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Oginni OA, Adelola AI, Ogunbajo A, Opara OJ, Akanji M, Ibigbami OI, Afolabi OT, Akinsulore A, Mapayi BM, Mosaku SK. Antiretroviral therapy non-adherence and its association with psychosocial factors in Nigeria: comparative study of sexual minority and heterosexual men living with HIV. AIDS Care 2024:1-13. [PMID: 38869985 DOI: 10.1080/09540121.2024.2366511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
Sexual minority men (gay, bisexual and other men who have sex with men; SMM) in Nigeria are disproportionately affected by HIV compared to heterosexual men. There is a dearth of research on the correlates of antiretroviral therapy (ART) non-adherence and correlates in both groups. The current study examined the associations of ART non-adherence with sociodemographic and psychosocial characteristics among a sample of Nigerian heterosexual and SMM. Between March and September 2014, we surveyed 120 SMM and 108 heterosexual men receiving ART in Lagos and Abuja, Nigeria. We specified univariate and multivariable linear regression models to examine correlates of ART non-adherence. We found that 50.8% and 29.6% of sexual minority and heterosexual men respectively self-reported ART non-adherence which was significantly associated with psychosocial factors such as stigma, depressive symptoms, and suicidality. Mental health care and psychosocial support should be incorporated into routine HIV care for Nigerian SMM living with HIV.
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Affiliation(s)
- O A Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - A I Adelola
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - O J Opara
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - O I Ibigbami
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - O T Afolabi
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - A Akinsulore
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - B M Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - S K Mosaku
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Starks TJ, Sauermilch D, Doyle KM, Kalichman S, Cain D. Main Partner Relationships and the HIV Care Cascade: Examining the Predictive Utility of Sexual Agreements, Partner Concordance, and Drug Use Among Sexual Minority Men Living With HIV in the USA. Ann Behav Med 2024; 58:422-431. [PMID: 38703112 PMCID: PMC11112277 DOI: 10.1093/abm/kaae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. PURPOSE This study evaluated associations between relational covariates (relationship status, sexual agreements, and seroconcordance) and HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load (VL) testing, and VL detectability) above and beyond cannabis and stimulant drug use. METHODS Adult SMM (n = 36,874) living with HIV in the USA were recruited between November 1, 2017 and March 15, 2020 through social networking applications. They completed a cross-sectional survey online. RESULTS Nonmonogamous SMM with serodiscordant partners were most likely to have an ART prescription. Those with seroconcordant partners (regardless of sexual agreements) were least likely to be adherent. While relational covariates were not associated with VL testing, SMM in nonmonogamous relationships with serodiscordant partners were significantly more likely to have an undetectable VL. Those in monogamous relationships with seroconcordant partners were significantly less likely to have an undetectable VL. CONCLUSIONS SMM with seroconcordant partners and monogamous sexual agreements may experience diminished interpersonal motivation for HIV care engagement. HIV care cascade retention messages that emphasize the prevention of onward transmission may have limited relevance for these SMM. Novel intervention strategies are needed to enhance HIV care outcomes in this population, ideally ones that incorporate attention to drug use.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
| | | | - Kendell M Doyle
- Health Psychology and Clinical Science Doctoral Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
| | - Seth Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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Moradi S, Moradi Y, Rahmani K, Nouri B, Moradi G. The association between methamphetamine use and number of sexual partners in men who have sex with men: a systematic review and meta-analysis. Subst Abuse Treat Prev Policy 2022; 17:27. [PMID: 35397571 PMCID: PMC8994254 DOI: 10.1186/s13011-022-00453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Methamphetamine use in men who have sex with men population is significantly higher than that in the general population. Meth use can cause high-risk sexual behaviors, such as having sex with a variety of sexual partners. The aim of this study was to determine the association between meth use and the number of sexual partners in MSM. Methods Searching international databases (PubMed (Medline), Scopus, Web of Sciences, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) until March 2021 was performed in this meta-analysis using appropriate keywords terms to identify related articles. After retrieving articles in these databases, screening was performed based on the title, abstract and full text of the articles, and the final related studies were selected and evaluated using the Newcastle Ottawa scale checklist. Results The sample size consisted 18,455 people in this study, including four cohort studies with a sample size of 15,026 MSM and four case–control studies with a sample size of 3429 MSM. The results of meta-analysis showed that meth use increased the number of sexual partners in MSM (RR: 3.70; % 95 CI: 2.04—6.70). The results of subgroup analyze based on the number of sexual partners showed that in MSM taking meth, the risks of having one to three, four to five, and six or more than six sexual partners were respectively 2.82, 2.98 and 5.89 times higher than those in MSM who did not take meth. Conclusion The results showed that meth uses in MSM increased the number of their sexual partners. Due to the fact that increasing the number of sexual partners and high-risk sexual behaviors increase the risk of contracting sexually transmitted diseases such as HIV, it is necessary to adopt control programs to prevent meth use by this group, or to implement programs of reduction in the risk of STIs for this group.
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Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020712. [PMID: 35055534 PMCID: PMC8775683 DOI: 10.3390/ijerph19020712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/01/2023]
Abstract
Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10–16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41–35.95). Those who completed bachelor’s degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17–0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.
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Balut MD, Chu K, Gin JL, Dobalian A, Der-Martirosian C. Predictors of COVID-19 Vaccination among Veterans Experiencing Homelessness. Vaccines (Basel) 2021; 9:1268. [PMID: 34835200 PMCID: PMC8619196 DOI: 10.3390/vaccines9111268] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/19/2022] Open
Abstract
Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020-August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.
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Affiliation(s)
- Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - Karen Chu
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN 38152, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
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Walter TJ, Young JW, Milienne-Petiot M, Deben DS, Heaton RK, Letendre S, Grelotti DJ, Perry W, Grant I, Minassian A. Both HIV and Tat expression decrease prepulse inhibition with further impairment by methamphetamine. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110089. [PMID: 32891668 PMCID: PMC7750302 DOI: 10.1016/j.pnpbp.2020.110089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
HIV infection and methamphetamine (METH) use are highly comorbid and represent a significant public health problem. Both conditions are known to negatively impact a variety of brain functions. One brain function that may be affected by HIV and METH use is sensorimotor gating, an automatic, pre-conscious filtering of sensory information that is thought to contribute to higher order cognitive processes. Sensorimotor gating is often measured using prepulse inhibition (PPI), a paradigm that can be conducted in both humans and animals, thereby enabling cross-species translational studies. While previous studies suggest HIV and METH may individually impair PPI, little research has been conducted on the effects of combined HIV and METH on PPI. The goal of this cross-species study was to determine the effects of METH on PPI in the inducible Tat (iTat) mouse model of HIV and in people with HIV. PPI was measured in the iTat mouse model before, during, and after chronic METH treatment and after Tat induction. Chronic METH treatment decreased PPI in male but not female mice. PPI normalized with cessation of METH. Inducing Tat expression decreased PPI in male but not in female mice. No interactions between chronic METH treatment and Tat expression were observed in mice. In humans, HIV was associated with decreased PPI in both men and women. Furthermore, PPI was lowest in people with HIV who also had a history of METH dependence. Overall, these results suggest HIV and METH may additively impair early information processing in humans, potentially affecting downstream cognitive function.
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Affiliation(s)
- T. Jordan Walter
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA,Corresponding Author at: 410 Dickinson St, Office 6, San Diego CA, 92103, Telephone: 619-543-3098,
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA,Research Services, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego CA, 92161, USA
| | - Morgane Milienne-Petiot
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. S. Deben
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - David J. Grelotti
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health, Veterans Administration San Diego HealthCare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Fleming T, Collins AB, Bardwell G, Fowler A, Boyd J, Milloy MJ, Small W, McNeil R. A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs. PLoS One 2021; 16:e0246999. [PMID: 33635886 PMCID: PMC7909635 DOI: 10.1371/journal.pone.0246999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
Antiretroviral therapy (ART) dispensing is strongly associated with treatment adherence. Among illicit drug-using populations, whom experience greater structural barriers to adherence, directly administered antiretroviral therapy (DAAT) is often regarded as a stronger predictor of optimal adherence over self-administered medications. In Vancouver, Canada, people living with HIV (PLHIV) who use drugs and live in low-income housing are a critical population for treatment support. This group is typically able to access two key DAAT models, daily delivery and daily pickup, in addition to ART self-administration. This ethno-epidemiological qualitative study explores how key dispensing models impact ART adherence among PLHIV who use drugs living in low-income housing, and how this is framed by structural vulnerability. Semi-structured interviews lasting 30-45 minutes were conducted between February and May 2018 with 31 PLHIV who use drugs recruited from an ongoing prospective cohort of PLHIV who use drugs. Interviews were audio-recorded, transcribed verbatim, and analyzed using QSR International's NVivo 12 software. Interviews focused on housing, drug use, and HIV management. Models that constrained agency were found to have negative impacts on adherence and quality of life. Treatment interruptions were framed by structural vulnerabilities (e.g., housing vulnerability) that impacted ability to maintain adherence under certain dispensing models, and led participants to consider other models. Participants using DAAT models which accounted for their structural vulnerabilities (e.g., mobility issues, housing instability), credited these models for their treatment adherence, but also acknowledged factors that constrained agency, and the negative impacts this could have on both adherence, and quality of life. Being able to integrate ART into an established routine is key to supporting ART adherence. ART models that account for the structural vulnerability of PLHIV who use drugs and live in low-income housing are necessary and housing-based supports could be critical, but the impacts of such models on agency must be considered to ensure optimal adherence.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra B. Collins
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M. J. Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Abstract
This study evaluated whether a history of lifetime methamphetamine (MA) use disorder increases risk for poor sleep quality in people with or without HIV infection (HIV+/HIV-). Participants (n = 313) were stratified into four groups based on HIV status and lifetime MA use disorder diagnosis [HIV+/MA+ (n = 84); HIV+/MA- (n = 141); HIV-/MA+ (n = 16); and HIV-/MA- (n = 72)] and compared on global sleep outcomes using the Pittsburgh Sleep Quality Index (PSQI). Significant differences on global sleep were observed between HIV+/MA+ and HIV+/MA- groups, but not between the HIV- groups. Follow-up multiple regression analyses within the HIV+ subgroups examined global sleep scores as a function of MA status and clinical covariates, including those related to HIV disease and demographics. HIV+ individuals with a history of MA use disorder evidenced significantly poorer sleep quality and were more likely to be classified as problematic sleepers than those without a lifetime disorder. This was independent of depressed mood, body mass index, and viral suppression while on treatment. Poorer reported sleep quality among HIV+/MA+ was associated also with multiple adverse functional outcomes, including greater objective cognitive impairment, unemployment, clinical ratings of functional impairment, and self-reported cognitive difficulties, decreased independence in activities of daily living, and poorer overall life quality. Interventions to avoid or curtail MA use in HIV+ individuals may help protect sleep quality and improve functioning.
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Fletcher JB, Clark KA, Reback CJ. Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men. ADDICTION RESEARCH & THEORY 2020; 29:263-270. [PMID: 34248451 PMCID: PMC8262401 DOI: 10.1080/16066359.2020.1807960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine. METHOD From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time. RESULTS Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94). CONCLUSIONS Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.
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Affiliation(s)
| | - Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, CA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles
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11
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Maloney KM, Beer L, Tie Y, Dasgupta S. Prevalence of Non-medical Amphetamine Use Among Men with Diagnosed HIV Infection Who Have Sex with Men in the United States, 2015-2016. AIDS Behav 2020; 24:1865-1875. [PMID: 31834542 DOI: 10.1007/s10461-019-02761-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Amphetamine use is higher among men who have sex with men (MSM) compared with other men, and is associated with sexual behavior linked to HIV transmission. No national estimates of amphetamine use among MSM with HIV have been published. We used data from the Medical Monitoring Project, a nationally representative sample of persons with diagnosed HIV, to describe patterns in amphetamine use in the past 12 months among MSM during 2015-2016 (N = 3796). Prevalence of amphetamine use in this population was 9.6% (95% CI 7.6, 11.6%) in the past 12 months. MSM who used amphetamines were more likely to have condomless sex with partners without HIV or of unknown serostatus (PR 1.87; 95% CI 1.62, 2.16) and less likely to be durably virally suppressed (PR 0.81; 95% CI 0.71, 0.91). Interventions to address amphetamine use and associated transmission risk behaviors among MSM living with HIV may decrease transmission.
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Affiliation(s)
- Kevin M Maloney
- Department of Epidemiology, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA.
| | - Linda Beer
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Paschen-Wolff MM, Campbell ANC, Tross S, Choo TH, Pavlicova M, Jarlais DD. DSM-5 substance use disorder symptom clusters and HIV antiretroviral therapy (ART) adherence. AIDS Care 2019; 32:645-650. [PMID: 31682153 DOI: 10.1080/09540121.2019.1686600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study examines self-reported 30-day antiretroviral therapy (ART) adherence among 101 people living with HIV and substance use disorders (SUD) in New York City in terms of Diagnostic and Statistical Manual - 5th Edition (DSM-5) SUD symptom clusters: impaired control, social impairment, risky use and pharmacological criteria. Overall, 60.4% met DSM-5 criteria for stimulant, 55.5% for alcohol, 34.7% for cannabis and 25.7% for opioid SUD. Of the 76 participants with a current ART prescription, 75.3% reported at least 90% 30-day adherence. Participants with vs. without alcohol SUD were significantly less likely to report ART adherence (64.3% vs. 88.2%, p = .017). Endorsement of social impairment significantly differed among adherent vs. non-adherent participants with alcohol SUDs (74.1% vs. 100%, p = .038) and with opioid SUDs (94.1% vs. 50.0%, p = .040). Understanding specific SUD symptom clusters may assist providers and patients in developing strategies to improve ART adherence.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University Medical Center and New York State Psychiatric Institute, 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
| | - Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Don Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA
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13
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Abstract
Black people living with HIV (BPLWH) are less likely to adhere to antiretroviral treatment than are members of other racial/ethnic groups. Data were combined from two studies of BPLWH (n = 239) to estimate adherence trajectories using a semiparametric, group-based modeling strategy over three time-points (spanning 6 months). Analyses identified three groups of individuals (high-stable, moderately low-stable, low-decreasing). Multinomial logistic regressions were used to predict trajectory membership with multiple levels of socio-ecological factors (structural, institutional/health system, community, interpersonal/network, individual). Older age was associated with being in the high-stable group, whereas substance use, lower perceived treatment effectiveness, and lower quality healthcare ratings were related to being in the moderately low-stable group. In sum, multiple socio-ecological factors contribute to adherence among BPLWH and thus could be targeted in future intervention efforts.
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14
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Grov C, Rendina HJ, John SA, Parsons JT. Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research. AIDS Behav 2019; 23:1277-1286. [PMID: 30306433 DOI: 10.1007/s10461-018-2309-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.
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15
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Tsuyuki K, Shoptaw SJ, Ransome Y, Chau G, Rodriguez-Diaz CE, Friedman RK, Srithanaviboonchai K, Li S, Mimiaga MJ, Mayer KH, Safren SA. The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063). AIDS Behav 2019; 23:649-660. [PMID: 30725397 DOI: 10.1007/s10461-019-02415-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.
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16
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Passaro RC, Ramsey K, Segura ER, Lake JE, Reback CJ, Clark JL, Shoptaw S. Speed kills: Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment. Drug Alcohol Depend 2019; 195:164-169. [PMID: 30429048 PMCID: PMC6512788 DOI: 10.1016/j.drugalcdep.2018.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. METHODS We searched public records to identify deaths among men screened between 1998-2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54-7.89), club drug use prior to starting methamphetamine (2.63, 1.15-6.00), or other clinical diagnoses at baseline (3.89, 1.15-13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). CONCLUSION In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.
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Affiliation(s)
- R. Colby Passaro
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA,South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA
| | - Keenan Ramsey
- UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA; National Institute on Drug Abuse, Office of Science Policy and Communications, Public Information and Liaison Branch, 6001 Executive Blvd., Room 5213, MSC 9561, Bethesda, MD, 20892, USA.
| | - Eddy R. Segura
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos s/n, Chorrillos (Lima 09), Lima, Peru
| | - Jordan E. Lake
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,McGovern Medical School at UTHealth, Department of Internal Medicine, Division of Infectious Diseases, 6341 Fannin St., MSB 2.112, Houston, TX, 77030, USA
| | - Cathy J. Reback
- UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA,Friends Research Institute, 11835 Olympic Blvd., #775E, Los Angeles, CA, 90064, USA
| | - Jesse L. Clark
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA
| | - Steve Shoptaw
- South American Program in HIV Prevention Research, UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA; UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA; UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA.
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17
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Shover CL, Javanbakht M, Shoptaw S, Bolan RK, Lee SJ, Parsons JT, Rendina J, Gorbach PM. HIV Preexposure Prophylaxis Initiation at a Large Community Clinic: Differences Between Eligibility, Awareness, and Uptake. Am J Public Health 2018; 108:1408-1417. [PMID: 30138062 PMCID: PMC6137770 DOI: 10.2105/ajph.2018.304623] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk. METHODS We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data. RESULTS Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated. CONCLUSIONS Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.
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Affiliation(s)
- Chelsea L Shover
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Marjan Javanbakht
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Steven Shoptaw
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Robert K Bolan
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Sung-Jae Lee
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jeffrey T Parsons
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jonathon Rendina
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Pamina M Gorbach
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
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18
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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19
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Feelemyer J, Duong Thi H, Khuê Pham M, Hoang Thi G, Thi Tuyet Thanh N, Thi Hai Oanh K, Arasteh K, Moles JP, Vu Hai V, Vallo R, Quillet C, Rapoud D, Michel L, Hammett T, Laureillard D, Nagot N, Des Jarlais D. Increased Methamphetamine Use among Persons Who Inject Drugs in Hai Phong, Vietnam, and the Association with Injection and Sexual Risk Behaviors. J Psychoactive Drugs 2018; 50:382-389. [PMID: 30183558 DOI: 10.1080/02791072.2018.1508790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Methamphetamine use has increased significantly in Southeast Asia in the last 5-10 years, but there is little research on risk behaviors associated with the increase in this region. We evaluate injection and sexual risk behaviors associated with current methamphetamine use among heterosexual persons who inject drugs (PWID) in Hai Phong, Vietnam. We recruited 1336 PWID and assessed associations between methamphetamine use, injection and sexual risk behaviors, stratified by HIV serostatus. There were several statistically significant associations between methamphetamine use and sexual risk behaviors among HIV-positive PWID, but we did not find any associations between methamphetamine use and injection risk behaviors. Methamphetamine may increase the likelihood of PWID transmitting HIV to non-injecting primary sexual partners, as it can reduce ART adherence and can lead to weakening of the immune system and increased HIV viral loads. All participants were injecting heroin, and methamphetamine use may interfere with opiate use treatment. Public health efforts should focus on the large increase in methamphetamine use and the associated sexual risk behaviors. Emphasis on sexual risk behavior, particularly among those who are HIV-positive, in conjunction with continued monitoring of ART adherence and HIV viral loads, is critical.
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Affiliation(s)
- Jonathan Feelemyer
- a Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Huong Duong Thi
- b Department of Public Health , Hai Phong University of Medicine and Pharmacy , Hai Phong , Vietnam
| | - Minh Khuê Pham
- b Department of Public Health , Hai Phong University of Medicine and Pharmacy , Hai Phong , Vietnam
| | - Giang Hoang Thi
- b Department of Public Health , Hai Phong University of Medicine and Pharmacy , Hai Phong , Vietnam
| | | | | | - Kamyar Arasteh
- a Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Jean Pierre Moles
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France
| | - Vinh Vu Hai
- e Dept. of Infectious and Tropical Diseases , Viet Tiep Hospital , Hai Phong , Vietnam
| | - Roselyne Vallo
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France
| | - Catherine Quillet
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France
| | - Delphine Rapoud
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France
| | - Laurent Michel
- f CESP/Inserm1018 , Pierre Nicole Center , Paris , France
| | - Ted Hammett
- g International Health Division , Abt Associates , Cambridge , MA , USA.,h Consultant, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Didier Laureillard
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France.,i Infectious Diseases Department , Caremeau University Hospital , Nîmes , France
| | - Nicolas Nagot
- d Département de l'Information Médicale, Etablissement Français du Sang , University of Montpellier , Montpellier , France
| | - Don Des Jarlais
- a Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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20
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Parsons JT, John SA, Millar BM, Starks TJ. Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men. AIDS Behav 2018; 22:2674-2686. [PMID: 29536284 PMCID: PMC6051905 DOI: 10.1007/s10461-018-2086-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.
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Affiliation(s)
- Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center, CUNY, New York, NY, USA.
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College, CUNY, New York, NY, USA.
| | - Steven A John
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College, CUNY, New York, NY, USA
| | - Brett M Millar
- Health Psychology and Clinical Science Doctoral Program, Graduate Center, CUNY, New York, NY, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College, CUNY, New York, NY, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center, CUNY, New York, NY, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College, CUNY, New York, NY, USA
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Hood JE, Buskin SE, Golden MR, Glick SN, Banta-Green C, Dombrowski JC. The Changing Burden of HIV Attributable to Methamphetamine Among Men Who Have Sex with Men in King County, Washington. AIDS Patient Care STDS 2018; 32:223-233. [PMID: 29851502 DOI: 10.1089/apc.2017.0306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Methamphetamine use is a key driver of HIV transmission among men who have sex with men (MSM). We evaluated trends in incident HIV diagnosis rates among methamphetamine using and nonusing MSM and assessed the relationship between methamphetamine use and demographic, behavioral, and clinical characteristics among MSM newly diagnosed with HIV. We analyzed several sources of HIV and behavioral surveillance data to estimate incident rates of HIV diagnoses and the population attributable risk percent corresponding to methamphetamine use among MSM in King County, Washington. Missing values were recovered through multiple imputation. We report descriptive statistics and adjusted odds ratios yielded from multivariable logistic regression models. Between 2010 and 2015, the HIV diagnosis rate among methamphetamine-using MSM declined from 31.2 to 11.5 per 1000 MSM (vs. 6.4-3.9 per 1000 MSM overall), and the percent of new diagnoses attributable to methamphetamine use declined from 25% to 13%. During the same period, methamphetamine use among HIV-negative MSM remained relatively stable. Among MSM newly diagnosed with HIV, methamphetamine-using MSM were more likely to be unstably housed (24% vs. 6%), to have engaged in transactional sex (19% vs. 4%), and to have had female partners (17% vs. 10%). Methamphetamine-using MSM were less likely to be virally suppressed at 6 (31% vs. 54%) and 12 (59% vs. 73%) months following an HIV diagnosis. The declining HIV diagnosis rate among methamphetamine-using MSM is encouraging, but this subgroup continues to have considerable HIV risk and health disparities.
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Affiliation(s)
- Julia E. Hood
- HIV/STD Program, Public Health—Seattle & King County, Seattle, Washington
| | - Susan E. Buskin
- HIV/STD Program, Public Health—Seattle & King County, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
| | - Matthew R. Golden
- HIV/STD Program, Public Health—Seattle & King County, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sara N. Glick
- HIV/STD Program, Public Health—Seattle & King County, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Caleb Banta-Green
- Department of Health Services, University of Washington, Seattle, Washington
| | - Julia C. Dombrowski
- HIV/STD Program, Public Health—Seattle & King County, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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Fletcher JB, Swendeman D, Reback CJ. Mental Health and Substance Use Disorder Comorbidity among Methamphetamine-Using Men Who have Sex with Men. J Psychoactive Drugs 2018; 50:206-213. [PMID: 29608132 DOI: 10.1080/02791072.2018.1447173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder.
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Affiliation(s)
| | - Dallas Swendeman
- b Center for HIV Identification, Prevention and Treatment Services , University of California , Los Angeles , CA , USA
| | - Cathy J Reback
- c Friends Research Institute, Inc; David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior , University of California , Los Angeles , CA , USA
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23
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Swartz JA, McCarty-Caplan D. A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM. AIDS Behav 2018; 22:1395-1409. [PMID: 29248970 DOI: 10.1007/s10461-017-2008-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.
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Closson EF, Mitty JA, Malone J, Mayer KH, Mimiaga MJ. Exploring strategies for PrEP adherence and dosing preferences in the context of sexualized recreational drug use among MSM: a qualitative study. AIDS Care 2017; 30:191-198. [PMID: 28830220 DOI: 10.1080/09540121.2017.1360992] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The use of recreational drugs while having sex is associated with increased HIV incidence among men who have sex with men (MSM). Taking a daily antiretroviral pill, or pre-exposure prophylaxis (PrEP) is a biomedical intervention to prevent HIV. However, the efficacy of PrEP is closely tied with high levels of adherence. While PrEP has the potential to reduce HIV acquisition, the use of recreational drugs may impede adherence. We explored perceptions of PrEP utilization and regimen preferences among 40 HIV-negative, MSM who reported concurrent recreational drug use and condomless anal sex with a man. Semi-structured qualitative interviews were conducted and the data were analyzed using a qualitative descriptive approach. Participants perceived that it would be challenging to take PrEP while high on crystal meth, crack, powder cocaine, ecstasy and/or GHB. However, men identified strategies for using PrEP when they were not high on these drugs, including taking the pill when they started their day and integrating PrEP into an established routine, such as when taking other medications or preparing for sex. PrEP regimen preferences seemed to be shaped by the frequency in which participants used drugs and their ability to plan for sex. Taking PrEP everyday was appealing for those who regularly engaged in sexualized recreational drug use. Accounts depict these sexual interactions as frequent but unpredictable. A daily regimen would allow them to be prepared for sex without having to plan. An event-driven regimen was acceptable to men who occasionally used recreational drugs in the context of sex. For this group, sex usually occurred was generally prearranged. Patterns of sex and recreational drug use figured largely into participants' framings of how they would use PrEP. These behaviors will likely play a role in the uptake of and adherence to PrEP among this population.
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Affiliation(s)
- Elizabeth F Closson
- a The Fenway Institute , Fenway Health , Boston , MA , USA.,b Department of Social and Environmental Health , The London School of Hygiene and Tropical Medicine , London , UK
| | - Jennifer A Mitty
- c Brown University Alpert Medical School , Providence , RI , USA
| | - Jowanna Malone
- a The Fenway Institute , Fenway Health , Boston , MA , USA.,d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Kenneth H Mayer
- a The Fenway Institute , Fenway Health , Boston , MA , USA.,c Brown University Alpert Medical School , Providence , RI , USA.,d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Matthew J Mimiaga
- a The Fenway Institute , Fenway Health , Boston , MA , USA.,c Brown University Alpert Medical School , Providence , RI , USA.,e Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,f Departments of Epidemiology and Behavioral & Social Health Sciences , Brown University School of Public Health , Providence , RI , USA.,g Institute for Community Health Promotion, Brown University , Providence , RI , USA
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25
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Hartzler B, Dombrowski JC, Crane HM, Eron JJ, Geng EH, Christopher Mathews W, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, Donovan DM. Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States. AIDS Behav 2017; 21:1138-1148. [PMID: 27738780 DOI: 10.1007/s10461-016-1584-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: (1) a 48 % SUD prevalence rate (between-site range of 21-71 %), with 20 % of the sample evidencing polysubstance use disorder; (2) substance-specific SUD rates of 31 % for marijuana, 19 % alcohol, 13 % methamphetamine, 11 % cocaine, and 4 % opiate; and (3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - Julia C Dombrowski
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elvin H Geng
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Kenneth H Mayer
- School of Medicine, Harvard University, Boston, MA, USA
- School of Public Health, Harvard University, Boston, MA, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Benigno Rodriguez
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Dennis M Donovan
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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26
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Lea T, Kolstee J, Lambert S, Ness R, Hannan S, Holt M. Methamphetamine treatment outcomes among gay men attending a LGBTI-specific treatment service in Sydney, Australia. PLoS One 2017; 12:e0172560. [PMID: 28207902 PMCID: PMC5313217 DOI: 10.1371/journal.pone.0172560] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Gay and bisexual men (GBM) report higher rates of methamphetamine use compared to heterosexual men, and thus have a heightened risk of developing problems from their use. We examined treatment outcomes among GBM clients receiving outpatient counseling at a lesbian, gay, bisexual, transgender and intersex (LGBTI)-specific, harm reduction treatment service in Sydney, Australia. GBM receiving treatment for methamphetamine use from ACON’s Substance Support Service between 2012–15 (n = 101) were interviewed at treatment commencement, and after 4 sessions (n = 60; follow-up 1) and 8 sessions (n = 32; follow-up 2). At each interview, clients completed measures of methamphetamine use and dependence, other substance use, injecting risk practices, psychological distress and quality of life. The median age of participants was 41 years and 56.4% identified as HIV-positive. Participants attended a median of 5 sessions and attended treatment for a median of 112 days. There was a significant reduction in the median days of methamphetamine use in the previous 4 weeks between baseline (4 days), follow-up 1 (2 days) and follow-up 2 (2 days; p = .001). There was a significant reduction in the proportion of participants reporting methamphetamine dependence between baseline (92.1%), follow-up 1 (78.3%) and follow-up 2 (71.9%, p < .001). There were also significant reductions in psychological distress (p < .001), and significant improvements in quality of life (p < .001). Clients showed reductions in methamphetamine use and improved psychosocial functioning over time, demonstrating the potential effectiveness of a LGBTI-specific treatment service.
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
| | | | | | - Ross Ness
- ACON, Sydney, New South Wales, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
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27
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Obong'o CO, Alexander AC, Chavan PP, Dillon PJ, Kedia SK. Choosing to Live or Die: Online Narratives of Recovering from Methamphetamine Abuse. J Psychoactive Drugs 2016; 49:52-58. [PMID: 27938305 DOI: 10.1080/02791072.2016.1262085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of this study is to explore motivating factors for recovering from methamphetamine abuse. The source of data was 202 anonymous letters and stories submitted to an online support platform for methamphetamine users. Qualitative data were analyzed in Dedoose software using grounded theory methodology. Ten primary motivating factors for recovering from methamphetamine abuse were identified and mapped onto four constructs from the Health Belief Model: (1) perceived susceptibility (learning from others and learning from self); (2) perceived severity (fear of death and declining health); (3) perceived benefits (reconnecting with family, reconnecting with society, and recovering self-esteem); and (4) cues to action (hitting rock bottom, finding God, and becoming pregnant). By using data from an online support group and categorizing emerging themes within a theoretical framework, findings from this study provide a comprehensive understanding of factors involved in recovery from methamphetamine abuse and offer further insights in developing theoretically informed interventions for methamphetamine users. This study suggests the utility of online platforms for obtaining anonymous but unique experiences about drug abuse and recovery. Findings may benefit healthcare professionals, counselors, and researchers by helping to develop theoretically informed interventions for methamphetamine abuse.
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Affiliation(s)
- Christopher O Obong'o
- a Graduate Assistant, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Adam C Alexander
- a Graduate Assistant, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Prachi P Chavan
- b Graduate Assistant, Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Patrick J Dillon
- c Assistant Professor, School of Communication Studies , Kent State University , North Canton , OH , USA
| | - Satish K Kedia
- d Professor, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
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28
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Soontornniyomkij V, Kesby JP, Morgan EE, Bischoff-Grethe A, Minassian A, Brown GG, Grant I. Effects of HIV and Methamphetamine on Brain and Behavior: Evidence from Human Studies and Animal Models. J Neuroimmune Pharmacol 2016; 11:495-510. [PMID: 27484318 PMCID: PMC4985024 DOI: 10.1007/s11481-016-9699-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
Methamphetamine (Meth) use is frequent among HIV-infected persons. Combined HIV and Meth insults may exacerbate neural injury in vulnerable neuroanatomic structures or circuitries in the brain, leading to increased behavioral disturbance and cognitive impairment. While acute and chronic effects of Meth in humans and animal models have been studied for decades, the neurobehavioral effects of Meth in the context of HIV infection are much less explored. In-depth understanding of the scope of neurobehavioral phenotypes and mechanisms in HIV/Meth intersection is needed. The present report summarizes published research findings, as well as unpublished data, in humans and animal models with regard to neurobehavioral disturbance, neuroimaging, and neuropathology, and in vitro experimental systems, with an emphasis on findings emerging from the National Institute on Drug Abuse (NIDA) funded Translational Methamphetamine AIDS Research Center (TMARC). Results from human studies and animal (primarily HIV-1 gp120 transgenic mouse) models thus far suggest that combined HIV and Meth insults increase the likelihood of neural injury in the brain. The neurobehavioral effects include cognitive impairment and increased tendencies toward impaired behavioral inhibition and social cognition. These impairments are relevant to behaviors that affect personal and social risks, e.g. worse medication adherence, riskier behaviors, and greater likelihood of HIV transmission. The underlying mechanisms may include electrochemical changes in neuronal circuitries, injury to white matter microstructures, synaptodendritic damage, and selective neuronal loss. Utilization of research methodologies that are valid across species is instrumental in generating new knowledge with clinical translational value.
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Affiliation(s)
- Virawudh Soontornniyomkij
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA.
| | - James P Kesby
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
- Queensland Brain Institute, The University of Queensland, St. Lucia, Qld, Australia
| | - Erin E Morgan
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Amanda Bischoff-Grethe
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Arpi Minassian
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Gregory G Brown
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Igor Grant
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
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Dew BJ, Elifson KW, Sterk CE. Differences in HIV Sexual Risk Behaviors between Heterosexual and Nonheterosexual Male Users of Methamphetamine. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260703700203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies examining HIV sexual risk behaviors among male methamphetamine users have primarily focused on men who have sex with men (MSM) while ignoring heterosexual methamphetamine users. In this study, active male users of methamphetamine are differentiated based on sexual orientation. Targeted sampling guided the recruitment, and face-to-face survey interviews were conducted with 108 active male methamphetamine users. Participants were classified into heterosexual (n = 69) and non-heterosexual (n = 39) users. Between-group differences were found based on socio-demographics, drug use histories, and HIV sexual risk behavior. Heterosexual males were more likely than their nonheterosexual peers to be younger, less educated, unemployed, and less likely to be tested for HIV. Nonheterosexual males were more likely than heterosexual males to identify methamphetamine as their primary drug of choice, commence poly-drug use at a later age, and report more sexual partners in the past year. Findings from this study may lead to the development and/or refinement of successful prevention and intervention strategies that are more culturally sensitive to heterosexual and nonheterosexual male users of methamphetamine.
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30
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Kuchinad KE, Hutton HE, Monroe AK, Anderson G, Moore RD, Chander G. A qualitative study of barriers to and facilitators of optimal engagement in care among PLWH and substance use/misuse. BMC Res Notes 2016; 9:229. [PMID: 27103162 PMCID: PMC4841053 DOI: 10.1186/s13104-016-2032-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/08/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLWH) and substance use/misuse experience significant barriers to engagement in HIV care at every step of the HIV care continuum including: (1) HIV testing and diagnosis (2) linkage to clinical care (3) retention in care pre-antiretroviral therapy (ART) (4) ART initiation and adherence (5) viral suppression. We qualitatively explored the facilitators of and barriers to participation in the HIV care continuum among PLWH with substance use/misuse. METHODS We performed semi-structured in-depth interviews with 34 PLWH in care with recent substance use. The transcripts were analyzed in an iterative process using an editing style analysis. Interviews were conducted until thematic saturation was achieved. RESULTS Participants attributed an escalation in drug use at the time of diagnosis to denial of their disease and the belief that their death was inevitable and cited this as a barrier to treatment entry. In contrast, participants reported that experiencing adverse physical effects of uncontrolled HIV infection motivated them to enroll in care. Reported barriers to retention and adherence to care included forgetting medications and appointments because of drug use, prioritizing drug use over HIV treatment and side effects associated with medications. Participants described that progression of illness, development of a medication taking ritual and a positive provider-patient relationship all facilitated engagement and reengagement in care. CONCLUSIONS PLWH with substance use engaged in care describe barriers to and facilitators of optimal engagement related to and distinct from substance use. Greater understanding of the biologic, psychological and social factors that promote and impair engagement in care can inform interventions and reduce the increased morbidity and mortality experienced by PLWH with substance use.
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Affiliation(s)
- Kamini E Kuchinad
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Heidi E Hutton
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anne K Monroe
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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31
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Horvath KJ, Alemu D, Danh T, Baker JV, Carrico AW. Creating Effective Mobile Phone Apps to Optimize Antiretroviral Therapy Adherence: Perspectives From Stimulant-Using HIV-Positive Men Who Have Sex With Men. JMIR Mhealth Uhealth 2016; 4:e48. [PMID: 27084049 PMCID: PMC4851721 DOI: 10.2196/mhealth.5287] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/25/2015] [Accepted: 01/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of stimulant drugs among men who have sex with men (MSM) with human immunodeficiency virus (HIV) is associated with decreased odds of antiretroviral therapy (ART) adherence and elevated risk of forward HIV transmission. Advancing tailored and innovative mobile phone-based ART adherence app interventions for stimulant-using HIV-positive MSM requires greater understanding of their needs and preferences in this emerging area. OBJECTIVE The purpose of this study is to (1) assess reasons that stimulant-using HIV-positive MSM download and sustain their use of mobile phone apps in general, and (2) obtain feedback on features and functions that these men prefer in a mobile phone app to optimize their ART adherence. METHODS Focus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes. RESULTS Men reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner. CONCLUSIONS In this study, we were able to recruit a relatively high proportion (42%) of HIV-positive MSM reporting weekly or more stimulant use. These results suggest critical design elements that may need to be considered during development of ART adherence-related mobile phone apps for this, and possibly other, high-risk groups. In particular, finding the optimal balance of security, engagement, usefulness, control capabilities, and credibility will be critical to sustained used of HIV treatment apps.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.
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Sayegh P, Thaler NS, Arentoft A, Kuhn TP, Schonfeld D, Castellon SA, Durvasula RS, Myers HF, Hinkin CH. Medication Adherence in HIV-Positive African Americans: The Roles of Age, Health Beliefs, and Sensation Seeking. COGENT PSYCHOLOGY 2016; 3:1137207. [PMID: 29104879 PMCID: PMC5667904 DOI: 10.1080/23311908.2015.1137207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022] Open
Abstract
We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV+ African Americans, and whether these factors mediate the association between age and adherence. Two-hundred-and-eighty-six HIV+ African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation-seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which was directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation-seeking tendencies to help identify HIV+ African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV+ individuals with poorer neurocognitive function.
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Affiliation(s)
- Philip Sayegh
- University of California, Los Angeles (UCLA) Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 925-788-1657
| | - Nicholas S Thaler
- UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 310-570-5113
| | - Alyssa Arentoft
- UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 818-677-2809
| | - Taylor P Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 321-698-1832
| | - Daniel Schonfeld
- Veterans Administration (VA) Greater Los Angeles Healthcare System, Psychology Service, 11301 Wilshire Blvd., Los Angeles, CA 90073, 305-788-0358
| | - Steven A Castellon
- VA Greater Los Angeles Healthcare System, Psychology Service, and UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 310-268-3597
| | - Ramani S Durvasula
- California State University, Los Angeles, 5151 State University Dr., Los Angeles, CA 90032, 323-343-5872
| | - Hector F Myers
- UCLA Department of Psychology and Vanderbilt University Center for Medicine, Health, and Society, 2301 Vanderbilt Pl., Nashville, TN, 37235, 615-322-5881
| | - Charles H Hinkin
- VA Greater Los Angeles Healthcare System, Psychology Service, and UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, #C8-749, Los Angeles, CA, 90095, 310-268-4357
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Gay Men and Men Who Have Sex with Men: Intersectionality and Syndemics. SOCIAL DISPARITIES IN HEALTH AND HEALTH CARE 2016. [DOI: 10.1007/978-3-319-34004-3_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Borgmann K, Ghorpade A. HIV-1, methamphetamine and astrocytes at neuroinflammatory Crossroads. Front Microbiol 2015; 6:1143. [PMID: 26579077 PMCID: PMC4621459 DOI: 10.3389/fmicb.2015.01143] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/05/2015] [Indexed: 12/30/2022] Open
Abstract
As a popular psychostimulant, methamphetamine (METH) use leads to long-lasting, strong euphoric effects. While METH abuse is common in the general population, between 10 and 15% of human immunodeficiency virus-1 (HIV-1) patients report having abused METH. METH exacerbates the severity and onset of HIV-1-associated neurocognitive disorders (HAND) through direct and indirect mechanisms. Repetitive METH use impedes adherence to antiretroviral drug regimens, increasing the likelihood of HIV-1 disease progression toward AIDS. METH exposure also directly affects both innate and adaptive immunity, altering lymphocyte numbers and activity, cytokine signaling, phagocytic function and infiltration through the blood brain barrier. Further, METH triggers the dopamine reward pathway and leads to impaired neuronal activity and direct toxicity. Concurrently, METH and HIV-1 alter the neuroimmune balance and induce neuroinflammation, which modulates a wide range of brain functions including neuronal signaling and activity, glial activation, viral infection, oxidative stress, and excitotoxicity. Pathologically, reactive gliosis is a hallmark of both HIV-1- and METH-associated neuroinflammation. Significant commonality exists in the neurotoxic mechanisms for both METH and HAND; however, the pathways dysregulated in astroglia during METH exposure are less clear. Thus, this review highlights alterations in astrocyte intracellular signaling pathways, gene expression and function during METH and HIV-1 comorbidity, with special emphasis on HAND-associated neuroinflammation. Importantly, this review carefully evaluates interventions targeting astrocytes in HAND and METH as potential novel therapeutic approaches. This comprehensive overview indicates, without a doubt, that during HIV-1 infection and METH abuse, a complex dialog between all neural cells is orchestrated through astrocyte regulated neuroinflammation.
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Affiliation(s)
- Kathleen Borgmann
- Department of Cell Biology and Immunology, University of North Texas Health Science Center Fort Worth, TX, USA
| | - Anuja Ghorpade
- Department of Cell Biology and Immunology, University of North Texas Health Science Center Fort Worth, TX, USA
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Passaro RC, Pandhare J, Qian HZ, Dash C. The Complex Interaction Between Methamphetamine Abuse and HIV-1 Pathogenesis. J Neuroimmune Pharmacol 2015; 10:477-86. [PMID: 25850893 PMCID: PMC4779551 DOI: 10.1007/s11481-015-9604-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 03/17/2015] [Indexed: 12/30/2022]
Abstract
The global HIV/AIDS pandemic has claimed the lives of an estimated 35 million people. A significant barrier for combating this global pandemic is substance use since it is associated with HIV transmission, delayed diagnosis/initiation of therapy, and poor adherence to therapy. Clinical studies also suggest a link between substance use and HIV-disease progression/AIDS-associated mortality. Methamphetamine (METH) use is one of the fastest-growing substance use problems in the world. METH use enhances high-risk sexual behaviors, therefore increases the likelihood of HIV-1 acquisition. METH use is also associated with higher viral loads, immune dysfunction, and antiretroviral resistance. Moreover, METH use has also been correlated with rapid progression to AIDS. However, direct effects of METH on HIV-1 disease progression remains poorly understood because use of METH and other illicit drugs is often associated with reduced/non adherence to ART. Nevertheless, in vitro studies demonstrate that METH increases HIV-1 replication in cell cultures and animal models. Thus, it has been proposed that METH's potentiating effects on HIV-1 replication may in part contribute to the worsening of HIV-1 pathogenesis. However, our recent data demonstrate that METH at physiologically relevant concentrations has no effect and at higher concentrations inhibits HIV-1 replication in CD4+ T cells. Thus, the goal of this review is to systematically examine the published literature to better understand the complex interaction between METH abuse and HIV-1 disease progression.
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Affiliation(s)
- Ryan Colby Passaro
- Vanderbilt Institute for Global Health, Vanderbilt University Schools of Medicine, Nashville, Tennessee, USA
| | - Jui Pandhare
- The Laboratory of Retrovirology and Epigenetics, Center for AIDS Health Disparities Research, Meharry Medical College, Nashville, Tennessee, USA
- Department of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Schools of Medicine, Nashville, Tennessee, USA
| | - Chandravanu Dash
- The Laboratory of Retrovirology and Epigenetics, Center for AIDS Health Disparities Research, Meharry Medical College, Nashville, Tennessee, USA
- Department of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, Tennessee, USA
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36
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Huang SW, Wang SF, Cowó ÁE, Chen M, Lin YT, Hung CP, Chen YH, Yang JY, Tang HJ, Chen YMA. Molecular Epidemiology of HIV-1 Infection among Men who Have Sex with Men in Taiwan in 2012. PLoS One 2015; 10:e0128266. [PMID: 26039757 PMCID: PMC4454672 DOI: 10.1371/journal.pone.0128266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/23/2015] [Indexed: 11/19/2022] Open
Abstract
The number of men who have sex with men (MSM) infected with HIV-1 in Taiwan has increased rapidly in the past few years. The goal of this study was to conduct a molecular epidemiological study of HIV-1 infection among MSM in Taiwan to identify risk factors for intervention. Voluntary counseling program and anonymous testing were provided to patrons at 1 gay bar, 7 night clubs and 3 gay saunas in Taipei and New Taipei Cities in 2012. HIV-1 subtypes were determined using gag subtype-specific PCR and phylogenetic analysis by env sequences. Recent HIV-1 infection was determined using LAg-Avidity EIA. In-depth interviews and questionnaires were used to identify risk factors. The prevalence and incidence of HIV-1 among MSM in Taiwan were 4.38% (53/1,208) and 3.29 per 100 person-years, respectively. Of 49 cases genotyped, 48 (97.9%) were infected with subtype B and 1 with CRF01_AE (2%). Phylogenetic analysis of 46 HIV-1 strains showed that 25 (54.4%) subtype B strains formed 9 clusters with each other or with other local strains. The CRF01_AE case clustered with a reference strain from a Thai blood donor with bootstrap value of 99. Multivariate logistic regression analysis showed that risk factors associated with HIV-1 infection included use of oil-based solution as lubricant (vs. saliva or water-based lubricants, OR= 4.23; p <0.001); exclusively receptive role (vs. insertive role, OR= 9.69; p <0.001); versatile role (vs. insertive role, OR= 6.45; p= 0.003); oral sex (vs. insertive role, OR= 11.93; p= 0.044); times of sexual contact per week (2-3 vs. zero per week, OR= 3.41; p= 0.021); illegal drug use (OR= 4.12; p <0.001); and history of sexually transmitted diseases (OR= 3.65; p= 0.002). In conclusion, there was no new HIV-1 subtype or circulating recombinant form responsible for the increase of HIV-1 among MSM in Taiwan in 2012. Misuse of oil-based solution as lubricant is a new risk factor identified among MSM in Taiwan. The Taiwan's Centers for Disease Control has created a video (www.youtube.com/watch?v=BinExvvOTMM&feature=iv&src_vid=BW81-PfmY3E&annotation_id=annotation_2436493705) to correct such misconception in its AIDS prevention campaign.
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Affiliation(s)
- Szu-Wei Huang
- Institute of Microbiology and Immunology, National Yang Ming University, Taipei 11221, Taiwan
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Sheng-Fan Wang
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ángel E. Cowó
- International Health Program, National Yang Ming University, Taipei 11221, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
- School of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Yu-Ting Lin
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chun-Po Hung
- Rainbow Queer Health and Culture Center, Living with Hope Organization, Taiwan Society of Preventive Medicine, Taipei 10084, Taiwan
| | - Yi-Hsien Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | | | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71067, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Yi-Ming Arthur Chen
- Institute of Microbiology and Immunology, National Yang Ming University, Taipei 11221, Taiwan
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Microbiology and Immunology, Institute of Medical Research and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- * E-mail:
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Azar P, Wood E, Nguyen P, Luma M, Montaner J, Kerr T, Milloy MJ. Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis. BMC Infect Dis 2015; 15:193. [PMID: 25927573 PMCID: PMC4411762 DOI: 10.1186/s12879-015-0913-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/25/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Among people living with HIV/AIDS, illicit drug use is a risk for sub-optimal treatment outcomes. However, few studies have examined the relative contributions of different patterns of drug use on adherence to antiretroviral therapy (ART). We sought to estimate the effect of different types of illicit drug use on adherence in a setting of universal free HIV/AIDS treatment and care. METHODS Using data from ongoing prospective cohorts of HIV-positive illicit drug users linked to comprehensive pharmacy dispensation records in Vancouver, Canada, we examined factors associated with ≥95% prescription refill adherence using generalized estimating equations (GEE) logistic regression. RESULTS Between 1996 and 2013, 692 ART-exposed individuals were followed for a median of 42.7 months (Interquartile Range: 29.1-71.7). In multivariable GEE analyses, heroin injection (Adjusted Odds Ratio [AOR] = 0.75, 95% Confidence Interval [CI]: 0.66-0.85) as well as cocaine injection (AOR = 0.80, 95% CI: 0.72-0.90) were associated with lower likelihoods of optimal adherence. Methadone maintenance therapy (AOR = 1.88, 95% CI: 1.68-2.11) was associated with a greater likelihood of adherence. CONCLUSIONS Periods of heroin and cocaine injection appeared to have the most deleterious impact upon antiretroviral adherence. The findings point to the need for improved access to treatment for heroin use disorder, particularly methadone, and highlight the need to identify strategies to support ART adherence among cocaine injectors.
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Affiliation(s)
- Pouya Azar
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Nguyen
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.
| | - Maxo Luma
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.
| | - Julio Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - M-J Milloy
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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38
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Cattie J, Marquine MJ, Bolden KA, Obermeit LC, Morgan EE, Franklin DR, Umlauf A, Beck JM, Atkinson JH, Grant I, Woods SP. Predictors of Attrition in a Cohort Study of HIV Infection and Methamphetamine Dependence. JOURNAL OF SUBSTANCE USE 2015; 20:407-416. [PMID: 26752974 DOI: 10.3109/14659891.2014.942397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Longitudinal cohort studies of HIV and substance use disorders play an important role in understanding these conditions, but high rates of attrition can threaten their integrity and generalizability. This study aimed to identify factors associated with attrition in a 5-year observational cohort study of 469 individuals with and without HIV infection and methamphetamine (MA) dependence. Rates of attrition in our four study groups were approximately 24% in HIV-MA-, 15% in HIV+MA-, 56% in HIV-MA+, and 47% in HIV+MA+ individuals. Predictors of attrition in the overall cohort included history of MA, alcohol, and other substance dependence, learning impairment, reduced cognitive reserve, and independence in activities of daily living (all ps < .05), but varied somewhat by clinical group. Of particular note, enrollment in a neuroimaging substudy was associated with significantly boosted rates of retention in the MA groups. Results from this investigation highlight the complexity of the clinical factors that influence retention in cohort studies of HIV-infected MA users and might guide the development and implementation of targeted retention efforts.
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Affiliation(s)
- J Cattie
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California, USA
| | - M J Marquine
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - K A Bolden
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California, USA
| | - L C Obermeit
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California, USA
| | - E E Morgan
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - D R Franklin
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - A Umlauf
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - J M Beck
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - J H Atkinson
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA; Psychiatry Service, San Diego VA Healthcare System; San Diego, California, USA
| | - I Grant
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
| | - S P Woods
- Department of Psychiatry, University of California, San Diego; San Diego, California, USA
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Feldman MB, Thomas JA, Alexy ER, Irvine MK. Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York. Drug Alcohol Depend 2015; 147:266-71. [PMID: 25482501 DOI: 10.1016/j.drugalcdep.2014.09.780] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between the use of crystal methamphetamine ("crystal meth") and HIV disease progression specifically among HIV-infected men who have sex with men (MSM). Understanding this relationship among HIV-infected MSM is particularly critical because of the high rates of crystal meth use reported in the population. METHODS Associations between recent crystal meth use and poor HIV medical outcomes (viral load>200 copies/mL, CD4 count <350 cells/mm(3)) were analyzed for 2896 HIV-infected MSM enrolled in Ryan White Part A programs in the greater New York metropolitan area between November 2010 and June 2012. RESULTS Crystal meth use (reported by 4%) was independently associated with unsuppressed viral load (AOR=1.8, CI=1.1-2.9) in multivariate analyses controlling for sociodemographic characteristics. There was no significant relationship between crystal meth use and low CD4 counts. CONCLUSIONS To date, little research has examined how crystal meth use influences HIV medical outcomes among HIV-infected MSM. This analysis showed a significant independent association between crystal meth use and unsuppressed viral load among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators, moderators and confounders of this relationship to inform intervention development for MSM crystal meth users in HIV care settings.
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Affiliation(s)
- Matthew B Feldman
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States.
| | - Jacinthe A Thomas
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
| | - Emily R Alexy
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
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Landovitz RJ, Fletcher JB, Shoptaw S, Reback CJ. Contingency management facilitates the use of postexposure prophylaxis among stimulant-using men who have sex with men. Open Forum Infect Dis 2015; 2:ofu114. [PMID: 25884003 PMCID: PMC4396429 DOI: 10.1093/ofid/ofu114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/04/2022] Open
Abstract
Compared to a control behavioral intervention, Contingency Management, an escalating voucher-based incentive system to reinforce stimulant abstinence, better supported MSM stimulant users in PEP course completion, decreased stimulant use, and a trend toward fewer condomless sexual acts. Background. Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence. Methods. We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent “yoked” control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors. Results. At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1–47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9–21.9). Conclusions. CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters.
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Affiliation(s)
- Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine , University of California
| | | | | | - Cathy J Reback
- Friends Research Institute, Inc., ; UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles
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Mayer KH, Skeer MR, O'Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers. Ann Behav Med 2014; 47:165-71. [PMID: 23873338 DOI: 10.1007/s12160-013-9527-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The HIV epidemic continues unabated in the USA, with men who have sex with men (MSM) being most frequently infected. PURPOSE The purpose of this study is to understand the biological and behavioral risk factors associated with increased HIV transmission efficiency, which is HIV transmission risk behavior in the context of uncontrolled HIV replication or intercurrent sexually transmitted infections. METHODS Participants were 201 HIV-infected MSM who received their primary care at an HIV ambulatory care center in Boston. Logistic regression models were conducted to determine factors associated with engaging in behavior associated with potentially amplified transmission. RESULTS In the final model, heavy alcohol use (AOR, 3.27; 95 % CI 1.37-7.79), as well as stimulant drug use (crystal meth, crack, or other cocaine; AOR, 3.00; CI 1.32-6.84), having at least a college degree (OR, 2.74; CI, 1.15-6.54), and decreased duration of HIV infection (OR, 0.91; CI, 0.85-0.97) were each uniquely associated with enhanced HIV transmission behavior. CONCLUSIONS HIV primary care providers should routinely assess patients for potential HIV transmission behaviors, particularly those who are younger and more recently diagnosed with HIV, who drink alcohol heavily, and who use any nonprescription drugs, particularly stimulants, in order to decrease the spread of HIV.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA,
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42
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Hermanstyne KA, Santos GM, Vittinghoff E, Santos D, Colfax G, Coffin P. Event-level relationship between methamphetamine use significantly associated with non-adherence to pharmacologic trial medications in event-level analyses. Drug Alcohol Depend 2014; 143:277-80. [PMID: 25156227 PMCID: PMC4170077 DOI: 10.1016/j.drugalcdep.2014.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Methamphetamine use has been previously associated with poor medication adherence, but, to date, there have been no studies that have conducted event-level analyses on correlates of medication adherence in studies of pharmacologic agents for methamphetamine dependence. METHODS We pooled data from two previous, randomized controlled trials (using bupropion and mirtazapine, respectively) for methamphetamine dependence and used a mixed effects logistic model to examine correlates of daily opening of the medication event monitoring system (MEMS) cap as a repeated measure. We explored whether periods of observed methamphetamine use via urine testing were associated with study medication adherence based on MEMS cap openings. RESULTS We found a significant negative association between methamphetamine-urine positivity and event-level study medication adherence as measured by MEMS cap openings (AOR: 0.69; 95% CI: 0.49-0.98). In addition, age (AOR: 1.07; 95% CI: 1.02-1.11) and depressive symptoms (AOR: 0.78; 95% CI: 0.64-0.90) were significantly associated with adherence. Finally, participants were more likely to open their study medication bottles on days when they presented for in-person urine testing. CONCLUSIONS Our event-level analysis shows that methamphetamine use can be associated with reduced medication adherence as measured by MEMS cap openings in pharmacologic trials, which corroborates prior research. These findings may suggest that medication adherence support in pharmacologic trials among methamphetamine users may be needed to improve study compliance and could be targeted towards periods of time when there are more likely to not open their study medication pill bottles.
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Affiliation(s)
- Keith A. Hermanstyne
- University of California – Los Angeles Robert Wood Johnson Foundation Clinical Scholars Program, 10920 Wilshire Boulevard, Suite 710, Los Angeles, CA 90024
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Eric Vittinghoff
- University of California-San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762, USA.
| | - Deirdre Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Grant Colfax
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Phillip Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
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Montoya JL, Georges S, Poquette A, Depp CA, Atkinson JH, Moore DJ. Refining a personalized mHealth intervention to promote medication adherence among HIV+ methamphetamine users. AIDS Care 2014; 26:1477-81. [PMID: 24911433 DOI: 10.1080/09540121.2014.924213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.
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Affiliation(s)
- Jessica L Montoya
- a SDSU/UCSD Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA
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Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend 2014; 139:33-40. [PMID: 24745475 PMCID: PMC4028151 DOI: 10.1016/j.drugalcdep.2014.02.704] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/26/2014] [Accepted: 02/26/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The population of older adults living with HIV is increasing in the United States. Despite an increased focus on the health of HIV-positive older adults, knowledge about their substance use, a primary risk factor for HIV medication non-adherence, and the association between use, problems associated with use, and adherence behavior, is limited. METHODS Data were collected from 557 HIV-positive adults aged 50 and older in the New York City area via telephone interview. Participants reported the number of days in the past month on which they missed any doses of HIV medication as well as the number of days they used alcohol, marijuana, cocaine/crack, opiates, amyl nitrite (poppers), and other drugs. The severity of substance use associated problems was assessed using the DAST-10 and AUDIT-C. RESULTS The sample included gay/bisexual (40.4%) and heterosexual (28.1%) men as well as lesbian/bisexual (4.9%) and heterosexual (26.7%) women. Latent class analyses identified four distinct patterns of substance use: Exclusive Alcohol Use; Alcohol and Marijuana; Alcohol and Cocaine/Crack; and Multiple-Substance Use. Variability in the number of missed HIV medication days and perceptions of substance use associated problems were observed across classes, with poorest adherence reported in the Alcohol and Marijuana class, the Alcohol and Cocaine/Crack class, and the Multiple-Substance Use class. The latter two classes also reported the greatest perceived impairment from substance use. CONCLUSIONS Patterns of recent substance use were associated with varying levels of HIV medication adherence and perceived substance use impairment, indicating that substance type matters when considering the health of older adults living with HIV, and that multiple-substance use needs to be addressed by interventions aimed at improving medication adherence.
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Affiliation(s)
- Jeffrey T. Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA,Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA,CUNY School of Public Health at Hunter College, New York, NY, USA,Corresponding author: tel +1 212 772 5533; fax: +1 212 650 3271.
| | - Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA,Department of Psychology, Pace University, New York, NY, USA
| | - Brett M. Millar
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Kailip Boonrai
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
| | - David Marcotte
- Department of Psychology, Fordham University, New York, NY, USA
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Santos GM, Rapues J, Wilson EC, Macias O, Packer T, Colfax G, Raymond HF. Alcohol and substance use among transgender women in San Francisco: prevalence and association with human immunodeficiency virus infection. Drug Alcohol Rev 2014; 33:287-95. [PMID: 24628655 DOI: 10.1111/dar.12116] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/25/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Alcohol and substance use can have negative health consequences among both human immunodeficiency virus (HIV)-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition. The relationship of substance use and HIV is well documented among key populations at risk for HIV. However, although transwomen (male-to-female transgender) are disproportionately impacted by HIV, this overlap remains understudied in this population. We sought to evaluate the association between HIV, alcohol and substance use among transwomen. DESIGN AND METHODS We conducted a secondary data analysis of Respondent Driven Sampling study which collected information on self-reported alcohol and substance use among 314 transwomen. We used multivariable logistic regression to assess relationship between HIV infection and classes and patterns of alcohol and substance use. RESULTS We found that 58% of transwomen used alcohol, and 43.3% used substances. The most common substances used were: marijuana (29%), methamphetamine (20.1%), crack cocaine (13.4%), and 'club drugs' (13.1%). Transwomen who reported any methamphetamine use [adjusted odds ratio (AOR) 3.02 (95% confidence interval (CI) = 1.51-6.02)], methamphetamine use before or during anal intercourse [AOR 3.27 (95% CI = 1.58-6.77)], and at least weekly methamphetamine use [AOR 3.89 (95% CI = 1.64-9.23)] had significantly greater odds of testing positive for HIV. DISCUSSION AND CONCLUSIONS Transfemales have high prevalence of alcohol and substance use; those tested positive for HIV used significantly more methamphetamine in general, and in conjunction with sex. Given the disproportionate prevalence of HIV and substance use in this population, interventions aimed at addressing both substance use and HIV risk among transwomen are urgently needed.
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Affiliation(s)
- Glenn-Milo Santos
- San Francisco Department of Public Health, HIV Prevention, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
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Martinez O, Roth AM, Kelle G, Downs M, Rhodes SD. Adaptation and implementation of HoMBReS: a community-level, evidence-based HIV behavioral intervention for heterosexual Latino men in the midwestern United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:68-80. [PMID: 24450279 PMCID: PMC3987858 DOI: 10.1521/aeap.2014.26.1.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Over the past decade, the midwestern United States has witnessed a dramatic increase in its Latino population. The lack of culturally and linguistically congruent resources coupled with high incidence and prevalence rates of HIV among Latinos living in the Midwest merits attention. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) is a community-level social network intervention designed for Latino men. We describe the adaptation and implementation of HoMBReS for Latino men living in Indianapolis, Indiana, the second largest city in the Midwest. Five Navegantes (lay health educators) were trained; they provided a total of 34 educational charlas (small group didactic sessions). A total of 270 Latino men attended the charlas and were offered no-cost screening for HIV and sexually transmitted infections (STI). Three participants tested HIV positive and 15 screened positive for STI. The charlas coupled with the testing initiative, served as a successful method to increase sexual health knowledge among Latino men and to link newly-diagnosed HIV/STI-positive individuals to treatment and care. The adaptation and implementation of HoMBReS respond to the CDC and NIH call to increase HIV testing and service provision among vulnerable populations.
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Bruce RD, Altice FL, Friedland GH. Pharmacokinetic drug interactions between drugs of abuse and antiretroviral medications: implications and management for clinical practice. Expert Rev Clin Pharmacol 2014; 1:115-27. [PMID: 24410515 DOI: 10.1586/17512433.1.1.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Substance abuse and HIV/AIDS are two of the most serious, yet treatable diseases worldwide. Global access to HIV treatment continues to expand. In settings where both active illicit drug use and HIV treatment are concurrent, potentional problematic pharmacokinetic drug interactions may arise and complicate therapy. Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between only a few drugs of abuse and approved antiretroviral therapies. Important pharmacokinetic drug interactions have been described for benzodiazepines, 3,4-methylenedioxymethamphetamine, methadone and buprenorphine; however, most have not been studied and few well-controlled studies have been conducted to adequately address the clinical implications of these interactions. The metabolism of drugs of abuse, description of the known interactions, and clinical implications and management of these interactions are reviewed. Certain interactions between drugs of abuse and antiretroviral therapies are known and others are likely based upon shared metabolic pathways. These may result in important clinical consequences. To optimize care, clinicians must be alert, knowledgeable about known and possible interactions and equipped to clinically manage the medical consequences. Moreover, there is considerable need for carefully controlled studies in this important and emerging area.
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Affiliation(s)
- R Douglas Bruce
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06511, USA.
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Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:99-106. [PMID: 24243002 PMCID: PMC4532732 DOI: 10.1007/s10508-013-0208-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Men who have sex with men (MSM) remain at great risk of HIV in the United States, representing 65 % of incident HIV infections. One factor contributing to the high rate of HIV infection among MSM is use of "recreational" drugs that are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis (PrEP) is a novel biomedical HIV prevention strategy that has the potential to reduce HIV transmission in MSM. Main and casual sex partners play a role in HIV prevention efforts for MSM. The study aimed to qualitatively explore the perceived influences of sexual relationships on promoting and inhibiting PrEP use among high-risk MSM who report regular drug use. Semi-structured qualitative interviews were conducted with 40 participants recruited in Boston, Massachusetts. Data were analyzed using descriptive qualitative analysis. Casual partners presented a distinct set of concerns from primary partnerships. MSM generally viewed main partners as a potential source of support for taking PrEP. Given their informal and often temporary nature, PrEP disclosure to casual partners was considered unnecessary. HIV-related stigma and substance use were also perceived as barriers to discussing PrEP use with casual partners. MSM articulated a high degree of personal agency regarding their ability to take PrEP. Findings suggest that behavioral interventions to improve PrEP utilization and adherence for high-risk MSM should be tailored to sex partner type and the parameters established between sex partners. Approaches to PrEP disclosure and partner engagement should be informed by the relative benefits and limitations characterized by these different types of relationships.
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Affiliation(s)
- Matthew J Mimiaga
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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3.0 Patient involvement in decision-making. HIV Med 2013. [DOI: 10.1111/hiv.12119_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lyons A, Pitts M, Grierson J. Methamphetamine use in a nationwide online sample of older Australian HIV-positive and HIV-negative gay men. Drug Alcohol Rev 2013; 32:603-10. [PMID: 24219659 DOI: 10.1111/dar.12072] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/01/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Use of methamphetamine appears to be greater among gay men than in the general population, yet little data are available on factors associated with use, especially among older men. This study identifies factors associated with reported methamphetamine use among older Australian gay men. DESIGN AND METHODS Data were collected from an online survey involving 1135 HIV-positive and HIV-negative gay-identified men aged 40 years and older. RESULTS One in eight men in the sample, or 13%, reported using methamphetamine in the past 12 months. Patterns of reported use were similar across the country, with no significant differences between major states and territories. Reported methamphetamine use was considerably more prevalent among HIV-positive (24%) than HIV-negative men (11%). In a multivariable logistic regression, reported use was significantly greater among men in their 40s compared with those in their 50s and older (P = 0.002), who were single as opposed to being in an ongoing relationship (P = 0.03), who were HIV-positive (P = 0.003), and who reported using other drugs for non-medical purposes in the past 12 months (P < 0.001). Socioeconomic status and psychosocial variables, such as experiences of discrimination and psychological distress, were not significant factors for reported methamphetamine use. DISCUSSION AND CONCLUSIONS Relatively high rates of reported use of methamphetamine were found across the country in this online sample of older Australian gay men. National approaches to health education strategies may be needed, with a focus on high prevalence populations, such as those infected with HIV.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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