Predictors of intention to change HIV sexual and injection risk behaviors among heterosexual methamphetamine-using offenders in drug treatment: a test of the AIDS Risk Reduction Model

SWATH-MS and MRM: Quantification of Ras-related proteins in HIV-1 infected and methamphetamine-exposed human monocyte-derived macrophages (hMDM)

HIV-1 infection of macrophages is a multistep and multifactorial process that has been shown to be enhanced by exposure to methamphetamine (Meth). In this study, we sought to identify the underlying mechanisms of this effect by quantifying the effect of Meth on the proteome of HIV-1-infected macrophages using sequential windowed acquisition of all theoretical fragment ion mass spectra (SWATH-MS) approach. The analyses identified several members of the Rab family of proteins as being dysregulated by Meth treatment, which was confirmed by bioinformatic analyses that indicated substantial alteration of vesicular transport pathways. Validation of the SWATH-MS was performed using an MRM based approach, which confirmed that Meth exposure affects expression of the Rab proteins. However, the pattern of expression changes were highly dynamic, and displayed high donor-to-donor variability. Surprisingly a similar phenomenon was observed for Actin. Our results demonstrate that Meth affects vesicular transport pathways, suggesting a possible molecular mechanism underlying its effect on HIV infection hMDM and a potential broader effect of Meth on cellular homeostasis.

Sexual partnership types as determinant of HIV risk in South African MSM: an event-level cluster analysis

While individual determinants of HIV risk among MSM have been widely studied, there is limited understanding of how relational characteristics determine sexual risk. Based on data collected among 300 South African men who have sex with men (MSM) and using cluster analysis, this study developed a typology of four partnership types: the "Race-Economic Similar," "Age-Race-Economic Discordant," "Non-regular Neighbourhood," and "Familiar" partnership types. Support for the meaningfulness of these types was found through associations of these partnership types with participant characteristics and characteristics of the last anal sex event. Furthermore, in a multivariate analysis, only partnership type independently predicted whether the last anal sex event was unprotected. Findings of the study illustrate the importance of taking into account the relational context in understanding unprotected sexual practices and present ways to target intervention efforts as well as identify relationship specific determinants of unprotected sex.

Treatment outcomes for methamphetamine users: California Proposition 36 and comparison clients

Methamphetamine (meth) is a major drug of abuse in California and several other states, particularly among criminal offender populations. Over the past decade, substance abuse treatment systems have had to adapt to and accommodate the increasing needs of meth users and, in California, deal with the impact of Proposition 36, which has resulted in a greater number of criminal offenders entering the treatment system. This study examines selected treatment performance and outcome indicators for California Proposition 36 offenders entering substance abuse treatment for meth use and compares their performance and outcomes to other subgroups of California treatment clients differentiated by whether or not they were admitted to treatment through Proposition 36 and whether or not their primary substance was meth. Significant improvements in all outcome domains were seen across the populations, and treatment performance and outcomes were not substantively inferior for the offender or meth-using groups.

Promising practices for delivery of court-supervised substance abuse treatment: perspectives from six high-performing California counties operating Proposition 36

Operative for nearly a decade, California's voter-initiated Proposition 36 program offers many offenders community-based substance abuse treatment in lieu of likely incarceration. Research has documented program successes and plans for replication have proliferated, yet very little is known about how the Proposition 36 program works or practices for achieving optimal program outcomes. In this article, we identify policies and practices that key stakeholders perceive to be most responsible for the successful delivery of court-supervised substance abuse treatment to offenders under Proposition 36. Data was collected via focus groups conducted with 59 county stakeholders in six high-performing counties during 2009. Discussion was informed by seven empirical indicators of program performance and outcomes and was focused on identifying and describing elements contributing to success. Program success was primarily attributed to four strategies, those that: (1) fostered program engagement, monitored participant progress, and sustained cooperation among participants; (2) cultivated buy-in among key stakeholders; (3) capitalized on the role of the court and the judge; and (4) created a setting which promoted a high-quality treatment system, utilization of existing resources, and broad financial and political support for the program. Goals and practices for implementing each strategy are discussed. Findings provide a "promising practices" resource for Proposition 36 program evaluation and improvement and inform the design and study of other similar types of collaborative justice treatment efforts.

The role of critical self-reflection of assumptions in an online HIV intervention for men who have sex with men

The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants (n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions.

How willing are men who have sex with men in China to be circumcised for the sake of protecting his female sex partner?

INTRODUCTION

The HIV prevalence among men who have sex with men (MSM) is increasing sharply in China. Many MSM have female sexual partners, representing a bridge of transmitting HIV to the general population. Circumcision reduces the risk of HIV prevention via heterosexual intercourse.

AIM

The study investigated the prevalence and factors related to willingness to undergo circumcision when MSM were informed that circumcision could reduce risk of heterosexual HIV transmission.

METHODS

An anonymous cross-sectional survey was conducted in Jiangsu, China. A total of 157 MSM with bisexual behaviors in the last six months were recruited using snowball sampling.

MAIN OUTCOME MEASURES

Self-reported circumcision status and foreskin conditions were recorded. HIV-related knowledge, risk perceptions, risky sexual behaviors, cognitive and behavioral intention factors regarding circumcision were assessed.

RESULTS

Among all respondents, 5.7% were circumcised. In the uncircumcised subsample, the willingness to be circumcised increased from 8.1% to 35.1% after they were informed about the 50% risk reduction effect of circumcision regarding heterosexual HIV transmission. Risk behaviors, uncertainty about the prevalence of HIV among MSM, perception of overly long foreskin, peer's suggestion, disagreement with the statements "MSM in general are not willing to be circumcised" and "circumcisions are for children, not for adults" and self-efficacy for circumcision were significantly associated with willingness for circumcision given the hypothetical risk reduction effect (OR = 2.37 and 3.11, respectively, P < 0.05). Perception of overly long foreskin, self-efficacy, and having used a condom in the last episode of sex with a woman remained significantly associated with the conditional willingness for circumcision in the multivariate analysis (OR = 3.03, 2.84 and 2.42, respectively, P < 0.05).

CONCLUSIONS

Interventions promoting circumcision among bisexual MSM, based on the risk reduction effect on heterosexual HIV transmission, are likely to be successful. Such programs should focus on increasing self-efficacy and may consider utilizing a peer educator approach.

Initial commitment to pre-exposure prophylaxis and circumcision for HIV prevention amongst Indian truck drivers

Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP) and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India.

Introduction to the special issue on addiction health services: in memory of Douglas Longshore

This is an Introduction to a special issue in memory of Douglas Longshore, a prominent researcher in the field of addiction health services. The findings from the ten papers in this issue are summarized and discussed within the context of Doug's development as a researcher and the core themes from his work. Three core areas are addressed: (1) internal processes related to change among substance abusers, (2) processes related to ethnicity and gender, and (3) treatment effectiveness, particularly regarding interventions to reduce risk of HIV/AIDS among substance abusers. The implications for addiction health services are discussed with regard to the application of these themes to practice.