usan mal los opioides por receta, incluidas las personas que se inyectan drogas y sus parejas.

¿Quién lo dice?

  1. RTI International. Opioids In America: A complex crisis. A comprehensive response.
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Gracias a Rachel Anderson, Emily Behar, Neisha Becton, Holvis Delgadillo, Linda Gowing, Barbara Green-Ajufo, Renata Henry, Daryl Mangosing y Savannah O’Neill por revisar esta hoja informativa. Kathleen Clanon está afiliada con Alameda County Health Care Services Agency. Agradecemos la reproducción y la difusión de esta hoja, siempre que sea de manera gratuita y que se cite a la University of California San Francisco. ©2017, University of CA. Preguntas y comentarios pueden enviarse a [email protected].

Esta publicación es un producto del Centro de Investigación sobre la Prevención con el apoyo de los Centros de Control y Prevención de Enfermedades (Cooperative Agreement Number 5U48DP004998).


HOME (Prevention for Women with Incarcerated Partners)

Please see the Science-to-Community Report on HOME. Women with incarcerated partners are at particular risk for HIV infection. Their partners are over five times more likely than men in the general population to be HIV+. Incarcerated men also have a high incidence of injection drug use. Women with incarcerated partners are primarily low-income women of color for whom racism, poverty and sexism contribute to increased HIV risk and whose life stressors are exacerbated by their partners' imprisonment.


The purpose of the HOME project is to design and test an intervention to reduce HIV risk among women whose male partner is being released from San Quentin State Prison. This study is funded by the National Institute of Nursing Research (NINR). The 12-month HOME intervention ran from February 2005 through January 2006. Weekly activities addressing HIV and STD prevention, women's health, and population-specific topics such as parole information were held at a center for visitors directly outside of the gates of San Quentin. Eleven women who visit incarcerated men were trained as peer educators and were closely involved with project staff in facilitating weekly activities. We collected data during the intervention period using the same quantitative surveys used in our formative research. We also are comparing participants in two cross-sectional surveys, one conducted immediately prior to the launch of the intervention and one conducted immediately after the intervention left the field. Finally, we conducted longitudinal qualitative interviews with the project peer educators.

Formative research

Prior to developing HOME, we conducted several studies with women with incarcerated partners. Based on information gathered in focus groups and pilot studies, we developed an HIV prevention intervention that addresses the specific needs of women with incarcerated partners and facilitates their utilization of community services. This intervention was a peer-led HIV education workshop that provided HIV information, facilitated supportive relationships between visitors and provided referrals as needed. This program and its evaluation are described in a published article (Comfort M, Grinstead OA, Faigeles B, Zack B. Reducing HIV risk among women visiting their incarcerated male partners.Criminal Justice and Behavior, 2000, Vol 21, p. 57-71). We also conducted a series of cross-sectional surveys of women leaving the prison after visiting. These descriptive surveys showed that women visitors are most often low income women of color and that the majority of visitors are raising children. Survey results also indicated that women are spending a large portion of their income on visiting, phone calls and other costs of maintaining their relationship with an incarcerated man. (Grinstead O, Faigeles B, Bancroft C, Zack B. The financial cost of maintaining relationships with incarcerated men: results from a survey of women prison visitors. Journal of African American Men. 2001.)


Inside Out logo In response to our findings that many women are unaware of or minimize the risk of having an incarcerated partner, we created the videotape "Inside/Out: Real Stories of Men and Women and Life After Incarceration." This 17 minute video presents real stories of four women whose partners have been incarcerated and five men who have served time. The video explores the challenges faced by women after their partners are released from prison. Inside/Out focuses on the health risks in prison and highlights the need for honest communication around health issues when planning for the future. The accompanying discussion guide is designed to draw women with incarcerated partners and other at-risk women into a discussion about the risks of partner incarceration and other partner risk issues. To order a copy of Inside/Out, please visit the Centerforce web site.

Research findings

In an effort to deepen our understanding of how circumstances of forced separation and the interdiction of physical contact affect women's sexual behavior, we investigated the development and maintenance of heterosexual couples' intimacy when the male partner is incarcerated. We recognize that correctional control extends to these women's bodies, both when they are within the facility's walls visiting their mates and when they are at home striving to remain connected to absent men. Using our formative qualitative interviews with 20 women who visit their incarcerated partners and 13 correctional officers who interact with prison visitors, we examined how institutional constraints such as the regulation of women's apparel, the prohibition of physical contact, and the lack of forums for privacy result in couples forging alternative "spaces" in which their relationships occur. Romantic scripts, the build-up of sexual tension during the incarceration period and conditions of parole promote unprotected sexual intercourse and other HIV/STD risk behavior following release from prison. (Comfort M, Grinstead O, McCartney K, Bourgois P, Knight K. You cannot do nothing in this damn place": sex and intimacy among couples with an incarcerated male partner. J Sex Res. 2005 Feb;42(1):3-12.)


The following research instruments were used for the HOME study.
  • Longitudinal survey - baseline (We administered these to women visiting their incarcerated partners at the prison under study. Women completed the baseline while their partner was incarcerated and they completed the follow-up 30 days after their partner was released from custody.)
  • Longitudinal survey - follow-up
  • Cross-sectional survey (We administered this survey to women visiting incarcerated men at the prison under study before our intervention began and after our intervention ended to measure community impact.)

Adherence Abstracts

Adherence to Combination Therapy in AIDS Clinical Trials (1997)

Chesney, M., Ickovics J., for the Recruitment, Adherence and Retention Committee of the ACTG (1997). Presented at the Annual Meeting of the AIDS Clinical Trials Group, July 1997,Washington, D.C.
The Recruitment, Adherence and Retention Subcommittee of the AIDS Clinical Trials Group administered two questionnaires to 76 patients on combination therapy from 10 clinic AIDS Clinical Trials Units during May and June of 1997 (results were presented at the July, 1997 ACTG meeting by Drs. Margaret Chesney and Jeannette Ickovics). Eighty percent of the respondents were male, 30% were persons of color, the mean age was 40 years, 41 % were college graduates and the mean income was US$ 25,000. Of the 76 patients, 41% reported missing at least one dose "yesterday" (i.e., the day before completing the survey). Fourteen percent reported missing at least one dose the "day before yesterday." When these two days were examined together, a total of 18% of the patients missed at least one dose in the last two days. When asked about the last two weeks, 36% reported missing at least one dose. These data probably underestimate the problem because most of these patients were relatively new to their regimens. Adherence research indicates that adherence is better early on in the course of treatment and declines with time. The report of the ACTG survey also provided preliminary findings on some of the variables that are associated with or 'predict' nonadherence. These variables are important because they suggest ways that individuals who may have difficulties with adherence could be identified. The intent of studies finding such "predictors" is not to characterize persons who might not be prescribed medication but rather, to identify persons who may need additional assistance and to provide information that could be used to maximize the effectiveness of the assistance. The ACTG survey identified two predictors of nonadherence. The first of these was the frequency of alcohol intake, with a higher frequency associated with skipped doses. The average number of drinks per month among those who did not report skipping medication was 9, whereas the average number of drinks per month among those who reported skipping medication was 17. The second variable significantly associated with non adherence was "working outside the home for pay' " Specifically, 59% of the adherent survey respondents worked outside the home, the prevalence of working outside the home was significantly higher, at 85%, among those who are nonadherent. This latter variable is consistent with the data indicating that among the reasons for missing medications is being away from home and busy with other daily activities. A primary purpose of this survey was to test the feasibility of the two instruments: the baseline and the adherence follow-up questionnaires. The questionnaires took an average of 10 minutes each to complete and 89% and 93% thought the lengths of each (respectively) were fine. Ninety-six and 99% of the patients said that they thought others would be willing to complete the two instruments, respectively. Feb 01, 1998

Adherence and Effectiveness of Protease Inhibitors in Clinical Practice

Abstract of Presentation from the 5th Conference on Retroviruses and Opportunistic Infections February 1-5, 1998, Chicago, ILHECHT FM1, COLFAX G2, SWANSON M1, CHESNEY MA11University of California San Francisco, CA and 2Department of Public Health, SF CA Background: Adherence to protease inhibitor containing regimens for HIV infection is thought to be a important factor in determining the effectiveness of treatment, but there is limited data linking adherence to virologic outcomes. We measured adherence to protease inhibitor (PI) regimens in a public hospital clinic setting, and determined the association between adherence and undetectable HIV viremia. Methods: In 1-97 and 2-97 we surveyed patients at half of all clinic sessions at the San Francisco General Hospital AIDS clinic. Adherence was measured using a self-administered questionnaire that was reviewed by a trained interviewer for completeness. The questionnaire asked how many doses of protease inhibitors had been missed in each of the past 3 days. Patients were also asked if they took less pills than their doctor told them to take at each dose. A composite adherence measure was produced by calculating the proportion of recommended medication actually taken by patients in the prior 3 days, accounting for both missed and reduced doses. HIV-1 plasma RNA was measured by the bDNA test (Chiron, limit of detection 500 copies/ml), using measurements requested by physicians the day of the interview or the first measure performed after the interview. Results: Table 1: Patient Characteristics (n=135)
Characteristic Number Percent
Male 123 91.1 %
White 90 67.2 %
African American 20 14.9 %
Latino 15 11.2 %
Median age (years) 39.8 years Range 27.0-59.5 years
HIV Risk
MSM* 93 68.9 %
IDU* 12 8.9 %
MSM/IDU 11 8.1 %
41 7 14.1 %
Baseline CD4**
0-100 49 36.6 %
101-200 29 21.6 %
201-500 39 29.1 %
> 500 2 1.5 %
Unknown 16 11.9 %
Baseline median VL (n=61) 16060 copies/ul
Protease Inhibitor
Saquinavir 17 13.1 %
Indinavir 80 61.5 %
Ritonavir 24 18.5 %
Nelfinavir 2 1.5 %
Saquinavir/Ritonavir 7 5.4 %
Duration of PI Tx 205 days Range 60-624 days
Adherence to PI Tx
100% adherent 98 72.6 %
80-99% adherent 10 7.4 %
< 80% adherent 27 20.0 %
* MSM=Men having sex with men and IDU=Injection drug use ** Before starting treatment with protease inhibitors. Patients: 388 patients agreed to fill out the survey (response rate 72%). Of these, 183 had taken protease inhibitors. Of the 183, 135 had taken protease inhibitors for more than 2 months at the time of the interview, and provided a medical record number to match laboratory data with the questionnaire. Overall, 41% of patients had detectable viremia. Figure 1: Proportion of Patients with Undetectable Viremia by Adherence Multivariate predictors of undetectable viremia: In a multiple logistic regression model controlling for CD4 count prior to beginning PI treatment, type of protease inhibitor, and whether new or changed reverse transcriptase inhibitors were started with the PI, adherence was associated with non-detectable viremia, OR=4.7, 95% CI 1.1 ñ 20.6. Conclusions (1) The proportion of patients with undetectable viremia was nearly twice as high in patients who reported taking 100% of their recommended protease inhibitor medication in a 3 day period, compared with patients taking less than 80% of medication. Adherence to protease inhibitor treatment is an important predictor of reaching undetectable viremia in clinical practice. (2) While self-reported adherence is likely underestimate missed doses, a simple self-report measure identifies clinically important non-adherence. (3) Nearly half our pts had detectable viremia. This is higher than reported in several clinical trials of protease inhibitor regimens, and suggest that the effectiveness of protease inhibitor regimens in clinical practice may be lower than the efficacy of these treatments established in clinical trial settings. Frederick M. Hecht, MD UCSF AIDS Program San Francisco General Hospital 995 Potrero Ave, Ward 84 San Francisco, CA, 94110 Phone:             (415) 476-4082       x.431 Fax: (415) 476-6953 [email protected]