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Idrisov B, Lunze K, Cheng DM, Blokhina E, Gnatienko N, Patts G, Bridden C, Rossi SL, Weiser SD, Krupitsky E, Samet JH. Food Insecurity and Transmission Risks Among People with HIV Who Use Substances. AIDS Behav 2023; 27:2376-2389. [PMID: 36670209 PMCID: PMC9859749 DOI: 10.1007/s10461-022-03965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/22/2023]
Abstract
Food insecurity (FI) impacts people with HIV (PWH) and those who use substances (i.e. drugs and alcohol). We evaluated the longitudinal association between FI and HIV transmission risks (unprotected sexual contacts and shared needles/syringes). Among 351 PWH who use substances in Russia, 51.6% reported FI and 37.0% past month injection drug use. The mean number of unprotected sexual contacts in the past 90 days was 13.4 (SD 30.1); 9.7% reported sharing needles/syringes in the past month. We did not find a significant association between mild/moderate FI (adjusted IRR = 0.87, 95% CI 0.47, 1.61) or severe FI (aIRR = 0.84, 95% CI 0.46, 1.54; global p = 0.85) and unprotected sexual contacts. We observed a significant association between severe FI and sharing needles/syringes in the past month (adjusted OR = 3.27, 95% CI 1.45, 7.39; p = 0.004), but not between mild/moderate FI and sharing needles/syringes in the past month (aOR = 1.40,95% CI 0.58, 3.38; p = 0.45). These findings suggest that severe FI could be a potential target for interventions to lower HIV transmission.
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Affiliation(s)
- Bulat Idrisov
- Bashkir State Medical University, Ufa, Russia.
- Department of Health Systems and Population Health, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195-7660, USA.
| | - Karsten Lunze
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- Lab of Clinical Pharmacology of Addictions, Pavlov University, St. Petersburg, Russia
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Sarah L Rossi
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Sheri D Weiser
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Evgeny Krupitsky
- Lab of Clinical Pharmacology of Addictions, Pavlov University, St. Petersburg, Russia
- V.M. Bekhterev National Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Nelson JD, Fischer S. Recent Sexual Assault Predicting Changes in Coping Motives for Alcohol Use in First-Year College Women. VIOLENCE AND VICTIMS 2021; 36:424-435. [PMID: 34103415 DOI: 10.1891/vv-d-19-00159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual assault and heavy alcohol consumption are common among college students. There is strong evidence that the two are associated, but more remains to be understood about the nature of the relationship. Drinking motives have been found to mediate the relationship between sexual assault and drinking problems and between depression and alcohol risk (Kenney, Anderson, & Stein, 2018; Lindgren, Neighbors, Blayney, Mullins, & Kasen, 2012), however drinking motives have not been studied as an outcome. The current study investigated the impact of a recent sexual assault on the endorsement of coping motives for drinking in first year college women using hierarchical regression analysis with Time 2 coping motives as the outcome variable. Lifetime experience of sexual assault and Time 1 coping motives were entered in the first step of the model and a dichotomous variable indicating a recent sexual assault was entered in the second step of the model. Sexual assault during the first semester of college was found to be a significant predictor of coping motives at the end of the semester after controlling for lifetime history of sexual assault and endorsement of coping motives at Time 1. These findings suggest that coping motives for drinking may change following a sexual assault and are of concern due to the negative outcomes associated with drinking to cope. Drinking motives may be an important target of interventions provided to survivors of sexual assault to reduce risk of future drinking-related problems.
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Affiliation(s)
- Jillian D Nelson
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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Ragetlie R, Hounkpatin WA, Luginaah I. Community perceptions of gendered alcohol misuse in a food insecure context: The case of northwestern Benin. Soc Sci Med 2021; 280:114016. [PMID: 34029862 DOI: 10.1016/j.socscimed.2021.114016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/11/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
In many sub-Saharan African countries there have been concerns about the varied effects of increasing rates of alcohol consumption and misuse. These concerns have led to the need for research on the relationship between alcohol misuse and food insecurity in agrarian contexts where alcohol consumption is rising. We present the findings of a qualitative study involving in-depth interviews and focus groups with men and women, which explores the connection between alcohol misuse and food insecurity in the Atacora region of Benin. Our findings show that farmers are misusing alcohol as a response to hunger and distress resulting from persistent food insecurity. These drinking behaviours are gendered and shaped by the rigid division of labour roles, wherein primarily men are misusing alcohol. The misuse of alcohol subsequently undermines farm labour and diverts household resources, further worsening food insecurity. Importantly, women reported that alcohol misuse as a coping response to food insecurity contributes to intimate partner violence. Given this complex cyclical relationship, food relief policy-makers in Benin must consider the intersection of alcohol misuse and intimate partner violence when implementing policy and programs intended to improve food security.
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Affiliation(s)
- R Ragetlie
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada.
| | | | - I Luginaah
- Department of Geography, Western University, Social Science Building, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
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Raja A, Heeren TC, Walley AY, Winter MR, Mesic A, Saitz R. Food insecurity and substance use in people with HIV infection and substance use disorder. Subst Abus 2020; 43:104-112. [PMID: 32374225 PMCID: PMC7644575 DOI: 10.1080/08897077.2020.1748164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Food insecurity and substance use are common among people living with HIV (PLWH). Substance use may help people cope with hunger and thus be associated with food insecurity, but the association is uncertain. This study assessed whether, in PLWH and substance dependence, if there was an association between food insecurity and substance use. Methods: We studied adults with HIV and current substance dependence or ever injection drug use interviewed at 12 and 24 months after enrollment in a prospective cohort study. The presence of food insecurity (insufficient food quantity or quality, or anxiety about its availability) was assessed using the Household Food Insecurity Assessment Scale questionnaire (HFIAS). Unhealthy alcohol use was assessed with the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and past 30-day other drug use with the Addiction Severity Index. Associations using repeat cross-sectional data from each of two time-points, 12 months apart, from the same participants were tested using generalized estimating equations logistic regressions. Results: The 233 participants had a mean age of 50 years and 65% were male. At the first interview, 44% reported food insecurity, 40% unhealthy alcohol use, 25% past 30-day cocaine use, and 17% past 30-day illicit opioid use. In analyses adjusted for demographics, social factors, physical and mental health function, and substance use related variables, there was no significant association between food insecurity and unhealthy alcohol use (adjusted odds ratio (aOR) = 1.06 (95% CI: 0.59, 1.87)). Those with food insecurity had higher odds of illicit opioid use (aOR = 2.5 (95% CI: 1.12, 5.58)) and cocaine use (aOR = 1.95 (CI 95%: 1.00, 3.81)). Conclusion: Food insecurity was not associated with unhealthy alcohol use but was associated with cocaine and illicit opioid use. Given the prevalence and impact substance use has on PLWH, food insecurity should be identified and addressed.
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Affiliation(s)
- Akila Raja
- Graduate Medical Sciences, Boston University School of Medicine, 72 East Concord Street, Boston MA 02118, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118, USA
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, Boston, MA 02118, USA
| | - Aldina Mesic
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA
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Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania. AIDS Behav 2019; 23:1612-1622. [PMID: 30465107 DOI: 10.1007/s10461-018-2340-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than one month, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.
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Coleman SM, Gnatienko N, Lloyd-Travaglini CA, Winter MR, Bridden C, Blokhina E, Lioznov D, Adong J, Samet JH, Liegler T, Hahn JA. False-positive HIV diagnoses: lessons from Ugandan and Russian research cohorts. HIV CLINICAL TRIALS 2018; 19:15-22. [PMID: 29384717 PMCID: PMC5949866 DOI: 10.1080/15284336.2018.1429846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research studies rely on accurate assessment of entry criteria in order to maintain study integrity and participant safety, however, challenges can exist with HIV studies in international settings. OBJECTIVE Examine the unexpectedly high proportion of study participants with an undetectable HIV viral load found in Ugandan and Russian research cohorts meeting antiretroviral therapy (ART)-naïve entry criteria. METHODS Russian participants with documented HIV and ART-naïve status were recruited between 2012 and 2015 from clinical and non-clinical sites in St. Petersburg. Participants in Uganda were recruited from Mbarara Regional Referral Hospital from 2011 to 2014 with documented HIV infection via rapid diagnostic testing and recorded ART-naïve in the clinic database. HIV viral load testing of baseline samples was performed; the lower limit of detection was 500 copies/mL in Russia and 40 in Uganda. Due to an unexpectedly high proportion of participants with undetectable viremia, additional tests were performed: enzyme-linked immunosorbent assay HIV testing and testing for ART. RESULTS In Russia, 16% (58/360) had undetectable viremia; 3% (9/360) re-tested HIV-seronegative and 4% (13/360) tested positive for ART. In Uganda 11% (55/482) had undetectable viremia; 5% (26/482) re-tested HIV-seronegative, while <1% (4/482) tested positive for ART. CONCLUSIONS In both Russia & Uganda, undetectable viremia was much higher than would be expected for an HIV-infected ART-naïve cohort. Misclassification of study participants was due to misdiagnosis of HIV with rapid diagnostic testing and inaccurate accounting of ART use. Confirmatory HIV testing could improve accuracy of participants meeting entry criteria for HIV infection as might increased scrutiny of medication use in an ART-naïve cohort.
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Affiliation(s)
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
| | | | | | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
| | - Elena Blokhina
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
| | - Dmitry Lioznov
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
| | - Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
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Idrisov B, Lunze K, Cheng DM, Blokhina E, Gnatienko N, Patts GJ, Bridden C, Kleinman RE, Weiser SD, Krupitsky E, Samet JH. Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART. AIDS Behav 2017; 21:3486-3495. [PMID: 28822002 PMCID: PMC5705384 DOI: 10.1007/s10461-017-1885-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Food insecurity (FI) has been associated with HIV disease progression among people on antiretroviral therapy (ART), presumably a consequence of poor medication adherence. We assessed whether there is a longitudinal association between FI and two primary outcomes reflecting on HIV disease progression (i.e., CD4 count and time to ART initiation) among people not on ART. Analyses used linear mixed effects and Cox models controlling for confounders. In this cohort (n = 310) FI was common (53%). Most (71.3%) reported past month heavy alcohol use and 37.1% reported past month injection drug use. Only 50 participants initiated ART during the study and mean time to ART was 128 days (SD 120). There were no significant differences in CD4 cell count between the groups with mild/moderate FI or severe FI versus those with no FI [adjusted mean difference, mild/moderate insecurity versus no FI -32.5 (95% CI -94.3, 29.3); severe versus no FI -45.5 (95% CI -124.1, 33.0); global p = 0.42]. We found no significant association between FI and longer time to ART initiation (p = 0.36). Food security is a desirable goal for overall health and shown beneficial for those on ART, however it does not appear to be associated with HIV disease progression among those with high prevalence of substance use and not yet on ART.
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Affiliation(s)
- Bulat Idrisov
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Karsten Lunze
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
| | - Natalia Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Gregory J Patts
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ronald E Kleinman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, UCSF, San Francisco, USA
| | - Evgeny Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
- Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
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Abstract
Food insecurity (FI) is associated with depressive symptoms among HIV mono-infected people. Our objective was to examine to what extent this association holds among HIV-hepatitis C virus (HCV) co-infected people. We used data from a prospective cohort study of HIV-HCV co-infected people in Canada. FI was measured using the ten-item adult scale of Health Canada's Household Food Security Survey Module and was classified into three categories: food secure, moderate FI, and severe FI. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10) and was classified into absence or presence of depressive symptoms. FI, depressive symptoms, and other covariates were updated every 6 months. The association between FI and depressive symptoms was assessed using a stabilized inverse probability weighted marginal structural model. The study sample included 725 HIV-HCV co-infected people with 1973 person-visits over 3 years of follow up. At baseline, 23% of participants experienced moderate food insecurity, 34% experienced severe food insecurity and 52% had depressive symptoms. People experiencing moderate FI had 1.63 times (95% CI 1.44-1.86) the risk of having depressive symptoms and people experiencing severe FI had 2.01 times (95% CI 1.79-2.25) the risk of having depressive symptoms compared to people who were food secure. FI is a risk factor for developing depressive symptoms among HIV-HCV co-infected people. Food supplementation, psychosocial support and counseling may improve patient health outcomes.
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