Increased drug use and STI risk with injection drug use among HIV-seronegative heterosexual methamphetamine users

"Jail isn't the answer for these inmates": how to respond to methamphetamine use in prisons

PURPOSE

The correctional system continues to face challenges with responding to and managing methamphetamine use among incarcerated individuals. This study aims to uncover what resources and policies could better help correctional workers deal with these challenges. The authors also examined methamphetamine's impact on correctional work and staff well-being.

DESIGN/METHODOLOGY/APPROACH

An online survey was distributed to correctional workers (n = 269) in Manitoba, Canada, featuring questions about their experiences related to methamphetamine use in populations under their care, what supports are needed to adequately address the concern, and the potential effects on self and their occupational responsibilities. Using NVivo software, survey responses were analysed using an emergent theme approach.

FINDINGS

Correctional workers believed policies and protocols for managing methamphetamine use and withdrawal are currently inadequate. Correctional workers reported having monthly contact with incarcerated individuals experiencing methamphetamine withdrawal, posing safety concerns to them and other incarcerated individuals. Respondents proposed more education and training on managing incarcerated people withdrawing from methamphetamines, related to the symptoms of use and withdrawal and how to support persons detoxing. Increased human and material resources were reported as being needed (e.g. more nurses onsite and better screening devices). Respondents also desired more medical intervention, safe living spaces for methamphetamine users and programming to support addiction.

ORIGINALITY/VALUE

The current study unpacks correctional workers' perspectives, support desires and their experiences managing methamphetamine use amongst incarcerated people. The authors discuss the required knowledge to respond to gaps in prison living, re-entry and related policy needs.

Geographic Patterns of Human Immunodeficiency Virus (HIV) Risk Behaviors Among Older Adults: A Strategy for Identifying Space as a Risk Exposure

OBJECTIVES

This study examined geographical patterns of HIV risk among adults aged 60 and older.

METHODS

The 2019 Behavioral Risk Factor Surveillance System (BRFSS) weighted data was used to analyze self-reported participation in HIV risk behaviors among older adults (n = 62,852). Logistic regression models were used on a dichotomous HIV risk variable to map the distribution of HIV risk behaviors across both census regions and divisions.

RESULTS

The weighted model revealed significance across regions. Across all regions, identifying as female, identifying as Hispanic, and reporting not having depression were protective from participating in HIV risk behaviors.

DISCUSSION

The geographic heterogeneity in patterns of high-risk behaviors among older adults are discussed, along with the implications of partner access (marital status) and emotional health (depression) that need further examination. Recommendations for additional geographic analysis are made.

Associations between prescription stimulant use as prescribed, nonmedical use, and illicit stimulant use among adults evaluated for substance use treatment, 2017-2021

Background

Limited data exist on risk factors for illicit stimulant use, including associations between prescription stimulant use/nonmedical use (NMU) and illicit stimulant use.

Methods

We used 2017-2021 data from adults assessed for substance use disorder (SUD) treatment using the National Addictions Vigilance Intervention and Prevention Program Addiction Severity Index-Multimedia Version® tool. Multivariable Poisson regression models analyzed associations between past 30-day prescription stimulant use as prescribed or NMU and past 30-day illicit stimulant use. Separate models examined past 30-day illicit stimulant, methamphetamine, and cocaine use. We explored problem severity across seven biopsychosocial domains (e.g., drug, psychiatric, family) by past 30-day prescription stimulant use/NMU and illicit stimulant use.

Results

Among 218,981 assessments, 1.8% reported prescription stimulant NMU; 1.6% reported use as prescribed. Past 30-day prescription stimulant NMU (vs. no use) was associated with past 30-day illicit stimulant use (adjusted prevalence ratio [aPR] [95% CI]: 2.67 [2.59, 2.75]), methamphetamine use (aPR: 2.81 [2.71, 2.92]), and cocaine use (aPR: 3.53 [3.33, 3.74]). Prescription stimulant use as prescribed (vs. no use) was associated with lower prevalence of past 30-day illicit stimulant use. Assessments reporting prescription stimulant NMU (vs. no use, or use as prescribed) appeared more likely to have moderate-to-extreme problem scores across biopsychosocial domains, indicating greater need for treatment or assistance. Assessments reporting prescription stimulant use as prescribed or NMU frequently reported opioids, alcohol, or other substances as their primary substance problem.

Conclusions

Adults using illicit stimulants/nonmedically using prescription stimulants may benefit from care addressing polysubstance use, mental health, social, and recovery support services.

The health needs of people leaving prison with a history of methamphetamine and/or opioid use

INTRODUCTION

Methamphetamine use is more common than opioid use among prison entrants in some countries, including Australia, yet most research and policy focuses on opioid use. This suggests that traditional opioid-focused interventions are no longer appropriate for the majority of this group in countries such as Australia. To inform policy and practice, we compared socio-demographic characteristics and health needs of people leaving prison with a history of methamphetamine use and/or opioid use.

METHODS

A cross-sectional survey of incarcerated adults administered the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test was used to identify moderate-/high-risk methamphetamine use (n = 909), opioid use (n = 115) or combined methamphetamine/opioid use (n = 356) before incarceration. We compared groups using modified log-linked Poisson regression with robust error variance.

RESULTS

Compared to the opioid-only group, the methamphetamine-only group were: significantly more often aged <25 years; significantly more likely to identify as Indigenous; significantly less likely to have a history of prior incarceration, drug injection or overdose. A significantly lower proportion of methamphetamine-only and methamphetamine-and-opioid participants self-reported current hepatitis C infection compared to opioid-only participants. A majority of participants in all groups screened positive for current psychological distress according to the K10.

DISCUSSION AND CONCLUSIONS

People leaving prison with a history of methamphetamine use differ from opioid users with respect to demographics, patterns of substance use and related health concerns. Treatment and harm reduction efforts for people who experience incarceration must respond to patterns of drug use in this population, and invest at scale in coordinated, continuous services for co-occurring substance use and mental health problems.

Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction

Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.

Challenges of sexually transmitted infections and sexual health among people who inject drugs

PURPOSE OF REVIEW

This review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID.

RECENT FINDINGS

Modern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently.

SUMMARY

Integration of sexual health into prevention programs for PWID is essential to curb transmission of STI, including HIV, among PWID and their sexual partners.

Adverse childhood experiences and stimulant use disorders among adults in the United States

Recent data indicate a resurgence of stimulant use and harms in the United States; thus, there is a need to identify risk factors to inform development of effective prevention strategies. Prior research suggests adverse childhood experiences (ACEs) are common among individuals using stimulants and may be an important target for prevention. National Epidemiological Survey on Alcohol and Related Conditions was used to estimate prevalence of ACEs among U.S. adults using amphetamine-type stimulants (ATS), cocaine, or both. Multivariable logistic regression examined associations between ACEs and stimulant use and use disorders. Among adults reporting lifetime ATS use, 22.1% had ≥4 ACEs, 24.9% had 2-3 ACEs, 22.4% had 1 ACE, 30.6% reported no ACEs. Among adults with lifetime ATS use disorder, 29.3% reported ≥4 ACEs, 28.7% reported 2-3 ACEs, 21.6% reported 1 ACE, and 20.4% reported no ACEs. Multivariable logistic regression found a significant relationship between number of ACEs and stimulant use and use disorders. In conclusion, we found a strong relationship between increasing ACE exposures and stimulant use and use disorders. Advancing comprehensive strategies to prevent ACEs and treating underlying trauma among those using stimulants holds great promise to reduce stimulant use and its health and social consequences in the United States.

Resurgent Methamphetamine Use at Treatment Admission in the United States, 2008-2017

Objectives. To evaluate trends and correlates of methamphetamine use in the United States.Methods. Data are from 15 747 334 drug-related treatment admissions among persons aged 12 years or older in the 2008-2017 Treatment Episode Data Set. We analyzed trends and used multivariable logistic regression.Results. Methamphetamine-related admissions increased from 15.1% of drug-related treatment admissions in 2008 to 23.6% in 2017. Increases occurred among nearly all demographic groups. Methamphetamine injection increased from 17.5% of admissions in 2008 to 28.4% in 2017. Among methamphetamine-related admissions, heroin use increased from 5.3% of admissions in 2008 to 23.6% in 2017. Characteristics associated with increased odds of reporting methamphetamine use at admission included female sex; admissions aged 35 to 44 years; admissions in the Midwest, South, and West; unemployment; not in labor force; living dependent; living homeless; and having a referral from criminal justice, a health care provider, or other community treatment source.Conclusions. Treatment admissions involving methamphetamine use increased significantly over the past decade and appear to be linked to the ongoing opioid crisis in the United States. Efforts to mobilize public health prevention, treatment, and response strategies to address rising methamphetamine use and overdose are needed.

Increases in methamphetamine use among heroin treatment admissions in the United States, 2008-17

BACKGROUND AND AIMS

Due to their small sample sizes, geographic specificity and limited examination of socio-demographic characteristics, recent studies of methamphetamine use among people using heroin in the United States are limited in their ability to identify national and regional trends and to characterize populations at risk for using heroin and methamphetamine. This study aimed to examine trends and correlates of methamphetamine use among heroin treatment admissions in the United States.

DESIGN

Longitudinal analysis of data from the 2008 to 2017 Treatment Episode Data Set. Descriptive statistics, trend analyses and multivariable logistic regression were used to examine characteristics associated with methamphetamine use among heroin treatment admissions.

SETTING

United States.

PARTICIPANTS

Treatment admissions of people aged ≥ 12 years whose primary substance of use is heroin.

MEASUREMENTS

Primary measurement was heroin treatment admissions involving methamphetamine. Secondary measurements were demographics of sex, age, race/ethnicity, US census region, living arrangement and employment status.

FINDINGS

The percentage of primary heroin treatment admissions reporting methamphetamine use increased each year from 2.1% in 2008 to 12.4% in 2017, a relative percentage increase of 490% and an annual percentage change (APC) of 23.4% (P < 0.001). During the study period, increases were seen among males and females and among all demographic and geographic groups examined. Among primary heroin treatment admissions reporting methamphetamine use in 2017, 47.1% reported injecting, 46.0% reported smoking, 5.1% reporting snorting and 1.8% reported oral/other as their usual route of methamphetamine use.

CONCLUSIONS

Methamphetamine use among heroin treatment admissions in the United States increased from one in 50 primary heroin treatment admissions in 2008 to one in 8 admissions in 2017.

Risk Factors for Recent Intimate Partner Violence among Methamphetamine-Using Men and Women

The Substance Abuse, Violence, and HIV/AIDS (SAVA) syndemic model describes how the confluence of the three epidemics of substance abuse, violence, and HIV risk work synergistically to create excess burden among populations. We sought to identify risk factors associated with recent intimate partner violence (IPV) victimization among heterosexual methamphetamine (meth)-using men (n = 108) and women (n = 122) enrolled in FASTLANE-II, an HIV behavioral intervention in San Diego, CA. Women and men reported high rates of physical-only (women: 20%; men: 18%) and sexual (women: 25%; men: 23%) IPV. Multinomial regression analysis revealed that individuals who reported lower social support and individuals who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were more likely to report IPV versus no IPV. Women who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were 1.58 times more likely to report physical-only IPV versus no IPV, while men who reported similar behaviors were 1.15 times more likely to report physical-only IPV versus no IPV. Our findings highlight the influence of interpersonal factors on IPV. This research supports further study on gender-specific risk/protective factors and the development of gender-specific interventions targeting the SAVA syndemic among meth users.

Frequency of Group Sex Participation and Risk for HIV/STI Among Young Adult Nightclub Scene Participants

OBJECTIVES

This study examines frequency of group sex participation and associated characteristics and behaviors among a sample of heterosexual young adult participants in Miami's nightclub scene (n = 498).

METHODS

Baseline survey assessments were analyzed using zero-inflated binomial regression.

RESULTS

Forty-one percent of the sample reported group sex participation history. Greater frequency of group sex is associated with buying sex, sex with an injection drug user, being high during sex, condomless vaginal sex, victimization history, and sexually transmitted infection incidence (p < .02).

CONCLUSIONS

Sexually transmitted infection prevention and intervention efforts should address risks associated with group sex participation.

Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico

OBJECTIVE

Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball").

METHOD

Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection.

RESULTS

The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana.

CONCLUSIONS

These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Regional differences, socio-demographics, and hidden population of HIV/AIDS in India

This study examines the prevalence of HIV/AIDS in different regions of India, their socio-demographic indicators, and the presence of hidden population infected with HIV. Secondary data analyzed were obtained from national and international agencies. Considering the prevalence of HIV/AIDS in India, the low-prevalence regions in the last decade have shown a steady increase in recent years. Productive age, urbanization, male gender, lower level of education, minority religions, low income, and mobile occupations are associated with HIV pandemic. The hidden population vulnerable to HIV/AIDS are: street children, homeless population, and refugees. These observations can help map the high-risk behavior groups and formulate targeted strategies to curb the HIV menace.

Individual and population level impacts of illicit drug use, sexual risk behaviours on sexually transmitted infections among young Aboriginal and Torres Strait Islander people: results from the GOANNA survey

BACKGROUND

Sexually transmitted infections (STIs) have been increasing among Australian Indigenous young people for over two decades. Little is known about the association between alcohol and other drug use and sexual risk behaviours and diagnosis of STIs among this population.

METHODS

A cross-sectional, community based self-administered survey was conducted among young Aboriginal people aged 16-29 years of age. Questionnaires included socio-demographic characteristics, knowledge, sexual risk behaviours alcohol and other drug use and health service access including self-reported history of diagnosis with a STI. Logistic regression models and population attributable risks were used to assess individual and population level impacts of illicit drug use on high risk sexual behaviours and ever reported diagnosis of an STI.

RESULTS

Of the 2877 participants, 2320 (81 %) identified as sexually active and were included in this study. More than 50 % of the study population reported that they had used at least one illicit drug in past year. Cannabis, ecstasy and methamphetamines were the three most commonly used illicit drugs in the past year. The prevalence of self-reported STI diagnosis was 25 %. Compared with people who did not report using illicit drugs, risky alcohol use and sexual behaviours including inconsistent condom use, multiple sexual partners in the past year and sex with casual partners were all significantly higher among illicit drug users. In adjusted analysis, participants who reported using illicit drugs were significantly more likely to engage in sexual risk behaviours and to ever have been diagnosed with an STI. Adjusted Odds Ratios ranged from 1.86 to 3.00 (males) and from 1.43 to 2.46 (females). At the population level, more than 70 % of the STI diagnoses were attributed to illicit drug-use and sexual risk behaviours for males and females.

CONCLUSION

Illicit drug use in this population is relatively high compared to other similar aged populations in Australia. Illicit drug use was associated with risky sexual behaviours and STI diagnoses among this study population. Developing and implementing effective STI prevention strategies should include not only safe sex messages but also include drug and alcohol harm reduction messages.

Identification of Treatment Targets in a Genetic Mouse Model of Voluntary Methamphetamine Drinking

Methamphetamine has powerful stimulant and euphoric effects that are experienced as rewarding and encourage use. Methamphetamine addiction is associated with debilitating illnesses, destroyed relationships, child neglect, violence, and crime; but after many years of research, broadly effective medications have not been identified. Individual differences that may impact not only risk for developing a methamphetamine use disorder but also affect treatment response have not been fully considered. Human studies have identified candidate genes that may be relevant, but lack of control over drug history, the common use or coabuse of multiple addictive drugs, and restrictions on the types of data that can be collected in humans are barriers to progress. To overcome some of these issues, a genetic animal model comprised of lines of mice selectively bred for high and low voluntary methamphetamine intake was developed to identify risk and protective alleles for methamphetamine consumption, and identify therapeutic targets. The mu opioid receptor gene was supported as a target for genes within a top-ranked transcription factor network associated with level of methamphetamine intake. In addition, mice that consume high levels of methamphetamine were found to possess a nonfunctional form of the trace amine-associated receptor 1 (TAAR1). The Taar1 gene is within a mouse chromosome 10 quantitative trait locus for methamphetamine consumption, and TAAR1 function determines sensitivity to aversive effects of methamphetamine that may curb intake. The genes, gene interaction partners, and protein products identified in this genetic mouse model represent treatment target candidates for methamphetamine addiction.

Is there any difference in patterns of use and psychiatric symptom status between injectors and non-injectors of mephedrone?

OBJECTIVE

In recent years, increasing intravenous mephedrone use was reported in several countries. The aim of this study was to describe the characteristics of such a form of mephedrone use, while identifying the differences between injectors and non-injectors in patterns of mephedrone use and psychiatric symptom status.

METHODS

One hundred and forty-five mephedrone users were surveyed on patterns of mephedrone use using a structured questionnaire as well as the Brief Symptom Inventory.

RESULTS

Majority of users received mephedrone from acquaintances and used it in discos/parties settings regarding both first and current mephedrone use. Intranasal use was the most typical route of administration (84.4%). Injectors (11%) used the drug more frequently and in higher dosages. This group included a greater proportion of opiate users (37.5%) and showed more diffuse psychiatric symptoms. Regarding the predictors of being an injector, heroin use showed the highest odds ratio.

CONCLUSIONS

Intravenous mephedrone use is associated with a higher risk of harmful drug use, elevated psychiatric symptom profile and increased possibility of mephedrone being considered as an addictive substance. These findings might be important in efficient treatment planning.

Methamphetamine use among women attending sexually transmitted disease clinics in Los Angeles County

BACKGROUND

Methamphetamine (meth) use is a continuing problem in the United States and is associated with increased risk of HIV and sexually transmitted infections (STIs). However, few studies have examined the meth use/STI risk association among women.

METHODS

We conducted a cross-sectional study of women attending public sexually transmitted disease clinics in Los Angeles County, California, from 2009 to 2010. Routinely collected clinic intake data were used to compare the prevalence of meth use among women with different demographics/sexual behaviors. Multivariable logistic regression was used to identify predictors of meth use.

RESULTS

There were 1.4% (n = 277) women who reported meth use, with a mean age of 29 years. Prevalence was highest among Whites and those reporting both male and female partners. Most women who reported meth use also reported polysubstance use. In a multivariable model controlling for age, race/ethnicity, condom use, having a new sex partner, and other illicit substance use, women who reported sex with an injection drug user were nearly 10 times more likely to report meth use as compared with those who did not (adjusted odds ratio [AOR], 9.90; 95% confidence interval [CI], 5.86-16.75). Other factors associated with meth use included sex with a recently incarcerated partner (AOR, 3.24; 95% CI, 2.16-4.86), anonymous partner (AOR, 2.49; 95% CI, 1.54-4.04), and transactional sex (AOR, 3.26; 95% CI, 1.69-6.32). Women who tested positive for chlamydia/gonorrhea were 1.48 times more likely to use meth as compared with those who did not.

CONCLUSIONS

Female meth users have high-risk behaviors that could increase their risk for STIs/HIV.

Health and social harms associated with crystal methamphetamine use among street-involved youth in a Canadian setting

BACKGROUND AND OBJECTIVES

Despite recent increases in crystal methamphetamine use among high-risk populations such as street-involved youth, few prospective studies have examined the health and social outcomes associated with active crystal methamphetamine use.

METHODS

We enrolled 1,019 street-involved youth in Vancouver, Canada, in a prospective cohort known as the at-risk youth study (ARYS). Participants were assessed semi-annually and a generalized estimating equation (GEE) logistic regression was used to identify factors independently associated with active crystal methamphetamine use.

RESULTS

Among 1,019 participants recruited into ARYS between 2005 and 2012 the median follow up duration was 17 months, 320 (31.4%) participants were female and 454 (44.6%) had previously used crystal methamphetamine at baseline. In adjusted GEE analyses, active crystal methamphetamine use was independently associated with Caucasian ethnicity (adjusted odds ratio [AOR] = 1.37; 95% confidence interval [CI]: 1.04-1.81), homelessness (AOR = 1.34; 95% CI: 1.15-1.56), injection drug use (AOR = 3.40; 95% CI: 2.76-4.19), non-fatal overdose (AOR = 1.46; 95%CI: 1.07-2.00), being a victim of violence (AOR = 1.19; 95% CI: 1.02-1.38), involvement in sex work (AOR = 1.39; 95% CI: 1.03-1.86), and drug dealing (AOR = 1.60; 95% CI: 1.35-1.90).

DISCUSSION AND CONCLUSIONS

Prevalence of crystal methamphetamine use was high in this setting and active use was independently associated with a range of serious health and social harms.

SCIENTIFIC SIGNIFICANCE

Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

Knowledge about human immunodeficiency virus infection and sexual behavior among drug users: a cross sectional study in Pokhara submetropolitan city, Nepal

Drug abuse is one of the public health problems in Nepal. Only limited research has been done to explore knowledge and sexual behaviors of injection drug users in Nepal. The objective of this research was to explore knowledge about human immunodeficiency virus (HIV) infection and sexual behavior among drug users in Nepal. More than 90% of participants had heard of HIV. Almost all participants who had heard of HIV knew that HIV is transmitted through unsafe sexual intercourse and through syringe use. In comparison to that, a small percentage of participants knew of infected blood and mother to child as modes of transmission of HIV. Injection drug users were less likely to use condoms during sexual intercourse with their wives. Awareness programs and behavior-change communication to alert drug users to the risks of sharing syringes need to be conducted, in addition to promoting the use of condoms during sexual intercourse with other women as well as with their wives.

Prevalence and correlates of rectal Chlamydia and gonorrhea among female clients at sexually transmitted disease clinics

BACKGROUND

The prevalence and correlates of rectal sexually transmitted infections are well described among men who report receptive anal intercourse (AI); however, little is known about the epidemiology of rectal sexually transmitted infections among women.

METHODS

We conducted a cross-sectional study of women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible for inclusion in this study if they reported AI in the previous 90 days, were tested for rectal chlamydia and gonorrhea, and were seen between January 2008 and December 2010.

RESULTS

Among the 2084 clinic visits by women in this analysis, chlamydia and gonorrhea percent positivity by anatomic site was 12% (n = 144) for urogenital chlamydia, 14.6% (n = 171) for rectal chlamydia, 3.3% (n = 66) for urogenital gonorrhea, and 3.0% (n = 60) for rectal gonorrhea, with 25% of chlamydia cases and 19% of gonorrhea cases having rectal-only infections. Among women 25 years or younger, rectal infections were higher in visits in which women reported sex with an injection drug user (46.5% vs. 15.5%; P < 0.01) or sex with a HIV-positive partner (66.7% vs. 15.8%; P = 0.02). Among women older than 25 years, rectal infections were higher in visits where women reported substance use (10.6% vs. 5.8%; P ≤ 0.01). In multivariable models controlling for age and the presence of a urogenital infection, these associations remained.

CONCLUSIONS

Chlamydia and gonorrhea positivity was high among women reporting AI, and a large proportion of these cases would be missed in the absence of rectal testing. The high-risk behaviors of women with rectal infections highlight the need for rectal screening recommendations.

Testing for amphetamine-type stimulant (ATS) use to ascertain validity of self-reported ATS use among young female sex workers in Cambodia

Objective

To assess concordance between self-reported amphetamine-type stimulant (ATS) use and toxicology results among young female sex workers (FSW) in Phnom Penh, Cambodia.

Methods

Cross-sectional data from the Young Women’s Health Study-2 (YWHS-2), a prospective study of HIV and ATS use among young (15 to 29 years) FSW in Phnom Penh, Cambodia, was analyzed. The YWHS-2 assessed sociodemographic characteristics, HIV serology, HIV risk, and ATS use by self-report and urine toxicology testing at each quarterly visit, the second of which provided data for this assessment. Outcomes include sensitivity, specificity, positive- and negative predictive values (overall and stratified by age), sex-work setting, and HIV status.

Results

Among 200 women, prevalence of positive toxicology screening for ATS use was 14% (95% confidence interval [CI], 9.2, 18.9%) and concurrent prevalence of self-reported ATS was 15.5% (95% CI, 10.4, 20.6%). The sensitivity and specificity of self-reported ATS use compared to positive toxicology test results was 89.3% (25/28), and 96.5% (166/172), respectively. The positive predictive value of self-reported ATS use was 80.6% (25/31); the negative predictive value was 98.2% (166/169). Some differences in concordance between self-report and urine toxicology results were noted in analyses stratified by age group and sex-work setting but not by HIV status.

Conclusion

Results indicate a high prevalence of ATS use among FSW in Phnom Penh, Cambodia, and high concordance between self-reported and toxicology-test confirmed ATS use.

Methamphetamine and inflammatory cytokines increase neuronal Na+/K+-ATPase isoform 3: relevance for HIV associated neurocognitive disorders

Methamphetamine (METH) abuse in conjunction with human immunodeficiency virus (HIV) exacerbates neuropathogenesis and accelerates neurocognitive impairments in the central nervous system (CNS), collectively termed HIV Associated Neurocognitive Disorders (HAND). Since both HIV and METH have been implicated in altering the synaptic architecture, this study focused on investigating alterations in synaptic proteins. Employing a quantitative proteomics approach on synaptosomes isolated from the caudate nucleus from two groups of rhesus monkeys chronically infected with simian immunodeficiency virus (SIV) differing by one regimen, METH treatment, we identified the neuron specific Na(+)/K(+)-ATPase alpha 1 isoform 3 (ATP1A3) to be up regulated after METH treatment, and validated its up regulation by METH in vitro. Further studies on signaling mechanisms revealed that the activation of ATP1A3 involves the extracellular regulated kinase (ERK) pathway. Given its function in maintaining ionic gradients and emerging role as a signaling molecule, changes in ATP1A3 yields insights into the mechanisms associated with HAND and interactions with drugs of abuse.

Social, structural and behavioral determinants of overall health status in a cohort of homeless and unstably housed HIV-infected men

BACKGROUND

Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men.

METHODS AND FINDINGS

Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, the median CD4 cell count was 349 cells/µl and 18% of eligible persons (CD4<350) took antiretroviral therapy (ART). Marginal structural models were used to estimate the population-level effects of behavioral, social, and structural factors on overall physical and mental health status (measured by the SF-36), and targeted variable importance (tVIM) was used to empirically rank factors by their influence. After adjusting for confounding, and in order of their influence, the three factors with the strongest negative effects on physical health were unmet subsistence needs, Caucasian race, and no reported source of instrumental support. The three factors with the strongest negative effects on mental health were unmet subsistence needs, not having a close friend/confidant, and drug use. ART adherence >90% ranked 5th for its positive influence on mental health, and viral load ranked 4th for its negative influence on physical health.

CONCLUSIONS

The inability to meet food, hygiene, and housing needs was the most powerful predictor of poor physical and mental health among homeless and unstably housed HIV-infected men in an urban setting. Impoverished persons will not fully benefit from progress in HIV medicine until these barriers are overcome, a situation that is likely to continue fueling the US HIV epidemic.

The Relationship between Sexual Coping and the Frequency of Sexual Risk among 'At Risk' African American Women

This study examines the relationship between one specific type of avoidant coping behavior-namely, having sex to cope with one's worries or problems-and the frequency with which 'at risk' women engage in risky sexual relations. Face-to-face interviews were conducted with 221 African American women drug abusers in the Atlanta, Georgia metropolitan area. The community identification process was used for recruitment, with additional recruitment done via targeted sampling. A variety of demographic characteristics, background and experiences measures, childhood maltreatment experiences, substance use-related measures, psychosocial and attitudinal items, and relationship characteristics were examined for their influence both on the frequency of engaging in risky sex and the extent to which women had sex to cope. Multivariate analysis revealed that having sex to cope was a statistically-significant predictor of the frequency with which women engaged in risky sexual behaviors. A separate analysis of the predictors of having sex to cope yielded seven items that were important for understanding the extent to which women engaged in sexual coping: age, number of health information sources, amount of physical abuse, reasons for not using condoms, overall attitudes toward condom use, level of partner communication, and the amount of help available from one's support network. The intervention-related implications of these findings are discussed, emphasizing the needs: to target younger women, to target and help survivors of childhood maltreatment to deal with unresolved issues, to make attitudes toward using condoms more conducive, to improve partner communication, and to bolster support network relationships.

Dopamine receptor D3 genetic polymorphism (rs6280TC) is associated with rates of cognitive impairment in methamphetamine-dependent men with HIV: preliminary findings

Macrophages are one of HIV-1's principal targets and chiefly responsible for translocating HIV into the central nervous system (CNS). Previous research suggested an increase in macrophages being infected by HIV in the presence of methamphetamine (METH) or increased extracellular dopamine (DA). Experimental studies indicate that this is mediated by DA receptors, including DA receptor D3 (DRD3), which is expressed in macrophages. A single nucleotide polymorphism (SNP) of the DRD3 gene (rs6280TC) modulates its dopamine binding affinity, resulting in the possibility that inheriting a variant of this SNP increases macrophage susceptibility to HIV infection in the presence of METH and DA, particularly in the CNS where METH is sequestered, leading to cognitive impairment (CI). Thus, we conducted a retrospective clinical investigation to evaluate whether rs6280TC is associated with CI among HIV-positive METH users. We stratified 310 males by HIV serostatus (HIV-positive, -negative) and METH dependence (METH-positive, -negative) and then by rs6280TC genotype (CC, CT, and TT). Genotypic groups within each of four HIV/METH groups were compared for rates of CI. We hypothesized that only HIV-positive/METH-positive carriers of the C allele, which increases the DRD3's binding to DA, would be more likely to develop CI. Cochran-Armitage test for trends in proportions yielded significant (p < 0.05) association between three genotypes and impairment rates in the hypothesized order, but only among HIV-positive/METH-positive subjects. The results also confirmed that C allele carriers (CC and CT, 53.3%) in this group had higher impairment rates (p = 0.05) than TT carriers (33.3%). These findings support the theory that rs6280TC influences the frequency of CI in HIV-positive/METH-positive males.