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Heads AM, de Dios C, An K, Yoon JH, Suchting R, Gilmore-Thomas A, Schmitz JM. Interest in and Willingness to Use PrEP: A Cross-Sectional Study of Individuals with Problematic Substance Use Residing in a High HIV Prevalence Jurisdiction. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02936-z. [PMID: 39020242 DOI: 10.1007/s10508-024-02936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/23/2024] [Accepted: 06/08/2024] [Indexed: 07/19/2024]
Abstract
Although it is an effective HIV prevention method, pre-exposure prophylaxis (PrEP) is underutilized in the Southern US. Many people who use drugs (PWUD) have increased susceptibility to HIV which could be lessened by using PrEP. Potential barriers to PrEP use include lack of awareness of PrEP, low knowledge about HIV prevention, low self-efficacy for HIV prevention, inaccurate risk perceptions, and anticipated stigma. The current study examined predisposing, enabling, and reinforcing factors that may predict interest in PrEP. The purpose of the current study was to explore factors associated with interest in and willingness to use daily oral and long acting injectable PrEP among sexually active adult PWUD. The data were collected from adult participants (n = 270) residing in Harris County, TX, who self-reported problematic substance use and who reported oral, anal, or vaginal sex in the six months prior to completing the survey. The survey was distributed and completed online via Qualtrics Panels in March of 2022 and included measures of PrEP and HIV knowledge, PrEP stigma, sexual health self-efficacy, experiences of discrimination, health literacy, and medical mistrust. The majority of participants reported circumstances or behaviors that increased their susceptibility to HIV. Findings indicated that PrEP user stereotypes and PrEP anticipated disapproval by others were associated with interest in using daily oral PrEP and willingness to use long acting injectable PrEP. These results provide insight into reasons for low PrEP uptake among PWUD who live in a high HIV prevalence jurisdiction. Implications for HIV prevention intervention are discussed.
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Affiliation(s)
- Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA.
| | - Constanza de Dios
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Kaixuan An
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Adrienne Gilmore-Thomas
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
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Constructing Taxonomies: Identifying Distinctive Class of HIV Support and Risk Networks among People Who Use Drugs (PWID) and Their Network Members in the HPTN 037 Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127205. [PMID: 35742460 PMCID: PMC9223677 DOI: 10.3390/ijerph19127205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
Injection drug use is a significant mode of HIV transmission. Social networks are potential avenues for behavior change among high-risk populations. Increasing knowledge should include a classification or taxonomy system of networks’ attributes, risks, and needs. The current study employed 232 networks comprising 232 indexes, with 464 network members enrolled in Philadelphia. LCA revealed a three-class solution, Low-Risk, Paraphernalia Risk, and High Sex/Moderate Paraphernalia Risk class, among participants. The analysis found receiving money or drugs for sex and employment status increased the odds of belonging to PR and PSR classes. Homelessness and incarceration increased the odds of belonging to the PR class when compared to the LR class. Our findings suggest that classes of risk among PWID comprise clusters of information concerning their members. These findings add depth to our understanding while extending our knowledge of the contextual environment that nurtures or exacerbates the problem.
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Heads AM, Hill MJ, Suchting R, Yammine L, Gilmore-Thomas A. Predictors of Anticipated PrEP Stigma among Women with Self-Reported Problematic Substance Use: Implications for Engaging Women in the PrEP Care Continuum. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2955-2964. [PMID: 34561793 DOI: 10.1007/s10508-021-02031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but it has been underutilized by women. Anticipated stigma regarding use of PrEP is a contributing factor in the underutilization of this prevention strategy. The current study explored the relationships among PrEP stigma, sex risk (i.e., inconsistent condom use, condomless sex with persons of unknown serostatus, or sex in exchange for money or drugs), substance use, attitudes toward HIV testing, and medical mistrust. Participants were 106 primarily ethnic-minority women who reported recent substance use and agreed to participate in a study exploring HIV prevention attitudes. Within this sample, the majority of participants had one or more CDC-defined PrEP indications. Findings indicate that medical mistrust was associated with perceived PrEP stereotypes and HIV testing attitudes. These results provide some insight into reasons for low PrEP uptake among women at risk for HIV. Implications for HIV prevention with women are discussed.
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Affiliation(s)
- Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA.
| | - Mandy J Hill
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
| | - Luba Yammine
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
| | - Adrienne Gilmore-Thomas
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
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Bertholet N, Meli S, Palfai TP, Cheng DM, Alford DP, Bernstein J, Samet JH, Lloyd-Travaglini C, Saitz R. Screening and brief intervention for lower-risk drug use in primary care: A pilot randomized trial. Drug Alcohol Depend 2020; 213:108001. [PMID: 32563116 PMCID: PMC10772359 DOI: 10.1016/j.drugalcdep.2020.108001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
AIMS The efficacy of screening and brief intervention for lower-risk drug use is unknown. This pilot study tested the efficacy of two brief interventions (BIs) for drug use compared to no BI in primary care patients with lower-risk drug use identified by screening. METHODS We randomly assigned participants identified by screening with Alcohol Smoking and Substance Involvement Screening Test (ASSIST) drug specific scores of 2 or 3 to: no BI, a brief negotiated interview (BNI), or an adaptation of motivational interviewing (MOTIV). Primary outcome was number of days use of main drug in the past 30 as determined by validated calendar method at 6 months. Analyses were performed using negative binomial regression adjusted for baseline use and main drug. RESULTS Of 142 eligible adults, 61(43 %) consented and were randomized. Participant characteristics were: mean age 41; 54 % male; 77 % black. Main drug was cannabis 70 %, cocaine 15 %, prescription opioid 10 %; 7% reported injection drug use and mean days use of main drug (of 30) was 3.4. At 6 months, 93 % completed follow-up and adjusted mean days use of main drug were 6.4 (no BI) vs 2.1 (BNI) (incidence rate ratio, IRR 0.33[0.15-0.74]) and 2.3 (MOTIV) (IRR 0.36[0.15-0.85]). CONCLUSIONS BI appears to have efficacy for preventing an increase in drug use in primary care patients with lower-risk use identified by screening. These findings raise the potential that less severe patterns of drug use in primary care may be uniquely amenable to brief intervention and warrant replication.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Bugnon 23A, Lausanne, 1011, Switzerland.
| | | | - Tibor P Palfai
- Department of Psychology, Boston University, 900 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, and the Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
| | - Daniel P Alford
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, and the Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA, and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, and the Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
| | | | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA, and Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, and the Grayken Center for Addiction, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
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Otiniano Verissimo AD, Dyer TP, Friedman SR, Gee GC. Discrimination and sexual risk among Caribbean Latinx young adults. ETHNICITY & HEALTH 2020; 25:639-652. [PMID: 29495893 DOI: 10.1080/13557858.2018.1444148] [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: 10/29/2016] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Discrimination, such as being treated unfairly due to race, contributes to stress. Individuals may cope with this by engaging in risky behaviors. Consistent with this premise, prior studies found that discrimination is associated with substance use. Research has also shown that sex while 'high' on alcohol and drugs is associated with increased risk for HIV and other STIs. The present study examines the relationship between discrimination and sexual risk. We investigate whether discrimination is associated with sex while high on alcohol and drugs. Design: Analyses focus on a sample of 356 Caribbean Diasporic young adults, primarily Caribbean Latinx, aged 18 to 25 who participated in the Drug Use and HIV Risk among Youth Survey carried out from 1997 to 2000 in Brooklyn, New York. Logistic regression examined the association between self-reported discrimination and sex while high. Results: More than half (52.3%) of respondents reported moderate discrimination. Sex while high was also reported: 35.7% for alcohol, 43.3% for marijuana, and 32.6% for heroin/cocaine. Discrimination was associated with increased risk of sex while high on (1) marijuana and (2) heroin/cocaine, but was not with alcohol. Conclusions: Discrimination may be a risk factor for engaging in sex while high on drugs, which may put individuals at risk for HIV as well as other STIs. Future research should explore relationships between discrimination and sex while high on alcohol and drugs among various racial/ethnic groups and Diasporas, while also assessing how this relationship may contribute to HIV incidence.
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Affiliation(s)
| | - Typhanye Penniman Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, The University of Maryland, College Park, MD, USA
| | - Samuel R Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, New York, NY, USA
| | - Gilbert C Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
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Ojikutu BO, Bogart LM, Klein DJ, Galvan FH, Wagner GJ. Neighborhood Crime and Sexual Transmission Risk Behavior among Black Men Living with HIV. J Health Care Poor Underserved 2019; 29:383-399. [PMID: 29503307 DOI: 10.1353/hpu.2018.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Here, we examined the association of exposure to neighborhood crime with sexual risk-taking behavior among Black men living with HIV. HIV-positive Black men on antiretroviral therapy in California completed an audio computer-assisted self-interview. Crime risk per census block group was derived from the Federal Bureau of Investigation's Uniform Crime Report. Among 193 men, the mean (SD) number of sexual partners among those who were sexually active was 2.7 (3.3). 49% reported condomless sex, and 23% reported sex with an HIV-negative or unknown-serostatus partner. In multivariate analysis, illicit drug use ([IRR=1.86; 95%CI: 1.20-2.89] p=.006), depressive symptoms ([IRR=1.59; 95%CI: 1.03-2.44] p=.03), an undetectable viral load ([IRR=1.91; 95%CI: 1.22-3.00] p=.005), and neighborhood total crime risk ([IRR=1.02; 95%CI: 1.01-1.04] p=.007) remained significant. Among Black men living with HIV, exposure to neighborhood crime is associated with having multiple sexual partners whose HIV status was negative or unknown.
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Kuiper LB, Coolen LM. Compulsive Sexual Behavior in Humans and Preclinical Models. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0157-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Recurrent use of inpatient withdrawal management services: Characteristics, service use, and cost among Medicaid clients. J Subst Abuse Treat 2018; 92:77-84. [PMID: 30032948 DOI: 10.1016/j.jsat.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs.
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9
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Campbell ANC, Wolff M, Weaver L, Jarlais DD, Tross S. "It's Never Just About the HIV:" HIV Primary Care Providers' Perception of Substance Use in the Era of "Universal" Antiretroviral Medication Treatment. AIDS Behav 2018; 22:1006-1017. [PMID: 29264736 DOI: 10.1007/s10461-017-2007-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Antiretroviral therapy (ART) is recommended for all people living with HIV (PLWH), regardless of disease status. Substance use disorders (SUD) are common barriers to successful HIV treatment; however, few studies have comprehensively explored how HIV primary care providers take SUDs into account in the context of universal ART implementation. This study uses thematic analysis of qualitative interviews to explore providers' (N = 25) substance use assessment and factors associated with ART initiation. 64% of providers had 15 or more years of HIV treatment experience. Almost all providers agreed with the guidelines for universal ART initiation despite the presence of SUD. Still, identification and management of SUD is challenged by inconsistent assessment, providers' misperceptions about SUD and patients' willingness to discuss it, and lack of accessible treatment resources when SUD is identified. Greater guidance in systematic SUD assessment and management, combined with integrated addiction services, could enhance universal ART implementation among PLWH/SUD.
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Affiliation(s)
- Aimee N C Campbell
- Division on Substance Use Disorders and New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside, Drive Box 120, New York, NY, 10032, USA.
| | - Margaret Wolff
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Laurel Weaver
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Don Des Jarlais
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Kidd JD, Tross S, Pavlicova M, Hu MC, Campbell ANC, Nunes EV. Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network. Subst Use Misuse 2017; 52:858-865. [PMID: 28426361 PMCID: PMC5710008 DOI: 10.1080/10826084.2016.1264971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. OBJECTIVES The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. METHODS Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. RESULTS When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.
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Affiliation(s)
- Jeremy D Kidd
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Susan Tross
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Martina Pavlicova
- c Department of Biostatistics , Columbia University Mailman School of Public Health , New York , New York , USA
| | - Mei-Chen Hu
- b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Aimee N C Campbell
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Edward V Nunes
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
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11
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Pan Y, Metsch LR, Wang W, Wang KS, Duan R, Kyle TL, Gooden LK, Feaster DJ. Gender Differences in HIV Sexual Risk Behaviors Among Clients of Substance Use Disorder Treatment Programs in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1151-1158. [PMID: 26892100 PMCID: PMC6261376 DOI: 10.1007/s10508-015-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21-2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11-2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77-0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69-1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53-0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work at Florida International University, Miami, FL, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | | | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
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12
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Pan Y, Liu H, Metsch LR, Feaster DJ. Factors Associated with HIV Testing Among Participants from Substance Use Disorder Treatment Programs in the US: A Machine Learning Approach. AIDS Behav 2017; 21:534-546. [PMID: 27933461 PMCID: PMC5583728 DOI: 10.1007/s10461-016-1628-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HIV testing is the foundation for consolidated HIV treatment and prevention. In this study, we aim to discover the most relevant variables for predicting HIV testing uptake among substance users in substance use disorder treatment programs by applying random forest (RF), a robust multivariate statistical learning method. We also provide a descriptive introduction to this method for those who are unfamiliar with it. We used data from the National Institute on Drug Abuse Clinical Trials Network HIV testing and counseling study (CTN-0032). A total of 1281 HIV-negative or status unknown participants from 12 US community-based substance use disorder treatment programs were included and were randomized into three HIV testing and counseling treatment groups. The a priori primary outcome was self-reported receipt of HIV test results. Classification accuracy of RF was compared to logistic regression, a standard statistical approach for binary outcomes. Variable importance measures for the RF model were used to select the most relevant variables. RF based models produced much higher classification accuracy than those based on logistic regression. Treatment group is the most important predictor among all covariates, with a variable importance index of 12.9%. RF variable importance revealed that several types of condomless sex behaviors, condom use self-efficacy and attitudes towards condom use, and level of depression are the most important predictors of receipt of HIV testing results. There is a non-linear negative relationship between count of condomless sex acts and the receipt of HIV testing. In conclusion, RF seems promising in discovering important factors related to HIV testing uptake among large numbers of predictors and should be encouraged in future HIV prevention and treatment research and intervention program evaluations.
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Affiliation(s)
- Yue Pan
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Hongmei Liu
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th ST, New York, NY, 10032, USA
| | - Daniel J Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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Hatch-Maillette MA, Beadnell B, Campbell ANC, Meade CS, Tross S, Calsyn DA. Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials. JOURNAL OF SEX RESEARCH 2017; 54:33-41. [PMID: 26820608 PMCID: PMC4965331 DOI: 10.1080/00224499.2015.1118426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.
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Affiliation(s)
- Mary A. Hatch-Maillette
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, WA
| | - Aimee N. C. Campbell
- Columbia University Medical Center, New York State Psychiatric Institute and Mount Sinai St. Lukes Hospital, New York, NY
| | - Christina S. Meade
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Susan Tross
- Columbia University Medical Center, New York State Psychiatric Institute and Mount Sinai St. Lukes Hospital, New York, NY
| | - Donald A. Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- In memory of, deceased February 3, 2013 during the preparation of this manuscript
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O'Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA. The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for Three Parallel Multi-Site Stepped Care Effectiveness Studies for Unhealthy Alcohol Use in HIV-Positive Patients. Contemp Clin Trials 2016; 52:80-90. [PMID: 27876616 DOI: 10.1016/j.cct.2016.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/20/2023]
Abstract
Unhealthy alcohol use is common among HIV-positive patients, yet effective evidence-based treatments are rarely provided in clinical settings providing HIV care. Further, given patient variability in response to initial treatments, stepped care approaches may be beneficial. We describe the rationale, aims and study design for the current StartingTreatment forEthanol inPrimary care Trials (STEP Trials); three parallel randomized controlled effectiveness trials being conducted in five Infectious Disease Clinics. Participants meeting criteria for: 1) at-risk drinking, 2) moderate alcohol use with liver disease (MALD), or 3) alcohol use disorder (AUD) are randomized to integrated stepped care versus treatment as usual. For those with at-risk drinking or MALD, integrated stepped care starts with a one session brief intervention and follow-up 2-week telephone booster. Based on pre-specified nonresponse criteria, participants may be "stepped up" at week 4 to receive four sessions of motivational enhancement therapy (MET) and "stepped up" again at week 12 for addiction physician management (APM) and consideration of alcohol pharmacotherapy. For those with AUD, integrated stepped care begins with APM. Non-responders may be "stepped up" at week 4 to receive MET and again at week 12 for a higher level of care (e.g. intensive outpatient program). The primary outcome is alcohol consumption assessed at 24weeks, and secondary outcome is the VACS Index, a validated measure of HIV morbidity and mortality risk. Results from the STEP Trials should inform future research and the implementation of interventions to address unhealthy alcohol use among HIV-positive individuals.
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States; College of Public Health, University of Georgia, Athens, GA 30602, United States
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT 06511, United States
| | - Lynn E Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX 75216, United States
| | - Cynthia Gibert
- D.C. Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, D.C. 20422, United States
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas Houston, TX 77030, United States
| | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, United States
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT 06510, United States; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD 20892-7003, United States
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
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Campbell ANC, Des Jarlais D, Hannah C, Braunstein S, Tross S, Kersanske L, Borges C, Pavlicova M, Jefferson K, Newville H, Weaver L, Wolff M. Antiretroviral medication treatment for all HIV-infected individuals: a protocol using innovative multilevel methodologies to evaluate New York City's universal ART policy among problem substance users. BMC Health Serv Res 2016; 16:341. [PMID: 27485435 PMCID: PMC4971753 DOI: 10.1186/s12913-016-1554-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of "treatment as prevention," in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The "ART for ALL" (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use. METHODS/DESIGN The AFA Study is informed by two complementary frameworks: Glasgow and colleagues' RE-AIM model, a multi-level framework developed to guide the evaluation of implementation of new policies, and Bronfrenbrenner's ecological systems model, which conceptualizes the bi-directional interplay between people and their environment. Using multi-level data and mixed methods, the primary aims of the AFA Study are to assess rates of viral load suppression, using the NYC HIV Surveillance Registry, within 12 months of HIV diagnosis with (a) yearly cohorts of high-risk-to-transmit, difficult-to-treat, substance using patients recruited from NYC Sexually Transmitted Disease clinics and a large detoxification unit and (b) yearly cohorts of all newly HIV diagnosed people in NYC. Further goals include (c) recruiting cross-sectional samples of HIV/AIDS service providers to assess ART initiation with problem substance users and d) examining geographic factors that influence rates of viral load suppression. An Implementation Collaborative Board meets regularly to guide study procedures and interpret results. DISCUSSION The AFA Study has the unique strength of accessing and analyzing data at multiple levels using mixed methodology, taking advantage of NYC DOHMH biomedical surveillance data. If successful, others may benefit from lessons learned to inform local and state policies to improve the health of PLWH and further reduce HIV transmission.
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Affiliation(s)
- Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY 10032 USA
| | - Don Des Jarlais
- Icahn School of Medicine at Mount Sinai, 39 Broadway, 5th Floor, New York, NY 10006 USA
| | - Cooper Hannah
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Room 568, Atlanta, GA 30322 USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Susan Tross
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Laura Kersanske
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Christine Borges
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th Floor, #637, New York, NY 10032 USA
| | - Kevin Jefferson
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Room 568, Atlanta, GA 30322 USA
| | - Howard Newville
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Laurel Weaver
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Margaret Wolff
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
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Campbell ANC, Brooks AJ, Pavlicova M, Hu MC, Hatch-Maillette MA, Calsyn DA, Tross S. Barriers to Condom Use: Results for Men and Women Enrolled in HIV Risk Reduction Trials in Outpatient Drug Treatment. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:130-146. [PMID: 27766067 PMCID: PMC5067067 DOI: 10.1080/15381501.2016.1166090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV transmission often occurs through heterosexual high-risk sex. Even in the era of HIV combination prevention, promoting condom use, and understanding condom barriers, remain priorities, especially among substance-dependent individuals. Men and women (N=729) in outpatient drug treatment participated in a five-session gender-specific risk reduction group or one-session HIV Education group. Condom barriers (Motivation, Partner-related, Access/Availability, Sexual experience) were assessed at baseline and 6-month follow-up. Completing either intervention was associated with fewer motivation and partner-related barriers. Among women, reductions in motivation and sexual experience barriers were associated with less sexual risk with primary partners. Condom barriers are important to gender-specific HIV prevention; given limited resources, brief interventions maximizing active components are needed.
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Affiliation(s)
- Aimee N C Campbell
- Columbia University College of Physicians & Surgeons, Department of Psychiatry; New York State Psychiatric Institute, New York, NY; St. Luke's Roosevelt Hospital, Mount Sinai Health System, Department of Psychiatry, New York, NY
| | - Audrey J Brooks
- University of Arizona, Arizona Center for Integrative Medicine, Tucson, AZ
| | - Martina Pavlicova
- Columbia University Medical Center, Department of Biostatistics, New York, NY
| | - Mei-Chen Hu
- Columbia University College of Physicians & Surgeons, Department of Psychiatry
| | - Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Donald A Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Susan Tross
- Columbia University College of Physicians & Surgeons, Department of Psychiatry; St. Luke's Roosevelt Hospital, Mount Sinai Health System, Department of Psychiatry, New York, NY; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
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17
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Tross S, Feaster DJ, Thorens G, Duan R, Gomez Z, Pavlicova M, Hu MC, Kyle T, Erickson S, Spector A, Haynes L, Metsch LR. Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients. J Addict Med 2015; 9:457-63. [PMID: 26501786 PMCID: PMC4779311 DOI: 10.1097/adm.0000000000000162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. METHODS Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). RESULTS Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. CONCLUSIONS Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.
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Affiliation(s)
- Susan Tross
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Daniel J. Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Gabriel Thorens
- Department of Mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Rui Duan
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Zoilyn Gomez
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
| | - Mei Chen Hu
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | | | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Anya Spector
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Louise Haynes
- Medical University of South Carolina, Charleston, South Carolina
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
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Adaptation and Validation of the Sexual Assertiveness Scale (SAS) in a Sample of Male Drug Users. SPANISH JOURNAL OF PSYCHOLOGY 2015; 18:E21. [PMID: 25896498 DOI: 10.1017/sjp.2015.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the present study was to adapt and validate the Sexual Assertiveness Scale (SAS) in a sample of male drug users. A sample of 326 male drug users and 322 non-clinical males was selected by cluster sampling and convenience sampling, respectively. Results showed that the scale had good psychometric properties and adequate internal consistency reliability (Initiation = .66, Refusal = .74 and STD-P = .79). An evaluation of the invariance showed strong factor equivalence between both samples. A high and moderate effect of Differential Item Functioning was only found in items 1 and 14 (∆R 2 Nagelkerke = .076 and .037, respectively). We strongly recommend not using item 1 if the goal is to compare the scores of both groups, otherwise the comparison will be biased. Correlations obtained between the CSFQ-14 and the safe sex ratio and the SAS subscales were significant (CI = 95%) and indicated good concurrent validity. Scores of male drug users were similar to those of non-clinical males. Therefore, the adaptation of the SAS to drug users provides enough guarantees for reliable and valid use in both clinical practice and research, although care should be taken with item 1.
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19
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Crooks D, Tsui J, Anderson B, Dossabhoy S, Herman D, Liebschutz JM, Stein MD. Differential risk factors for HIV drug and sex risk-taking among non-treatment-seeking hospitalized injection drug users. AIDS Behav 2015; 19:405-11. [PMID: 25063229 DOI: 10.1007/s10461-014-0754-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets.
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20
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Kyle TL, Horigian VE, Tross S, Gruber VA, Pereyra M, Mandler RN, Feaster DJ, Metsch LR. Uptake of HIV testing in substance use disorder treatment programs that offer on-site testing. AIDS Behav 2015; 19:536-42. [PMID: 25074737 PMCID: PMC4312252 DOI: 10.1007/s10461-014-0864-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Increasing rates of HIV testing within substance use disorder (SUD) treatment clients is an important public health strategy for reducing HIV transmission rates. The present study examined uptake of HIV testing among 1,224 clients in five SUD treatment units that offered on-site testing in Florida, New York, and California. Nearly one-third (30 %) of the participants, who had not previously tested positive, reported not having been tested for HIV within the past 12 months. Women, African Americans, and injection drug users had a higher likelihood of having been tested within the past 12 months. The SUD treatment program was the most frequently identified location of participants' last HIV test. Despite the availability of free, on-site testing, a substantial proportion of clients were not tested, suggesting that strategies to increase uptake of testing should include addressing barriers not limited to location and cost.
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Affiliation(s)
- Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, 32804, USA,
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21
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Crits-Christoph P, Gallop R, Sadicario JS, Markell HM, Calsyn DA, Tang W, He H, Tu X, Woody G. Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:3. [PMID: 24433412 PMCID: PMC3929547 DOI: 10.1186/1747-597x-9-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
Background The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. Methods Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model. Results Severity of drug use (p < .01), gender (p < .001), and age (p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status (p < .001) and race/ethnicity (p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol (p < .01 in non-zero portion of model), duration of abuse of primary drug (p < .05 in non-zero portion of model), and Hispanic ethnicity (p < .01 in the zero portion, p < .05 in the non-zero portion of model). Conclusion These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups.
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22
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Fisher WA, Fisher JD, Shuper PA. Social Psychology and the Fight Against AIDS. ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2014. [DOI: 10.1016/b978-0-12-800284-1.00003-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Brooks AJ, Lokhnygina Y, Meade CS, Potter JS, Calsyn DA, Greenfield SF. Racial/ethnic differences in the rates and correlates of HIV risk behaviors among drug abusers. Am J Addict 2013; 22:136-47. [PMID: 23414499 DOI: 10.1111/j.1521-0391.2013.00303.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/24/2011] [Accepted: 02/03/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND HIV infection disproportionately impacts minorities; yet research on racial/ethnic differences in the prevalence and correlates of HIV risk behaviors is limited. OBJECTIVE This study examined racial/ethnic differences in the rates of HIV risk behaviors and whether the relationship between HIV risk factors and HIV risk behaviors varies by race/ethnicity in clients participating in NIDA Clinical Trials Network trials. RESULTS The sample was 41% non-Hispanic White, 32% non-Hispanic Black, and 27% Hispanic (N = 2,063). HIV risk behaviors and measures of substance and psychosocial HIV risk factors in the past month were obtained. Non-Hispanic Blacks engaged in less HIV sexual risk behaviors overall than non-Hispanic Whites. While non-Hispanic Whites were the most likely to report any injection drug use, Hispanics engaged in the most HIV drug risk behaviors. Specific risk factors were differentially predictive of HIV risk behavior by race/ethnicity. Alcohol use severity was related to engaging in higher sex risk behaviors for non-Hispanic Blacks and Whites. Greater psychiatric severity was related to engaging in higher sex risk behaviors for non-Hispanic Whites. Drug use severity was associated with engaging in higher risk drug behaviors for non-Hispanic Whites and Hispanics with the magnitude of the relationship stronger for Hispanics. CONCLUSIONS These findings highlight the need for further research testing HIV risk prevention interventions within racial/ethnic groups to identify target behaviors or risk factors that are salient to inform HIV interventions. SCIENTIFIC SIGNIFICANCE The present study provides a systematic examination of race/ethnicity differences in the relationship between psychosocial risk factors and HIV risk behaviors.
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Affiliation(s)
- Audrey J Brooks
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, AZ 85724, USA.
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24
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Calsyn DA, Hatch-Maillette MA, Meade CS, Tross S, Campbell ANC, Beadnell B. Gender differences in heterosexual anal sex practices among women and men in substance abuse treatment. AIDS Behav 2013; 17:2450-8. [PMID: 23321947 DOI: 10.1007/s10461-012-0387-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. Rates of HAI for women (n = 441) and men (n = 539) were identified for any, main and casual partners. More men (32.8 %) than women (27.1 %) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6.0-15.9 %) and women (3.5-13.0 %) ages 25-59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1 %) than women (16.7 %). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and White were significantly associated with HAI. For men, having more sex partners was also a significant correlate. HAI is a logical target for increased focus in HIV prevention interventions.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, 1107 NE 45th St., Ste. 120, Seattle, WA 98105, USA.
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25
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Urada LA, Raj A, Cheng DM, Quinn E, Bridden C, Blokhina EA, Krupitsky E, Samet JH. History of intimate partner violence is associated with sex work but not sexually transmitted infection among HIV-positive female drinkers in Russia. Int J STD AIDS 2013; 24:287-92. [PMID: 23970660 DOI: 10.1177/0956462412472809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper assesses the associations between intimate partner violence (IPV) and sexually transmitted infections (STIs) and sexual risks among HIV-positive female drinkers in St Petersburg, Russia. Survey and STI data were analysed from 285 women in HERMITAGE, a secondary prevention study of HIV-positive heavy drinkers. Logistic and Poisson regression analyses assessed associations of IPV with STI and risky sex. Most women (78%) experienced IPV and 19% were STI positive; 15% sold sex. IPV was not significantly associated with STI, but was with selling sex (adjusted odds ratio = 3.56, 95% confidence interval = 1.02-12.43). In conclusion, IPV is common and associated with sex trade involvement among Russian HIV-positive female drinkers.
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Affiliation(s)
- L A Urada
- Division of Global Public Health, Department of Medicine, University of California - San Diego School of Medicine, San Diego, CA 92093-0507, USA.
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Campbell ANC, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:333-48. [PMID: 23731423 PMCID: PMC3694750 DOI: 10.1080/19371918.2013.774665] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Social workers are often on the front lines of the HIV/AIDS epidemic delivering prevention education and interventions, offering or linking individuals to HIV testing, and working to improve treatment access, retention, and adherence, especially among vulnerable populations. Individuals with substance use disorders face additional challenges to reducing sexual and drug risk behaviors, as well as barriers to testing, treatment, and antiretroviral therapy adherence. This article presents current data on HIV transmission and research evidence on prevention and intervention with substance abusers and highlights how individual social workers can take advantage of this knowledge in practice and through adoption and implementation within organizations.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Vallejo-Medina P, Sierra JC. Effect of drug use and influence of abstinence on sexual functioning in a Spanish male drug-dependent sample: a multisite study. J Sex Med 2012; 10:333-41. [PMID: 23095213 DOI: 10.1111/j.1743-6109.2012.02977.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To date, it has been difficult to address the issue of sexual functioning and drug use, and many approaches to it have basic problems and methodological errors. AIM The present cross-sectional study compared the sexual functioning scores of a group of drug users with those of a group of nondrug users. It explored the relationship between drug abstinence and sexual functioning. MAIN OUTCOME MEASURES A sample of 905 males participated in this study (549 met the substance dependence criteria and 356 were controls). All of them were assessed with the Changes in Sexual Functioning Questionnaire-Drugs version. METHOD The assessment was conducted from September 2009 to January 2011. The clinical sample was evaluated in nine different substance abuse treatment facilities. RESULTS Results show that, overall, all dimensions (pleasure, desire, arousal, and orgasm) were moderately impaired. Yet, differences regarding preferred substance were observed. Pleasure and orgasm were the two areas most significantly impaired. In these areas, all drugs seemed to negatively affect sexual functioning. However, desire and arousal were not affected by all the substances. In addition, at least after 2 weeks of drug abstinence, no relationship was found between drug abstinence and improvement in sexual functioning. The sample studied had an average of 1 year of drug abstinence and was found to have poorer sexual functioning than the control group. CONCLUSIONS Therefore, these results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use.
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Affiliation(s)
- Pablo Vallejo-Medina
- Department of Personality and Psychological Assessment and Treatment, School of Psychology, University of Granada, Granada, Spain.
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Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med 2012; 4:123-30. [PMID: 20936079 DOI: 10.1097/adm.0b013e3181db6b67] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.
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Tameru B, Gerbi G, Nganwa D, Bogale A, Robnett V, Habtemariam T. The Association between Interrelationships and Linkages of Knowledge about HIV/AIDS and its Related Risky Behaviors in People Living with HIV/AIDS. JOURNAL OF AIDS & CLINICAL RESEARCH 2012; 3:1-7. [PMID: 24977102 PMCID: PMC4073788 DOI: 10.4172/2155-6113.s7-002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The relationship between knowledge about HIV/AIDS and its associated risky behaviors is complex and has not been sufficiently explored. It is especially important to look at some of the aspects of this relationship among people living with HIV/AIDS (PLWHA) in order to develop effective intervention strategies to reduce HIV/AIDS risky behaviors. The objective of this study was to investigate the association between knowledge about HIV/AIDS and its risky behaviors among PLWHA.
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Affiliation(s)
- Berhanu Tameru
- Professor and Director, Tuskegee University, Center for Computational Epidemiology, Bioinformatics and Risk Analysis, 107-Williams-Bowie Hall, College of Vet Med, Nursing and Allied Health (CVMNAH), Tuskegee, AL 36832, USA
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Sansone RA, Wiederman MW, Muennich E, Barnes J. Alcohol and drug problems and their relationship to sexual impulsivity among female internal medicine outpatients. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:167-8. [PMID: 18458718 DOI: 10.4088/pcc.v10n0213h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wen XJ, Balluz L, Town M. Prevalence of HIV risk behaviors between binge drinkers and non-binge drinkers aged 18- to 64-years in US, 2008. J Community Health 2012; 37:72-9. [PMID: 21643823 DOI: 10.1007/s10900-011-9418-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Using data from the 2008 Behavioral Risk Factor Surveillance System on 281,303 adults aged 18-64 years in the United States, we examined the relationship between HIV risk behaviors and binge drinking of alcoholic beverages and the frequency of binge drinking among a subgroup of 41,073 respondents who were acknowledged binge drinkers (bingers), based on reported drinking behavior in the year preceding survey. Our findings show that the weighted prevalence of HIV risk behaviors (including injection drug use, exchange of sex for money/drugs, and anal sex without a condom) among binge drinkers [corrected] [7.0%, 95% confidence interval (95% CI): 6.4-7.6%] is twice that among nonbingers (2.9%, 95% CI: 2.7-3.0%). The highest prevalence of HIV risk behaviors is among the bingers aged 18-20 years (14%, 95% CI: 11.2-18.2%). After adjusting for covariates, bingers are 1.77 (95% CI: 1.58-2.00) times more likely than nonbingers to report HIV risk behaviors. Risk increases in bingers with the number of episodes. Compared with bingers reporting 1-2 binge episodes in the month proceeding survey, the adjusted odds of reporting HIV risk behaviors among bingers are 1.27 (1.08-1.49), 1.68 (1.35-2.10), 1.67 (1.08-2.57), and 1.70 (1.34-2.16), respectively for bingers with 3-4, 5-6, 7-8, and ≥9 episodes in the same period. Our results suggest that HIV risk behaviors are strongly linked with binge drinking and its frequency. Effective measures to prevent binge drinking are essential to HIV prevention, especially among youth aged 18-20 years.
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Affiliation(s)
- Xiao-Jun Wen
- Division of Behavioral Surveillance, Public Health SurveillanceProgram Office, Office of Surveillance, Epidemiology, andLaboratory Services, Centers for Disease Control andPrevention, 1600 Clifton Road NE, Mailstop E-97,Atlanta, GA 30333, USA. e-mail:
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Harrell PT, Mancha BE, Petras H, Trenz RC, Latimer WW. Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors. Drug Alcohol Depend 2012; 122:220-7. [PMID: 22030276 PMCID: PMC3309123 DOI: 10.1016/j.drugalcdep.2011.10.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections. METHODS Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV. RESULTS Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR=6.97, 95% CI=4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR=2.66, 95% CI=1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR=2.50, 95% CI=1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR=0.10, 95% CI=0.06-0.18), but no significant differences were found for HIV. CONCLUSIONS Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.
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Affiliation(s)
- P T Harrell
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205, United States.
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Concurrent exposure to methamphetamine and sexual behavior enhances subsequent drug reward and causes compulsive sexual behavior in male rats. J Neurosci 2012; 31:16473-82. [PMID: 22072697 DOI: 10.1523/jneurosci.4013-11.2011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Methamphetamine (Meth) users report having heightened sexual pleasure, numerous sexual partners, and engaging in unprotected sex due to loss of inhibitory control. This compulsive sexual behavior contributes to increased prevalence of sexually transmitted infections, but the neural basis for this is unknown. We previously established a paradigm for compulsive sexual behavior in male rats in which visceral illness induced by lithium chloride was paired with sexual behavior (Davis et al., 2010; Frohmader et al., 2010a). The current study examined the effects of repeated Meth administration on sexual performance, compulsive sexual behavior, and sex or Meth reward. First, results demonstrated that seven daily administrations of 2 mg/kg, but not 1 mg/kg, Meth increased latencies to initiate mating. This impairment was evident 30 min after last Meth administration, but dissipated after 1 or 7 d of subsequent drug abstinence. Repeated 1 mg/kg Meth exposure resulted in compulsive sex-seeking behavior 2 weeks following last Meth administration. This effect was dependent on Meth administration being concurrent with sexual experience and was not observed in sexually experienced animals that received Meth alone. Moreover, concurrent Meth and sexual experience enhanced conditioned place preference (CPP) for Meth, and for concurrent Meth and mating compared with Meth or mating alone. In contrast, CPP for mating alone was decreased. Together, these data indicate that the association between drug use and mating may be required for expression of compulsive sexual behavior and is correlated with increased reward seeking for concurrent Meth exposure and mating.
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Horton EG, Diaz N, Peluso PR, Mullaney D, Weiner M, McIlveen JW. Relationships Between Trauma, Posttraumatic Stress Disorder Symptoms, Dissociative Symptoms, and Lifetime Heroin Use Among Individuals Who Abuse Substances in Residential Treatment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2009.tb00047.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Claire Van Hout M, Brennan R. “Bump and grind”: an exploratory study of Mephedrone users' perceptions of sexuality and sexual risk. DRUGS AND ALCOHOL TODAY 2011. [DOI: 10.1108/17459261111174046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF. Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 2010; 45:2444-69. [PMID: 20536356 PMCID: PMC3169437 DOI: 10.3109/10826084.2010.490928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.
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Affiliation(s)
- Audrey Brooks
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.
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Guerrero EG, Cederbaum JA. Adoption and utilization of sexually transmitted infections testing in outpatient substance abuse treatment facilities serving high risk populations in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:41-8. [PMID: 20970314 DOI: 10.1016/j.drugpo.2010.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/29/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although adoption and utilization of sexually transmitted infection (STI) testing is a cost effective public health intervention, it is inconsistently offered or referred out for by outpatient substance abuse treatment (OSAT) programs where at-risk racial/ethnic and sexual minorities receive services. METHODS We explored the organizational adoption and client utilization of STI testing using a nationally representative sample of OSAT facilities in the U.S. in 2005 (N=566). Data missing at random was imputed and the resulting database was analysed using multivariate Tobit and logistic regressions. RESULTS The analyses suggest that private non-profit facilities, which are the largest providers of OSAT treatment are less likely than public facilities to offer STI testing or to report adequate client utilization rates. Higher utilization was instead associated with professionally accredited facilities, and with facilities whose majority of clients were Latino/a, reported a history of treatment, stayed in treatment longer, or received case management. CONCLUSION While OSAT facilities are poised to be primary intervention points for diagnosis and treatment of STIs, only a segment of these facilities provide this preventive practice or manage to refer clients out. As such, U.S. health care policy should ensure the adoption and comprehensive utilization, particularly among high risk clients, of this cost-effective prevention strategy in OSAT admission protocols.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089-041, USA.
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Frohmader KS, Bateman KL, Lehman MN, Coolen LM. Effects of methamphetamine on sexual performance and compulsive sex behavior in male rats. Psychopharmacology (Berl) 2010; 212:93-104. [PMID: 20623108 DOI: 10.1007/s00213-010-1930-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 06/20/2010] [Indexed: 01/19/2023]
Abstract
RATIONALE Methamphetamine (Meth) is a highly addictive psychostimulant associated with enhanced sexual desire, arousal, and sexual pleasure. Moreover, Meth abuse is frequently linked with the practice of sexual risk behavior and increased prevalence of human immunodeficiency virus. Currently, there is a lack of studies investigating the effects of Meth on maladaptive sexual behavior under controlled experimental settings in animal studies. OBJECTIVE The overall objective of the current study was to examine the effects of Meth on various aspects of male sexual behavior including maladaptive sex-seeking behavior. METHODS First, a dose-response curve of the effects of Meth (0, 1, 2, and 4 mg/kg; s.c.) on sexual motivation and performance was conducted in sexually naïve and experienced male rats. Next, the effects of Meth (1 mg/kg; s.c.) on inhibition of maladaptive sexual behavior was tested using a sex aversion conditioning paradigm, in which visceral illness induced by lithium chloride (LiCl) was paired with sexual behavior. RESULTS Meth administration inhibited sexual performance in a dose-dependent matter as evidenced by the decreased percentages of males that mated and increased latencies to initiate sexual behavior when injected with 2 or 4 mg/kg Meth. Moreover, an acute dose of Meth prior to or following sex aversion conditioning resulted in disrupted conditioned inhibition of sexual behavior. CONCLUSIONS These data suggest that Meth administration in male rats impairs sexual motivation and performance. In addition, low doses of Meth that do not disrupt sexual function may result in maladaptive seeking of sexual behavior.
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Affiliation(s)
- Karla S Frohmader
- Department of Anatomy & Cell Biology, University of Western Ontario, London, ON, Canada
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Calsyn DA, Cousins SJ, Hatch-Maillette MA, Forcehimes A, Mandler R, Doyle SR, Woody G. Sex under the influence of drugs or alcohol: common for men in substance abuse treatment and associated with high-risk sexual behavior. Am J Addict 2010; 19:119-27. [PMID: 20163383 DOI: 10.1111/j.1521-0391.2009.00022.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sex under the influence of drugs or alcohol is associated with high-risk sexual behavior. Heterosexual men (n = 505) in substance abuse treatment completed a computer-administered interview assessing sexual risk behaviors. Most men (73.3%) endorsed sex under the influence in the prior 90 days, and 39.1% endorsed sex under the influence during their most recent sexual event. Sex under the influence at the most recent event was more likely to involve anal intercourse, sex with a casual partner, and less condom use. Patients might benefit from interventions targeting sexual behavior and substance use as mutual triggers. (Am J Addict 2010;00:1-9).
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
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Calsyn DA, Campbell ANC, Crits-Christoph P, Doyle SR, Tross S, Hatch-Maillette MA, Mandler R. Men in methadone maintenance versus psychosocial outpatient treatment: differences in sexual risk behaviors and intervention effectiveness from a multisite HIV prevention intervention trial. J Addict Dis 2010; 29:370-82. [PMID: 20635286 DOI: 10.1080/10550887.2010.489451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The effectiveness of the Real Men Are Safe (REMAS) HIV prevention intervention was examined as a function of treatment program modality. REMAS was associated with significantly larger decreases in unprotected sexual occasions than an HIV education control condition in both treatment modalities. REMAS had superior effectiveness for reducing unprotected sexual occasions in the psychosocial outpatient compared to methadone. At the 6-month follow-up, the adjusted mean change for REMAS completers in psychosocial outpatient (M=6.4, d=0.38) was greater than for REMAS completers in methadone programs (M=2.3, d=0.25). Reasons for why REMAS appears to be especially effective in psychosocial outpatient programs are explored.
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Affiliation(s)
- Donald A Calsyn
- University of Washington Alcohol and Drug Abuse Institute, Seattle, WA 98105, USA.
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Frohmader KS, Pitchers KK, Balfour ME, Coolen LM. Mixing pleasures: review of the effects of drugs on sex behavior in humans and animal models. Horm Behav 2010; 58:149-62. [PMID: 20004662 DOI: 10.1016/j.yhbeh.2009.11.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 11/17/2009] [Accepted: 11/24/2009] [Indexed: 02/04/2023]
Abstract
Drugs of abuse act on the brain circuits mediating motivation and reward associated with natural behaviors. There is ample evidence that drugs of abuse impact male and female sexual behavior. First, the current review discusses the effect of drugs of abuse on sexual motivation and performance in male and female humans. In particular, we discuss the effects of commonly abused drugs including psychostimulants, opiates, marijuana/THC, and alcohol. In general, drug use affects sexual motivation, arousal, and performance and is commonly associated with increased sexual risk behaviors. Second, studies on effects of systemic administration of drugs of abuse on sexual behavior in animals are reviewed. These studies analyze the effects on sexual performance and motivation but do not investigate the effects of drugs on risk-taking behavior, creating a disconnect between human and animal studies. For this reason, we discuss two studies that focus on the effects of alcohol and methamphetamine on inhibition of maladaptive sex-seeking behaviors in rodents. Third, this review discusses potential brain areas where drugs of abuse may be exerting their effect on sexual behavior with a focus on the mesolimbic system as the site of action. Finally, we discuss recent studies that have brought to light that sexual experience in turn can affect drug responsiveness, including a sensitized locomotor response to amphetamine in female and male rodents as well as enhanced drug reward in male rats.
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Affiliation(s)
- Karla S Frohmader
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatment. Addiction 2010; 105:100-8. [PMID: 20078464 PMCID: PMC2808629 DOI: 10.1111/j.1360-0443.2009.02812.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. DESIGN Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. PARTICIPANTS The participants were assigned randomly to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI) or human immunodeficiency virus (HIV) education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. FINDINGS Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (t(intervention) = -2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. CONCLUSIONS Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up.
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Affiliation(s)
- Donald A. Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Mary A. Hatch-Maillette
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Yong S. Song
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
| | - Susan Coyer
- Prestera Center for Mental Health Services Inc., Huntington, WV
| | - Sara Pelta
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
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Calsyn DA, Hatch-Maillette M, Tross S, Doyle SR, Crits-Christoph P, Song YS, Harrer JM, Lalos G, Berns SB. Motivational and skills training HIV/sexually transmitted infection sexual risk reduction groups for men. J Subst Abuse Treat 2009; 37:138-50. [PMID: 19150206 PMCID: PMC2749552 DOI: 10.1016/j.jsat.2008.11.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/17/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
The effectiveness of a motivational and skills training HIV/AIDS group intervention designed for men in substance abuse treatment was evaluated. Men in methadone maintenance (n = 288) or outpatient psychosocial treatment (n = 302) completed assessments at baseline, 2 weeks, 3 months, and 6 months postintervention. Participants were randomly assigned to attend either Real Men Are Safe (REMAS; five sessions containing information, motivational exercises, and skills training) or HIV education (HIV-Ed; one session containing HIV prevention information). REMAS participants engaged in significantly fewer unprotected vaginal and anal sexual intercourse occasions (USO) during the 90 days prior to the 3- and 6-month follow-ups than HIV-Ed participants. Completing REMAS resulted in an even stronger effect: Completers reduced their number of USO by 21% from baseline to 6-month follow-up. In contrast, HIV-Ed completers increased the number of USO by 2%. A motivational and skills training HIV prevention intervention designed for men was associated with greater sexual risk reduction over standard HIV-Ed. Substance abuse treatment programs can therefore help reduce sexual risk among their clientele by providing a more intensive intervention than what is traditionally provided.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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Raj A, Reed E, Santana MC, Walley AY, Welles SL, Horsburgh CR, Flores SA, Silverman JG. The associations of binge alcohol use with HIV/STI risk and diagnosis among heterosexual African American men. Drug Alcohol Depend 2009; 101:101-6. [PMID: 19117698 DOI: 10.1016/j.drugalcdep.2008.11.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 11/10/2008] [Accepted: 11/10/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies on the mechanisms of the association between illicit drug use and HIV/STI provide important insight into why there are disproportionate rates of HIV/STI among heterosexual African American men; far less work has been conducted to examine the associations between binge alcohol use and HIV/STI risks in this population. OBJECTIVE To assess whether binge alcohol use is associated with risky sexual behaviors and recent HIV/STI diagnosis among heterosexual African American men reporting multiple sex partners in the past year. METHODS Participants (n=672) were heterosexually active African American men age 18-65 years recruited from urban health centers and clinics in Boston, MA, and who participated in a health survey. Logistic regression analyses were used to assess associations between past 30 day binge drinking and the following outcome variables: unprotected sex, six or more sex partners in the past year, sex trade involvement, and past 6 month HIV/STI diagnosis. Analyses were adjusted to control demographics, incarceration history, illicit drug use, and injection drug use. RESULTS Significant associations were observed between binge alcohol use and unprotected vaginal sex with non-main female partners (AOR=1.7, 95% CI=1.2-2.3), unprotected anal sex with non-main female partners (AOR=2.3, 95% CI=1.4-4.0), sex trade involvement (AOR=2.1, 95% CI=1.3-3.5), and recent HIV/STI diagnosis (AOR=1.9; 95% CI=1.05-3.6). CONCLUSION Heterosexual African American men engaging in binge alcohol use may be at increased risk for HIV/STI; findings support the need for integrating alcohol risk reduction into HIV prevention programs targeting this population.
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Affiliation(s)
- Anita Raj
- Social Behavioral Sciences Department, Boston University School of Public Health, Boston, MA 02118, USA.
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Correlates of any condom use among Russian narcology patients reporting recent unprotected sex. AIDS Behav 2009; 13:310-7. [PMID: 18401698 DOI: 10.1007/s10461-008-9383-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess whether HIV/sexually transmitted infection (STI) risk factors: risky sex (multiple sex partners and sex trade involvement), past HIV or STI diagnosis and substance use (at risk drinking and injection drug use) are associated with the outcome any condom use in the past 6 months among Russian narcology hospital patients. Participants (N = 178) included only those who reported unprotected sex in the past 6 months and were aged 18-55 years and 76% male. Any condom use in the past 6 months was reported by 55% of the sample. History of STIs was reported by 43% of participants; 15% were HIV-infected. Regression analyses adjusted for demographics demonstrated that those reporting multiple sex partners (OR(adj) = 4.2, 95% CI = 2.0-8.7) and sex trade involvement (OR(adj) = 2.4, 95% CI = 1.1-5.1) in the past 6 months had significantly higher odds of reporting any condom use in this same timeframe. HIV/STI and substance use were not associated with increased odds of condom use.
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Samet JH, Krupitsky EM, Cheng DM, Raj A, Egorova VY, Levenson S, Meli S, Bridden C, Verbitskaya EV, Kamb ML, Zvartau EE. Mitigating risky sexual behaviors among Russian narcology hospital patients: the PREVENT (Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment) randomized controlled trial. Addiction 2008; 103:1474-83. [PMID: 18636998 PMCID: PMC2588416 DOI: 10.1111/j.1360-0443.2008.02251.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the effectiveness of a sexual risk reduction intervention in the Russian narcology hospital setting. DESIGN, SETTING AND PARTICIPANTS This was a randomized controlled trial from October 2004 to December 2005 among patients with alcohol and/or heroin dependence from two narcology hospitals in St Petersburg, Russia. INTERVENTION Intervention subjects received two personalized sexual behavior counseling sessions plus three telephone booster sessions. Control subjects received usual addiction treatment, which did not include sexual behavior counseling. All received a research assessment and condoms at baseline. MEASUREMENTS Primary outcomes were percentage of safe sex episodes (number of times condoms were used / by number of sexual episodes) and no unprotected sex (100% condom use or abstinence) during the previous 3 months, assessed at 6 months. FINDINGS Intervention subjects reported higher median percentage of safe sex episodes (unadjusted median difference 12.7%; P = 0.01; adjusted median difference 23%, P = 0.07); a significant difference was not detected for the outcome no unprotected sex in the past 3 months [unadjusted odds ratio (OR) 1.6, 95% confidence interval (CI) 0.8-3.1; adjusted OR 1.5, 95% CI 0.7-3.3]. CONCLUSIONS Among Russian substance-dependent individuals, sexual behavior counseling during addiction treatment should be considered as one potential component of efforts to decrease risky sexual behaviors in this HIV at-risk population.
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Affiliation(s)
- Jeffrey H. Samet
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA,Boston University School of Public Health, Department of Social and Behavioral Sciences, MA, USA
| | - Evgeny M. Krupitsky
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Debbie M. Cheng
- Boston University School of Public Health, Department of Biostatistics, MA, USA
| | - Anita Raj
- Boston University School of Public Health, Department of Social and Behavioral Sciences, MA, USA
| | - Valentina Y. Egorova
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Suzette Levenson
- Boston University School of Public Health, Data Coordinating Center, MA, USA
| | - Seville Meli
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA
| | - Carly Bridden
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA
| | - Elena V. Verbitskaya
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Mary L. Kamb
- Centers for Disease Control and Prevention (CDC), Division of STD Prevention, Atlanta, GA, USA
| | - Edwin E. Zvartau
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
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