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Cherenack EM, Chavez JV, Martinez C, Hirshfield S, Balise R, Horvath KJ, Viamonte M, Jimenez DE, Paul R, Dilworth SE, DeVries B, Pallikkuth S, Stevenson M, Alvarado TC, Pahwa S, Carrico AW. Stimulant use, HIV, and immune dysregulation among sexual minority men. Drug Alcohol Depend 2023; 251:110942. [PMID: 37651812 PMCID: PMC10544798 DOI: 10.1016/j.drugalcdep.2023.110942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/30/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Sexual minority men (SMM) report high rates of stimulant use (e.g., crystal methamphetamine, cocaine) and HIV infection. Stimulant use contributes to immune dysfunction, which enhances risk for HIV acquisition and pathogenesis. Research is needed to examine the independent and interactive relationships of stimulant use and HIV infection with systemic immune dysregulation among SMM, especially during the COVID-19 pandemic. METHODS From 2020-2022, 75 SMM in Miami, Florida with and without HIV completed an online survey and provided biospecimens to assess HIV status and viral load (VL), recent stimulant use, and soluble markers of immune activation and inflammation in plasma, including soluble CD14 (sCD14) and elevated high-sensitivity C-reactive protein (hs-CRP > 1.0mg/L). Sociodemographics and prior SARS-CoV-2 infection were compared across HIV status/stimulant use groups. Moderation models examined the independent and interactive associations of stimulant use and HIV status with sCD14 and elevated hs-CRP. RESULTS Thirty participants were persons living with HIV (PWH) (50% with stimulant use), and 45 were HIV-negative (44% with stimulant use). SARS-CoV-2 infection was not associated with stimulant use/HIV groups or immune outcomes. HIV-negative SMM without stimulant use had lower sCD14 compared to other SMM, as well as lower odds of elevated hs-CRP compared to PWH who used stimulants. Stimulant use showed independent associations with immune dysregulation that persisted after controlling for HIV status and VL, whereas HIV status was only independently associated with elevated hs-CRP in one model not controlling for VL. CONCLUSIONS Among SMM, stimulant use was independently associated with elevated immune activation and inflammation.
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Affiliation(s)
- Emily M Cherenack
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States.
| | - Jennifer V Chavez
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Claudia Martinez
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, 1120 NW 14 ST Suite 1126, Miami, FL 33136, United States
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, United States
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA 92120, United States
| | - Michael Viamonte
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Suite 1436, Miami , FL 33136, United States
| | - Robert Paul
- Missouri Institute of Mental Health, Department of Psychological Sciences, University of Missouri, St. Louis, One University Blvd, St. Louis, MO 63141, United States
| | - Samantha E Dilworth
- University of California, San Francisco, Center for AIDS Prevention Studies, Department of Medicine, 550 16th St, 3rd Floor, San Francisco, CA 94158, United States
| | - Britt DeVries
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Suresh Pallikkuth
- Department of Microbiology & Immunology, University of Miami Miller School of Medicine, 1580 NW 10 AVE, Miami, FL 33136, United States
| | - Mario Stevenson
- Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14 ST, Miami, FL 33136, United States
| | - Thaissa Cordeiro Alvarado
- Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14 ST, Miami, FL 33136, United States
| | - Savita Pahwa
- Department of Microbiology & Immunology, University of Miami Miller School of Medicine, 1580 NW 10 AVE, Miami, FL 33136, United States
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
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Darlington CK, Lipsky RK, Teitelman AM, Koblin BA, Davis A, Walcott M, Compton PA, Tieu HV. HIV risk perception, pre-exposure prophylaxis (PrEP) awareness, and PrEP initiation intention among women who use drugs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209119. [PMID: 37451517 PMCID: PMC10529693 DOI: 10.1016/j.josat.2023.209119] [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: 11/09/2022] [Revised: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Women who use drugs (WWUD) are prime candidates for pre-exposure prophylaxis (PrEP) due to their elevated risk of acquiring HIV through biological, behavioral, and contextual factors. However, PrEP uptake among WWUD remains low. The relationship between unhealthy drug use and correlates of PrEP uptake in this vulnerable population is not well defined. The purpose of this study is to characterize the relationships between specific types and routes of drug use and several precursors of PrEP uptake among WWUD. METHODS The study collected data via a computer-based survey from 233 women living in New York City and Philadelphia who participated in a study designed to develop and pilot a women-focused intervention for PrEP uptake. The sample of cisgender, HIV-negative women were not currently taking PrEP but considered PrEP eligible. This analysis is focused on women's HIV risk perception, PrEP awareness, PrEP initiation intention, and any use of the following drugs: barbiturates, benzodiazepines, crack cocaine, powder cocaine, hallucinogens, heroin, methamphetamines, and prescription opioids. RESULTS Within the three months prior to study enrollment, 63.1 % of participants reported any drug use; 42 % reported polydrug use; 19.8 % had injected drugs; 75 % reported getting high or drunk before sex; and 44 % had been enrolled in drug treatment. Of our total sample, 41.2 % perceived themselves at risk for HIV infection, 41.6 % were aware of PrEP prior to the study, and 62.7 % intended to initiate PrEP after they were informed. When compared to other PrEP-eligible women, women who reported prescription opioid use and polydrug use perceived themselves at higher risk for HIV infection and had higher intention to start PrEP. However, they and women who reported injecting drugs also reported lower awareness of PrEP. CONCLUSION These findings have implications for increasing education about PrEP and the various modes of HIV exposure to support PrEP uptake in this vulnerable population.
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Affiliation(s)
| | | | - Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | | | - Annet Davis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Peggy A Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Mott MN, Goeders NE. Methamphetamine-induced vaginal lubrication in rats. J Sex Med 2023; 20:1145-1152. [PMID: 37291060 DOI: 10.1093/jsxmed/qdad076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Based on previous studies of vaginal lubrication as well as our own previously reported interview study of women who self-reported methamphetamine (meth)-induced vaginal lubrication, in the current study we sought to determine the potential dose-response relationship leading to meth-induced vaginal lubrication. We also developed an animal model to study the reported effects and examine potential mechanisms mediating this phenomenon. AIM We sought to characterize the effects of meth on vaginal lubrication in an animal model with the aim of providing a potential framework for new mechanisms that incorporate novel therapeutic agents for the treatment of vaginal dryness. METHODS Vaginal lubrication was measured via insertion of a preweighed, cotton-tipped swab into the vaginal canal of anesthetized rats following treatment with various doses of intravenous (IV) meth, up to 0.96 mg/kg, and after additional pharmacological manipulations, including administration of a nitric oxide synthase inhibitor and an estrogen receptor antagonist. Plasma signaling molecules, including estradiol, progesterone, testosterone, nitric oxide, and vasoactive intestinal polypeptide, were measured immediately before and at 9 time points after IV meth administration. Blood was collected via a previously implanted chronic indwelling jugular catheter and analyzed by use of commercially available kits per the manufacturer's instructions. OUTCOMES Outcomes for this study include the measurement of vaginal lubrication in anesthetized rats following various pharmacological manipulations and plasma levels of various signaling molecules. RESULTS Meth dose-dependently increased vaginal lubrication in anesthetized female rats. Meth significantly increased plasma levels compared to baseline of estradiol (2 and 15 minutes after meth infusion) as well as progesterone, testosterone, and nitric oxide (10 minutes after meth infusion). Also, vasoactive intestinal polypeptide decreased significantly compared to baseline for 45 minutes following meth infusion. Our data further suggest that nitric oxide, but not estradiol, is critical in the production of vaginal secretions in response to meth. CLINICAL IMPLICATIONS This study has far-reaching implications for women who are suffering from vaginal dryness and for whom estrogen therapy is unsuccessful, as the investigation has demonstrated that meth presents a novel mechanism for producing vaginal lubrication that can be targeted pharmacologically. STRENGTHS AND LIMITATIONS This study is, to our knowledge, the first performed to measure the physiological sexual effects of meth in an animal model. Animals were anesthetized when they were administered meth. In an ideal situation, animals would be self-administering the drug to recapitulate better the contingent nature of drug taking; however, this method was not feasible for the study reported here. CONCLUSION Methamphetamine increases vaginal lubrication in female rats through a nitric oxide-dependent mechanism.
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Affiliation(s)
- Maggie N Mott
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
- Louisiana Addiction Research Center, Shreveport, LA, United States
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Vavala G, Wang Q, Jimenez S, Ramos WE, Ocasio MA, Romero-Espinoza A, Flynn R, Bolan R, Fernandez MI, Doan P, Arnold EM, Swendeman D, Comulada WS, Klausner JD. Substance Use, Violence, and Sexual Risk Among Young Cis-Gender Women Placed at High-Risk for Human Immunodeficiency Virus Infection. AIDS Behav 2022; 26:3008-3015. [PMID: 35303189 PMCID: PMC10003641 DOI: 10.1007/s10461-022-03631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/01/2022]
Abstract
The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual risk behavior. Among all participants (n = 195, median age, 20), 37.9%, 19.5%, and 6.7% reported occurrence of one, two, and all three SAVA conditions, respectively. We found that more than one SAVA condition experienced by women was significantly associated with having more than one sex partner (adjusted prevalence ratio [aPR] = 1.88; 95% confidence interval [CI] = 1.28, 2.76) and with substance use before sex (aPR = 1.61 95% CI = 1.06, 2.45).
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Affiliation(s)
- Gabriella Vavala
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Qiao Wang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Sergio Jimenez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Wilson E Ramos
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Manuel A Ocasio
- Department of Pediatrics/ Section of Adolescent Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Adriana Romero-Espinoza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | | | | | - Pearl Doan
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ngubane LB, Nöthling J, Moletsane R, Wilkinson A, Qulu L. Why Men Rape: Perspectives From Incarcerated Rapists in a KwaZulu-Natal Prison, South Africa. Front Psychol 2022; 13:805289. [PMID: 35859829 PMCID: PMC9291727 DOI: 10.3389/fpsyg.2022.805289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Sexual offending is a global problem but is particularly prevalent on the African continent and in South Africa. Childhood experiences related to abuse, alcohol use, and criminal activities in the household and community has been associated with an increased risk for violence perpetration in adulthood. Less is known about sexual violence perpetration, especially in the South African context. In this study, the experiences of incarcerated male perpetrators of rape in South Africa are investigated along with the collective social context and individual childhood experiences that potentially contribute to rape perpetration. Eighteen male perpetrators of rape who were inmates at Westville Correctional Services in KwaZulu Natal, South Africa, were interviewed. The semi-structured in-depth qualitative interviews were transcribed, coded and annotated using an interpretive paradigm and thematic analysis approach. Five main themes emerged from the research and included (1) childhood trauma and adverse events, e.g., an absent father, being raised without parents, exposure to criminal or violent behavior, physical abuse, sexual abuse and poverty, (2) understanding rape, e.g., rape as sex by force and without consent, rape as a violent act, rape as sex with a minor, myths about rape (3) substance abuse, e.g., history of alcohol and drug use, and intoxication during rape perpetration, (4) gender roles and avoiding responsibility, e.g., victim blaming, rape as male prerogative, transactional sex, being framed or set-up, ignoring an ancestral call and (5) recidivism. The findings revealed that all rape perpetrators were exposed to at least one childhood trauma type. Family and community violence and criminality was common. Most participants avoided taking responsibility for their actions and blamed the victim and recidivism/prior convictions were often reported. The findings demonstrate the complex personality dynamic involved in the cycle of abuse and the evolution of criminal behavior, starting as a victim and ending as a perpetrator. The findings also highlight the need for interventions aimed at reducing childhood trauma exposure and improving the social and relational context of those at risk for childhood neglect and abuse.
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Affiliation(s)
- Lindokuhle Blessing Ngubane
- School of Laboratory Medicine and Medical Sciences, College of Health Science, University of KwaZulu-Natal, Westville, South Africa
- *Correspondence: Lindokuhle Blessing Ngubane,
| | - Jani Nöthling
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health, South African Medical Research Council, Stellenbosch University, Cape Town, South Africa
| | - Relebohile Moletsane
- School of Education, College of Humanities, University of KwaZulu-Natal, Durban, South Africa
| | - Abigail Wilkinson
- School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Lihle Qulu
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Lihle Qulu,
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