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Morgan E, Dyar C. Rural and urban differences in marijuana use following passages of medical marijuana laws. Public Health 2024; 234:64-70. [PMID: 38954884 DOI: 10.1016/j.puhe.2024.05.036] [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: 11/06/2023] [Revised: 03/24/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Understanding differences in post-legalization patterns of marijuana between rural and urban environments has the potential to go a long way towards targeting intervention efforts aimed at reducing marijuana use disorders. METHODS Data come from the National Survey on Drug Use and Health (NSDUH, 2015-2019, N = 210,392). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between key marijuana-related variables and the status of medical marijuana use in each state with interaction terms for rural versus urban status. RESULTS Among the entire sample, the prevalence of marijuana abuse and dependence were 0.7% and 1.8%, respectively. Among marijuana users, the average number of days on which marijuana was used was 131.3 (SD = 136.3) days. Those living in states with legalized medical marijuana reported use on a greater number of days (B = 10.69; 95% CI: 5.26, 16.13) with frequency of use increasing as rurality increased, compared to a core based statistical area (CBSA) of ≥1 million: a CBSA of <1 million residents (B = 23.02; 95% CI: 17.38, 28.66) and non-CBSA (B = 37.62; 95% CI: 22.66, 52.58). We also observed lower odds of driving under the influence of marijuana in states where medical marijuana was legal (aOR = 0.86; 95% CI: 0.77, 0.95). CONCLUSION We observed an increase in the frequency of marijuana use and a decrease in driving under the influence of marijuana in states with legalized medical marijuana use relative to those states where it remained illegal. We also observed key moderation based on rural-urban status. This body of results suggests that problematic marijuana use may be on the rise following the legalization of marijuana use, but also that corresponding protective attitudes exist.
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Affiliation(s)
- E Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA; College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - C Dyar
- College of Nursing, The Ohio State University, Columbus, OH, USA
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Khalifa A, Kim B, Regan S, Moline T, Chaix B, Chen YT, Schneider J, Duncan DT. Examination of multidimensional geographic mobility and sexual behaviour among Black cisgender sexually minoritized men in Chicago. GEOSPATIAL HEALTH 2024; 19:10.4081/gh.2024.1273. [PMID: 38752862 PMCID: PMC11194757 DOI: 10.4081/gh.2024.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/13/2024] [Indexed: 06/06/2024]
Abstract
Black sexually minoritized men (BSMM) are the most likely to acquire HIV in Chicago- a racially segregated city where their daily travel may confer different HIV-related risks. From survey and GPS data among participants of the Neighbourhoods and Networks Cohort Study, we examined spatial (proportion of total activity space away from home), temporal (proportion of total GPS points away from home), and motivation-specific (discordance between residential and frequented sex or socializing neighbourhoods) dimensions of mobility. To identify potential drivers of BSMM's risk, we then examined associations between mobility and sexual behaviours known to cause HIV transmission: condomless anal sex, condomless anal sex with a casual partner, transactional sex, group sex, and sex-drug use. Multivariable logistic regression models assessed associations. Of 269 cisgender BSMM, most were 20-29 years old, identified as gay, and lowincome. On average, 96.9% (Standard Deviation: 3.7%) of participants' activity space and 53.9% (Standard Deviation: 38.1%) of participants' GPS points occurred outside their 800m home network buffer. After covariate adjustment, those who reported sex away from home were twice as likely to report condomless sex (Odds Ratio: 2.02, [95% Confidence Interval (CI): 1.08, 3.78]). Those who reported socializing away from home were four times more likely to have condomless sex with a casual partner (Odds Ratio: 4.16 [CI: 0.99, 29.0]). BSMM are on the move in Chicago, but only motivation-specific mobility may increase HIV transmission risk. Multidimensional investigations of mobility can inform place-based strategies for HIV service delivery.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY.
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY.
| | - Seann Regan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Tyrone Moline
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Némésis Research Team, Paris.
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - John Schneider
- Department of Medicine, Public Health Sciences, University of Chicago, Chicago, IL.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Morgan E, Manuzak JA, Broedlow C, Hudson H, D'Aquila R, Carrico AW, Klatt NR, Mustanski B. Problematic Cannabis Use Is Associated with Reduced Rectal Microbial Species Richness and Diversity Among a Pilot Sample of Young Sexual and Gender Minorities. AIDS Res Hum Retroviruses 2024; 40:1-6. [PMID: 37022787 PMCID: PMC10790549 DOI: 10.1089/aid.2022.0143] [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: 04/07/2023] Open
Abstract
Compared to young heterosexual men, young sexual and gender minorities (YSGM) have elevated systemic inflammation and unique intestinal microbial profiles, influenced by HIV infection and substance use. However, links between cannabis use and microbial dysbiosis in this population have not been well described. In this pilot study, we aimed to characterize the complex interrelationships between cannabis use and microbial community structure in YSGM in relationship to HIV status. Cannabis use was assessed by self-administered Cannabis Use Disorder Identification Test (CUDIT) questionnaires and rectal microbial community alpha-diversity metrics were assessed via 16S ribosomal ribonucleic acid (rRNA) sequencing in a subset of YSGM (n = 42) in the RADAR cohort (aged 16-29) in Chicago. Multivariable regression models were used to assess the relationship between cannabis use and microbiome alpha-diversity metrics, adjusting for HIV status and other risk characteristics, including inflammation, which was evaluated by plasma levels of C-reactive protein (CRP). Problematic cannabis use, but not general use, was significantly inversely associated with microbial community richness (Adj. Beta = -8.13; 95% confidence interval [CI]: -15.68 to -0.59) and Shannon diversity (Adj. Beta = -0.04; 95% CI: -0.07 to 0.009). No significant association was observed between CUDIT score and community evenness, nor was any significant moderation observed by HIV status. We observed that problematic cannabis use was associated with reduced microbial community richness and Shannon diversity, adjusting for within population differences in inflammation and HIV status. Future research should aim to assess how cannabis use contributes to microbiome-related health factors among YSGM and if decreasing cannabis use can restore gut microbial community structure.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, and The Ohio State University, Columbus, Ohio, USA
- Infectious Disease Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Manuzak
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, Louisiana, USA
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Courtney Broedlow
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hannah Hudson
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard D'Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Nichole R. Klatt
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, and Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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Morgan E, Eaton LA, Watson RJ. Cannabis Use Frequency is Associated with PrEP Cessation and Self-reported HIV Diagnosis. AIDS Behav 2023; 27:4033-4040. [PMID: 37422575 DOI: 10.1007/s10461-023-04117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/10/2023]
Abstract
To achieve stated targets in the United States of Ending the HIV Epidemic by 2030, it is necessary to decrease rates of pre-exposure prophylaxis use (PrEP) cessation. In particular, it is key to assess PrEP use and cannabis use frequency given the recent wave of cannabis decriminalization across the U.S., particularly among sexual minority men and gender diverse (SMMGD) individuals. We used data from the baseline visit of a national study of Black and Hispanic/Latino SMMGD. Among participants reporting any lifetime cannabis use, we further assessed the association between frequency of cannabis use in the past 3 months and: (1) self-reported PrEP use, (2) recency of last PrEP dose, and (3) HIV status using adjusted regression models. Compared to those who never used cannabis, odds of PrEP cessation were higher among those who used it once or twice (aOR 3.27; 95% CI 1.38, 7.78), those who used it monthly (aOR 3.41; 95% CI 1.06, 11.01), and those who used it weekly or more frequently (aOR 2.34; 95% CI 1.06, 5.16). Similarly, those reporting cannabis use 1-2 times in the past 3 months (aOR 0.11; 95% CI 0.02, 0.58) and those reporting weekly or more frequent use (aOR 0.14; 95% CI 0.03, 0.68) were each more likely to report more recent PrEP cessation. These results suggest that cannabis users in general may be a population at elevated risk of HIV diagnosis although more research regarding these findings is needed with nationally representative populations.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA.
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
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Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Kalinowski J, Layland EK, Eaton LA, Watson RJ. Strong Ethnic Identity Buffers the Association of Heterosexism with Substance Use Among Black Sexual Minority Men. J Racial Ethn Health Disparities 2023; 10:1270-1279. [PMID: 35556225 PMCID: PMC9936572 DOI: 10.1007/s40615-022-01312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Heterosexist stigma, including microaggressions experienced in their own racial/ethnic communities, may partially explain disproportionate levels of substance use involvement among Black sexual minority men (BSMM). A strong sense of ethnic identity may provide BSMM with a protective resource. The purpose of this study was to explore associations between ethnic identity and substance use in BSMM. METHODS Data were from Black sexual minority men (n = 390 Mage = 25.28; SD = 2.81) in the PrEP and Substance Use National Survey collected from March 2020 to August 2020 that included self-reported cannabis, cocaine, methamphetamines, inhalants, hallucinogens, prescription drugs misuse, and overall substance use involvement. Using zero-inflated negative binomial regression, we assessed the association between heterosexist microaggressions within BSMM's racial/ethnic communities and substance use involvement, moderated by subjective sense of ethnic identity. RESULTS More than half of participants reported past 3-month substance use. Heterosexist microaggressions were associated with higher relative risk of cannabis use involvement (RR = 1.76; 95% CI 1.13-2.73) and overall substance use involvement (RR = 2.23; 95% CI 1.39-3.56). Stronger ethnic identity buffered the association of heterosexism on substance use involvement (cannabis: RR = 0.82; 95% CI 0.72-0.95; overall: RR = 0.77; 95% CI 0.66-0.89). CONCLUSION Nurturing ethnic identity development and reducing heterosexist stigma in Black communities may be a culturally responsive, two-pronged approach to reducing substance use involvement among BSMM. BSMM with strong ethnic identity demonstrated resilience to heterosexist stigma. Future research should examine the extent to which ethnic identity may be cultivated as a protective resource against substance use involvement.
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Affiliation(s)
- Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
| | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
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Cénat JM, Kogan CS, Kebedom P, Ukwu G, Moshirian Farahi SMM, Darius WP, Mulopo Bakombo S, Dalexis RD, Ndengeyingoma A, Noorishad PG, Labelle PR. Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review. Addict Behav 2023; 138:107567. [PMID: 36521424 DOI: 10.1016/j.addbeh.2022.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession. METHODS Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16. RESULTS Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment. CONCLUSIONS High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Philmona Kebedom
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Assumpta Ndengeyingoma
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Nursing, Université du Québec en Outaouais, Quebec, Canada
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Flores R, Kerman J, Schneider J, Harawa N. "I feel like marijuana is the only drug that wouldn't kill me": perceptions of cannabis use in previously incarcerated Black men who have sex with other men. Harm Reduct J 2023; 20:13. [PMID: 36737793 PMCID: PMC9896444 DOI: 10.1186/s12954-023-00744-7] [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: 07/22/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fragmented state laws have impacted cannabis uptake and perceptions in the USA. Little research has explored the attitudes, beliefs, and social network influences of young Black men who have sex with men (BMSM) who have experienced incarceration and use cannabis. While problematic cannabis use is not well defined and understudied, scholars have found that a person's social network can mediate problematic substance use and reduce recidivism rates by providing both tangible and emotional support. This analysis examines how social networks contribute to cannabis perceptions and use among BMSM with criminal legal system involvement in Chicago, IL, and Houston TX. METHODS Researchers conducted interviews with 25 cis gender Black men informed by life course theory, with a focus on the role of social networks, incarceration, and other life experiences in substance use. All interviews were audio-recorded, de-identified, and transcribed; participants were compensated $50. A deductive-inductive thematic analysis was used to analyze all qualitative data collected. RESULTS Twelve BMSM in Chicago and 13 BMSM in Houston (M = 26.6 years old, SD = 3.7) were interviewed. A majority identified as gay (56%), with 12 participants (48%) reporting having a high school diploma or equivalent; their average age of first substance use was 15.2 (SD = 2.9). Participants perceived cannabis usage to be categorically distinct from other intoxicating substance usage, with many describing it as not harmful and potentially beneficial. Three themes shaped their choices and attitudes regarding cannabis and "hard" drugs-social networks, need fulfillment, and knowledge of risk. CONCLUSION Participant descriptions of cannabis use emphasize their drug-use behavior as being produced by agent decision-making and risk assessment. Future work should expand on how these decisions are made, and how social networks can be leveraged to encourage non-harmful drug consumption behaviors.
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Affiliation(s)
- Rey Flores
- University of Chicago, 5801 S Ellis Ave, Chicago, IL, 60637, USA. .,Chicago Center for HIV Elimination, 1525 E. 55th St. Suite 205, Chicago, IL, 60637, USA. .,University of Illinois at Chicago, 750 S Halsted St., Chicago, IL, 60607, USA.
| | - Jared Kerman
- University of Chicago, 5801 S Ellis Ave, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 1525 E. 55th St. Suite 205, Chicago, IL, 60637, USA
| | - John Schneider
- University of Chicago, 5801 S Ellis Ave, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 1525 E. 55th St. Suite 205, Chicago, IL, 60637, USA
| | - Nina Harawa
- David Geffen School of Medicine at UCLA, 1100 Glendon Ave. Suite 850, Los Angeles, CA, 90024, USA.,Charles Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA, 90059, USA
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10
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Morgan E, Dyar C, Feinstein BA. Differences in infection and prevention of HIV and other sexually transmitted infections among older adults in Columbus, Ohio. PLoS One 2023; 18:e0282702. [PMID: 36877711 PMCID: PMC9987766 DOI: 10.1371/journal.pone.0282702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION In the United States, rates of sexually transmitted infections (STIs) have increased year after year for the past six consecutive years. Even so, the majority of research has focused on younger populations with little work examining infections and prevention methods among older adults. METHODS Data come from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio with a particular focus on addressing disparities based on sexual and gender identity. Multivariable logistic regression models were used to examine the association between sociodemographic factors and risk of STI acquisition, HIV diagnosis, and several common prevention methods, adjusting for known confounders. RESULTS Key results suggest that cisgender women, intersex individuals, and transgender women are less likely to use condoms relative to cisgender men. Meanwhile, white individuals were least likely to use condoms while bisexual individuals were most likely. Transgender women and those living with family/roommates were most likely to use PrEP/PEP relative to cisgender men and those living with a spouse or partner. Cisgender women, compared to cisgender men, were most likely to report not using any prevention method. CONCLUSION This study highlights the need for better research among older adults in order to ascertain how interventions may be targeted to specific populations. Future research should aim to educate individuals differently based on their specific needs rather than treating older adults as a homogenous population or ignoring their sexually active nature entirely.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- Infectious Disease Institute, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America
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11
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Kisler KA, Fletcher JB, Reback CJ. Peer Case Management Promoting Advancement Along the HIV Care Continuum Among Black Men Who Have Sex with Men Living with HIV: Building Brothers Up. AIDS Patient Care STDS 2022; 36:S46-S53. [PMID: 36178380 PMCID: PMC9529306 DOI: 10.1089/apc.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black men who have sex with men (BMSM) in the United States are at elevated risk for HIV relative to their heterosexual and/or non-BMSM counterparts, yet on average demonstrate suboptimal HIV care linkage and rates of HIV primary care retention. From October 2019 to December 2020, 69 adult (i.e., aged 18-65) BMSM enrolled in Building Brothers Up (2BU), a 6-session peer case management intervention delivered across 3 months and designed to improve retention in HIV primary care through to full viral suppression. Peer case management sessions included detailed assessment of participants' needs and barriers to treatment, which led to the development of a participant-centered treatment plan. All participants self-identified as Black, about three-quarters self-identified as gay (72.5%), and 46.4% reported an annual income of $5000 or less. A total of 69 participants enrolled in 2BU; however, multiply imputed chained equation logistic regressions were carried out on the final analytical data set (n = 40; 99 imputations) due to a large amount of COVID-19-related missing data. Although analyses of retention and achievement of viral suppression did not reach full significance, the probability of a Type-II hypothesis testing error was high, and viral load results (adjusted odds ratio = 1.56; 95% confidence interval = 0.94-2.60; p = 0.08) suggested that increased attendance to peer case management sessions may be associated with improved odds of achieving full viral suppression among BMSM. The significant impact of national race-related civil unrest and the COVID-19 pandemic on the target population during implementation of 2BU is underscored.
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Affiliation(s)
- Kimberly A. Kisler
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Kimberly A. Kisler, PhD, MPH, Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | | | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California, Los Angeles, Los Angeles, California, USA
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12
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Watson RJ, Morgan E, Collibee C, Kalinowski J, Cunningham C, Edelman EJ, Chan P, Eaton LA. Substance Use and Healthcare Utilization Across the Pre-Exposure Prophylaxis (PrEP) Care Cascade among Black and Latino Men Who Have Sex with Men. Subst Use Misuse 2022; 57:1698-1707. [PMID: 35938746 PMCID: PMC9554788 DOI: 10.1080/10826084.2022.2108059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: Despite the documented efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, large disparities in uptake and adherence exist among Black and Latino/Hispanic men who have sex with men (BLMSM). Limited data exists among BLMSM on the impact of substance use at different stages of the PrEP Care Cascade. We examined the ways substance (alcohol, cannabis, other drug) use is related to PrEP experiences across the PrEP Care Cascade (PrEP aware/no use; PrEP use/discontinuation; PrEP use/adherent).Methods: We utilized data from a national sample of 908 BLMSM (Mage = 25.17, range: 18-29), collected between February and October 2020.Results: We found that heavier alcohol use, more other drug (e.g., cocaine) use, more participant healthcare utilization, and higher number of partners across all measures of substance use were separately associated with a lower likelihood of being aware of PrEP. These same factors were also associated with a higher likelihood of PrEP adherence. Conversely, only cannabis use was associated with discontinuation of PrEP use.Conclusions: While we confirm some earlier findings (i.e., alcohol use is associated with both PrEP discontinuation and PrEP use), we newly identify cannabis as a barrier to the adherence of PrEP. Our findings highlight the need for improved PrEP interventions to increase awareness among BLMSM with substance use who are among the most at-risk for HIV infection.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, Ohio, USA
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Casey Cunningham
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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13
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Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148847. [PMID: 35886704 PMCID: PMC9323409 DOI: 10.3390/ijerph19148847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. Methods: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. Results: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23–28 age years (aOR = 1.86) and 29–33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. Conclusions: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders.
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14
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Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA. AIDS Behav 2022; 26:2503-2515. [PMID: 35094179 DOI: 10.1007/s10461-022-03598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
Abstract
We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11-8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.
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15
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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16
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Bowman B, Psichogyiou M, Papadopoulou M, Sypsa V, Khanna A, Paraskevis D, Chanos S, Friedman SR, Hatzakis A, Schneider J. Sexual Mixing and HIV Transmission Potential Among Greek Men Who have Sex with Men: Results from SOPHOCLES. AIDS Behav 2021; 25:1935-1945. [PMID: 33555414 PMCID: PMC8081711 DOI: 10.1007/s10461-020-03123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
HIV incidence among men who have sex with men (MSM) in Greece remains unchanged despite effective response to a recent outbreak among people who inject drugs (PWID). Network factors are increasingly understood to drive transmission in epidemics. The primary objective of the study was to characterize MSM in Greece, their sexual behaviors, and sexual network mixing patterns. We investigated the relationship between serostatus, sexual behaviors, and self-reported sex networks in a sample of MSM in Athens, Greece, generated using respondent driven sampling. We estimated mixing coefficients (r) based on survey-generated egonets. Additionally, multiple logistic regression was used to estimate adjusted odds ratios (AOR) and to assess relationships between serostatus, sexual behaviors, and sociodemographic indicators. A sample of 1,520 MSM participants included study respondents (n = 308) and their network members (n = 1,212). Mixing based on serostatus (r = 0.12, σr = 0.09–0.15) and condomless sex (r = 0.11, σr = 0.07–0.14) was random. However, mixing based on sex-drug use was highly assortative (r = 0.37, σr = 0.32–0.42). This study represents the first analysis of Greek MSM sexual networks. Our findings highlight protective behavior in two distinct network typologies. The first typology mixed assortatively based on serostatus and sex-drug use and was less likely to engage in condomless sex. The second typology mixed randomly based on condomless sex but was less likely to engage in sex-drug use. These findings support the potential benefit of HIV prevention program scale-up for this population including but not limited to PrEP.
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Affiliation(s)
- Benjamin Bowman
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
| | - Mina Psichogyiou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martha Papadopoulou
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aditya Khanna
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R. Friedman
- Institute for Infectious Disease Research, National Development & Research Institutes, New York, NY USA
- Department of Population Health, New York University Langone Medical School, New York, NY USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
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Morgan E, Dyar C, Hayford CS, Whitton SW, Newcomb ME, Mustanski B. Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use. Cannabis Cannabinoid Res 2021; 6:156-164. [PMID: 33912680 PMCID: PMC8064955 DOI: 10.1089/can.2019.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is a high rate of marijuana use among young sexual and gender minorities (SGM) and, as a result of recent state-level, fragmented marijuana laws, there is also likely high variability in their perceptions of marijuana decriminalization (PMD). Methods: Data came from two cohorts of young SGM (aged 16-29) in Chicago, RADAR and FAB400, recruited from 2015 to 2017 (N=1,114). We developed a measure to assess PMD among this population, performed initial validation, and assessed its relationship to longitudinal changes in patterns of marijuana use and geographic distribution. Results: In multivariable models, mean PMD score was prospectively associated with general (adjusted odds ratio [aOR]=2.00; 95% confidence interval [CI]: 1.46-2.77), but not problematic marijuana use. An increase in perceived decriminalization also predicted a significant increase in odds of general (aOR=1.67; 95% CI: 1.18-2.39) marijuana use. Significant concentrations of high PMD scores existed in across the city. Conclusion: These results suggest further study of longitudinal changes in marijuana use as decriminalization or legalization increases in the U.S. to better understand shifting trends in use.
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Affiliation(s)
- Ethan Morgan
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Christina S. Hayford
- Third Coast Center for AIDS Research, Northwestern University, Chicago, Illinois, USA
| | - Sarah W. Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Third Coast Center for AIDS Research, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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Morgan E, Hudson H, D'Aquila R, Mustanski B. Plasma C-reactive protein is lower among marijuana using HIV-negative individuals but not among persons living with HIV. Sci Rep 2021; 11:4816. [PMID: 33649360 PMCID: PMC7921677 DOI: 10.1038/s41598-021-84352-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 02/12/2021] [Indexed: 12/23/2022] Open
Abstract
The use of marijuana is highly prevalent among young men who have sex with men (YMSM). Past work has also shown that inflammation is elevated among YMSM, independent of HIV status. Here, we aim to examine the relationship between marijuana use and inflammation among this high-risk cohort, relative to use of other substances. Data were collected among YMSM aged 16-29 in Chicago. Multiplex cytokine and inflammatory biomarker assays were run on plasma from all persons living with HIV (PLWH) (n = 195) and a subset of HIV-negative participants (n = 489). Bivariate analyses and multivariable models assessed relationships between various substances and inflammatory biomarkers. Models were stratified by HIV status and adjusted for demographic characteristics. Most participants reported use of marijuana in the past 30 days (416, 60.8%). Mean blood C-reactive protein (CRP) levels were above the upper limit of normal (3.0 mg/L), indicative of increased risk for cardiovascular disease (mean CRP was 3.9 mg/L; SD = 8.5). In adjusted, stratified analyses, CRP was significantly lower among participants reporting frequent marijuana use (≥ 6 times per month), relative to those reporting never using marijuana, (β = - 0.38; 95% CI: - 0.73, - 0.03). However, this was entirely accounted for by an association among the HIV-negative participants and there was no significant association between marijuana use and blood CRP level among the PLWH. In summary, YMSM had markedly elevated marijuana use and blood CRP levels. Frequent marijuana use was associated with lower inflammation among only those not diagnosed with HIV. Further research is needed to explicate why there are differences between HIV-negative participants and PLWH and to leverage this information to characterize biological mechanisms by which marijuana decreases inflammation.
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Affiliation(s)
- Ethan Morgan
- Infectious Disease Institute and College of Nursing, The Ohio State University, 1595 Neil Ave, Room 393, Columbus, OH, 43210, USA.
| | - Hannah Hudson
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard D'Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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19
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Aivadyan C, Lee YG, El-Bassel N, Wu E. Substance Use and Sexual Risk Behavior Among Black Men Who Have Sex With Men in New York City: Evidence for Increased Risk During Young Adulthood. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:73-87. [PMID: 33617320 PMCID: PMC7905783 DOI: 10.1521/aeap.2021.33.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18-26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission-particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.
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Affiliation(s)
| | - Yong Gun Lee
- Columbia School of Social Work, New York, New York
| | | | - Elwin Wu
- Columbia School of Social Work, New York, New York
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20
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D'Anna LH, Chang K, Wood J, Washington TA. Marijuana Use and Sexual Risk Behavior Among Young Black Men Who Have Sex with Men in California. J Racial Ethn Health Disparities 2020; 8:1522-1532. [PMID: 33197039 DOI: 10.1007/s40615-020-00915-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/21/2020] [Accepted: 10/27/2020] [Indexed: 12/01/2022]
Abstract
Young black men who have sex with men (YBMSM) are disproportionately affected by HIV and continue to experience higher rates of new HIV infections when compared to other population groups. As part of the Peer Promotion of Wellness and Enhanced Linkage to Resources Project, we examined problem marijuana use and the overall sexual risk profile of 250 YBMSM. Eighty percent reported prior use of marijuana in their lifetime (n = 200). Among those, problem marijuana use was correlated with problem use of alcohol (r = 0.51, p < 0.001) and other drugs (r = 0.29, p < 0.001); lower household income (r = - .22, p < .01); homelessness (r = 0.15, p < 0.05); incarceration (r = 0.16, p < 0.05); exchanging sex for money, drugs, or shelter (r = 0.18, p < 0.05); having sex with someone known or suspected of having HIV and/or an STI (r = 0.20, p < 0.01); having sex with someone known or suspected of being an injector (r = 0.24, p < 0.01); and having unprotected sex while under the influence of alcohol or drugs (r = 0.32, p < 0.001). The complex relationship between marijuana and sexual risk behavior was examined while accounting for the possible moderating effects of alcohol or other drugs. Problem marijuana, alcohol, and other drug use each made unique contributions to predicting risky sex behavior. A significant marijuana and other drug interaction was found to predict sexual risk behaviors. Future efforts should include holistic intervention approaches for YBMSM that consider factors facilitating high-risk sexual behaviors.
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Affiliation(s)
- Laura Hoyt D'Anna
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., FO5-120, Long Beach, CA, 90840, USA.
| | - Kyle Chang
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., FO5-120, Long Beach, CA, 90840, USA
| | - Jefferson Wood
- Center for Health Equity Research, California State University, Long Beach, 1250 Bellflower Blvd., FO5-120, Long Beach, CA, 90840, USA
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Lemley SM, Klausner JD, Young SD, Stafylis C, Mulatya C, Oden N, Xie H, Revoredo L, Shmueli-Blumberg D, Hichborn E, McKelle E, Moran L, Jacobs P, Marsch LA. Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study. JMIR Res Protoc 2020; 9:e20417. [PMID: 33074164 PMCID: PMC7605984 DOI: 10.2196/20417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms - such as social media websites and dating apps - is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined. OBJECTIVE This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake. METHODS Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake. RESULTS Recruitment was completed in July 2020. CONCLUSIONS Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20417.
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Affiliation(s)
- Shea M Lemley
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sean D Young
- Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - Chrysovalantis Stafylis
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Neal Oden
- The Emmes Company, LLC, Rockville, MD, United States
| | - Haiyi Xie
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | | | - Emily Hichborn
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Erin McKelle
- ETR Associates (Education, Training and Research), Oakland, CA, United States
| | - Landhing Moran
- National Institute on Drug Abuse, Bethesda, MD, United States
| | - Petra Jacobs
- National Institute on Drug Abuse, Bethesda, MD, United States
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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22
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Skaathun B, Pho MT, Pollack HA, Friedman SR, McNulty MC, Friedman EE, Schmitt J, Pitrak D, Schneider JA. Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States. J Int AIDS Soc 2020; 23:e25554. [PMID: 33119195 PMCID: PMC7594703 DOI: 10.1002/jia2.25554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Incident HIV infections persist in the United States (U.S.) among marginalized populations. Targeted and cost-efficient testing strategies can help in reaching HIV elimination. This analysis compares the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. METHODS We performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men. All occurred at the same academic medical centre during the following times: routine testing, 2011 to 2016; MPS, 2013 to 2016; SN: 2013 to 2014. Costs were in 2016 dollars and included personnel, HIV testing, training, materials, overhead. Outcomes included cost per test, HIV-positive test and new diagnosis. Sensitivity analyses were performed to assess the impact of population demographics. RESULTS The RS programme completed 57,308 HIV tests resulting in 360 (0.6%) HIV-positive tests and 165 new HIV diagnoses (0.28%). The MPS completed 146 HIV tests, resulting in 79 (54%) HIV-positive tests and eight new HIV diagnoses (5%). The SN strategy completed 508 HIV tests, resulting in 210 (41%) HIV-positive tests and 37 new HIV diagnoses (7.2%). Labour accounted for the majority of costs in all strategies. The estimated cost per new HIV diagnosis was $16,773 for the RS programme, $61,418 for the MPS programme and $15,683 for the SN testing programme. These costs were reduced for the RS and MPS strategies in sensitivity analyses limiting testing efficacy to the highest prevalence patient populations ($2,841 and $33,233 respectively). CONCLUSIONS The SN strategy yielded the highest proportion of new diagnoses, followed closely by the MPS programme. Both the SN strategy and RS programme were comparable in the cost per new diagnosis. A simultaneous approach that consists of RS in combination with SN testing may be most effective for identifying new HIV infections in settings with heterogeneous epidemics with both high rates of HIV prevalence and HIV testing.
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Affiliation(s)
- Britt Skaathun
- Department of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCAUSA
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
| | - Mai T Pho
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - Harold A Pollack
- School of Social Service AdministrationUniversity of ChicagoChicagoILUSA
| | - Samuel R Friedman
- Department of Population HealthNew York University Medical SchoolNew YorkNYUSA
| | - Moira C McNulty
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | | | | | - David Pitrak
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - John A Schneider
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
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23
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Montgomery L, Bagot K, Brown JL, Haeny AM. The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review. Curr HIV/AIDS Rep 2020; 16:17-28. [PMID: 30671919 DOI: 10.1007/s11904-019-00422-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Approximately 77% of HIV-infected adults report lifetime marijuana use. Given the high rates and social acceptability of marijuana use among HIV-infected individuals, it is important to gain a stronger understanding of if, and how, marijuana impacts HIV care cascade outcomes. The purpose of this study is to systematically review recent articles that assess the relationship between marijuana use and HIV continuum of care outcomes. RECENT FINDINGS One hundred and ninety articles from PubMed were considered for inclusion, and 15 were included in the review. The studies focus on marijuana use among HIV-infected individuals aware of their serostatus (k = 4), individuals engaged in treatment (k = 1), marijuana use in association with adherence to antiretroviral medications (k = 6), and marijuana use in relation to multiple stages of the HIV care cascade (k = 4). Preliminary findings from the small number of studies revealed an association between marijuana use, especially current heavy use, and HIV seropositivity. However, results from studies assessing marijuana use and treatment engagement and adherence to antiretroviral medications were inconsistent and inconclusive. Additional research is needed to assess the nuanced relationship between marijuana use and HIV continuum of care outcomes, especially among subgroups of HIV-infected individuals, such as men who have sex with men and young adults.
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Affiliation(s)
- LaTrice Montgomery
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Kara Bagot
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, MC 0405, La Jolla, CA, 92093, USA
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA
| | - Angela M Haeny
- Division of Prevention and Community Research, Yale School of Medicine, The Consultation Center, 389 Whitney Avenue, New Haven, CT, 06511, USA
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24
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Dennis ML, Smith CN, Belenko S, Knight D, McReynolds L, Rowan G, Dembo R, DiClemente R, Robertson A, Wiley T. Operationalizing a Behavioral Health Services Cascade of Care Model: Lessons Learned from a 33-Site Implementation in Juvenile Justice Community Supervision. FEDERAL PROBATION 2019; 83:52-64. [PMID: 34366438 PMCID: PMC8341285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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25
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Young LE, Fujimoto K, Alon L, Zhang L, Schneider JA. The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement. JOURNAL OF SOCIAL STRUCTURE : JOSS 2019; 20:70-95. [PMID: 32855626 PMCID: PMC7449318 DOI: 10.21307/joss-2019-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.
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Affiliation(s)
- Lindsay E Young
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Leigh Alon
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liang Zhang
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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26
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Bruce D, Bouris AM, Bowers S, Blocker O, Lee SY, Glidden MF, Schneider JA, Reirden DH. Medical, therapeutic, and recreational use of cannabis among young men who have sex with men living with HIV. ADDICTION RESEARCH & THEORY 2019; 28:250-259. [PMID: 32952491 PMCID: PMC7500448 DOI: 10.1080/16066359.2019.1629427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 06/11/2023]
Abstract
Cannabis plays a role in symptoms management in HIV, especially the alleviation of pain and nausea and stimulation of appetite, and prevalence of cannabis use in HIV-positive populations exceeds that of the general U.S. population. Previous research has described an "overlap" between medical and recreational cannabis use among persons living with HIV. To understand better the motives associated cannabis use among young men who have sex with men living with HIV (HIV+ YMSM), we conducted semi-structured interviews with 30 HIV+YMSM in Denver and Chicago. Interviews were audio-recorded, transcribed, and coded by a diverse team of analysts. In addition to findings that mapped onto previously identified medical motives and recreational motives, we identified several themes that straddled medical and recreational use in a domain we describe as therapeutic. Themes identified in this therapeutic domain of cannabis use include (a) enhanced introspection among individuals that promotes psychological adjustment to an HIV diagnosis, improved medical management, and future orientation; (b) reflection processes that mitigate interpersonal conflict and improve interpersonal communication; and (c) a social-therapeutic phenomena of cannabis use among young persons with living HIV that is characterized by both enhanced introspection and improved interpersonal communication. Our findings suggest a spectrum of cannabis use among HIV+ YMSM that may be characterized not only by an overlap between medical and recreational use, but also by a distinct therapeutic domain that incorporates stress alleviation and cognitive expansion processes to improve focus on HIV management and self-care.
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Affiliation(s)
- Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL
| | - Alida M. Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Shannon Bowers
- Department of Health Sciences, DePaul University, Chicago, IL
| | - Olivia Blocker
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Soo Young Lee
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Mary F. Glidden
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - John A. Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Daniel H. Reirden
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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Skaathun B, Voisin DR, Cornwell B, Lauderdale DS, Schneider JA. A Longitudinal Examination of Factors Associated with Network Bridging Among YMSM: Implications for HIV Prevention. AIDS Behav 2019; 23:1326-1338. [PMID: 30136156 PMCID: PMC6386635 DOI: 10.1007/s10461-018-2258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Social-environmental factors may be associated with social network stability, which has implications for HIV acquisition. However, the link between social-environmental factors, network composition and HIV risk has not been examined previously among a city-population based sample of young Black men who have sex with Men (YBMSM). Respondent driven sampling was used to recruit a cohort of 618 YMBSM. Respondents were evaluated at baseline, 9 and 18 months beginning June 2013. A logistic regression model was used to assess the relationship between bridging (i.e. having non-redundant contacts in one's network, indicating network instability) and social-environmental factors and HIV risk factors between respondents, and a conditional logit model was used to assess these relationships within respondents over time. Bridging was associated with adverse social-environmental factors and higher HIV risk, indicating that bridging may be on the explanatory pathway. Future studies should assess the extent to which network stability factors mitigate HIV risk.
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Affiliation(s)
- Britt Skaathun
- Department of Medicine, University of California-San Diego, San Diego, CA, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
- University of California, San Diego, 9500 Gillman Dr., La Jolla, CA, 92093-0507, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | | | - Diane S Lauderdale
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
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29
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Morgan E, D'Aquila R, Carnethon MR, Mustanski B. Cardiovascular disease risk factors are elevated among a cohort of young sexual and gender minorities in Chicago. J Behav Med 2019; 42:1073-1081. [PMID: 30968321 DOI: 10.1007/s10865-019-00038-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/30/2019] [Indexed: 12/28/2022]
Abstract
To date, little research has examined cardiovascular (CVD) risk among young sexual and gender minorities, a population which behavioral research has suggested may be at unique risk of poor CVD outcomes. We assessed behavioral risk factors and biomarkers of CVD risk among young sexual and gender minorities (YSGM) aged 16-29 in Chicago who are participants in the RADAR cohort (analytic N = 936). Multiplex cytokine and inflammatory biomarker assays were run on plasma from all HIV+ participants and demographically-matched HIV- participants (n = 237). Geographic data were used to assess mean C-reactive protein (CRP) level per community area of residence in Chicago. YSGM in this cohort exhibited lower rates of obesity (19.2% in RADAR vs. 35.7% in earlier studies of heterosexual youth) and comparable rates of past 30-day tobacco use (37.9 vs. 38.1%). Conversely, higher rates were observed among several other risk factors including C-reactive protein (mean = 6.9 mg/L vs. 2.1 mg/L), marijuana use (72.5 vs. 45.3%), perceived stress (mean = 15.5 vs. 14.2), and HIV (20.0 vs. < 1% nationally). Finally, we observed geographic heterogeneity in mean CRP values by community area across the Chicago region with the highest and lowest values both found in neighborhoods on the North side of the city. In sum, these analyses demonstrate that YSGM may be at increased risk of CVD beginning from an early age. Future research should assess whether sexual minority-related stressors increase long-term CVD risk and should also longitudinally study the role of multiple risk factors on CVD morbidity and mortality among YSGM.
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Affiliation(s)
- Ethan Morgan
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 14-061, Chicago, IL, 60611, USA
| | - Richard D'Aquila
- Department of Medicine, Division of Infectious Diseases and HIV Translational Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 14-061, Chicago, IL, 60611, USA. .,Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
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Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals? J Acquir Immune Defic Syndr 2018; 77:128-134. [PMID: 29135652 DOI: 10.1097/qai.0000000000001586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Debate remains as to the relative HIV transmission contributions from individuals who are recently HIV-infected and individuals who have long-term infections. In this study, we examine the relationship between new HIV seroconversions occurring among young black men who have sex with men and network proximity to recently or long-term HIV-infected individuals. A cohort of young black men who have sex with men (N = 618) was generated through respondent-driven sampling across 3 waves. A recent HIV infection was defined as either: (1) a confirmed seroconversion ≤9 months before interview date or (2) a laboratory confirmed acute infection; long-term HIV-infected individuals were defined as a diagnosis date ≥9 months before interview date. Respondent-driven sampling-weighted logistic regression was used to examine network proximity of HIV transmission events to HIV-infected individuals in the network. Within the cohort, 343 (55.5%) participants were identified as HIV seronegative at baseline. Of these, 33 (9.6%) seroconverted during the study period. The odds of seroconversion increased significantly with each additional recent HIV-infected individual in one's network [adjusted odds ratio = 12.96; 95% confidence interval: 5.69 to 29.50], but were not significantly altered by the number of long-term infected individuals in one's network. In addition, for each member of one's network who used pre-exposure prophylaxis, the odds of seroconversion decreased significantly (adjusted odds ratio = 0.44; 95% confidence interval: 0.20 to 0.96). Early diagnosis and treatment is a critical first step in the HIV care continuum and together with pre-exposure prophylaxis awareness and use are critical targets for disrupting the transmission of HIV through most at-risk networks.
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Gore D, Ferreira M, Khanna AS, Schneider J. Human Immunodeficiency Virus Partner Notification Services Among a Representative Sample of Young Black Men Who Have Sex With Men Demonstrates Limited Service Offering and Potential Benefits of Clinic Involvement. Sex Transm Dis 2018; 45:636-641. [PMID: 29465643 PMCID: PMC6089660 DOI: 10.1097/olq.0000000000000806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partner notification (PN) is commonly offered to persons recently diagnosed with human immunodeficiency virus (HIV) to improve linkage to care and prevent onward transmission. Yet, much remains unknown about the factors associated with successful PN participation in populations at highest risk. METHODS Data were collected during the first 2 waves (2013-2015) of "uConnect," a population-based cohort study of young black men who have sex with men in Chicago (N = 618). Participants completed a biobehavioral survey and were tested for HIV. Among HIV-infected participants (N = 187), weighted logistic regression models examined the relationship between participant characteristics and being offered PN and providing partner names. RESULTS 30.3% (n = 187) of the sample was HIV-positive, of which 71.7% (n = 134) were offered PN, including: 8.2% (n = 11) by the city health department; 51.5% (n = 69) by health care providers; and 40.3% (n = 54) by both. Being offered PN was significantly associated with criminal justice involvement history (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.38-4.49), volatile nitrates usage (aOR, 2.88; 95% CI, 1.20-6.94), and recent conversations with HIV outreach workers (aOR, 2.68; 95% CI, 1.25-5.77). Providing partner names was significantly associated with intermittent (aOR, 7.26; 95% CI, 1.75-30.07) and heavy (aOR, 11.47; 95% CI, 2.57-51.22) marijuana use, and being offered PN by both the city health department and health care provider (aOR, 8.36; 95% CI, 2.73-25.62). CONCLUSIONS A substantial proportion of HIV-diagnosed individuals were never offered PN. Being offered PN by multiple sources is associated with participation, and improved collaboration within health systems may improve participation rates.
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Affiliation(s)
- Daniel Gore
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Matthew Ferreira
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - Aditya S. Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - John Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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Regular Marijuana Use is Associated with Poor Viral Suppression in HIV-Infected Adolescents and Young Adults. AIDS Behav 2018; 22:1363-1372. [PMID: 29094229 DOI: 10.1007/s10461-017-1961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is a paucity of data regarding the impact of drug use on HIV suppression and care retention among adolescents and young adults (AYAs). We recruited a clinic-based sample of HIV infected AYAs to assess the prevalence of self-reported drug use. Clinical data, including retention and viral suppression, were abstracted from the electronic medical record. Logistic regression was used to evaluate marijuana and illicit drug use associations and to identify other risk factors. Of 200 participants (mean age 21, 2.4 years, 69% horizontally infected), 46% reported current drug use, with marijuana as the most commonly used drug. Any illicit drug use (aOR 1.99, 95% CI 1.06-3.73, p = 0.032) and lower education (aOR 2.11, 95% CI 1.09-4.08, p = 0.046) were associated with poor viral suppression in multivariable analyses. Considering marijuana use only, an association with poor viral suppression was more pronounced (aOR 2.10, 95% CI 1.12-3.94, p = 0.021). Drug use did not have a significant association with retention in care, but AYAs who were retained in HIV care were less likely to have poorly suppressed HIV (aOR 0.22, 95% CI 0.10-0.49, p < 0.001). High prevalence of marijuana use among HIV infected AYAs, and its association with poorly suppressed HIV, demonstrates the need for intervention strategies to decrease its consumption.
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Skaathun B, Khanna AS, Morgan E, Friedman SR, Schneider JA. Network Viral Load: A Critical Metric for HIV Elimination. J Acquir Immune Defic Syndr 2018; 77:167-174. [PMID: 29112042 PMCID: PMC5762423 DOI: 10.1097/qai.0000000000001584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Associations have been observed between an aggregate viral load measure, the community viral load, and new HIV diagnoses. The community viral load aggregates viral loads within chosen geographic areas, restricting inferences about HIV acquisition risk to these areas. We develop a more precise metric, the network viral load (NVL), to measure the composite viral load within a risk network of a HIV-negative individual. METHODS We examined the relationship between NVL and HIV infection among young men who have sex with men in Chicago, United States. Networks were generated using respondent-driven sampling. NVL was defined as the prevalence of viremic individuals in one's risk network, characterized as those with a viral load ≥20 k copies per milliliter. Permutation tests were conducted to account for dependency. RESULTS After controlling for total connections, age, substance use during sex, syphilis diagnosis (previous 12 months), and frequency of condomless anal sex (previous 6 months), we found a positive association between NVL and HIV infection. Compared with a network with all HIV-seronegative members, the odds of HIV infection with an NVL of <10% viremia were 1.85 (95% confidence interval: 1.18 to 2.92) times higher and those with an NVL of ≥10% viremia were 2.73 (95% confidence interval: 1.54 to 4.85) times higher. CONCLUSIONS We found a positive association between NVL and HIV seroprevalence. Although limited in its ability to infer causality, NVL could have substantial public health implications for persons most at risk for HIV infection, given that this novel metric avoids overreliance on individual level behavior or broad community indices.
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Affiliation(s)
| | | | | | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
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Schneider JA, Lancki N, Schumm P. At the intersection of criminal justice involvement and sexual orientation: Dynamic networks and health among a population-based sample of young Black men who have sex with men. SOCIAL NETWORKS 2017; 51:73-87. [PMID: 29062165 PMCID: PMC5650246 DOI: 10.1016/j.socnet.2017.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mass incarceration of young Black men has a significant impact on their network composition and stability that, in turn, may have major implications for health and well-being. A sub-group of young Black men with criminal justice involvement (CJI) identify as gay, bisexual or are non-identified men who have sex with men (hereafter MSM). This paper focuses on the potential effects of CJI on the composition of Black MSM social and sexual networks, their stability over time, and concomitant health and social outcomes. We use data from the UConnect study, a population-based cohort of young Black MSM 16-29 years of age (n=618) selected using respondent-driven sampling in Chicago from 2013-2016. Both confidant and sexual network name generators and interpreters were administered at 9-month intervals over three waves of data collection. Ego and dyadic-level data were collected on behaviors prevalent among MSM and including factors associated with network CJI, network stability, and health outcomes. Generalized Structural Equation Models (GSEM) were utilized to determine the relationship between CJI network composition, network stability and behaviors prevalent among young Black MSM and their networks. In the UConnect cohort, 46% had at least once been detained, arrested or spent time in jail or prison. In addition, 20% of participants reported incident CJI over the study period. Respondents with a history of CJI were significantly more likely to have CJI homophily in their confidant and sexual networks. Multivariate analyses demonstrate that the association between one's history of CJI, housing instability and drug use is partially explained by one's network CJI. In addition, a higher prevalence of network CJI is associated with increased turnover in the confidant network, and this network instability is also related to important health and social outcomes. This analysis describes the networks of criminal justice involved men among a representative sample of young Black MSM and demonstrates the relationship between CJI network homophily, network stability and their impact on several key health and social outcomes relevant to this population.
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Affiliation(s)
- J A Schneider
- Department of Medicine, University of Chicago
- Department of Public Health Sciences, University of Chicago
- Chicago Center for HIV Elimination, University of Chicago
| | - N Lancki
- Department of Medicine, University of Chicago
- Chicago Center for HIV Elimination, University of Chicago
| | - P Schumm
- Department of Public Health Sciences, University of Chicago
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Morgan E, Nyaku AN, D’Aquila RT, Schneider JA. Determinants of HIV Phylogenetic Clustering in Chicago Among Young Black Men Who Have Sex With Men From the uConnect Cohort. J Acquir Immune Defic Syndr 2017; 75:265-270. [PMID: 28328553 PMCID: PMC5472497 DOI: 10.1097/qai.0000000000001379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Phylogenetic analysis determines similarities among HIV genetic sequences from persons infected with HIV, identifying clusters of transmission. We determined characteristics associated with both membership in an HIV transmission cluster and the number of clustered sequences among a cohort of young black men who have sex with men (YBMSM) in Chicago. METHODS Pairwise genetic distances of HIV-1 pol sequences were collected during 2013-2016. Potential transmission ties were identified among HIV-infected persons whose sequences were ≤1.5% genetically distant. Putative transmission pairs were defined as ≥1 tie to another sequence. We then determined demographic and risk attributes associated with both membership in an HIV transmission cluster and the number of ties to the sequences from other persons in the cluster. RESULTS Of 86 available sequences, 31 (36.0%) were tied to ≥1 other sequence. Through multivariable analyses, we determined that those who reported symptoms of depression and those who had a higher number of confidants in their network had significantly decreased odds of membership in transmission clusters. We found that those who had unstable housing and who reported heavy marijuana use had significantly more ties to other individuals within transmission clusters, whereas those identifying as bisexual, those participating in group sex, and those with higher numbers of sexual partners had significantly fewer ties. CONCLUSIONS This study demonstrates the potential for combining phylogenetic and individual and network attributes to target HIV control efforts to persons with potentially higher transmission risk, as well as suggesting some unappreciated specific predictors of transmission risk among YBMSM in Chicago for future study.
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Affiliation(s)
- Ethan Morgan
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - Amesika N Nyaku
- Department of Medicine, Northwestern University, Chicago, USA
| | | | - John A Schneider
- Department of Public Health Sciences, University of Chicago, Chicago, USA
- Department of Medicine, University of Chicago, Chicago, USA
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Kipp AM, Rebeiro PF, Shepherd BE, Brinkley-Rubinstein L, Turner M, Bebawy S, Sterling TR, Hulgan T. Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care. AIDS Behav 2017; 21:1996-2004. [PMID: 28213820 PMCID: PMC5493511 DOI: 10.1007/s10461-017-1716-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine's (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose-response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.
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Affiliation(s)
- Aaron M Kipp
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, 37203, USA.
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren Brinkley-Rubinstein
- Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally Bebawy
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd Hulgan
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Hightow-Weidman L, LeGrand S, Choi SK, Egger J, Hurt CB, Muessig KE. Exploring the HIV continuum of care among young black MSM. PLoS One 2017; 12:e0179688. [PMID: 28662170 PMCID: PMC5491033 DOI: 10.1371/journal.pone.0179688] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young, black men who have sex with men (YBMSM) who experience disparities across the HIV care continuum. A more nuanced understanding of facilitators and barriers to engagement in care, missed visits, antiretroviral uptake, adherence and viral suppression could improve care and intervention design. METHODS A randomized controlled trial of an online intervention, healthMpowerment, enrolled 465 YBMSM (18-30 years); 193 identified as HIV-positive. Bivariable and multivariable analyses of baseline data explored predictors of: engagement in care, missed visits, antiretroviral uptake, self-reported adherence, and viral suppression. RESULTS Mean age was 24.9 years; most identified as gay (71.0%) and were receiving HIV care (89.1%). Among those in care, 52.1% reported no missed visits in the past 12 months, 41 (24.6%) reported one missed visit, and 39 (23.4%) reported two or more. Having insurance (prevalence odds ratio [POR] 4.5; 95% CI: 1.3, 15.8) and provider self-efficacy (POR 20.1; 95% CI: 6.1, 64.1) were associated with being in care. Those with a college degree (POR 9.1; 95% CI: 1.9, 45.2) and no recent marijuana (POR 2.6; 95% CI: 1.2, 5.6) or methamphetamine use (POR 5.4; 95% CI: 1.0, 28.5) were less likely to miss visits. Most (n = 153, 84.1%) had been prescribed antiretroviral therapy. A majority of participants (70.8%) reported ≥90% adherence; those with depressive symptoms had 4.7 times the odds of reporting adherence <90% (95% CI: 1.65, 13.37). Of participants who reported viral load testing in the past six months, 65% (n = 102) reported an undetectable viral load. Disclosure to sex partners was associated with viral suppression (POR 6.0; 95% CI: 1.6, 22.4). CONCLUSIONS Multi-level facilitators and barriers to engagement across the continuum of care were identified in this sample of YBMSM. Understanding the distinct needs of YBMSM at each stage of the continuum and addressing them through tailored approaches is critical for long term success in care.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Seul Ki Choi
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Christopher B. Hurt
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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