Jefferson County is home to less than 15% of Alabama’s population, yet it was responsible for 22% of new HIV cases in 2017. That puts the county among the hardest hit nationwide in terms of new HIV infections.
Digging into those figures, additional disparities emerge. More than half of those new infections came from people younger than 30, and more than 65% of the infections were in African American residents.
“We know that youth and young adults are the age group at greatest risk of HIV infection in the current era, especially African American youth,” said Ellen Eaton, M.D., an assistant professor in the Division of Infectious Diseases. For many of those youth, the road to an HIV diagnosis leads through substance use, said Eaton, who is the director of the Outpatient-Based Opioid Treatment Clinic at UAB’s 1917 HIV/AIDS Clinic.
“HIV can be transmitted through sharing syringes and other materials used to prepare illicit drugs,” Eaton said. “But we also know that many patients with substance-use disorder have other behaviors that put them at risk for sexual transmission of HIV. Patients may also become physically dependent on illicit drugs and resort to exchanging sex for drugs and/or money in order to satisfy drug cravings or prevent withdrawal symptoms.”
That is why Eaton proposed an innovative new program, called Project LEAP (Linkage, Education and Prevention), to the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention. The program, funded by a five-year, $1 million grant, is focused on racial/ethnic minority youth ages 14-24 in Jefferson County.
| “What is novel about this proposal is that we are hoping to address both HIV and substance use with an integrated approach…. It is our hope that by using lessons learned from HIV, we can also tackle substance use and the inherent risk for poor health outcomes.” |
One of Project LEAP’s signature elements is the Prevention Navigator, a trained layperson who “can facilitate candid discussions, break down stigma and link eligible youth to appropriate services,” Eaton said. These services include free or low-cost HIV testing, counseling and connection to care, including HIV prevention through pre-exposure prophylaxis, otherwise known as PrEP.
Prevention navigators have been used in other projects to link individuals to HIV prevention, Eaton noted. “But what is novel about this proposal is that we are hoping to address both HIV and substance use with an integrated approach,” she said. “We know that illicit drug use is associated with many HIV risk factors: sharing syringes, sexual risk behaviors, poverty, lack of health care access and stigma. It is our hope that by using lessons learned from HIV, we can also tackle substance use and the inherent risk for poor health outcomes.”
Ellen Eaton, M.D.Education is a major need and Project LEAP’s first aim, Eaton said. “Many youth don’t realize that substance-use prevention is HIV prevention,” she said. There are many substances being used in Jefferson County — including marijuana, alcohol, opioids and cocaine — “that can all lead to HIV,” Eaton said. “We will use educational models that have reduced stigma around substance use for this demographic with hopes we can reduce the stigma around HIV, raise awareness and increase the likelihood that young people will adopt preventive measures.”
Project LEAP includes a number of partnerships with community resources and other UAB services. These include the Addiction Prevention Coalition (APC), AIDS Alabama, the UAB Adolescent Health Clinic, UAB Family Clinic and UAB Beacon, which offers substance-use interventions for adolescents ages 13-18.
Eaton and other team members — including Li Li, M.D., associate professor in the Department of Psychiatry and Behavioral Neurobiology — will partner particularly closely with APC, a nonprofit organization working to eliminate addiction in central Alabama. APC has existing programs and collaborations with schools, coaches, faith-based communities and in criminal-justice settings. It has developed education and prevention strategies for students, youth volunteers and families. “APC has done a great job of getting into youth-centered events and venues, identifying young prevention champions and designing campaigns that can raise awareness among youth, families and their caregivers,” Eaton said.
“Our partners at APC will help us to identify and train 10 Project LEAP student prevention champions from Birmingham,” Eaton said. “We know that we have to have materials and messaging that are attractive to young people and the best way to design an intervention that is appealing to a certain group is to have them at the table developing and designing educational resources, social media campaigns and other tools that can be used to achieve the mission of this proposal.”
The work will begin virtually, at first, due to the COVID-19 pandemic. “We will have frequent roundtables, via Zoom for the time being, where we work with our prevention champions to identify ways to access youth in the new virtual world,” Eaton said, “including ways to make youth aware of our educational offerings, prevention navigator and resources that our community partners have to keep our young people healthy.”
