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Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Lloyd-Smith JO, Gorbach PM. Association of current substance use treatment with future reduced methamphetamine use in an observational cohort of men who have sex with men in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209228. [PMID: 37981239 PMCID: PMC10984139 DOI: 10.1016/j.josat.2023.209228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Methamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use. METHODS This analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use. RESULTS This analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use. CONCLUSIONS Findings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.
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Affiliation(s)
- Allison D Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Steven J Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marissa J Seamans
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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2
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Davis-Ewart L, Grov C, Verhagen R, Manuel J, Viamonte M, Dilworth S, O'Dell N, Valentin O, Carr S, Cherenack E, Henderson C, Doblecki-Lewis S, Nahum-Shani I, Carrico AW. Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial. JMIR Res Protoc 2023; 12:e48459. [PMID: 37831485 PMCID: PMC10612012 DOI: 10.2196/48459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum. OBJECTIVE PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP. METHODS A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US $50) and filling a PrEP prescription (US $50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions. RESULTS Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing. CONCLUSIONS Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants. TRIAL REGISTRATION ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48459.
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Affiliation(s)
- Leah Davis-Ewart
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Rachel Verhagen
- Department of Psychology, College of Arts and Science, University of Miami, Miami, FL, United States
| | - Jennifer Manuel
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Michael Viamonte
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Samantha Dilworth
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Nicole O'Dell
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Omar Valentin
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Sidney Carr
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Emily Cherenack
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Chelsea Henderson
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | | | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Adam W Carrico
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
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3
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Lauckner C, Haney K, Sesenu F, Kershaw T. Interventions to Reduce Alcohol Use and HIV Risk among Sexual and Gender Minority Populations: a Systematic Review. Curr HIV/AIDS Rep 2023; 20:231-250. [PMID: 37225923 PMCID: PMC10436179 DOI: 10.1007/s11904-023-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals. RECENT FINDINGS Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.
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Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA.
| | - Kimberly Haney
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA
| | - Fidelis Sesenu
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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4
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Forchuk C, Serrato J, Scott L, Rudnick A, Dickey C, Silverman M. "No Good Choice": What are the Issues of Having no Harm Reduction Strategies in Hospitals? Subst Abuse 2023; 17:11782218231186065. [PMID: 37476501 PMCID: PMC10354823 DOI: 10.1177/11782218231186065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
Background Despite an increase in methamphetamine use and subsequent hospitalizations, the majority of Canadian hospitals currently lack harm reduction strategies for substance use. This can mean that people with lived experience of methamphetamine use are faced with a number of difficult decisions to make when admitted to hospital. Caring for people with lived experience of methamphetamine use can also be problematic with zero tolerance policies requiring abstinence to be maintained. This analysis set out to understand potential health care issues due to a lack of harm reduction strategies from the prospective of people with lived experience of methamphetamine use as well as health care/service professionals. Methods Based on a larger study, this secondary analysis explored issues discussed by people with lived experience of methamphetamine use and health care/service professionals regarding the challenges of providing harm reduction approaches in the hospital setting. A total of 108 individuals with lived experience of methamphetamine use completed a qualitative component of a mixed-method interview. In addition, 31 health care/service professionals participated in virtual focus groups and one-to-one interviews. Responses were analyzed using an ethnographic thematic approach. Results People with lived experience of methamphetamine use reported 3 choices upon admission: leave or avoid the hospital, stay but experience unsupported withdrawal, or stay but hide their substance usage from health care professionals. Health care/service professionals described 2 options: uphold zero tolerance that can lead to stigma and a lack of knowledge regarding addiction, or accept harm reduction but be unable to implement such strategies. This could lead to health being compromised due to policy and practice that requires abstinence. Neither group of participants described a good choice for them. Conclusion Current policy and education related to substance use needs to be revised.
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Affiliation(s)
- Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | | | - Leanne Scott
- Lawson Health Research Institute, London, ON, Canada
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5
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Chang JE, Lindenfeld Z, Hagan H. Integrating Harm Reduction into Medical Care: Lessons from Three Models. J Am Board Fam Med 2023; 36:449-461. [PMID: 37169587 PMCID: PMC10636714 DOI: 10.3122/jabfm.2022.220303r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 02/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care. METHODS We conducted a qualitative study using in-depth, semistructured interviews with 20 staff and providers at 3 integrated harm reduction and medical care sites across New York State from March to June 2021. Interview questions focused on how harm reduction approaches were implemented, how harm reduction philosophies were demonstrated in practice, and barriers to adoption. RESULTS The interviews resulted in 8 main themes of integrated harm reduction medical care: 1) role of provider as both learner and informer; 2) pragmatic measures of success; 3) collaborative and interdisciplinary care teams; 4) developing a stigma-free culture; 5) creating a comfortable and welcoming physical space; 6) low-threshold care with flexible scheduling; and; 7) reaching beyond the clinic to disseminate harm reduction orientation; and 8) creating robust referral networks to enhance transitions of care. These themes existed at the patient-provider level (#1 to 3), the organizational level (#4 to 6), and the level extending beyond the clinic (#7 to 8). CONCLUSIONS All 3 sites followed 8 common themes in delivering harm reduction-informed care, most of which are consistent with the broader movement toward patient-centered care. These practices demonstrate how medical providers may overcome some of the barriers imposed by the medical model and successfully integrate harm reduction as an orienting framework toward care delivery.
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Affiliation(s)
- Ji Eun Chang
- From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, ZL); Department of Social Behavioral Sciences and Epidemiology, School of Global Public Health, New York University, New York, NY (HH).
| | - Zoe Lindenfeld
- From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, ZL); Department of Social Behavioral Sciences and Epidemiology, School of Global Public Health, New York University, New York, NY (HH)
| | - Holly Hagan
- From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, ZL); Department of Social Behavioral Sciences and Epidemiology, School of Global Public Health, New York University, New York, NY (HH)
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6
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Davis-Ewart L, Grov C, Verhagen R, Manuel J, Viamonte M, Dilworth S, Valentin O, Cherenack EM, Carr S, Doblecki-Lewis S, Nahum-Shani I, Carrico AW. Randomized Controlled Trial of Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants. RESEARCH SQUARE 2023:rs.3.rs-2787003. [PMID: 37131755 PMCID: PMC10153377 DOI: 10.21203/rs.3.rs-2787003/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men (SMM) who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex in this population, but these motivational enhancement interventions require adaptation to promote engagement along the PrEP care continuum. Methods PRISM is a pilot sequential multiple assignment randomized trial (SMART) testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender SMM who use stimulants that are not currently taking PrEP. A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with non-reactive HIV results are randomized to receive either: 1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or condomless anal sex (session 2); or 2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider ($50) and filling a PrEP prescription ($50). At the 3-month follow-up assessment, participants who report they have not filled a prescription for PrEP are randomized a second time to either: 1) Switch to a second-stage intervention (i.e., MI + CM or CM + MI); or 2) Continue with assessments only. Outcomes for both responders and non-responders are reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription. Self-reported, secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and condomless anal sex. Qualitative exit interviews are conducted with a sub-group of responders and non-responders to characterize their experiences with the MI and CM interventions. Discussion Implementation of this pilot SMART underscores the challenges in reaching SMM who use stimulants to optimize HIV prevention efforts such that approximately one in ten (104/1,060) eligible participants enrolled. However, 85% (70/82) of enrolled participants with non-reactive HIV results were randomized. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in SMM who use stimulants. Trial Registration This protocol was registered on clinicaltrials.gov (NCT04205487) on December 19, 2019.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sidney Carr
- University of Miami Miller School of Medicine
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7
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McLaughlin MF, Jain JP, Ikeda J, Walker JE, Coffin P, Santos GM. Correlates of high phosphatidylethanol (PEth) levels and their concordance with self-reported heavy alcohol consumption among men who have sex with men who binge drink alcohol. Alcohol Clin Exp Res 2022; 46:1565-1579. [PMID: 35722862 PMCID: PMC10079307 DOI: 10.1111/acer.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heavy alcohol use, including binge drinking, is associated with high morbidity and mortality among men who have sex with men (MSM). Self-reported alcohol measures may lead to inaccurate estimates due to recall and social desirability biases. Objective alcohol biomarkers like phosphatidylethanol (PEth) can be used to corroborate self-report and could help to inform treatment approaches and research strategies for alcohol using MSM. METHODS From 2015 to 2020, alcohol using MSM ≥18 years were enrolled in a randomized controlled trial evaluating the efficacy of naltrexone in reducing binge drinking. Using this trial's baseline data, we applied multivariable logistic regression to identify the correlates of high PEth levels (i.e., ≥87 ng/ml) and concordance between PEth levels and self-reported heavy drinking. RESULTS Of 118 MSM, 64% had PEth levels ≥87 ng/ml and 72% had PEth levels that were concordant with self-reported heavy alcohol use. Factors significantly associated in separate models with elevated PEth levels were income ≥$60,000 (adjusted odds ratio [aOR] = 4.09; 95% CI = 1.13 to 14.82), being employed (aOR = 4.04; 95% CI = 1.45 to 11.32), episodic cannabis use (aOR = 4.63; 95% CI = 1.27 to 16.92), and any alcohol/substance use prior to or during anal intercourse (aOR = 2.52; 95% CI = 1.08 to 5.90). Living with HIV was associated with significantly lower odds of elevated PEth levels (aOR = 0.23; 95% CI = 0.09 to 0.61). Factors associated with significantly higher concordance between PEth levels and self-reported heavy alcohol use included at least weekly use of poppers (aOR = 6.41; 95% CI = 1.27 to 32.28) and polysubstance use (aOR = 2.53; 95% CI = 1.02 to 6.27). Living with HIV was associated with lower odds of concordance (aOR = 0.36; 95% CI = 0.14 to 0.97). CONCLUSIONS PEth may enhance the detection of heavy drinking among MSM, including the identification of subpopulations that may benefit from targeted alcohol reduction interventions. However, PEth values for MSM living with HIV showed modest concordance with self-reported alcohol use and may need to be supplemented with additional biomarkers or evaluated against a different cutoff.
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Affiliation(s)
- Matthew F McLaughlin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - Jennifer P Jain
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Janet Ikeda
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - John E Walker
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - Phillip Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Glenn-Milo Santos
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
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8
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Li H, Kang S, Sun L. A Study on the Evaluation of Polyenoic Vegetable Oils and Their Female Health Benefits Based on Time Series Analysis Model: The Case of Peony Seed Oil. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3127698. [PMID: 35368936 PMCID: PMC8975637 DOI: 10.1155/2022/3127698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
Polyenoic vegetable oils mainly contain polyenoic acids such as linoleic acid and linolenic acid, as well as active ingredients such as VE, phytosterols, mineral elements, and squalene. Among them, schisandra oil, kiwi seed oil, grape seed oil, maitake fruit oil, and evening primrose seed oil all contain up to 80% or more polyenoic acids. Studies have shown that polygenic vegetable oils have the effects of assisting in lowering blood lipids, antioxidation, delaying ageing, anti-inflammation, sun protection, moisturizing, slimming and weight loss, etc. They can be widely used in nutritional and healthy edible oils, health food, skin care, and cosmetic products and have great prospects for development and utilization. This paper explores the application of artificial neural networks in the analysis of data. A nonlinear time series prediction method based on the BP algorithm is proposed. The prediction accuracy is much higher than that of the traditional method.
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Affiliation(s)
- Haibo Li
- Shengnong Technology Group, Jinzhong, Shanxi 030805, China
| | - Songhao Kang
- College of Engineering, China Agricultural University, Haidian, Beijing 100083, China
| | - Lijuan Sun
- Beijing Madixin Food Technology Co,Ltd., Haidian, Beijing 100036, China
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9
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Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat 2022; 133:108539. [PMID: 34175174 PMCID: PMC8674383 DOI: 10.1016/j.jsat.2021.108539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
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Affiliation(s)
- Jeremy D Kidd
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Margaret M Paschen-Wolff
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, USA.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
| | - Laurie A Drabble
- San Jose State University, College of Health and Human Sciences, One Washington Square, San Jose, CA 95191, USA.
| | - Tonda L Hughes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
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10
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Viera A, Sosnowy CD, van den Berg JJ, Mehta NA, Edelman EJ, Kershaw T, Chan PA. Substance Use Treatment Engagement among Men Who Have Sex with Men Who Use Stimulants in the Northeastern United States. Subst Use Misuse 2022; 57:595-602. [PMID: 35068332 PMCID: PMC9343172 DOI: 10.1080/10826084.2022.2026965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Stimulant use is increasing in the United States (U.S.), especially among men who have sex with men (MSM). Objectives: We sought to ascertain barriers and facilitators to substance use treatment utilization among MSM who use stimulants in the northeastern U.S. Methods: We conducted semi-structured interviews with MSM who reported recent stimulant use. Interviews explored perceptions of and experiences with substance use treatment. We used thematic analysis to identify factors that facilitated or impeded substance use treatment engagement. Results: We interviewed 21 MSM in Providence, Rhode Island (n = 15) and New Haven, Connecticut (n = 6). Most participants identified as White (57.1%) and gay (52.4%). Over half (52.4%) screened positive for stimulant use disorder. We identified themes in how participants defined, entered, and engaged in substance use treatment. Participants described treatment to include a variety of modalities, including self-help and peer support groups; they defined treatment as an iterative process. Social networks played both a supportive and obstructive role in treatment entry depending on the relationships and approaches of network members. Meanwhile, social connection during treatment could be both therapeutic (reducing isolation) and counterproductive (precipitating cravings to use). Participants generally expressed a desire for harm reduction approaches to treatment over abstinence-only ones. Finally, participants did not find treatment responsive to their needs as MSM. Conclusion: This study highlights key barriers and facilitators to substance use treatment engagement and underscores the urgent need for culturally-responsive treatment programs that employ harm reduction approaches and are tailored to the unique circumstances of MSM who use stimulants. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/10826084.2022.2026965.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Collette D Sosnowy
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jacob J van den Berg
- Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence/Boston Center for AIDS Research, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts, USA
| | - Nikita A Mehta
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - E Jennifer Edelman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.,Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Philip A Chan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence/Boston Center for AIDS Research, Rhode Island, USA
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Liboro RM, Yates TC, Bell S, Ranuschio B, Da Silva G, Fehr C, Ibañez-Carrasco F, Shuper PA. Protective Factors That Foster Resilience to HIV/AIDS: Insights and Lived Experiences of Older Gay, Bisexual, and Other Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168548. [PMID: 34444297 PMCID: PMC8394869 DOI: 10.3390/ijerph18168548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS based on the insights and lived experiences of racially and ethnically diverse, older gbMSM. Applying a community-based participatory research approach that included the meaningful involvement of older gbMSM living with HIV/AIDS in different roles (i.e., advisory committee member, collaborator, peer researcher, and participant), the study recruited and included forty-one older gbMSM living with HIV/AIDS from Ontario, Canada, in confidential, semi-structured interviews. Utilizing thematic analysis, we identified three major themes from the participant interviews as factors that fostered the resilience of older gbMSM to HIV/AIDS and helped to address HIV/AIDS health disparities: (1) established protective factors, (2) behavioral protective factors, and (3) controversial protective factors. This paper argues for the importance of valuing and capitalizing on these protective factors in the conceptualization and development of interventions, services, and programs that are dedicated to fostering resilience to HIV/AIDS.
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Affiliation(s)
- Renato M. Liboro
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
- Correspondence:
| | | | - Sherry Bell
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
| | - Brandon Ranuschio
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.)
| | - George Da Silva
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
| | - Charles Fehr
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
| | | | - Paul A. Shuper
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada; (G.D.S.); (C.F.); (P.A.S.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
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Dimova ED, Elliott L, Frankis J, Drabble L, Wiencierz S, Emslie C. Alcohol interventions for LGBTQ+ adults: A systematic review. Drug Alcohol Rev 2021; 41:43-53. [PMID: 34333818 DOI: 10.1111/dar.13358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Gender and sexual minority populations are more likely to drink excessively compared to heterosexual and cisgender people. Existing reviews of alcohol interventions focus on specific subgroups within the lesbian, gay, bisexual, trans*, queer, questioning or otherwise gender or sexuality diverse (LGBTQ+) population and neither identify their theoretical basis nor examine how interventions are tailored to meet the needs of specific subgroups. METHODS This systematic review includes published studies reporting the effectiveness of interventions to reduce alcohol use in LGBTQ+ people. The review followed PRISMA guidelines. Quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. RESULTS The review includes 25 studies, with the earliest published in 2005. The majority (n = 20) focused on men who have sex with men; only two included sexual minority women and three included trans* people. Most studies were conducted in the USA (n = 21) and used a randomised design (n = 15). Five studies were assessed to be of strong quality, seven moderate and 13 weak. Interventions were mainly delivered face-to-face (n = 21). The most common approaches used to inform interventions were Motivational Interviewing (n = 8) and Cognitive Behavioural Therapy (n = 8). Nineteen studies reported a significant reduction in alcohol consumption. DISCUSSION AND CONCLUSIONS This review suggests that for interventions to be effective in reducing alcohol consumption in LGBTQ+ people, they need to be informed by theory and adapted for the target population. Alcohol interventions that focus on sexual minority women, trans* people and people with other gender identities are needed. The findings have implications for professionals who need to identify when gender and/or sexuality are peripheral or central to alcohol use.
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13
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Mutumba M, Moskowitz JT, Neilands TB, Lee JY, Dilworth SE, Carrico AW. A mindfulness-based, stress and coping model of craving in methamphetamine users. PLoS One 2021; 16:e0249489. [PMID: 34003834 PMCID: PMC8130914 DOI: 10.1371/journal.pone.0249489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
There is increasing interest in the role of mindfulness and mindfulness-based interventions to optimize recovery from a substance use disorder (SUD). However, relatively little is known about the theory-based psychological and social pathways whereby mindfulness could have beneficial effects for managing a chronic, relapsing SUD. Informed by Revised Stress and Coping Theory, the present cross-sectional study examined affective, cognitive, and social pathways whereby mindfulness is associated with lower methamphetamine craving. A total of 161 HIV-positive, methamphetamine-using sexual minority men completed a screening visit for a randomized controlled trial. Using a hybrid structural equation model, we examined pathways whereby mindfulness is associated with lower methamphetamine craving. We found that greater mindfulness was directly associated with lower negative affect and higher positive affect as well as indirectly associated with less methamphetamine craving. Interestingly, the indirect association between mindfulness and methamphetamine craving appeared to be uniquely attributable to positive affect. Only positive affect was indirectly associated with lower methamphetamine craving via higher positive re-appraisal coping and greater self-efficacy for managing triggers for methamphetamine use. Methamphetamine craving was supported by moderate associations with greater substance use severity and more frequent methamphetamine use. These findings support the role of mindfulness in cultivating positive affect, which could be crucial to build the capacity of individuals to manage methamphetamine craving as a chronic stressor that threatens recovery from SUD.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, United States of America
| | - Torsten B. Neilands
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Ji-Young Lee
- School of Medicine, University of Miami, Coral Gables, Florida, United States of America
| | - Samantha E. Dilworth
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Adam W. Carrico
- School of Medicine, University of Miami, Coral Gables, Florida, United States of America
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14
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The Crisis We Are Not Talking About: One-in-Three Annual HIV Seroconversions Among Sexual and Gender Minorities Were Persistent Methamphetamine Users. J Acquir Immune Defic Syndr 2021; 85:272-279. [PMID: 32740370 DOI: 10.1097/qai.0000000000002461] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Methamphetamine use is once again on the rise among sexual and gender minorities who have sex with men (SGMSM). METHODS Baseline and 12-month data are taken from an ongoing cohort study of n = 4786 SGMSM aged 16-49 at risk for HIV from across the United States. Participants completed annual online surveys and at-home HIV testing (oral fluid samples returned through mail). RESULTS Overall, 2.47 per 100 persons seroconverted over 12 months. In addition, 13.8% of participants reported any methamphetamine use over the 12-month study period. Nearly three-fourths (74.7%; 422 of 565) of those who reported using methamphetamine at baseline were persistent users at 12 months. In adjusted analyses, compared with those who did not use methamphetamine, incident methamphetamine users (ie, those who indicated use between baseline and follow-up) and persistent methamphetamine users had significantly higher odds of HIV seroconverting (adjusted odds ratio = 3.95, 95% confidence interval: 1.64 to 9.47; and 7.11, 4.53 to 11.17, respectively). Persistent methamphetamine users accounted for one-third of all observed HIV seroconversions (41 of 115). DISCUSSION Among SGMSM at elevated risk for HIV, persistent methamphetamine use was prevalent and associated with substantially amplified risk for HIV seroconversion. Expanded efforts are needed to test implementation strategies for scalable, evidence-based interventions to reduce HIV risk in SGMSM who use methamphetamine.
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15
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Li CW, Ku SWW, Huang P, Chen LY, Wei HT, Strong C, Bourne A. Factors associated with methamphetamine dependency among men who have sex with men engaging in chemsex: Findings from the COMeT study in Taiwan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103119. [PMID: 33468444 DOI: 10.1016/j.drugpo.2021.103119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sexualized drug use or "chemsex" in Taiwan commonly incorporates the use of methamphetamine. Our study aimed to assess the extent of severity of dependence of methamphetamine among MSM in Taiwan as well as motivations for engagement in chemsex. METHODS Direct messages were sent to users of a large MSM social networking application in Taiwan between November 2018 and January 2019. MSM who had at least one experience of using drugs during sex in the preceding 12 months were invited to complete an online survey that assessed their sexual behavior, substance use and motivations for engaging in chemsex. The Severity of Dependence Scale was used to assess methamphetamine dependency. Multivariable logistic regression was used to determine the factors associated with methamphetamine dependency. RESULTS From a total of 1906 responses, 517 had used methamphetamine in their lifetime and were included in the analysis. The majority (87.2%) used more than one substance when engaging in chemsex in the past six months, while a quarter reported injection of methamphetamine within the last six months. The most commonly reported motivations for participants to engage in chemsex were to have fun, for relaxation, and to increase the intensity of the sexual experience. Nearly half (46.0%) exhibited signs of methamphetamine dependency. Lower monthly income, injection of methamphetamine, ever feeling lonely in the past 3 months and concerns about their substance use expressed by others were significantly associated with methamphetamine dependency. CONCLUSION A high proportion of MSM population who engaged in chemsex were at risk of developing methamphetamine dependency. While motivations for engaging in chemsex were diverse and suggest potential for enhanced sexual experience for some, community health organization for gay men's health and healthcare providers should be vigilant at identifying the risk of methamphetamine dependency and provide in-time, brief intervention or referrals when needed.
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Affiliation(s)
- Chia-Wen Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Stephane Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Poyao Huang
- Fairbank Center for Chinese Studies, Harvard University, Cambridge, MA, United States
| | - Lian-Yu Chen
- Kumming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Ting Wei
- Kumming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, Branch of Linsen, Chiniese Medicine, and Kumming, Taipei City Hospital, Taipei, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, 8F-8068, No. 138, ShengLi Rd., North Dist, Tainan 704, Taiwan.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; Kirby Institute, UNSW Sydney, Australia
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17
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Miguel AQC, Smith CL, Burduli E, Roll JM, McPherson S. Long-term functioning to provide empirical support for the clinical relevance of treatment outcomes for methamphetamine use disorders. J Subst Abuse Treat 2021; 124:108291. [PMID: 33771286 DOI: 10.1016/j.jsat.2021.108291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/26/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research has yet to empirically evaluate methamphetamine (MA) use outcome measures commonly used to indicate treatment success. Clinically meaningful outcomes must be associated with long-term functioning in important life domains. This study evaluated the association between different MA use outcomes and long-term life-functioning. METHOD The data that this study used in its secondary analyses were pooled from two treatment trials for MA use disorders (n = 237). The study conducted multiple regression analyses (with multiple imputation for missing data) to determine the association of six within-treatment MA use outcome measures with problem severity in seven life domains and a proxy measure for overall functioning, measured with the Addiction Severity Index (ASI) and assessed at an 8-month follow-up. RESULTS The longest duration of abstinence (LDA) outcome achieved the most consistent performance, being associated with better scores in five of eight ASI outcomes (β ranging from -0.203 to -0.291; p < .01). The complete abstinence during treatment demonstrated the poorest performance and was not significantly associated with any of the ASI outcomes. All other MA use outcome measures were significantly (p < .01) associated with at least one ASI outcome. CONCLUSION This study provides empirical support for the use of LDA as a clinically relevant indicator of treatment success for MA use disorders, while also indicating the limitations of using complete abstinence during treatment to determine treatment success. Based on these findings, providers and researchers should use LDA as a primary outcome for MA use disorder treatments and trials.
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Affiliation(s)
- André Q C Miguel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
| | - Ekaterina Burduli
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
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18
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Carrico AW, Horvath KJ, Grov C, Moskowitz JT, Pahwa S, Pallikkuth S, Hirshfield S. Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19. AIDS Behav 2020; 24:3020-3023. [PMID: 32266501 PMCID: PMC7137401 DOI: 10.1007/s10461-020-02854-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Adam W Carrico
- University of Miami School of Medicine, Miami, FL, USA.
- University of Miami Department of Public Health Sciences, 1120 NW 14th St., Office 1005, Miami, FL, 33136, USA.
| | - Keith J Horvath
- San Diego State University Department of Psychology, San Diego, CA, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health, New York, NY, USA
| | | | - Savita Pahwa
- University of Miami School of Medicine, Miami, FL, USA
| | | | - Sabina Hirshfield
- State University of New York - Downstate Health Sciences University, New York, NY, USA
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Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. JOURNAL OF SEX RESEARCH 2020; 57:681-708. [PMID: 32077326 PMCID: PMC7457381 DOI: 10.1080/00224499.2020.1728514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.
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Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | - Hamish A Gunn
- Department of Psychology, University of Massachusetts Boston
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Mericle AA, Carrico AW, Hemberg J, de Guzman R, Stall R. Several Common Bonds: Addressing the Needs of Gay and Bisexual Men in LGBT-Specific Recovery Housing. JOURNAL OF HOMOSEXUALITY 2020; 67:793-815. [PMID: 30614414 PMCID: PMC6612453 DOI: 10.1080/00918369.2018.1555394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, California, USA
| | - Adam W Carrico
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, Florida, USA
| | - Jordana Hemberg
- Alcohol Research Group at the Public Health Institute, Emeryville, California, USA
| | - Rebecca de Guzman
- Alcohol Research Group at the Public Health Institute, Emeryville, California, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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21
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Brief Report: Hazardous Cannabis Use and Monocyte Activation Among Methamphetamine Users With Treated HIV Infection. J Acquir Immune Defic Syndr 2020; 81:361-364. [PMID: 30958388 DOI: 10.1097/qai.0000000000002046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of stimulants, such as methamphetamine, has been associated with greater immune activation in treated HIV infection. However, relatively little is known about whether concomitant cannabis use is associated with lower immune activation among HIV-positive stimulant users. SETTING HIV-positive, sexual minority men with biologically confirmed, recent methamphetamine use were enrolled in San Francisco, CA. METHODS In total, 78 methamphetamine-using sexual minority men with an undetectable HIV viral load (<40 copies/mL) completed self-report measures of cannabis use and substance use disorder severity. Plasma biomarkers of monocyte activation (ie, sCD14 and sCD163) and intestinal barrier integrity (iFABP) were measured. The associations of hazardous cannabis use with these measurements were examined after adjusting for substance use disorder severity, age, antiretroviral therapy regimen, CD4 T-cell count, and interleukin-6. RESULTS Hazardous cannabis users had the highest mean sCD14 levels (2181 ng/mL) compared with nonhazardous users (1991 ng/mL) and nonusers (1859 ng/mL; P = 0.05). In adjusted analyses, greater cannabis use severity was associated with higher sCD14 compared with nonusers (unstandardized beta = 133.6 ng/mL, P = 0.03). Cannabis use severity was not significantly associated with sCD163 or iFABP. CONCLUSIONS Hazardous cannabis use is independently associated with elevations in a clinically relevant marker of immune activation in methamphetamine users with treated HIV.
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22
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Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend 2020; 207:107770. [PMID: 31841750 PMCID: PMC6981056 DOI: 10.1016/j.drugalcdep.2019.107770] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.
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Affiliation(s)
- Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
| | - Ron Brookmeyer
- UCLA Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | | | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
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Batchelder AW, Moskowitz JT, Jain J, Cohn M, Earle MA, Carrico AW. A novel technology-enhanced internalized stigma and shame intervention for HIV-positive persons with substance use disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:55-69. [PMID: 33790528 PMCID: PMC8009529 DOI: 10.1016/j.cbpra.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Internalized stigma, shame, and other negative self-conscious emotions are inadequately addressed barriers to HIV-related self-care, particularly among people actively using substances. Innovative approaches are needed to optimize antiretroviral treatment (ART) adherence as well as engagement in HIV care among people living with HIV and substance use disorders. Based on qualitative feedback from providers and patients, we iteratively developed and conducted a proof-of-concept study of a relatively brief transdiagnostic emotion regulation intervention designed to improve ART adherence care by addressing behavioral and psychological barriers, including internalized stigma and shame, among people living with HIV and active substance use disorders. The final intervention included 5 individual sessions focused on metacognitive awareness of emotions and thoughts, cognitive reframing of dysfunctional thoughts about the self using concepts such as self-compassion, and identifying and reaching the participants' personalized HIV-self-care goal(s). All participants received daily texts querying current emotion and weekly texts querying ART adherence and substance use. To extend the effects of the intervention, we developed a personalized bi-directional text component through which participants received their personalized compassionate self-statements, informed by the intervention content, in response to their answers to emotion queries for 8 weeks after the 5 sessions. The texts modeled using compassionate self-statements as a form of cognitive reframing, consistent with cognitive restructuring of distorted core beliefs. We consented 10 participants living with HIV and problematic substance use in the proof-of-concept pilot. Of the 8 participants who completed all intervention sessions, participants replied to 70% of all text messages sent. All 8 reported strong acceptability of the intervention content. This emotion-focused, technology-enhanced intervention demonstrated proof-of-concept, in that this patient population would participate in this intervention. A larger randomized controlled pilot is needed to determine feasibility and acceptability among people living with HIV and substance use disorders, a hard-to-reach and underserved population.
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Affiliation(s)
- Abigail W Batchelder
- Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts
- University of California, San Francisco, San Francisco, California
| | | | - Jennifer Jain
- University of California, San Francisco, San Francisco, California
| | - Michael Cohn
- University of California, San Francisco, San Francisco, California
| | - Maya A Earle
- University of California, San Francisco, San Francisco, California
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Carrico AW, Neilands TB, Dilworth SE, Evans JL, Gόmez W, Jain JP, Gandhi M, Shoptaw S, Horvath KJ, Coffin L, Discepola MV, Andrews R, Woods WJ, Feaster DJ, Moskowitz JT. Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine. J Int AIDS Soc 2019; 22:e25436. [PMID: 31860172 PMCID: PMC6924317 DOI: 10.1002/jia2.25436] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/28/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In the era of HIV treatment as prevention (TasP), evidence-based interventions that optimize viral suppression among people who use stimulants such as methamphetamine are needed to improve health outcomes and reduce onward transmission risk. We tested the efficacy of positive affect intervention delivered during community-based contingency management (CM) for reducing viral load in sexual minority men living with HIV who use methamphetamine. METHODS Conducted in San Francisco, this Phase II randomized controlled trial tested the efficacy of a positive affect intervention for boosting and extending the effectiveness of community-based CM for stimulant abstinence to achieve more durable reductions in HIV viral load. From 2013 to 2017, 110 sexual minority men living with HIV who had biologically confirmed, recent methamphetamine use were randomized to receive a positive affect intervention (n = 55) or attention-control condition (n = 55). All individual positive affect intervention and attention-control sessions were delivered during three months of community-based CM where participants received financial incentives for stimulant abstinence. The 5-session positive affect intervention was designed to provide skills for managing stimulant withdrawal symptoms as well as sensitize individuals to natural sources of reward. The attention-control condition consisted of neutral writing exercises and self-report measures. RESULTS Men randomized to the positive affect intervention displayed significantly lower log10 HIV viral load at six, twelve and fifteen months compared to those in the attention-control condition. Men in the positive affect intervention also had significantly lower risk of at least one unsuppressed HIV RNA (≥200 copies/mL) over the 15-month follow-up. There were concurrent, statistically significant intervention-related increases in positive affect as well as decreases in the self-reported frequency of stimulant use at six and twelve months. CONCLUSIONS Delivering a positive affect intervention during community-based CM with sexual minority men who use methamphetamine achieved durable and clinically meaningful reductions in HIV viral load that were paralleled by increases in positive affect and decreases in stimulant use. Further clinical research is needed to determine the effectiveness of integrative, behavioural interventions for optimizing the clinical and public health benefits of TasP in sexual minority men who use stimulants such as methamphetamine.
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Affiliation(s)
| | - Torsten B Neilands
- San Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | | | - Jennifer L Evans
- San Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Walter Gόmez
- Berkeley School of Social WelfareUniversity of CaliforniaBerkeleyCAUSA
| | - Jennifer P Jain
- San Diego School of MedicineUniversity of CaliforniaLa JollaCAUSA
| | - Monica Gandhi
- San Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Steven Shoptaw
- Departments of Family Medicine and PsychiatryLos Angeles David Geffen School of MedicineUniversity of CaliforniaLos AngelesCAUSA
| | - Keith J Horvath
- Department of PsychologySan Diego State UniversitySan DiegoCAUSA
| | - Lara Coffin
- San Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | | | | | - William J Woods
- San Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | | | - Judith T Moskowitz
- Department of Medical Social SciencesNorthwestern UniversityChicagoCAUSA
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25
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Stimulant Use and Viral Suppression in the Era of Universal Antiretroviral Therapy. J Acquir Immune Defic Syndr 2019; 80:89-93. [PMID: 30272634 DOI: 10.1097/qai.0000000000001867] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-positive persons who use stimulants such as methamphetamine experience difficulties navigating the HIV care continuum that undermine the benefits of antiretroviral therapy (ART). However, few studies have examined the association of stimulant use with viral suppression in the era of universal ART. SETTING Zuckerberg San Francisco General Hospital. METHODS HIV-positive persons participating in a clinical cohort study and taking ART completed assessments every 4-6 months. The exposure was the cumulative, time-varying proportion of assessments with any self-reported stimulant use. The time-varying outcome, HIV viral suppression (ie, <200 copies/mL), was measured at assessments or extracted from the clinical record. RESULTS In total, 1635 HIV-positive participants on ART contributed 17,610 person-visits over a median of 2.3 [interquartile range (IQR) = 1.0-5.3] years of follow-up. Participants were middle-aged (median = 45.0; IQR = 38.0-52.0), predominantly white (57%), sexual minority men (78%), with a median CD4 T-cell count of 409 (IQR = 225-640) cells/mm at enrollment. Significant increases in odds of viral suppression over time were less pronounced among stimulant users compared with nonusers, particularly before the advent of universal ART. Increasing odds of viral suppression were paralleled by declining stimulant use over time. In the universal ART era, increasing odds of viral suppression were observed at lower levels of stimulant use, but not when participants reported using stimulants at every visit. CONCLUSIONS Although ART benefits are still not achieved as rapidly in stimulant users, this disparity is not as large in the era of universal ART.
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Mimiaga MJ, Pantalone DW, Biello KB, White Hughto JM, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care 2019; 31:1083-1095. [PMID: 30887824 PMCID: PMC6625920 DOI: 10.1080/09540121.2019.1595518] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jackie M. White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - John Frank
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Behavioral Medicine Service, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Dave S, Peter T, Fogarty C, Karatzas N, Belinsky N, Pant Pai N. Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018). PLoS One 2019; 14:e0219826. [PMID: 31314764 PMCID: PMC6636761 DOI: 10.1371/journal.pone.0219826] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background Reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets to end the HIV epidemic relies on effective interventions that engage untested HIV+ individuals and retain them in care. Evidence on community-based interventions through the lens of the targets has not yet been synthesized, reflecting a knowledge gap. We conducted a systematic review and meta-analysis to shed light on successful community-based interventions that have been effective in contributing, directly or indirectly, towards the UNAIDS 90-90-90 targets: knowledge of HIV status, linkage to care/on treatment, and viral suppression. Linkage to care was also included in this review due to the limitations of studies. Methods We conducted a systematic review and meta-analysis of the period 2007–2018. Eleven databases were searched to identify community-based interventions designed to improve knowledge of HIV status (in particular HIV testing), linkage to care/on treatment, and/or viral suppression. Eligible studies were classified by intervention, population, country income level, outcomes and success. Success was defined as interventions demonstrating statistical significance between intervention and control group or that reached any target by proportion; 90% testing, 81% linked to care/on treatment and 73% viral suppression. Results Of 82 eligible studies, 51.2% (42/82) reported on HIV testing (first 90), 20.7% (17/82) on linkage to care/ on treatment (second 90), and 45.1% (37/82) on viral suppression (third 90). In all, 67.1% (55/82) of studies reported success; 21 studies on the first 90, 9 towards linkage to care/on treatment, and 25 towards the third. By strategies, 36.6% deployed community workers/peers, 22% used combined test and treat strategies, 12.2% used educational methods, 8.5% used mobile testing, 7.3% used campaigns and 13.4% used technology. For HIV testing/linkage, combined test/treat interventions were often used, for viral suppression, educational interventions and technologies were commonly deployed. Our pooled analysis suggested that deployment of community health care workers/peer workers significantly improved viral suppression (pooled OR: 1.40 95% CI 1.06–1.86). Of the studies published after 2014, 50.0% reported metrics aligned with UNAIDS targets. Conclusions Data on linkage to care/on treatment (second target) remained weak, because many studies reported successes on the first and third targets. Stratification by targets and country income levels is informative and guides adaptation of successful interventions in comparable settings. Consistent reporting of clear metrics aligned with UNAIDS targets will aid in synergy of study data with programmatic data that will help reportage. Exploration of innovative interventions, for engagement and linkage and deployment of community/ peer workers is strongly encouraged.
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Affiliation(s)
- Sailly Dave
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Trevor Peter
- Clinton Health Access Initiative, Gaborone, Botswana
- * E-mail: (NPP); (TP)
| | - Clare Fogarty
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Nicolaos Karatzas
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Nandi Belinsky
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Nitika Pant Pai
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- * E-mail: (NPP); (TP)
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Mullens AB, Fein EC, Young RM, Dunne MP, Norton G, Daken K. Stimulant expectancy questionnaire for men who have sex with men: A measure of substance-related beliefs. Health Promot J Austr 2019; 31:309-319. [PMID: 31225931 DOI: 10.1002/hpja.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/22/2018] [Accepted: 06/09/2019] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Stimulant use has been identified as a key risk factor for sexual behaviours leading to HIV transmission. Substance-related expectancies are associated with substance use and postsubstance use thoughts, feelings and behaviours. Expectancies held by specific cultural subgroups have rarely been investigated, particularly regarding a range of commonly used stimulants. METHOD The Stimulant Expectancy Questionnaire for Men who have Sex with Men (SEQ-MSM) was initially generated through consumer panel and interviews regarding the most commonly used stimulants among MSM in Australia (methamphetamine, amphetamines and ecstasy), with initial administration among 98 MSM to facilitate item reduction. A community sample of 427 MSM was used to validate the SEQ-MSM, with exploratory factor analysis (EFA; n = 202) and confirmatory factor analysis (CFA; n = 225). RESULTS EFA revealed three distinct substance reinforcement domains ('Enhanced sexual experience', 'Sexual communication and negotiation' and 'Cognitive impairment'). The scale was associated with stimulant consumption patterns (including greater expectancies regarding sexual enhancement among methamphetamine users), and the factor structure, comprising a final form of the MSM-SEQ, was confirmed through CFA. CONCLUSIONS The SEQ-MSM represents a reliable measure of outcome expectancies related to the range of commonly used stimulants among Australian MSM. Development of applied validation studies with the SEQ-MSM is a key next step in advancing health promotion, clinical interventions and research efforts to reduce harm (eg, HIV transmission) associated with stimulant use (particularly methamphetamine) among MSM. SO WHAT?: Objectives: This research maps expectancies specific among gay and men who have sex with men (MSM), and relationships between expectancies and stimulant use patterns and behaviours postuse - including sexual activity (eg, condomless anal sex).
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Affiliation(s)
- Amy B Mullens
- School of Psychology & Counselling, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia.,School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Erich C Fein
- School of Psychology & Counselling, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Ross McD Young
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Michael P Dunne
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Graham Norton
- Haemophilia Foundation Queensland, Fortitude Valley, QLD, Australia
| | - Kirstie Daken
- School of Psychology & Counselling, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
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29
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Stauffer CS, Moschetto JM, McKernan SM, Hsiang E, Borsari B, Woolley JD. Oxytocin-enhanced motivational interviewing group therapy for methamphetamine use disorder in men who have sex with men: study protocol for a randomized controlled trial. Trials 2019; 20:145. [PMID: 30791944 PMCID: PMC6385415 DOI: 10.1186/s13063-019-3225-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background The prevalence of methamphetamine use disorder (MUD) in the United States has risen dramatically in the past four decades and is concentrated in populations such as men who have sex with men (MSM). Despite the public health consequences of MUD, there are no FDA-approved psychopharmacological treatments. Psychosocial treatment alone has been shown to reduce methamphetamine use, but high attrition rates limit treatment efficacy. Promising findings from animal models of MUD using exogenous oxytocin, a social neuropeptide, have set the stage for translational work. Along with unique anti-addiction effects, oxytocin holds a primary role in enhancing social salience and modulating stress. In humans, oxytocin administration, combined with evidence-based psychosocial interventions, may act synergistically to improve addiction treatment outcomes and improve retention rates in current MUD treatment. Methods/design We are conducting a randomized, double-blind, placebo-controlled trial of oxytocin-enhanced motivational interviewing group therapy (MIGT). Oxytocin or placebo 40 IU is administered intranasally in conjunction with six, weekly MIGT sessions. We will recruit 50 MSM, initiating treatment for MUD from specialized community health programs in San Francisco, CA, USA. Individuals will be randomized (1:1) to receive six, weekly sessions of MIGT with or without oxytocin. Our primary outcome is session attendance. Other outcomes of interest include: measures of group cohesion, anxiety, psychophysiology, and stimulant craving and use. Discussion This will be the first study of oxytocin’s effects in humans with MUD. Findings from this novel protocol will attempt to bridge existing animal data with the need for innovative clinical treatments for MUD, inform the growing field of pharmacologically-enhanced psychotherapy, and help to elucidate mechanisms behind oxytocin’s potential anti-addiction effects. Trial registration ClinicalTrials.gov, ID: NCT02881177. Registered on 26 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3225-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher S Stauffer
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA.
| | | | | | - Elaine Hsiang
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Brian Borsari
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Joshua D Woolley
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
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Knight R, Karamouzian M, Carson A, Edward J, Carrieri P, Shoveller J, Fairbairn N, Wood E, Fast D. Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: A systematic review. Drug Alcohol Depend 2019; 194:410-429. [PMID: 30502543 DOI: 10.1016/j.drugalcdep.2018.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Methamphetamine use is common among some populations of gay, bisexual and other men who have sex with men (gbMSM). This study reviewed the status of research on the efficacy of interventions that address harms among gbMSM who use methamphetamine. METHODS We searched MEDLINE, PsycINFO, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar to identify publications from inception to October 23, 2017, that assessed an intervention addressing methamphetamine use among gbMSM. RESULTS Of 1896 potential studies and 935 unique articles screened for inclusion, 28 eligible studies assessed 26 different interventions in the following categories: pharmacological (n = 5); psychosocial (n = 20); harm reduction (n = 1). Given that outcome variables were measured in highly variable ways, we were unable to conduct a meta-analysis of intervention effects. However, 22 studies reported a statistically significant effect on one or more methamphetamine-related outcomes. Among 21 studies that included measures of sexual health-related outcomes, 18 reported a significant effect on one or more sexual health-related outcomes, and 15 of those reported a concurrent effect on both drug- and sexual health-related outcomes. CONCLUSIONS This is the first review to provide compelling evidence that integrating interventions to address both drug- and sexual-related harms for gbMSM who use methamphetamine can be efficacious. Future research should focus on identifying differential effects of various intervention approaches by social positioning, as well as prioritize future evaluations of integrated harm reduction interventions (e.g., the distribution of harm reduction kits within sexual health care settings).
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Affiliation(s)
- Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada.
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anna Carson
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Joshua Edward
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Patrizia Carrieri
- Institute de la Santé et de la Recherché Médical (INSERM), Marseille, France
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
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31
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Millar BM, English D, Moody RL, Rendina HJ, Cain D, Antebi-Gruszka N, Carter JA, Parsons JT. Day-Level Associations Between Substance Use and HIV Risk Behavior Among a Diverse Sample of Transgender Women. Transgend Health 2018; 3:210-219. [PMID: 30596148 PMCID: PMC6308277 DOI: 10.1089/trgh.2018.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender women in the United States face elevated rates of HIV and of substance use. Studies measuring overall or aggregate levels of substance use have linked use to increased HIV transmission risk behavior (TRB). Although intensive longitudinal studies in other populations have found day-level links between substance use and TRB, no study has yet explored such links among transgender women. This study aimed to fill this gap in the literature. Methods: Utilizing survey and 60-day timeline follow-back interview data from a sample of 214 transgender women in New York City, we tested whether day-level heavy drinking, marijuana use, and/or nonprescription stimulant use were associated with odds of engaging in any sex (vs. no sexual activity) or engaging in TRB (vs. sex without TRB), adjusting for overall levels of use. Results: Multilevel models showed that each of the three substance types was associated with greater odds of engaging in sex on a given day-and more strongly so for heavy drinking among those with higher rates of heavy drinking, and for stimulant use among those with lower rates of stimulant use. Only marijuana use was associated with greater odds of TRB on a given day, but only among those with higher rates of use. Conclusion: These findings substantiate day-level links between substance use and engaging in sexual activity among transgender women, and importantly, between marijuana use and greater likelihood of TRB on a day when sexual activity occurs. This highlights the importance of addressing substance use for sexual health among transgender women especially focusing on marijuana use.
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Affiliation(s)
- Brett M Millar
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
| | - Devin English
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
| | - Raymond L Moody
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York
| | - Demetria Cain
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Community Health Sciences, University of Illinois-Chicago School of Public Health, Chicago, Illinois
| | - Nadav Antebi-Gruszka
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Mental Health Counseling, Department of Psychology, City College of the City University of New York (CUNY), New York, New York
| | - Joseph A Carter
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York
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Hsiang E, Jennings D, Matheson T, Hern J, Euren J, Santos GM. Acceptability of pharmacotherapy for hazardous alcohol use among men who have sex with men: Findings from a qualitative study. Addict Behav Rep 2018; 8:122-127. [PMID: 30258972 PMCID: PMC6154434 DOI: 10.1016/j.abrep.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) experience high rates of binge drinking, alcohol use disorder (AUD), and alcohol-related health issues. Pharmacotherapy for AUD can reduce hazardous drinking, yet remains underutilized among MSM. This qualitative study examined knowledge and perceptions regarding AUD medications among MSM, with an emphasis on naltrexone. METHODS Three focus group discussions (FGDs) with MSM who consumed alcohol in the past year were conducted in February 2015 (N = 39) in the San Francisco Bay Area. The FGD guide generated discussions about hazardous drinking, the social contexts of drinking, and alcohol reduction and cessation options, including pharmacotherapy. Interviews were analyzed via directed content analysis to codify themes. RESULTS For participants, drinking at LGBTQ bars was an important social activity. Many expressed interest in reducing alcohol use, but few had heard of pharmacotherapy for AUD. Potential uptake was limited by perceptions of disulfiram as the prototype medication, side effects associated with disulfiram, and concerns that medications do not address alcohol-related stigma or social drivers of drinking. Participants were more receptive to pharmacotherapy when presented with medication options that did not require abstinence. Participants reported being more likely to try pharmacotherapy as part of a peer group or treatment program. CONCLUSIONS Efforts to increase the knowledge and availability of naltrexone and harm reduction approaches, while addressing addiction- and medication-related stigma, might improve pharmacotherapy uptake for AUD and decrease hazardous drinking among MSM for whom alcohol holds social significance.
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Affiliation(s)
- Elaine Hsiang
- University of California, San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Danielle Jennings
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tim Matheson
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Jaclyn Hern
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Jason Euren
- Metabiota, 425 California Street, San Francisco, CA 94104, USA
| | - Glenn-Milo Santos
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA 94102, USA
- Department of Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA 94143, USA
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Jin H, Ogunbajo A, Mimiaga MJ, Duncan DT, Boyer E, Chai P, Dilworth SE, Carrico AW. Over the influence: The HIV care continuum among methamphetamine-using men who have sex with men. Drug Alcohol Depend 2018; 192:125-128. [PMID: 30248558 PMCID: PMC6612057 DOI: 10.1016/j.drugalcdep.2018.07.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND HIV-positive persons who use stimulants such as methamphetamine experience greater difficulties in navigating the HIV care continuum. In the era of HIV treatment as prevention (TasP), little is known about the prevalence and correlates of success along the HIV care continuum among people who use stimulants. SETTING San Francisco, California USA METHODS: Cross-sectional study that enrolled 129 HIV-positive men who have sex with men (MSM) from 2013 through 2017 who had biologically confirmed, recent methamphetamine use. Multivariable logistic regressions were built to identify correlates of success across the HIV care continuum. RESULTS Although two-thirds (87/129) of participants had undetectable HIV viral load (<40 copies/mL), only one-in-four (32/129) reported taking at least 90% of their antiretroviral therapy (ART). Those who were homeless in the past year (adjusted odds ratio [aOR] = 0.20; 95% CI = 0.06-0.65) had 80% lower odds of being undetectable and adherent to ART. Substance use disorder treatment was associated with 77% lower odds of being engaged in HIV care (aOR = 0.23; 95% CI = 0.06-0.84) but also close to 3-fold greater odds of being adherent to ART (aOR = 2.91; 95% CI = 1.12-7.60). CONCLUSION Despite the fact that many HIV-positive, methamphetamine-using MSM are able to achieve undetectable viral load in this sample, difficulties with ART adherence threaten to undermine the clinical and public health benefits of TasP. Expanded efforts to boost the effectiveness of TasP in this population should focus on meeting the unique needs of homeless individuals, optimizing ART adherence, and facilitating the integration of HIV care with substance use disorder treatment.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA
| | - Matthew J. Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA,Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA
| | - Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016 USA
| | - Edward Boyer
- Brigham and Women’s Hospital, Division of Medical Toxicology, Department of Emergency Medicine, 75 Francis Street, Boston Ma 02115 USA
| | - Peter Chai
- Brigham and Women’s Hospital, Division of Medical Toxicology, Department of Emergency Medicine, 75 Francis Street, Boston Ma 02115 USA
| | - Samantha E. Dilworth
- School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA
| | - Adam W. Carrico
- School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA,Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Office 1005, Miami, FL 33136 USA,Correspondence: Adam W. Carrico, Department of Public Health Sciences, University of Miami, 1120 NW 14 St., Office 1005, Miami, FL 33136, Tel: 305-243-6947,
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Edelman EJ, Oldfield BJ, Tetrault JM. Office-Based Addiction Treatment in Primary Care: Approaches That Work. Med Clin North Am 2018; 102:635-652. [PMID: 29933820 DOI: 10.1016/j.mcna.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with substance use and to identify optimal approaches to address substance use in primary care and specialty settings.
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Affiliation(s)
- E Jennifer Edelman
- Department of Medicine, Yale University School of Medicine and Public Health, 367 Cedar Street, E.S. Harkness Memorial Hall, Building A, Suite 401, New Haven, CT 06510, USA.
| | - Benjamin J Oldfield
- National Clinician Scholars Program, Yale University School of Medicine, PO Box 208088, New Haven, CT 06520, USA
| | - Jeanette M Tetrault
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, Suite 305, New Haven, CT 06510, USA
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Lim SH, Akbar M, Wickersham JA, Kamarulzaman A, Altice FL. The management of methamphetamine use in sexual settings among men who have sex with men in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:256-262. [PMID: 29605540 DOI: 10.1016/j.drugpo.2018.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/08/2018] [Accepted: 02/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The intentional use of illicit drugs for sexual purposes (also known as 'chemsex') is well known within the MSM communities in Malaysia although research in this population is scarce primarily because both drug use and homosexuality are illegal and stigmatised in Malaysia. METHODS From April to December 2014, interviews were conducted with twenty men (age range 21-43) living in Greater Kuala Lumpur who had sexual intercourse with other men in the past 6 months and who used illicit drugs at least monthly in the past 3 months. Fourteen men were recruited via gay social networking smartphone applications or websites while six were referred by the participants. Data were analsed using thematic analytic approach. FINDINGS The average duration of illicit drug use was 6.4 years (range 1-21) and all participants were using methamphetamine ("ice" or crystal meth) with frequency of use ranged from daily to once a month. Participants came from diverse ethnic, economic, and occupational backgrounds. Most participants used an inhalation apparatus ("bong") to consume methamphetamine and injection was rare in the sample. The primary motivation of methamphetamine use was to increase sexual capacity, heighten sexual pleasure and enhance sexual exploration and adventurism. Socializing with friends ("chilling"), and increased energy for work were secondary motivations. Participants emphasized the need to control the use of methamphetamine and some have established rules to control the amount and duration of use and a minority of men have maintained condom use during anal sex while under the influence of methamphetamine. Participants who professed to be in control of their drug use characterized themselves as functional users regardless of the health and social consequences from continuing use. Overall, participants perceived themselves differently from the traditional opioid users and reported limited access to sexual health and substance use treatment services. CONCLUSION There is a need to increase access to HIV prevention services such as PrEP and PEP, professional support, and substance abuse treatment for drug-using MSM. A more open and friendly environment towards drug-using MSM may help them access and engage with the health services.
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Affiliation(s)
- Sin How Lim
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohd Akbar
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Optimizing Contingency Management with Methamphetamine-Using Men who Have Sex with Men. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 25:286-295. [PMID: 32461714 DOI: 10.1016/j.cbpra.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among men who have sex with men (MSM), methamphetamine use is associated with multiple, overlapping syndemic conditions including increased risk for HIV seroconversion and onward HIV transmission. Contingency management (CM) is an evidence-based, behavioral intervention implemented to curb methamphetamine use and optimize HIV/AIDS prevention among MSM in San Francisco since 2003. We conducted a program evaluation to document the evolution of this 12-week CM program to include delivery of brief, individual counseling incorporating motivational interviewing and behavioral skills. A drop-in group delivered concurrently with CM urine-screening visits also provides peer support as well as referrals for other social and medical services. From December 2011-October 2013, a total of 131 clients enrolled in the CM program and provided a median of 22 urine samples (Interquartile Range = 10-34) that were non-reactive for methamphetamine. Findings support the feasibility and acceptability of integrating individual and group counseling with community-based CM for methamphetamine-using MSM.
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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Flores JM, Santos GM, Makofane K, Arreola S, Ayala G. Availability and Use of Substance Abuse Treatment Programs Among Substance-Using Men Who Have Sex With Men Worldwide. Subst Use Misuse 2017; 52:666-673. [PMID: 28139146 DOI: 10.1080/10826084.2016.1253744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM. OBJECTIVES We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use. METHODS This is a cross-sectional study of a multi-region, online sample of substance-using MSM. RESULTS In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48-6.89), mental health services (aOR = 2.53; CI = 1.32-4.83), and medical care (aOR = 2.32; CI = 1.12-4.80); less than college-level education (aOR = 0.32; CI = 0.18-0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30-2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22-6.22). CONCLUSION In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings.
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Affiliation(s)
- Juan M Flores
- a Columbia University Mailman School of Public Health , New York , USA
| | - Glenn-Milo Santos
- b Center for Public Health Research , San Francisco Department of Public Health , San Francisco , California , USA.,c Department of Community Health Systems , University of California San Francisco , San Francisco , California , USA
| | | | - Sonya Arreola
- d The Global Forum on MSM & HIV , Oakland , California , USA
| | - George Ayala
- d The Global Forum on MSM & HIV , Oakland , California , USA
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Jain J, Santos GM, Scheer S, Gibson S, Crouch PC, Kohn R, Chang W, Carrico AW. Rates and Correlates of Syphilis Reinfection in Men Who Have Sex with Men. LGBT Health 2016; 4:232-236. [PMID: 27991843 DOI: 10.1089/lgbt.2016.0095] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined rates and correlates of syphilis reinfection in men who have sex with men (MSM). METHODS From 2012 to 2015, time to reinfection was assessed in 323 MSM receiving initial treatment for syphilis in San Francisco. RESULTS One in five men was reinfected (71/323; 22%). The rate of syphilis reinfection was greater among HIV-infected men (adjusted hazard ratio [aHR] = 1.96; 95% confidence interval [95% CI] = 1.16-3.31) and ketamine users (aHR = 2.76; 95% CI = 1.09-7.00). CONCLUSION Expanded prevention efforts are needed with HIV-infected and substance-using MSM to reduce the burden of reinfection in this population.
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Affiliation(s)
- Jennifer Jain
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Glenn-Milo Santos
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California.,2 San Francisco Department of Public Health , San Francisco, California
| | - Susan Scheer
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Steve Gibson
- 3 San Francisco AIDS Foundation , San Francisco, California
| | | | - Robert Kohn
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Walter Chang
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Adam W Carrico
- 4 Department of Public Health Sciences, University of Miami School of Medicine , Miami, Florida
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Zhang C, Qian HZ, Yin L, Liu Y, Strauss SM, Ruan Y, Shao Y, Lu H, Vermund SH. Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China. Subst Use Misuse 2016; 51:1821-30. [PMID: 27608264 PMCID: PMC5423713 DOI: 10.1080/10826084.2016.1197264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. METHODS As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. RESULTS A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). CONCLUSION The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,b Division of Epidemiology , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Shiela M Strauss
- c College of Nursing , New York University , New York , New York , USA
| | - Yuhua Ruan
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Yiming Shao
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Hongyan Lu
- e Beijing Center for Disease Control and Prevention , Beijing , China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,f Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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Carrico AW, Jain J, Discepola MV, Olem D, Andrews R, Woods WJ, Neilands TB, Shoptaw S, Gómez W, Dilworth SE, Moskowitz JT. A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. BMC Public Health 2016; 16:673. [PMID: 27476110 PMCID: PMC4967339 DOI: 10.1186/s12889-016-3325-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/20/2016] [Indexed: 01/08/2023] Open
Abstract
Background Contingency management (CM) is an evidence-based intervention providing tangible rewards as positive reinforcement for abstinence from stimulants such as methamphetamine. Integrative approaches targeting affect regulation could boost the effectiveness of CM in community-based settings and optimize HIV/AIDS prevention efforts. Methods/Design This randomized controlled trial with HIV-positive, methamphetamine-using men who have sex with men (MSM) is examining the efficacy of a 5-session, individually delivered positive affect regulation intervention – Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). ARTEMIS is designed to sensitize individuals to non-drug-related sources of reward as well as assist with managing depression and other symptoms of stimulant withdrawal during CM. HIV-positive, methamphetamine-using MSM who are enrolled in a community-based, 12-week CM program are randomized to receive ARTEMIS or an attention-matched control condition. Follow-up assessments are conducted at 3, 6, 12, and 15 months after enrollment in CM. Four peripheral venous blood samples are collected over the 15-month follow-up with specimen banking for planned biomarker sub-studies. The primary outcome is mean HIV viral load. Secondary outcomes include: sustained HIV viral suppression, T-helper cell count, psychological adjustment, stimulant use, and potentially amplified transmission risk behavior. Discussion Implementation of this randomized controlled trial highlights the importance of delineating boundaries between research activities and community-based service provision. It also provides insights into best practices for integrating the distinct agendas of academic and community partners in clinical research. This trial is currently enrolling and data collection is anticipated to be completed in September of 2018. Trial registration This trial was registered on clinicaltrials.gov (NCT01926184) on August 16, 2013.
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Affiliation(s)
- Adam W Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, 1120 NW 14th St., Office 1005, Miami, FL, 33136, USA.
| | - Jennifer Jain
- University of California, San Francisco School of Nursing, San Francisco, USA
| | | | - David Olem
- University of California, San Francisco School of Nursing, San Francisco, USA
| | - Rick Andrews
- San Francisco AIDS Foundation, San Francisco, USA
| | - William J Woods
- University of California, San Francisco School of Nursing, San Francisco, USA.,University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Torsten B Neilands
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Steven Shoptaw
- Departments of Family Medicine and Psychiatry, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Walter Gómez
- University of California, San Francisco School of Nursing, San Francisco, USA
| | - Samantha E Dilworth
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, San Francisco, USA
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Takano A, Miyamoto Y, Kawakami N, Matsumoto T. Web-Based Cognitive Behavioral Relapse Prevention Program With Tailored Feedback for People With Methamphetamine and Other Drug Use Problems: Development and Usability Study. JMIR Ment Health 2016; 3:e1. [PMID: 26740264 PMCID: PMC4720953 DOI: 10.2196/mental.4875] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/31/2015] [Accepted: 09/28/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches. OBJECTIVE The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability. METHODS We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions. RESULTS In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested. CONCLUSIONS The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.
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Affiliation(s)
- Ayumi Takano
- Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan.
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Carrico AW, Gómez W, Siever MD, Discepola MV, Dilworth SE, Moskowitz JT. Pilot randomized controlled trial of an integrative intervention with methamphetamine-using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1861-7. [PMID: 26123068 PMCID: PMC4560962 DOI: 10.1007/s10508-015-0505-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/20/2014] [Accepted: 02/12/2015] [Indexed: 05/12/2023]
Abstract
Contingency management (CM) is an evidence-based intervention that provides tangible rewards as positive reinforcement for biologically confirmed abstinence from substance use. Integrative approaches targeting positive affect regulation could boost the effectiveness of CM by sensitizing individuals to non-drug-related sources of reward and assisting them with effectively managing symptoms of withdrawal. This pilot randomized controlled trial with 21 methamphetamine-using men who have sex with men (MSM) examined the feasibility and acceptability of a 5-session, positive affect intervention delivered during CM-Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). After completing 4 weeks of a 12-week CM program, participants were randomized to receive ARTEMIS+CM (n = 12) or CM-only (n = 9). Those randomized to receive the ARTEMIS positive affect intervention completed 98 % of sessions and reported marginally significant increases in positive affect over the five sessions. In exit interviews with ARTEMIS+CM participants, individuals noted that the positive affect regulation skills increased self-awareness and led to greater engagement in the recovery process. ARTEMIS+CM participants reported significant increases in positive affect and CM-only participants reported significant reductions in negative affect over a 2-month follow-up. These affective changes were not maintained, and no concurrent effects on stimulant use or sexual risk taking were observed over the 6-month follow-up. More definitive clinical research is necessary to examine the efficacy of ARTEMIS+CM with methamphetamine-using MSM.
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Affiliation(s)
- Adam W Carrico
- University of California San Francisco School of Nursing, 2 Koret Way, N511M, San Francisco, CA, 94143, USA,
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Abstract
PURPOSE OF REVIEW To summarize the recent literature (1st January 2014-1st February 2015) on stimulant treatment programme evaluations, and highlight key areas for future programme development. RECENT FINDINGS Advances have been made in addressing both sexual risks and stimulant use among gay and bisexual men in the United States, and in adapting evidence-based resource-intense interventions to real-world settings. Programme outcome measures increasingly include changes in substance use as well as health and wellbeing indicators and measures of risk. SUMMARY Future programme directions include: expansion of the psychosocial repertoire to include narrative and mindfulness-based therapies; web-based programme delivery; sex-sensitive programming to attract and retain women; comprehensive programming to address coexisting mental and physical illness and polysubstance use (including tobacco smoking); and improving accessibility to promote early intervention. Comparability of evaluation data can be improved by developing standardized tools particularly for measuring change in sexual-risk behavior. The use of new statistical techniques can address the lack of comparison populations.
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Hobkirk AL, Watt MH, Green KT, Beckham JC, Skinner D, Meade CS. Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa. Addict Behav 2015; 42:167-71. [PMID: 25479528 DOI: 10.1016/j.addbeh.2014.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/10/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
South Africa has high rates of interpersonal violence and a rapidly growing methamphetamine epidemic. Previous research has linked experiences of interpersonal violence to higher rates of substance use, and identified mental health constructs as potential mediators of this association. The aim of this study was to examine the relationship between interpersonal violence and addiction severity among active methamphetamine users in Cape Town, South Africa, and to explore symptoms of posttraumatic stress disorder (PTSD) and substance use coping as mediators of this relationship. A community sample of 360 methamphetamine users was recruited through respondent driven sampling and surveyed on their experiences of violence, mental health, coping, and drug use and severity. A series of one-way ANOVAs were conducted to examine the relationship of self-reported interpersonal violence with drug addiction severity, and multiple mediation analyses were used to determine if PTSD symptoms and substance use coping mediated this relationship. The majority (87%) of the sample reported experiencing at least one instance of interpersonal violence in their lifetime, and the number of violent experiences was associated with increased drug addiction severity. PTSD and substance use coping were significant mediators of this association. Only the indirect effect of substance use coping remained significant for the female sample when the mediation model was conducted separately for men and women. The findings point to the need for integrated treatments that address drug use and PTSD for methamphetamine users in South Africa and highlight the importance of coping interventions for women.
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Affiliation(s)
- Andréa L Hobkirk
- Duke University, Duke Global Health Institute, 310 Trent Drive, Trent Hall, Room 329, Durham, NC, 27708, USA.
| | - Melissa H Watt
- Duke University, Duke Global Health Institute, 310 Trent Drive, Trent Hall, Room 330, Durham, NC, 27708, USA.
| | - Kimberly T Green
- Durham VA Medical Center, 116B, 508 Fulton St., Durham, NC, 27705, USA.
| | - Jean C Beckham
- Durham VA Medical Center, 116B, 508 Fulton St., Durham, NC, 27705, USA.
| | - Donald Skinner
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Box 90519, Durham, NC, 27708, USA.
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Fletcher JB, Reback CJ. Depression mediates and moderates effects of methamphetamine use on sexual risk taking among treatment-seeking gay and bisexual men. Health Psychol 2015; 34:865-9. [PMID: 25581704 DOI: 10.1037/hea0000207] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mounting evidence suggests a syndemic relation between methamphetamine use and depression to increase sexual risk taking (i.e., HIV transmission risk behavior) among men who have sex with men. This prospective analysis of longitudinal data collected from an outpatient methamphetamine abuse treatment program for gay and bisexual men assessed whether symptoms of depression mediated and/or moderated the associations between methamphetamine use and unprotected insertive/receptive anal intercourse. METHOD From November 2005 through October 2007, 167 treatment-seeking gay and bisexual men (63% HIV-positive) enrolled in and attended a 16-week methamphetamine abuse outpatient treatment program. Participants' depressive symptoms, biomarker-confirmed methamphetamine use, and self-reported sexual risk taking were assessed at baseline and follow-up evaluations. Path analysis tested the mediating and moderating effects of depression on the associations between methamphetamine use and unprotected insertive/receptive anal intercourse. RESULTS Methamphetamine use during the treatment period had a significant indirect (Coef. = -.15; 95% CI [-.23, -.06]), but no direct (Coef. = .11; ns) or total effect (Coef. = -.04; ns) on participants' sexual risk taking after accounting for the significant mediating (Coef. = .56; 95% CI [.33, .78]) and moderating (Coef. = -.03; 95% CI [-.04, -.02]) effects of depression. CONCLUSIONS Depression fully mediated and weakly moderated associations between methamphetamine use and sexual risk taking in this sample. Interventions and treatment programs to reduce sexual risk taking among gay and bisexual men should simultaneously address methamphetamine use and depression to optimize health outcomes.
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Oldenburg CE, Jain S, Mayer KH, Mimiaga MJ. Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine. Drug Alcohol Depend 2015; 146:75-80. [PMID: 25482500 PMCID: PMC4272860 DOI: 10.1016/j.drugalcdep.2014.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. METHODS A Retrospective cohort study of all PEP prescriptions (N=1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. RESULTS Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). CONCLUSIONS While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.
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Affiliation(s)
- Catherine E. Oldenburg
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,The Fenway Institute, Fenway Community Health, Boston, MA
| | - Sachin Jain
- The Fenway Institute, Fenway Community Health, Boston, MA,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Community Health, Boston, MA,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA,Department of Global Health and Population, Harvard School of Public Health, Boston, MA
| | - Matthew J. Mimiaga
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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