HIV risk behaviors: risky sexual activities and needle use among adolescents in substance abuse treatment

Comparison of factors associated with successful transition of care in patients with HIV versus other chronic diseases

BACKGROUND

Transfer of pediatric patients to adult care is an integral part of optimizing care of chronically ill patients and requires advanced infrastructure and availability of a multidisciplinary team. Thus, assessing factors associated with transition to adult care in this and the other chronic disease group will aid in the targeting intervention programs. The aim of the study was to compare factors associated with transitional readiness and health risk behaviors between adolescents with HIV infection and other chronic diseases.

METHODS

Participants ages 14 to 18 were recruited from chronic care clinics at Siriraj hospital between 2015 and 2016. Self-assessment questionnaires composed of health risk behaviors and a 25-item Likert Scale transition readiness questionnaire with possible scores ranging from 25 to 100 were administered. Analysis was done by SPSS 18.

RESULTS

There were 165 adolescents who participated in the study. Median age was 16 years (range, 14-18). The overall transitional readiness average score was 54.15 ± 8.4 which showed no difference between HIV group (HIVG) and other chronic illness group (non-HIVG). The subjects in the HIVG scored significantly higher in self-management skills (13.03 ± 2.1 vs.12.09 ± 2.8, p < 0.05) than their non-HIV counterparts. However, they scored lower in their perception of transition readiness than non-HIVG (13.6 ±2.1 vs. 14.85 ± 2.5, p < 0.05). Adolescents who were not HIV-infected were more likely to not want to attend school because of their illness (OR = 4.33, 95% CI = 0.97-19.24.) Conversely, HIV-infected adolescents were more likely to used social media (OR=10.2, 95% CI = 3.26-31.98), consume alcohol beverage (OR = 2.83, 95% CI =1.23-6.49), smoked cigarettes (OR = 4.17, 95% CI =1.31-13.26), and lack STD knowledge (OR = 3.63, 95% CI = 1.49-8.81) rather than non-HIV infected adolescents.

CONCLUSION

HIV-infected adolescents perceived their self-management skills to be higher than adolescent with other chronic diseases. However, HIV-infected adolescents still possess increased health risk behaviors. To effectively formulate transitional care practice in the Thai context, the program should be focused on health risk behaviors.

A Comparison of Screening Practices for Adolescents in Primary Care After Implementation of Screening, Brief Intervention, and Referral to Treatment

PURPOSE

The American Academy of Pediatrics recommends screening adolescents for substance use at all well-child and appropriate acute-care visits. However, many pediatric practices aim for such screenings annually at well-child visits.

METHODS

As part of a larger study, 7 urban Federally Qualified Health Center clinics implemented universal screening for risky alcohol and drug use using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. The present study compared uptake of screening and screening results at well-child versus acute-care visits.

RESULTS

Over a period of 13 months for which encounter-level electronic medical records data were available, there were 6,346 clinic visits by 3,475 unique patients aged 12-17 years, at which 76.6% (n = 4,865) of visits had a screening for problematic substance use conducted. Rates of screening were 95.1% (2,750/2,891 involving 2,629 unique adolescents) for well-child visits and 61.2% (2,115/3,455 involving 1,535 unique adolescents) for acute-care visits. Rates of positive screening results were 9.0% (248/2,750 involving 245 unique adolescents) for well-child visits and 7.8% (164/2,115 involving 126 unique adolescents) for acute-care visits. Of the 469 unique adolescents screened only during an acute-care visit during that same period, 40 unique adolescents had positive screening results for a positive screening rate of 8.5%.

CONCLUSIONS

Nearly 10% of adolescent patients screened only at acute-care visits would not have been screened if screening was implemented solely at well-child visits, and 40 adolescents reporting substance use would have been missed. The findings highlight the benefits of screening adolescents at every primary care visit to better detect and intervene in adolescents' substance use.

Religiosity and Self-Efficacy in the Prevention of HIV-Risk Behaviours among Muslim University Students

Introduction: The high prevalence of HIV infection among an age group of 18–25 years, both globally or nationally, was indicating students vulnerable to HIV/AIDS infections. Prevention of HIV risk behaviours can be used as a religiosity approach to strengthening the self-efficacy on prevention HIV-risk behaviour. However, there were limited studies on the association between religiosity and self-efficacy on prevention of HIV-risk behaviour among student, especially Muslim students. The aims of this study were to identify the correlation between religiosity with self-efficacy in the prevention of HIV-risk behaviours.Methods: The study employed a correlation study. The sample size comprised 404 Muslim university students with proportionate stratified random sampling. Student’s religiosity was measured by The Muslim Piety questionnaire and self-efficacy was measured by Self-Efficacy in the Prevention of HIV-Risk Behaviour questionnaire. Descriptive analysis using mean, standard deviation, percentage and frequency distribution. Meanwhile, inferential analysis using Pearson's Correlation.Results: The results were found that most of the students have high levels of religiosity and strong self-efficacy in the prevention of high-risk behaviour. Further analysis revealed a significant (p < 0.005) and strong correlations (r = 0.6780) between religiosity and self-efficacy in the prevention of HIV-risk behaviour. Higher levels of religiosity were followed by higher levels of self-efficacy on the prevention of HIV-risk behaviours among students.Conclusion: findings can be used by academic and health professionals, to implement a religiosity based program to strengthen a self-efficacy of HIV-risk behaviour. Further research can be a focus on the nursing interventions based on religious beliefs to strengthen self-efficacy in the prevention of HIV/AIDS infections.

Re-traumatization Cycle: Sexual Abuse, Post-Traumatic Stress Disorder and Sexual Risk Behaviors among Club Drug Users

Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences - especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas - precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users

BACKGROUND

Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female.

OBJECTIVES

To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs.

METHODS

Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners.

RESULTS

Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners.

CONCLUSIONS

The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.

Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity

Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.

Risk factors of repeated infectious disease incidence among substance-dependent girls and boys court-referred to treatment

BACKGROUND

A small portion of Americans account for a disproportionate amount of the incidences of sexually transmitted infection observed over a short period of time. Studies with adults have begun to characterize this population, yet there is very little data on adolescent sexually transmitted infection repeaters (STIR). This study explores characteristics associated with STIR among 102 girls and 93 boys (aged 14-18) court-referred for residential treatment.

METHODS

Background characteristics, substance use disorders, risky and interpersonal behaviors, and history of sexually transmitted infections were collected at intake using valid and reliable instruments. A negative binomial logistic regression was performed to determine the background, risky behaviors, and social patterns associated with adolescent STIR.

RESULTS

Approximately two out of three adolescents (62%) did not use contraception the last time they had sex, and 15% had at least one sexually transmitted infection recorded in their medical chart. Sexually transmitted infection repeaters entered treatment with higher rates of cocaine abuse (13%) than youth without multiple infections (3%, p < 0.05). History of sexual abuse, having sex with a person who said no, higher exhibitionism, and social estrangement increased the odds of adolescent STIR. Main effects of exhibitionism and social estrangement on increased odds of STIR were more pronounced for sexually abused adolescents.

CONCLUSIONS

The findings suggest a need for incorporating HIV education during residential treatment to improve health outcomes and intervention strategies that further connectedness for youth and victims of sexual abuse.

Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.

Nonmedical prescription drug users in private vs. public substance abuse treatment: a cross sectional comparison of demographic and HIV risk behavior profiles

Background

Little is known regarding the demographic and behavioral characteristics of nonmedical prescription drug users (NMPDUs) entering substance abuse treatment settings, and information on the HIV-related risk profiles of NMPDUs is especially lacking. Participation in substance abuse treatment provides a critical opportunity for HIV prevention and intervention, but successful initiatives will require services appropriately tailored for the needs of NMPDUs.

Methods

This paper compares the HIV risk profiles of NMPDUs in public (n = 246) and private (n = 249) treatment facilities. Participants included in the analysis reported five or more recent episodes of nonmedical prescription drug use, a prior HIV negative test result, and current enrollment in a substance abuse treatment facility. A standardized questionnaire was administered by trained interviewers with questions about demographics, HIV risk, and substance use.

Results

Private treatment clients were more likely to be non-Hispanic White, younger, and opioid and heroin users. Injection drug use was higher among private treatment clients, whereas public clients reported higher likelihood of trading or selling sex. Public treatment clients reported higher rates of HIV testing and availability at their treatment facilities compared to private clients.

Conclusions

Findings suggest differing demographics, substance use patterns, profiles of HIV risk and access to HIV testing between the two treatment samples. Population tailored HIV interventions, and increased access to HIV testing in both public and private substance treatment centers, appear to be warranted.

Integrating adolescent substance abuse treatment with HIV services: evidence-based models and baseline descriptions

Adolescents with substance use disorders are at high risk for contracting Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and other sexually transmitted infections (STIs). Adolescence is the period of sexual maturation that compounds the issues associated with infection transmission for this risk-taking group. Integrated treatment models for implementing HIV education, counseling, and testing is a promising approach. This study describes four substance abuse treatment programs of varying levels of care that integrated HIV services for adolescents. Additionally, the evidence-based substance abuse treatment and HIV models are discussed and the baseline characteristics presented. The authors provide a discussion and offer recommendations for service implementation and additional research.

The GAIN Short Screener (GSS) as a Predictor of Future Arrest or Incarceration Among Youth Presenting to Substance Use Disorder (SUD) Treatment

The National Institutes of Health (NIH) data harmonization project on existing measures (www.phenx.org) has recommended the Global Appraisal of Individual Needs (GAIN)—Short Screener (GSS) as one of the most reliable, valid, efficient, and inexpensive general behavioral health screeners to quickly identify people with internalizing and externalizing mental health disorders, substance use disorders, and crime/violence problems. The present study examined how well the four GSS screeners and their sum predict future arrest or incarceration among individuals entering treatment for a substance use disorder. Using a cross-validation design, a diverse sample of 6,815 youth with substance use disorders was split into a development sample and a validation sample. Overall, results found the GSS’s crime and violence screener (CVScr) and the substance disorder screener (SDScr) to be the two best predictors of arrest/incarceration within the 12 months following treatment intake. Additionally, we found that these screeners could be used to categorize individuals into three groups (low risk, moderate risk, high risk) and this simplified classification had good predictive validity (Area Under the Curve = 0.601). In sum, the GSS’s predictive validity was similar to other instruments that have been developed to predict risk for recidivism; however, the GSS takes only a fraction of the time to collect (ie, approximately 2–3 minutes for just these two screeners).

The role of drinking severity on sex risk behavior and HIV exposure among illicit drug users

OBJECTIVES

The current study examined how drinking severity among injection and non-injection drug users is associated with sex risk behaviors and risk of HIV exposure.

METHOD

The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV epidemiologic study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: abstinent (no reported alcohol use in prior 30 days), moderate alcohol use (≤30 drinks for females, or ≤60 drinks for males), or problematic alcohol use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack.

RESULTS

Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07-16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09-11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29-6.80), and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14-6.49).

CONCLUSIONS

These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors.

Therapeutic Engagement and Posttreatment Substance Use in Adolescent TC Clients

The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.

Risky sex: interactions among ethnicity, sexual sensation seeking, sexual inhibition, and sexual excitation

Rates of sexually transmitted infections, including HIV, vary across ethnic minority groups, yet few studies have evaluated sexual risk behaviors and their psychological correlates to determine if risk and protective factors vary by ethnicity. The purpose of the current study was to assess sexual sensation seeking (SSS), sexual inhibition (SIS1 and SIS2), and sexual excitation (SES) as correlates of risky sexual behaviors in 106 (55 male and 51 female) Asian Americans, African Americans, and Caucasian Americans. Results revealed that higher SSS was associated with more vaginal and anal sex partners. Further, the association between SSS and the number of anal sex partners was positive among Asian Americans and Caucasians, but non-significant among African Americans. SIS1 was positively associated with unprotected sex on the first date among Asian Americans and African Americans. However, the association was not significant for Caucasians. SIS2 was negatively associated with general unprotected sex, and SES was positively associated with the number of vaginal sex partners. Findings suggest that ethnicity plays an important moderating role in the relationship between sexual traits and risky sexual behaviors.

HIV and club drugs in emerging adulthood

PURPOSE OF REVIEW

To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV.

RECENT FINDINGS

Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices. Robust data exists linking the use of club drugs by the men who have sex with men population with spread of HIV, but this data in other at-risk populations (e.g. African Americans) is not as robust. Additional research is needed to identify the rates of transmission among adolescents and emerging adults, as well as knowledge, attitudes, beliefs, and practices that affect HIV transmission in this population.

SUMMARY

Use of club drugs by adolescents and emerging adults contributes to the current rate of HIV transmission among this age group.

The use of the Risky Sex Scale among adolescents receiving treatment services for substance use problems: factor structure and predictive validity

This study evaluated the use of the Risky Sex Scale (RSS; T. O'Hare, 2001) among youth in outpatient treatment for substance use problems. An ethnically diverse sample of 394 adolescents (280 males; M(age) = 16.33 years, SD(age) = 1.15) was recruited from 2 treatment sites. The study was guided by two aims. First, a confirmatory factor analysis was conducted on RSS item responses. Findings replicated the factor structure identified in previous studies of undergraduate students cited for campus alcohol violations. Second, structural equation modeling was used to document associations between RSS subscales and self-reported substance use and sexual risk behaviors. The risky sex expectancies subscale was significantly associated with co-occurring alcohol use and sex, alcohol use at last intercourse, and alcohol use during the prior 30 days. The risky sexual behaviors subscale was significantly associated with co-occurring drug use and sex, condom use at last intercourse, and unprotected intercourse during the prior 30 days. The factor structure of the RSS was consistent across age group (12-16 and 16-18 years) and across gender, and the links between the RSS subscales and health risk behaviors varied somewhat by gender but not by age group. These findings suggest that the RSS is an appropriate brief screening tool for predicting health risk behaviors among adolescents in substance abuse treatment.

Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis

Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.