Gender and social rejection as risk factors for engaging in risky sexual behavior among crack/cocaine users

Neurological, Behavioral, and Pathophysiological Characterization of the Co-Occurrence of Substance Use and HIV: A Narrative Review

Combined antiretroviral therapy (cART) has greatly reduced the severity of HIV-associated neurocognitive disorders in people living with HIV (PLWH); however, PLWH are more likely than the general population to use drugs and suffer from substance use disorders (SUDs) and to exhibit risky behaviors that promote HIV transmission and other infections. Dopamine-boosting psychostimulants such as cocaine and methamphetamine are some of the most widely used substances among PLWH. Chronic use of these substances disrupts brain function, structure, and cognition. PLWH with SUD have poor health outcomes driven by complex interactions between biological, neurocognitive, and social factors. Here we review the effects of comorbid HIV and psychostimulant use disorders by discussing the distinct and common effects of HIV and chronic cocaine and methamphetamine use on behavioral and neurological impairments using evidence from rodent models of HIV-associated neurocognitive impairments (Tat or gp120 protein expression) and clinical studies. We also provide a biopsychosocial perspective by discussing behavioral impairment in differentially impacted social groups and proposing interventions at both patient and population levels.

Sexually Transmitted Infections in Women of Reproductive Age by Disability Type

INTRODUCTION

The objectives of this study were to estimate the prevalence of sexually transmitted infections in women of reproductive age by disability type and examine the association between disability types, participant characteristics, and the prevalence of sexually transmitted infections (STIs).

METHODS

Pooled data from 2015 to 2019 National Survey on Drug Use and Health were analyzed in 2022. The analytic sample included 90,233 women of reproductive age (18-49 years). Disability was defined as having any sensory, cognitive, physical, or ≥2 disabilities.. A total of 15% of women reported having a disability. Descriptive analyses were used to estimate the prevalence of STI, and logistic regression analyses were conducted to examine the association of disability type and other participant characteristics with the odds of having STIs.

RESULTS

The prevalence of STIs was more than twice as high for women of reproductive age with cognitive disabilities (6.8%) or ≥2 disabilities (6.7%) as for those without disabilities (2.7%). Women with sensory disabilities (AOR=1.47; 95% CI=1.17, 1.85), cognitive disabilities (AOR=1.89; 95% CI=1.65, 2.17), or ≥2 disabilities (AOR=1.78; 95% CI=1.49, 2.14) had greater odds of STIs than those without disabilities. Bisexual women had higher odds (AOR=1.31; 95% CI=1.14, 1.50) of STIs than straight women, whereas lesbian/gay women had lower odds (AOR=0.41; 95% CI=0.27, 0.63). The odds of STIs were higher among non-Hispanic Blacks (AOR=1.42; 95% CI=1.24, 1.63) and lower among Asian women (AOR=0.62; 95% CI=0.43, 0.90) than among non-Hispanic Whites. The odds of STIs were also greater among participants having any alcohol, cannabis, or illicit drug use.

CONCLUSIONS

Women of reproductive age with disabilities have a higher prevalence of sexually transmitted infections. In addition to disability type, the odds of sexually transmitted infections varied by race/ethnicity, sexual orientation, and substance use.

A Latent Class Analysis of HIV Risk Factors Among Men and Women with Opioid Use Disorder in Pre-trial Detention

Adults entering pre-trial detention who inject drugs are at high risk for acquiring HIV/AIDS. In the current study, we examined pre-incarceration HIV risk behaviors among 114 people with opioid use disorder who inject drugs. Participants were recruited from the Baltimore City Detention Center as part of a randomized controlled trial of pre-release methadone treatment. Using latent class analysis, we found three separate latent classes, which we identified as the sex exchange class (14.2%), drug equipment sharing class (36.8%) and lower risk class (49.0%). Women in the sex exchange class (n = 16) reported having multiple male partners and selling sex for money or drugs; however, this group also reported more consistent condom use and less frequent injection drug and equipment sharing than participants in the drug equipment sharing class. Our findings highlight distinct profiles of jail detainees with OUD based on their risks for HIV, and could inform more targeted interventions for each group.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.

Comparison of knowledge, attitude, and practices of animal and human brucellosis between nomadic pastoralists and non-pastoralists in Kenya

BACKGROUND

The seroprevalence of brucellosis among nomadic pastoralists and their livestock in arid lands is reported to be over10-fold higher than non-pastoralists farmers and their livestock in Kenya. Here, we compared the seroprevalence of nomadic pastoralists and mixed farming with their knowledge of the disease and high-risk practices associated with brucellosis infection.

METHODS

Across-sectional study was conducted in two counties - Kiambu County where farmers primarily practice smallholder livestock production and crop farming, and Marsabit County where farmers practice nomadic pastoral livestock production. Stratified random sampling was applied, in which sublocations were initially selected based on predominant livestock production system, before selecting households using randomly generated geographical coordinates. In each household, up to three persons aged 5 years and above were randomly selected, consented, and tested for Brucella spp IgG antibodies. A structured questionnaire was administered to the household head and selected individuals on disease knowledge and risky practices among the pastoralists and mixed farmers compared. Multivariable mixed effects logistic regression model was used to assess independent practices associated with human Brucella spp. IgG seropositivity.

RESULTS

While the majority (74%) of pastoralist households had little to no formal education when compared to mixed (8%), over 70% of all households (pastoralists and mixed farmers) had heard of brucellosis and mentioned its clinical presentation in humans. However, fewer than 30% of all participants (pastoralists and mixed farmers) knew how brucellosis is transmitted between animals and humans or how its transmission can be prevented. Despite their comparable knowledge, significantly more seropositive pastoralists compared to mixed farmers engaged in risky practices including consuming unboiled milk (79.5% vs 1.7%, p < 0.001) and raw blood (28.3% vs 0.4%, p < 0.001), assisting in animal birth (43.0% vs 9.3%, p < 0.001), and handling raw hides (30.6% vs 5.5%, p < 0.001).

, CONCLUSION

Nomadic pastoralists are more likely to engage in risky practices that promote Brucella Infection, probably because of their occupation and culture, despite having significant knowledge of the disease.

When less is more: mindfulness predicts adaptive affective responding to rejection via reduced prefrontal recruitment

Social rejection is a distressing and painful event that many people must cope with on a frequent basis. Mindfulness—defined here as a mental state of receptive attentiveness to internal and external stimuli as they arise, moment-to-moment—may buffer such social distress. However, little research indicates whether mindful individuals adaptively regulate the distress of rejection—or the neural mechanisms underlying this potential capacity. To fill these gaps in the literature, participants reported their trait mindfulness and then completed a social rejection paradigm (Cyberball) while undergoing functional magnetic resonance imaging. Approximately 1 hour after the rejection incident, participants reported their level of distress during rejection (i.e. social distress). Mindfulness was associated with less distress during rejection. This relation was mediated by lower activation in the left ventrolateral prefrontal cortex during the rejection incident, a brain region reliably associated with the inhibition of negative affect. Mindfulness was also correlated with less functional connectivity between the left ventrolateral prefrontal cortex and the bilateral amygdala and the dorsal anterior cingulate cortex, which play a critical role in the generation of social distress. Mindfulness may relate to effective coping with rejection by not over-activating top-down regulatory mechanisms, potentially resulting in more effective long-term emotion-regulation.

Another look at impulsivity: Could impulsive behavior be strategic?

In the present article, we propose that impulsive behavior may be a response to certain needs or goals that people have in the moment and could therefore be strategic. We review briefly the dominant approaches and findings in the impulsivity literature. We then examine different behaviors that are typically considered impulsive such as delay discounting, risky sexual behavior, risk taking in the context of emotion dysregulation, and adolescent risk behavior and present evidence suggesting that they follow the general principles of goal pursuit. Specifically, they are (a) enacted when perceived as relevant to the individual's motivation; (b) less likely when alternative means to fulfill these goals are available; and (c) supported rather than reduced by sufficient executive control, a hallmark of goal pursuit. We do not argue that there is no impulsive behavior. Rather, we suggest that such behavior may represent individuals' attempts to fulfill current motivations or needs. This approach emphasizes the functionality and dynamism of the behavior, it provides a framework to explain the inconsistencies in the literature, it helps us to move away from pathologizing or moralizing the behavior, and it provides insights about potential strategies to mitigate the negative consequences of acting impulsively.

Borderline personality disorder and substance use disorders: an updated review

For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).

HIV Risk, Substance Use, and Personality Characteristics among Adults with History of Serious Mental Illness

The present study examined the relationship between characteristics associated with personality disorders, substance use, and HIV risk among adults with a history of serious mental illness. Participants included 103 adults with antisocial or borderline personality disorder, serious mental illness, and recent HIV risk behavior. The sample was predominately male (64%), diverse (42% African American and 13% Hispanic), and homeless/marginally housed (76%). In order to examine the relationship between personality characteristics and risk we constructed a risk index comprising key symptoms of antisocial and borderline personality disorders, namely; impulsivity, affective instability, and disregard for safety of self/others. Contrary to our primary hypotheses, risk index scores did not predict HIV risk behavior and substance abuse did not mediate this risk. Exploratory analyses did reveal that women engaged in significantly more risk behaviors than their male counterparts and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Finally, recent alcohol use and increased impulsivity was associated with more condomless oral sex for men and women. These results suggest the relationship among serious mental illness, personality disorder, substance abuse, and gender is complex and merits further study.

Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual

RESUMO Este artigo visa investigar como se conformam, no Brasil e internacionalmente, as abordagens ao uso prejudicial do crack e outras drogas. Foi realizada uma revisão crítica da literatura acerca do padrão de consumo do crack e os fatores a ele relacionados com busca sistemática em bases eletrônicas no período de 2010 a 2016. Foram analisados 37 artigos por autor, ano, país do estudo, metodologia; padrão de consumo de crack e fatores individuais e contextuais relativos a esse uso. Conclui-se que a abordagem ao uso de drogas deve estar focada na perspectiva da redução de danos, na promoção da autonomia e dos direitos humanos, e não na utopia de eliminação do consumo e da produção de drogas.

Conformity motives for alcohol use are associated with risky sexual behavior among alcohol-dependent patients in residential substance abuse treatment

Alcohol misuse is associated with a variety of negative outcomes, including risky sexual behavior (RSB). In an attempt to better identify the subset of individuals at greatest risk for these negative outcomes, a growing body of research has begun to examine the role of alcohol use motives in risk for alcohol use-related negative outcomes. Although the majority of research in this area has focused on coping motives, conformity motives may be particularly relevant to outcomes such as RSB. Specifically, conformity motives may operate as a proxy risk factor for RSB, reflecting the tendency to engage in interpersonally-oriented risk behaviors in order to avoid rejection, interpersonal conflict, or social ostracism. Therefore, the current study examined the relation between conformity motives for alcohol use and RSB in a sample of 94 patients in a residential substance abuse treatment center. Results indicated that conformity motives were associated with RSB above and beyond other motives for alcohol use, as well as relevant covariates. Findings support the notion that conformity motives may operate as a proxy risk factor that could assist in identifying individuals at elevated risk for engaging in RSB.

Substance use and STI acquisition: Secondary analysis from the AWARE study

OBJECTIVES

Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics.

METHODS

A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender.

RESULTS

Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates.

CONCLUSIONS

Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.

History of abuse and risky sex among substance users: The role of rejection sensitivity and the need to belong

This study investigates abuse and rejection sensitivity as important correlates of risky sexual behavior in the context of substance use. Victims of abuse may experience heightened sensitivity to acute social rejection and consequently engage in risky sexual behavior in an attempt to restore belonging. Data were collected from 258 patients at a substance use treatment facility in Washington, D.C. Participants' history of abuse and risky sexual behavior were assessed via self-report. To test the mediating role of rejection sensitivity, participants completed a social rejection task (Cyberball) and responded to a questionnaire assessing their reaction to the rejection experience. General risk-taking propensity was assessed using a computerized lab measure. Abuse was associated with increased rejection sensitivity (B=0.124, SE=0.040, p=0.002), which was in turn associated with increased risky sex (B=0.06, SE=0.028, p=0.03) (indirect effect=0.0075, SE=0.0043; 95% CI [0.0006, 0.0178]), but not with other indices of risk-taking. These findings suggest that rejection sensitivity may be an important mechanism underlying the relationship between abuse and risky sexual behavior among substance users. These effects do not extend to other risk behaviors, supporting the notion that risky sex associated with abuse represents a means to interpersonal connection rather than a general tendency toward self-defeating behavior.

Relationships between risky sexual behaviour, dysexecutive problems, and mental health in the years following interdisciplinary TBI rehabilitation

Little is known about the long-term consequences of traumatic brain injury (TBI) regarding risky sexual behaviour. The objectives of the study were (1) to compare risky sexual behaviour in a sample of individuals with TBI having received interdisciplinary rehabilitation with that of healthy controls, and (2) to explore the relationships between risky sexual behaviour, executive functions, and mental health in individuals with TBI. The study group consisted of 42 individuals with TBI with a mean age of 37.9 years (SD = 9.7), 12.8 years of education (SD = 3.3), and 3.3 years post-injury (SD = 4.3). Healthy controls consisted of 47 participants, with a mean age of 37.6 years (SD = 10.7), and 13 years of education (SD = 3). Risky sexual behaviour was measured with the Sexual Risk Survey and executive function with the Dysexecutive Questionnaire. Mental health measures included the Generalised Anxiety Disorder Scale, and the Patient Health Questionnaire for depression. Compared to healthy controls, individuals with TBI reported more dysexecutive and mental health problems, without differences in risky sexual behaviour. In individuals with TBI, risky sexual behaviour was associated with behavioural, cognitive and emotional dysexecutive problems, but not with anxiety or depression. It was concluded that special attention should be given to individuals with TBI showing difficulties in executive functions given their association with risky sexual behaviour.

When the End Justifies the Means

We explore the possibility that self-defeating behaviors represent self-regulatory success rather than failure. Specifically, we suggest that drug use, overeating, risky sexual behavior, self-harm, and martyrdom represent means toward individuals’ goals. In this capacity, they may be initiated and pursued upon goal activation despite potentially negative consequences, and thus exemplify the long-held notion that the end justifies the means. We propose a means-end analysis, present evidence that these activities demonstrate the hallmarks of goal pursuit, and discuss novel implications for understanding these behaviors.

Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study

Background

For some adolescents feeling lonely can be a protracted and painful experience. It has been suggested that engaging in health risk behaviours such as substance use and sexual behaviour may be a way of coping with the distress arising from loneliness during adolescence. However, the association between loneliness and health risk behaviour has been little studied to date. To address this research gap, the current study examined this relation among Russian and U.S. adolescents.

Methods

Data were used from the Social and Health Assessment (SAHA), a school-based survey conducted in 2003. A total of 1995 Russian and 2050 U.S. students aged 13–15 years old were included in the analysis. Logistic regression was used to examine the association between loneliness and substance use, sexual risk behaviour, and violence.

Results

After adjusting for demographic characteristics and depressive symptoms, loneliness was associated with a significantly increased risk of adolescent substance use in both Russia and the United States. Lonely Russian girls were significantly more likely to have used marijuana (odds ratio [OR]: 2.28; confidence interval [CI]: 1.17–4.45), while lonely Russian boys had higher odds for past 30-day smoking (OR, 1.87; CI, 1.08–3.24). In the U.S. loneliness was associated with the lifetime use of illicit drugs (excepting marijuana) among boys (OR, 3.09; CI, 1.41–6.77) and with lifetime marijuana use (OR, 1.79; CI, 1.26–2.55), past 30-day alcohol consumption (OR, 1.80; CI, 1.18–2.75) and past 30-day binge drinking (OR, 2.40; CI, 1.56–3.70) among girls. The only relation between loneliness and sexual risk behaviour was among Russian girls, where loneliness was associated with significantly higher odds for ever having been pregnant (OR, 1.69; CI: 1.12–2.54). Loneliness was not associated with violent behaviour among boys or girls in either country.

Conclusion

Loneliness is associated with adolescent health risk behaviour among boys and girls in both Russia and the United States. Further research is now needed in both settings using quantitative and qualitative methods to better understand the association between loneliness and health risk behaviours so that effective interventions can be designed and implemented to mitigate loneliness and its effects on adolescent well-being.