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Ikeuchi K, Saito M, Adachi E, Koga M, Okushin K, Tsutsumi T, Yotsuyanagi H. Injection drug use and sexually transmitted infections among men who have sex with men: A retrospective cohort study at an HIV/AIDS referral hospital in Tokyo, 2013-2022. Epidemiol Infect 2023; 151:e195. [PMID: 37965724 PMCID: PMC10728981 DOI: 10.1017/s0950268823001772] [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: 04/03/2023] [Revised: 09/13/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
Men who have sex with men (MSM) who use injection drugs (MSM-IDU) are at high risk of sexually transmitted infections (STIs), but the long-term incidence is unclear. We conducted a single-centre retrospective cohort study using the clinical records of non-haemophilia men with human immunodeficiency virus (HIV) who visited the Institute of Medical Science, the University of Tokyo (IMSUT) Hospital, located in Tokyo, Japan, from 2013 to 2022. We analysed 575 patients including 62 heterosexual males and 513 MSM patients, of whom 6.8% (35/513) were injection drug use (IDU). Compared to non-IDU MSM, MSM-IDU had a higher incidence of hepatitis C virus (HCV) (44.8 vs 3.5 /1,000 person-years (PY); incidence rate ratio (IRR) [95% confidence interval (95% CI)], 12.8 [5.5-29.3], p < 0.001) and syphilis (113.8 vs 53.3 /1,000 PY; IRR, 2.1 [1.4-3.1], p < 0.001). The incidence of other symptomatic STIs (amoebiasis, chlamydia, and gonorrhoea infections) was <4/1,000 PY. In multivariable Poisson regression analysis, HCV incidence was associated with MSM (IRR, 1.8 × 106 [9.9 × 105-3.4 × 106], p < 0.001), IDU (IRR, 10.1 [4.0-25.6], p < 0.001), and syphilis infection during the study period (IRR, 25.0 [1.2-518.3]/time/year, p < 0.001). Among men with HIV, the prevalence of IDU in MSM and the long-term incidence of STIs in MSM-IDU were high. IDU and sexual contact are important modes of transmission of HCV among HIV-infected MSM in Tokyo.
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Affiliation(s)
- Kazuhiko Ikeuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Kazuya Okushin
- Department of Infection Control and Prevention, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
- Department of Infection Control and Prevention, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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Malloy GSP, Goldhaber-Fiebert JD, Enns EA, Brandeau ML. Predicting the Effectiveness of Endemic Infectious Disease Control Interventions: The Impact of Mass Action versus Network Model Structure. Med Decis Making 2021; 41:623-640. [PMID: 33899563 PMCID: PMC8295189 DOI: 10.1177/0272989x211006025] [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: 11/16/2022]
Abstract
BACKGROUND Analyses of the effectiveness of infectious disease control interventions often rely on dynamic transmission models to simulate intervention effects. We aim to understand how the choice of network or compartmental model can influence estimates of intervention effectiveness in the short and long term for an endemic disease with susceptible and infected states in which infection, once contracted, is lifelong. METHODS We consider 4 disease models with different permutations of socially connected network versus unstructured contact (mass-action mixing) model and heterogeneous versus homogeneous disease risk. The models have susceptible and infected populations calibrated to the same long-term equilibrium disease prevalence. We consider a simple intervention with varying levels of coverage and efficacy that reduces transmission probabilities. We measure the rate of prevalence decline over the first 365 d after the intervention, long-term equilibrium prevalence, and long-term effective reproduction ratio at equilibrium. RESULTS Prevalence declined up to 10% faster in homogeneous risk models than heterogeneous risk models. When the disease was not eradicated, the long-term equilibrium disease prevalence was higher in mass-action mixing models than in network models by 40% or more. This difference in long-term equilibrium prevalence between network versus mass-action mixing models was greater than that of heterogeneous versus homogeneous risk models (less than 30%); network models tended to have higher effective reproduction ratios than mass-action mixing models for given combinations of intervention coverage and efficacy. CONCLUSIONS For interventions with high efficacy and coverage, mass-action mixing models could provide a sufficient estimate of effectiveness, whereas for interventions with low efficacy and coverage, or interventions in which outcomes are measured over short time horizons, predictions from network and mass-action models diverge, highlighting the importance of sensitivity analyses on model structure. HIGHLIGHTS • We calibrate 4 models-socially connected network versus unstructured contact (mass-action mixing) model and heterogeneous versus homogeneous disease risk-to 10% preintervention disease prevalence.• We measure the short- and long-term intervention effectiveness of all models using the rate of prevalence decline, long-term equilibrium disease prevalence, and effective reproduction ratio.• Generally, in the short term, prevalence declined faster in the homogeneous risk models than in the heterogeneous risk models.• Generally, in the long term, equilibrium disease prevalence was higher in the mass-action mixing models than in the network models, and the effective reproduction ratio was higher in network models than in the mass-action mixing models.
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Affiliation(s)
- Giovanni S P Malloy
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Eva A Enns
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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Mistler CB, Copenhaver MM, Shrestha R. The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review. AIDS Behav 2021; 25:1490-1506. [PMID: 32749627 PMCID: PMC7858689 DOI: 10.1007/s10461-020-02988-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Injection drug use is a key risk factor for the transmission of HIV. Prevention strategies, such as the use of pre-exposure prophylaxis (PrEP), are effective at reducing the risk of HIV transmission in people who inject drugs (PWID). Following PRISMA guidelines, a literature search was conducted to identify the current state of the PrEP care cascade in PWID. Twenty-three articles were evaluated in this systematic review. A decline in engagement throughout the stages of the PrEP care cascade was found. High awareness and willingness to use PrEP was found, yet PrEP uptake was relatively low (0-3%). There is a lack of research on interventions to increase engagement of PrEP across all levels of the care cascade in PWID. Implications from the interventions that have been published provide insight into practice and public policy on efficacious strategies to reduce HIV incidence in PWID. Our findings suggest that more efforts are needed to identify and screen PWID for PrEP eligibility and to link and maintain them with appropriate PrEP care.
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Affiliation(s)
- Colleen B Mistler
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA.
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Roman Shrestha
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Distributive Syringe Sharing and Use of Syringe Services Programs (SSPs) Among Persons Who Inject Drugs. AIDS Behav 2019; 23:3306-3314. [PMID: 31512066 DOI: 10.1007/s10461-019-02615-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Monitoring distributive syringe sharing (DSS) and syringe services program (SSP) use among persons who inject drugs (PWID) is important for HIV prevention. PWID aged ≥ 18 in 20 US cities were recruited for National HIV Behavioral Surveillance in 2015 using respondent-driven sampling, interviewed and offered HIV testing. Bivariate and multivariable analyses via log-linked Poisson regression with generalized estimating equations were conducted to examine associations between demographic and behavioral variables and DSS. Effect of SSP use on DSS by HIV sero-status was assessed by including an interaction between SSP and sero-status. Analyses were adjusted for sampling design. Among 10,402 PWID, 42% reported DSS. DSS was less likely to be reported among HIV-positive compared to HIV-negative PWID (aPR = 0.51, CI 0.45-0.60), and among those who primarily obtained syringes from SSPs versus those who did not (aPR = 0.82, 95% CI 0.77-0.88). After adjustment, those who primarily used SSPs were less likely to report DSS than those who did not among both HIV-negative PWID (aPR = 0.84, 95% CI 0.78-0.90) and HIV-positive PWID (aPR = 0.54, 95% CI 0.39-0.75). Findings support expansion of SSPs, and referrals to SSPs by providers working with PWID.
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Abstract
We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6 months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR = 3.33), crystal methamphetamine use (AOR = 1.30), borrowing used syringes (AOR = 1.39), inconsistent condom use (AOR = 1.76), and HIV seropositivity (AOR = 3.82). MSM were less likely to be Hepatitis C-positive (AOR = 0.43) and to have accessed addiction treatment in the previous 6 months (AOR = 0.83) (all p < 0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.
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Reback CJ, Fletcher JB, Swendeman D. Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men. Subst Use Misuse 2018; 53:1826-1833. [PMID: 29432057 PMCID: PMC6179439 DOI: 10.1080/10826084.2018.1436566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors. OBJECTIVES This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners. METHODS From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors. RESULTS Participants' racial/ethnic identity (χ2(6) = 43.5; p < 0.0001), HIV status (χ2(6) = 22.0; p = 0.0012), educational attainment level (χ2(6) = 13.8; p = 0.0322), and years of age (χ2(6) = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ2(2) = 7.0; p = 0.0309) and marijuana (χ2(2) = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners. CONCLUSION Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.
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Affiliation(s)
- Cathy J Reback
- a Friends Research Institute, Inc. , Los Angeles , California , USA.,b David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior , University of California , Los Angeles , California , USA.,c Center for HIV Identification, Prevention and Treatment Services , University of California , Los Angeles , California , USA
| | - Jesse B Fletcher
- a Friends Research Institute, Inc. , Los Angeles , California , USA
| | - Dallas Swendeman
- c Center for HIV Identification, Prevention and Treatment Services , University of California , Los Angeles , California , USA
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Nerlander LMC, Hoots BE, Bradley H, Broz D, Thorson A, Paz-Bailey G. HIV infection among MSM who inject methamphetamine in 8 US cities. Drug Alcohol Depend 2018; 190:216-223. [PMID: 30055426 PMCID: PMC11301976 DOI: 10.1016/j.drugalcdep.2018.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Men who have sex with men (MSM) and inject drugs are at risk for HIV infection. Although research exists on non-injection methamphetamine (meth) use and sexual risk among MSM, less is known about meth injection and its association with HIV infection among MSM who inject drugs. METHODS We analyzed data from men aged ≥18 years who reported injecting drugs and male-to-male sexual contact. Men were recruited using respondent-driven sampling, interviewed, and tested for HIV during the 2012 and 2015 cycles of National HIV Behavioral Surveillance among persons who inject drugs. We included data from 8 cities where ≥10 MSM reported meth as the primary drug injected. We assessed differences in demographic characteristics, past 12 months risk behaviors, and HIV infection between MSM who primarily injected meth and those who primarily injected another drug. RESULTS Among 961 MSM, 33.7% reported meth as the drug they injected most often. Compared to MSM who primarily injected other drugs, MSM who primarily injected meth were more likely to have had ≥5 condomless anal sex partners, have been diagnosed with syphilis, and were less likely to report sharing syringes. In multivariable analysis, injecting meth was associated with being HIV-positive (adjusted prevalence ratio 1.48; 95% confidence interval 1.08-2.03). Including number of condomless anal sex partners in mediation analysis rendered this association no longer significant. CONCLUSIONS HIV prevalence among MSM who primarily injected meth was almost 50% higher than among MSM who primarily injected other drugs, and this association was mediated by sexual risk.
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Affiliation(s)
- Lina M C Nerlander
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA; Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Brooke E Hoots
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Heather Bradley
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Dita Broz
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Anna Thorson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Gabriela Paz-Bailey
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
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Nosyk B, Min JE, Krebs E, Zang X, Compton M, Gustafson R, Barrios R, Montaner JSG. The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 2018; 66:765-777. [PMID: 29028964 PMCID: PMC5850008 DOI: 10.1093/cid/cix832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Background Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | - Miranda Compton
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis. PLoS Med 2017; 14:e1002312. [PMID: 28542184 PMCID: PMC5443477 DOI: 10.1371/journal.pmed.1002312] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/28/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV-a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP). METHODS AND FINDINGS We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limited and, in practice, the expansion scenarios considered may exceed feasible levels. We assumed independence of interventions and constant returns to scale. Extensive sensitivity analyses allowed us to assess parameter sensitivity, but the use of a dynamic compartmental model limited the exploration of structural sensitivities. CONCLUSIONS We estimate that OAT, NSPs, and Test & Treat, implemented singly or in combination, have the potential to effectively and cost-effectively prevent HIV in US PWID. PrEP is not likely to be cost-effective in this population, based on the scenarios we evaluated. While local budgets or policy may constrain feasible coverage levels for the various interventions, our findings suggest that investments in combined prevention programs can substantially reduce HIV transmission and improve health outcomes among PWID.
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Nyamathi A, Reback CJ, Shoptaw S, Salem BE, Zhang S, Yadav K. Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men. Am J Mens Health 2017; 11:208-220. [PMID: 26130725 PMCID: PMC5675281 DOI: 10.1177/1557988315590837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A randomized controlled trial was conducted with homeless gay and bisexual men to assess the impact of two culturally sensitive intervention programs on reduction of drug use and risky sexual behavior. In this study, gay and bisexual men between 18 and 46 years of age were randomly assigned to one of two culturally sensitive behavioral intervention programs: a Nurse Case Management Plus Contingency Management (NCM + CM; n = 204) or a Standard Education Plus Contingency Management (SE + CM; n = 210) program. Regardless of group assignment, significant and clinically relevant reductions were observed in stimulant use over time. Multivariable predictors of stimulant use at 4- and 8-month follow-up evaluations were recent injection drug use, tested positive for HIV, or for use of amphetamine. Data revealed a significant linear decline over time for those who had sex with multiple partners. Furthermore, being HIV positive was associated with reporting multiple partners, while higher homophobia scores and having children were inversely related to reports of having sex with multiple partners at follow-up. Culturally sensitive approaches are needed to successfully reduce drug use and risky sexual activities among gay and bisexual populations.
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, de Wit J. The Prevalence and Correlates of HIV and Undiagnosed Infection among Men Who Have Sex with Men in Hanoi, Vietnam: Findings from a Cross-sectional, Biobehavioral Study. Front Public Health 2016; 4:275. [PMID: 28066754 PMCID: PMC5165257 DOI: 10.3389/fpubh.2016.00275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/02/2016] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are a key population for HIV infection in Vietnam, and the use of amphetamine type substances (ATS) is prevalent and possibly increasing in this population. The reported analysis examines the association between ATS use before or during sex and HIV infection among MSM in Hanoi, Vietnam. METHODS This cross-sectional study of 210 MSM was conducted in Hanoi, Vietnam, in late 2014. Men tested for HIV and answered questions about demographic characteristics, sexual sensation seeking, depression, belief in HIV prevention strategies, homosexuality-related stigma and discrimination, recent accessing of HIV prevention services, sexual behaviors and ATS, and other drug use behaviors. We performed logistic regression to assess correlates of HIV infection. RESULTS HIV prevalence was 6.7% (14/210), and 85.7% (12/14) of HIV-positive men were not aware of their HIV status. Of the 210 participants, 10.5, 2.9, and 3.8% of men had used methamphetamine, amphetamine, and ecstasy before or during sex in the last 3 months. In multivariable analysis, HIV infection was associated with recent sex-related methamphetamine use [adjusted odds ratio (AOR): 5.03, 95% confidence interval (CI): 1.35-18.68], engaging in recent sex work (AOR: 3.55, 95% CI: 1.07-11.75), and homosexuality-related perceived stigma (AOR: 2.32, 95% CI: 0.98-5.47). CONCLUSION Findings underscore the importance of integrating methamphetamine use interventions into HIV prevention services and scaling-up of gay-friendly, non-stigmatizing HIV testing services for MSM in Hanoi. We recommend the routine assessment of ATS use and undiagnosed infection in this population.
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Affiliation(s)
- Nga Thi Thu Vu
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia , Sydney, NSW , Australia
| | - Huong Thi Thu Phan
- Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | | | | | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Utrecht University, Utrecht, Netherlands
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Saw YM, Saw TN, Wai KM, Poudel KC, Win HH. Correlates of sex trading among male non-injecting drug users in Myanmar: a cross-sectional study. Harm Reduct J 2016; 13:34. [PMID: 27919289 PMCID: PMC5139087 DOI: 10.1186/s12954-016-0123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex trading is a recognized risk factor for human immune deficiency virus infection and other sexually transmitted infections among non-injecting drug users (NIDUs). However, very little research has addressed the factors associated with sex trading among male NIDUs in Myanmar. METHODS A cross-sectional study was conducted from January to February 2010 using the respondent-driven sampling method. In total, 210 NIDUs aged between 18 and 49 years, with no history of injecting drug use, and who used non-injected illicit drugs in the last 6 months were recruited. Face-to-face interviews were conducted using a structured questionnaire to collect information on participants' sexual and drug use behaviors. Binary and multivariate logistic regressions were applied to analyze the resulting data. RESULTS Of 210 NIDUs, 84 (40%) reported involvement in the sex trade during the last 3 months. In the adjusted model, factors associated with sex trade involvement included homosexual preference (adjusted odds ratio [AOR] 4.90; 95% confidence interval [CI] 1.61-14.95), having more than two partners (AOR = 3.88; 95% CI 1.55-9.72), had a regular job (AOR = 5.10; 95% CI 1.65-15.72), use of stimulant drugs rather than opiate (AOR = 2.38; 95% CI 1.10-5.15), and who used drugs more than twice per day. CONCLUSIONS More than one third of NIDUs were involved in sex trading. This study suggested that further comprehensive intervention programs that aim to reduce risk factors of trading sex among NIDUs may consider including NIDUs who used stimulant drugs, had regular/full-time jobs, used drugs more than twice per day, and had homosexual preferences.
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Affiliation(s)
- Yu Mon Saw
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Thu Nandar Saw
- Myanma Perfect Research, Yangon, Myanmar.,Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kyi Mar Wai
- Department of Human Ecology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
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15
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Golub SA, Thompson LI, Kowalczyk WJ. Affective differences in Iowa Gambling Task performance associated with sexual risk taking and substance use among HIV-positive and HIV-negative men who have sex with men. J Clin Exp Neuropsychol 2016; 38:141-57. [PMID: 26745769 DOI: 10.1080/13803395.2015.1085495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.
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Affiliation(s)
- Sarit A Golub
- a Department of Psychology , Hunter College of the City University of New York (CUNY) , New York , NY , USA.,b Doctoral Program in Psychology , The Graduate Center of the City University of New York (CUNY) , New York , NY , USA
| | - Louisa I Thompson
- b Doctoral Program in Psychology , The Graduate Center of the City University of New York (CUNY) , New York , NY , USA
| | - William J Kowalczyk
- c Clinical Pharmacology & Therapeutics Branch , Intramural Research Program, National Institute on Drug Abuse , Baltimore , MD , USA
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Bernard CL, Brandeau ML, Humphreys K, Bendavid E, Holodniy M, Weyant C, Owens DK, Goldhaber-Fiebert JD. Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States. Ann Intern Med 2016; 165:10-19. [PMID: 27110953 PMCID: PMC5118181 DOI: 10.7326/m15-2634] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear. OBJECTIVE To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID. DESIGN Empirically calibrated dynamic compartmental model. DATA SOURCES Published literature and expert opinion. TARGET POPULATION Adult U.S. PWID. TIME HORIZON 20 years and lifetime. INTERVENTION PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage. OUTCOME MEASURES Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years. RESULTS OF SENSITIVITY ANALYSIS Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence. LIMITATION Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited. CONCLUSION PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Cora L. Bernard
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Margaret L. Brandeau
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Keith Humphreys
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eran Bendavid
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mark Holodniy
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Christopher Weyant
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Douglas K. Owens
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jeremy D. Goldhaber-Fiebert
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Shrestha R, Copenhaver M. The Influence of Neurocognitive Impairment on HIV Risk Behaviors and Intervention Outcomes among High-Risk Substance Users: A Systematic Review. Front Public Health 2016; 4:16. [PMID: 26904535 PMCID: PMC4746254 DOI: 10.3389/fpubh.2016.00016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
Neurocognitive impairment (NCI) among high-risk substance users poses a substantial barrier to reducing risk behaviors in this population. Previous work suggests that NCI is intertwined in a close, reciprocal relationship with risk behaviors. Not only does substance use worsen cognitive impairment but cognitive impairment may also reduce the efficacy of interventions aimed at reducing risk and improving medication adherence. In this systematic review, we examine the potential impact of substance abuse and cognitive functioning in the context of HIV risk behaviors and risk-reduction intervention outcomes. The findings thus far suggest that, in order to be effective, risk-reduction interventions must take into account the impact of NCI on learning, memory, and behavior.
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Affiliation(s)
- Roman Shrestha
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut , Storrs, CT , USA
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Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs. Epidemiol Infect 2016; 144:1683-700. [PMID: 26753627 DOI: 10.1017/s0950268815003180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events ('risk acts'), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
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Burt RD, Thiede H. Reduction in Needle Sharing Among Seattle-Area Injection Drug Users Across 4 Surveys, 1994-2013. Am J Public Health 2015; 106:301-7. [PMID: 26691117 DOI: 10.2105/ajph.2015.302959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated time trends in sharing needles and other injection equipment from 1994 to 2013 among injection drug users in the Seattle, Washington area. METHODS We combined data from 4 sources: the Risk Activity Variables, Epidemiology, and Network (RAVEN) study, recruited from institutional settings; the Kiwi study, recruited from jails; National HIV Behavioral Surveillance system (NHBS) surveys, which used respondent-driven sampling; and surveys at needle-exchange sites. RESULTS Levels of needle sharing were higher in the earlier studies: RAVEN, 1994 to 1997 (43%) and Kiwi, 1998 to 2002 (61%). In the NHBS surveys, the initial level of 44% in 2005 declined to 31% in the period 2009 to 2012. Across needle-exchange surveys (2009-2013) the level was 21%. There was a parallel reduction in sharing other injection equipment. These trends persisted after control for sociodemographic and risk-associated variables. There was a contemporaneous increase in the number of needles distributed by local needle exchanges and a decline in the number of reported HIV cases among injection drug users. CONCLUSIONS The apparent long-term reduction in sharing injection equipment suggests substantial success in public health efforts to reduce the sharing of injection equipment.
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Affiliation(s)
- Richard D Burt
- The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA
| | - Hanne Thiede
- The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA
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20
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Oldenburg CE, Perez-Brumer AG, Reisner SL, Mimiaga MJ. Transactional Sex and the HIV Epidemic Among Men Who have Sex with Men (MSM): Results From a Systematic Review and Meta-analysis. AIDS Behav 2015; 19:2177-83. [PMID: 25652233 DOI: 10.1007/s10461-015-1010-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Engagement in transactional sex has been hypothesized to increase risk of HIV among MSM, however conflicting evidence exists. We conducted a systematic review and meta-analysis comparing HIV prevalence among MSM who engaged in transactional sex to those who did not (33 studies in 17 countries; n = 78,112 MSM). Overall, transactional sex was associated with a significant elevation in HIV prevalence (OR 1.34, 95 % CI 1.11-1.62). Latin America (OR 2.28, 95 % CI 1.87-2.78) and Sub-Saharan Africa (OR 1.72, 95 % CI 1.02-2.91) were the only regions where this elevation was noted. Further research is needed to understand factors associated with sex work and subsequent HIV risk in Latin America and Sub-Saharan Africa.
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Song DL, Altice FL, Copenhaver MM, Long EF. Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States. PLoS One 2015; 10:e0116694. [PMID: 25658949 PMCID: PMC4320073 DOI: 10.1371/journal.pone.0116694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/14/2014] [Indexed: 02/05/2023] Open
Abstract
AIMS Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. METHODS A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. RESULTS Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. CONCLUSIONS Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.
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Affiliation(s)
- Dahye L. Song
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
| | - Frederick L. Altice
- AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michael M. Copenhaver
- Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, United States of America
| | - Elisa F. Long
- UCLA Anderson School of Management, Los Angeles, California, United States of America
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Amphetamine-type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and meta-analysis. J Int AIDS Soc 2015; 18:19273. [PMID: 25609214 PMCID: PMC4302169 DOI: 10.7448/ias.18.1.19273] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 11/02/2014] [Accepted: 11/28/2014] [Indexed: 01/17/2023] Open
Abstract
Introduction HIV infections and the use of amphetamine-type stimulants (ATS) among men who have sex with men (MSM) have been increasing internationally, but the role of ATS use as a co-factor for HIV infection remains unclear. We aimed to summarize the association between ATS use and HIV infection among MSM. Methods We conducted a systematic search of MEDLINE, EMBASE, GLOBAL HEALTH and PsycINFO for relevant English, peer-reviewed articles of quantitative studies published between 1980 and 25 April 2013. Pooled estimates of the association – prevalence rate ratios (PRR, cross-sectional studies), odds ratio (OR, case-control studies) and hazard ratio (HR, longitudinal studies), with 95% Confidence Intervals (CI) – were calculated using random-effects models stratified by study design and ATS group (meth/amphetamines vs. ecstasy). We assessed the existence of publication bias in funnel plots and checked for sources of heterogeneity using meta-regression and subgroup analysis. Results We identified 6710 article titles, screened 1716 abstracts and reviewed 267 full text articles. A total of 35 publications were eligible for data abstraction and meta-analysis, resulting in 56 records of ATS use. Most studies (31/35) were conducted in high-income countries. Published studies used different research designs, samples and measures of ATS use. The pooled association between meth/amphetamine use and HIV infection was statistically significant in all three designs (PRR=1.86; 95% CI: 1.57–2.17; OR=2.73; 95% CI: 2.16–3.46 and HR=3.43; 95% CI: 2.98–3.95, respectively, for cross-sectional, case-control and longitudinal studies). Ecstasy use was not associated with HIV infection in cross-sectional studies (PRR=1.15; 95% CI: 0.88–1.49; OR=3.04; 95% CI: 1.29–7.18 and HR=2.48; 95% CI: 1.42–4.35, respectively, for cross-sectional, case-control and longitudinal studies). Results in cross-sectional studies were highly heterogeneous due to issues with ATS measurement and different sampling frames. Conclusions While meth/amphetamine use was significantly associated with HIV infection among MSM in high-income countries in all study designs, evidence of the role of ecstasy in HIV infection was lacking in cross-sectional studies. Cross-sectional study design, measurement approaches and source populations may also be important modifiers of the strength and the direction of associations. Event-specific measure of individual drug is required to establish temporal relationship between ATS use and HIV infection. HIV prevention programmes targeting MSM should consider including interventions designed to address meth/amphetamine use.
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Hopwood M, Lea T, Aggleton P. Drug, sex and sociality: factors associated with the recent sharing of injecting equipment among gay and bisexual men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:210-3. [PMID: 25480395 DOI: 10.1016/j.drugpo.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/16/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Max Hopwood
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia.
| | - Toby Lea
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW-Australia, Sydney 2052, Australia
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Burt RD, Thiede H. Evidence for risk reduction among amphetamine-injecting men who have sex with men; results from national HIV behavioral surveillance surveys in the Seattle area 2008-2012. AIDS Behav 2014; 18:1998-2008. [PMID: 24728999 DOI: 10.1007/s10461-014-0769-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the Seattle area men who have sex with men and also inject amphetamines (amphetamine-injecting MSM/IDU) are disproportionately likely to be infected with HIV. To characterize their distinctive characteristics, we combined data from two Seattle-area surveys of men who have sex with men (MSM) and two surveys of injection drug users (IDU). Amphetamine-injecting MSM/IDU were compared with: male IDU, MSM and other MSM/IDU. Amphetamine-injecting MSM/IDU were older than MSM but younger than IDU, more likely to be white than either group, and had an educational level higher than IDU but below MSM. They had the highest HIV prevalence (56 vs. 4-19 %). However, reported HIV cases among them fell from 92 in 1990 to 25 in 2012. They were most likely to report ten or more sex partners (49 vs. 4-26 %), an STD diagnosis (22 vs. 1-7 %) and be tested for HIV (odds ratio 1.00 vs. 0.34-0.52), and least likely to share needles (odds ratio 1.00 vs. 6.80-10.50). While sexual risk remains high, these data suggest measurable and effective risk reduction with respect to sharing injection equipment and HIV testing among Seattle-area amphetamine-injecting MSM/IDU.
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Armstrong G, Jorm AF, Samson L, Joubert L, Singh S, Kermode M. Male-to-male sex among men who inject drugs in Delhi, India: overlapping HIV risk behaviours. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:404-11. [PMID: 25440911 DOI: 10.1016/j.drugpo.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/12/2014] [Accepted: 08/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. METHODS We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. RESULTS One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). CONCLUSION Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Anthony F Jorm
- Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Luke Samson
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, University of Melbourne, Victoria, Australia
| | - Shalini Singh
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Oldenburg CE, Perez-Brumer AG, Reisner SL, Mattie J, Bärnighausen T, Mayer KH, Mimiaga MJ. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS One 2014; 9:e103549. [PMID: 25068720 PMCID: PMC4113434 DOI: 10.1371/journal.pone.0103549] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/29/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Men who engage in transactional sex, the exchange of sex for money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts. METHODS We searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional sex published between 2004-2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional sex as compared to general population men. FINDINGS Of 66 studies included representing 31,924 men who had engaged in transactional sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5). CONCLUSIONS The global burden of HIV is disproportionately high among men who engage in transactional sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.
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Affiliation(s)
- Catherine E. Oldenburg
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America
| | - Amaya G. Perez-Brumer
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, New York, United States of America
| | - Sari L. Reisner
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America
| | - Jason Mattie
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Africa Centre for Health and Population Science, Mtubatuba, South Africa
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess, Boston, Massachusetts, United States of America
| | - Matthew J. Mimiaga
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Friedman MR, Wei C, Klem ML, Silvestre AJ, Markovic N, Stall R. HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis. PLoS One 2014; 9:e87139. [PMID: 24498030 PMCID: PMC3907399 DOI: 10.1371/journal.pone.0087139] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. RESULTS We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. CONCLUSIONS This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population's HIV burden.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mary Lou Klem
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nina Markovic
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ron Stall
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Association of depression, anxiety, and suicidal ideation with high-risk behaviors among men who inject drugs in Delhi, India. J Acquir Immune Defic Syndr 2014; 64:502-10. [PMID: 23933769 DOI: 10.1097/qai.0b013e3182a7ef21] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sharing of needles and syringes and unprotected sex remain a common practice among people who inject drugs (PWID) in India and are important drivers of new HIV infections. Whether engagement in risk behaviors among PWID is associated with symptoms of common mental disorders in India is unknown. METHODS We analyzed the data collected in April and May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (Patient Health Questionnaire 9) and anxiety (Generalized Anxiety Disorder scale 2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months. RESULTS PWID with severe depressive symptoms and those with suicidal thoughts were 4 and 2 times more likely to share needles/syringes, respectively. PWID experiencing suicidal thoughts had 82% more female sexual partners and were 5 times more likely to have had unprotected sex at last sex with a paid female partner. Conversely, symptoms of anxiety were associated with a 30% decrease in the likelihood of needle/syringe sharing and a 70% decrease in the likelihood of unprotected sex at last sex with a paid female partner. CONCLUSIONS We found a high prevalence of symptoms of depression, anxiety, and suicidal ideation among men who inject drugs in Delhi and that depression and suicidal ideation are independently positively associated with HIV risk behaviors, whereas anxiety is associated with a reduction in such behaviors. Ameliorating mental health problems among PWID in India may aid in reducing HIV infections.
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Inglez-Dias A, Ribeiro JM, Bastos FI, Page K. Políticas de redução de danos no Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:147-57. [DOI: 10.1590/1413-81232014191.1778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 04/09/2013] [Indexed: 01/05/2023] Open
Abstract
Considerando a disseminação da epidemia de HIV e o controle de sua transmissão entre usuários de drogas injetáveis (UDI), estratégias de redução de danos foram incorporadas em diversos países, incluindo o Brasil. Considerando a emergência das drogas como tema central na agenda governamental, especialmente o crack, o presente artigo registra e discute as práticas observadas em um programa de pesquisa e atenção aos UDI: o UFO. Foram considerados aspectos tais como acesso e adesão do usuário, dificuldades de financiamento, sustentabilidade e avaliação de resultados. As etapas do estudo envolveram pesquisa documental, observação sistemática e entrevistas com informantes-chave. Destacamos características do UFO que poderiam contribuir para políticas de redução de danos no cenário brasileiro. O programa estudado se apresenta como um exemplo exitoso de iniciativas de redução de danos, obtendo sucesso no acesso e adesão desse grupo, favorecendo seu acesso aos serviços de saúde e prevenção de riscos associados ao uso de drogas.
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30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs. Adv Prev Med 2013; 2013:346372. [PMID: 23840957 PMCID: PMC3694369 DOI: 10.1155/2013/346372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/11/2013] [Accepted: 05/18/2013] [Indexed: 11/17/2022] Open
Abstract
After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.
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Injecting drug use among gay and bisexual men in Sydney: prevalence and associations with sexual risk practices and HIV and hepatitis C infection. AIDS Behav 2013; 17:1344-51. [PMID: 23321949 DOI: 10.1007/s10461-013-0409-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Injecting drug use is commonly reported among gay and bisexual men in Australia. We examined the prevalence and covariates of injecting drug use among men participating in the Sydney Gay Community Periodic Survey between 2004-06 and 2011. In 2004-06, data was collected about which drugs were injected, while in 2011, data was collected about hepatitis C (HCV) and esoteric sexual practices. In 2004-06, 5.6 % of men reported injecting drugs in the previous 6 months; 3.4 % reported methamphetamine injection and 0.4 % heroin injection. In 2011, men who injected drugs were less likely to be employed full-time, and more likely to be HCV-positive, HIV-positive, to have used party drugs for sex, and to have engaged in esoteric sexual practices. The strong associations between injecting drug use, sexual risk practices and blood-borne virus infection suggests the need for combined sexual health and harm reduction services for gay and bisexual men who inject drugs.
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Marshall BDL, Paczkowski MM, Seemann L, Tempalski B, Pouget ER, Galea S, Friedman SR. A complex systems approach to evaluate HIV prevention in metropolitan areas: preliminary implications for combination intervention strategies. PLoS One 2012; 7:e44833. [PMID: 23028637 PMCID: PMC3441492 DOI: 10.1371/journal.pone.0044833] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV transmission among injecting and non-injecting drug users (IDU, NIDU) is a significant public health problem. Continuing propagation in endemic settings and emerging regional outbreaks have indicated the need for comprehensive and coordinated HIV prevention. We describe the development of a conceptual framework and calibration of an agent-based model (ABM) to examine how combinations of interventions may reduce and potentially eliminate HIV transmission among drug-using populations. METHODOLOGY/PRINCIPAL FINDINGS A multidisciplinary team of researchers from epidemiology, sociology, geography, and mathematics developed a conceptual framework based on prior ethnographic and epidemiologic research. An ABM was constructed and calibrated through an iterative design and verification process. In the model, "agents" represent IDU, NIDU, and non-drug users who interact with each other and within risk networks, engaging in sexual and, for IDUs, injection-related risk behavior over time. Agents also interact with simulated HIV prevention interventions (e.g., syringe exchange programs, substance abuse treatment, HIV testing) and initiate antiretroviral treatment (ART) in a stochastic manner. The model was constructed to represent the New York metropolitan statistical area (MSA) population, and calibrated by comparing output trajectories for various outcomes (e.g., IDU/NIDU prevalence, HIV prevalence and incidence) against previously validated MSA-level data. The model closely approximated HIV trajectories in IDU and NIDU observed in New York City between 1992 and 2002, including a linear decrease in HIV prevalence among IDUs. Exploratory results are consistent with empirical studies demonstrating that the effectiveness of a combination of interventions, including syringe exchange expansion and ART provision, dramatically reduced HIV prevalence among IDUs during this time period. CONCLUSIONS/SIGNIFICANCE Complex systems models of adaptive HIV transmission dynamics can be used to identify potential collective benefits of hypothetical combination prevention interventions. Future work will seek to inform novel strategies that may lead to more effective and equitable HIV prevention strategies for drug-using populations.
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Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
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Abstract
BACKGROUND Little is known about the epidemiology of HIV in Japan, though newly-identified cases amongst men who have sex with men (MSM) show an increasing trend. Predictions of future trends in the HIV epidemic are essential to identify suitable interventions. METHODS A deterministic, compartmental model was developed that incorporated risk groups, disease stages, and treatment and testing parameters. This model was calibrated against current figures on new infections and run over 30 years to identify trends in prevalence amongst MSM, low-risk men and low-risk women. Multivariate sensitivity analysis was used to estimate sensitivity ranges for all outcomes. RESULTS Without new interventions amongst MSM in Japan, HIV prevalence will climb from its current rate of 2.1% to 10.4% (sensitivity range 7.4% to 18.7%), while HIV prevalence among low-risk men and women will likely decline. With small changes in safer sex behavior and testing rates, HIV prevalence can remain stable or even decline amongst MSM. CONCLUSIONS Japan is at risk of an epidemic of HIV amongst MSM unless significant changes are made to its current public health intervention framework. More research is necessary to understand the key drivers of the epidemic in Japan.
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Affiliation(s)
- Stuart Gilmour
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
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Forney JC, Miller RL. Risk and protective factors related to HIV-risk behavior: a comparison between HIV-positive and HIV-negative young men who have sex with men. AIDS Care 2012; 24:544-52. [PMID: 22292776 DOI: 10.1080/09540121.2011.630341] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The objective of this study was to assess and compare the prevalence of high-risk sexual behaviors among young HIV-negative (n=8064) and HIV-positive (n=171) men who have sex with men (MSM) on predictors of unprotected anal intercourse (UAI). Using venue-based time-space sampling, 8235 MSM aged 15-25 were anonymously surveyed as a part of the Community Intervention Trial for Youth (CITY). The Project was conducted in 13 communities across the USA from 1999 to 2002. Forty percent of HIV-positive men and 34% of HIV-negative men reported that they had UAI in the previous 3 months. HIV-positive MSM were more likely than their uninfected peers to have traded sex within the previous year, to have had sex while high during their last sexual encounter, and to have UAI with a greater number of partners. Multivariate analyses indicated that for HIV-negative men, positive peer norms regarding safer sex and being Black or Latino predicted avoidance of UAI. Among HIV-positive men, having social support for safer sex and positive peer norms predicted avoidance of UAI. Young HIV-positive MSM are a relevant subgroup for prevention because they constitute a significant source from which future infections could be generated.
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Affiliation(s)
- Jason C Forney
- Department of Psychology, Michigan State University, East Lansing, USA.
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Individual, social, and environmental factors associated with initiating methamphetamine injection: implications for drug use and HIV prevention strategies. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:173-80. [PMID: 21274628 DOI: 10.1007/s11121-010-0197-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study's commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study's conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95-0.98), female sex (aHR: 0.58, 95%CI: 0.41-0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18-2.23), using drugs in Vancouver's drug scene epicentre (aHR: 2.15 95%CI: 1.49-3.10), homelessness (aHR: 1.43, 95%CI: 1.01-2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36-3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03-6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city's open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual methamphetamine users. J Psychoactive Drugs 2011; 43:79-88. [PMID: 21858954 DOI: 10.1080/02791072.2011.587390] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0680, USA
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The cost-effectiveness of a modestly effective HIV vaccine in the United States. Vaccine 2011; 29:6113-24. [PMID: 21510996 DOI: 10.1016/j.vaccine.2011.04.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/17/2011] [Accepted: 04/04/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions. METHODS We developed a mathematical model to project the future course of the HIV epidemic in the United States under varying HIV vaccine scenarios. The model accounts for disease progression, infection transmission, antiretroviral therapy, and HIV-related morbidity and mortality. We projected HIV prevalence and incidence over time in multiple risk groups, and we estimated quality-adjusted life years (QALYs) and costs over a 10-year time horizon. We assumed an exponentially declining efficacy curve fit to trial data, and that subsequent vaccine boosters confer similar immunity. Variations in vaccine parameters were examined in sensitivity analysis. RESULTS Under existing HIV prevention and treatment efforts, an estimated 590,000 HIV infections occur over 10 years. One-time vaccination achieving 60% coverage of adults could prevent 9.8% of projected new infections over 10 years (and prevent 34% of new infections in the first year) and cost approximately $91,000/QALY gained relative to the status quo, assuming $500 per vaccination series. Targeted vaccination strategies result in net cost savings for vaccines costing less than $750. One-time vaccination of 60% of all adults coupled with three-year boosters only for men who have sex with men and people who inject drugs could prevent 21% of infections for $81,000/QALY gained relative to vaccination of higher risk sub-populations only. A program attaining 90% vaccination coverage prevents 15% of new HIV cases over 10 years (and approximately 50% of infections in the first year). CONCLUSIONS A partially effective HIV vaccine with effectiveness similar to that observed in the RV144 trial would provide large health benefits in the United States and could meet conventionally accepted cost-effectiveness thresholds. Strategies that prioritize key populations are most efficient, but broader strategies provide greater total population health benefit.
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Londish GJ, Templeton DJ, Regan DG, Kaldor JM, Murray JM. Minimal impact of circumcision on HIV acquisition in men who have sex with men. Sex Health 2011; 7:463-70. [PMID: 21062588 DOI: 10.1071/sh09080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 04/20/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by HIV. The proven efficacy of circumcision in reducing the risk of HIV acquisition among African heterosexual males has raised the question of whether this protective effect may extend to MSM populations. We examined the potential impact of circumcision on an HIV epidemic within a population of MSM. METHODS A mathematical model was developed to simulate HIV transmission in an MSM population. The model incorporated both circumcision and seropositioning, and was used to predict the reduction in HIV prevalence and incidence as a result of the two interventions. Estimates for the time required to achieve these gains were also calculated. RESULTS We derive simple formulae for the decrease in HIV prevalence with increased circumcision. Our model predicts that if an initially uncircumcised MSM population in a developed country with a baseline HIV prevalence of 10% underwent universal circumcision, HIV incidence would only be reduced to 95% of pre-intervention levels and HIV prevalence to 9.6% after 20 years. In the longer term, our model predicts that prevalence would only decrease from 10% to 6%, but this would take several generations to achieve. The effectiveness of circumcision increases marginally with higher degrees of seropositioning. CONCLUSIONS The results of these calculations suggest that circumcision as a public health intervention will not produce a substantial decrease in HIV prevalence or incidence among MSM in the near future, and only modest reductions are achievable in the long-term.
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Affiliation(s)
- Gregory J Londish
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia
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Long EF, Brandeau ML, Owens DK. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med 2011. [PMID: 21173412 DOI: 10.1059/0003-4819-153-12-201012210-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment. OBJECTIVE To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior. DESIGN Dynamic mathematical model of HIV transmission and disease progression and cost-effectiveness analysis. DATA SOURCES Published literature. TARGET POPULATION High-risk (injection drug users and men who have sex with men) and low-risk persons aged 15 to 64 years in the United States. TIME HORIZON Twenty years and lifetime (costs and quality-adjusted life-years [QALYs]). PERSPECTIVE Societal. INTERVENTION Expanded HIV screening and counseling, treatment with ART, or both. OUTCOME MEASURES New HIV infections, discounted costs and QALYs, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS One-time HIV screening of low-risk persons coupled with annual screening of high-risk persons could prevent 6.7% of a projected 1.23 million new infections and cost $22,382 per QALY gained, assuming a 20% reduction in sexual activity after screening. Expanding ART utilization to 75% of eligible persons prevents 10.3% of infections and costs $20,300 per QALY gained. A combination strategy prevents 17.3% of infections and costs $21,580 per QALY gained. RESULTS OF SENSITIVITY ANALYSIS With no reduction in sexual activity, expanded screening prevents 3.7% of infections. Earlier ART initiation when a CD4 count is greater than 0.350 × 10(9) cells/L prevents 20% to 28% of infections. Additional efforts to halve high-risk behavior could reduce infections by 65%. LIMITATION The model of disease progression and treatment was simplified, and acute HIV screening was excluded. CONCLUSION Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U.S. HIV epidemic without substantial reductions in risk behavior. PRIMARY FUNDING SOURCE National Institute on Drug Abuse, National Institutes of Health, and Department of Veterans Affairs.
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Affiliation(s)
- Elisa F Long
- Yale School of Management, New Haven, Connecticut 06520, USA.
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Long EF, Brandeau ML, Owens DK. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med 2010; 153:778-89. [PMID: 21173412 PMCID: PMC3173812 DOI: 10.7326/0003-4819-153-12-201012210-00004] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment. OBJECTIVE To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior. DESIGN Dynamic mathematical model of HIV transmission and disease progression and cost-effectiveness analysis. DATA SOURCES Published literature. TARGET POPULATION High-risk (injection drug users and men who have sex with men) and low-risk persons aged 15 to 64 years in the United States. TIME HORIZON Twenty years and lifetime (costs and quality-adjusted life-years [QALYs]). PERSPECTIVE Societal. INTERVENTION Expanded HIV screening and counseling, treatment with ART, or both. OUTCOME MEASURES New HIV infections, discounted costs and QALYs, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS One-time HIV screening of low-risk persons coupled with annual screening of high-risk persons could prevent 6.7% of a projected 1.23 million new infections and cost $22,382 per QALY gained, assuming a 20% reduction in sexual activity after screening. Expanding ART utilization to 75% of eligible persons prevents 10.3% of infections and costs $20,300 per QALY gained. A combination strategy prevents 17.3% of infections and costs $21,580 per QALY gained. RESULTS OF SENSITIVITY ANALYSIS With no reduction in sexual activity, expanded screening prevents 3.7% of infections. Earlier ART initiation when a CD4 count is greater than 0.350 × 10(9) cells/L prevents 20% to 28% of infections. Additional efforts to halve high-risk behavior could reduce infections by 65%. LIMITATION The model of disease progression and treatment was simplified, and acute HIV screening was excluded. CONCLUSION Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U.S. HIV epidemic without substantial reductions in risk behavior. PRIMARY FUNDING SOURCE National Institute on Drug Abuse, National Institutes of Health, and Department of Veterans Affairs.
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Affiliation(s)
- Elisa F Long
- Yale School of Management, New Haven, Connecticut 06520, USA.
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Social and behavioral characteristics of HIV-positive MSM who trade sex for methamphetamine. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:325-31. [PMID: 20955106 PMCID: PMC3383823 DOI: 10.3109/00952990.2010.505273] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common. OBJECTIVES This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not. RESULTS Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than $20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine. CONCLUSION AND SCIENTIFIC SIGNIFICANCE These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0680, USA
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Salazar LF, Crosby RA, Head S, Siegler A. Male injecting drug users in the Deep South: bisexual behaviour is a marker for elevated HIV risk. Int J STD AIDS 2010; 21:691-6. [DOI: 10.1258/ijsa.2010.010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study determined whether bisexual male injecting drug users (IDUs) as compared with heterosexual IDUs were more likely to engage in HIV-associated risk behaviours. Respondent-driven sampling was employed to recruit a sample of 382 male IDUs residing in the southeastern USA. Data were collected in face-to-face interviews. Weighted analyses showed that bisexual IDUs in the past 12 months were 4.6 times as likely to share needles and 3.5 times as likely to share a cooker; having multiple female sexual partners and trading money or drugs for sex with women were marginally significant. Bisexual IDUs were 10 times as likely to self-report HIV. Male IDUs, who engage in bisexual behaviour, are also engaging in HIV-associated drug and to some degree sexual-risk behaviours with women more so than heterosexual IDUs. Their higher prevalence of HIV infection coupled with their risk behaviours place themselves and other IDUs at heightened risk of both acquiring and transmitting HIV.
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Affiliation(s)
- L F Salazar
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
- Emory Center for AIDS Research, Atlanta, GA
| | - R A Crosby
- College of Public Health, University of Kentucky, Lexington, KY
- Rural Center for AIDS/STD Prevention at Indiana University, Bloomington, IN, USA
| | - S Head
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
| | - A Siegler
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
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Johnston LG, Holman A, Dahoma M, Miller LA, Kim E, Mussa M, Othman AA, Kim A, Kendall C, Sabin K. HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:485-92. [PMID: 20638262 DOI: 10.1016/j.drugpo.2010.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Men who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners. METHODS Respondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis. RESULTS Among the 509 MSM who enrolled in the survey, 14% (n=66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs. CONCLUSION MSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.
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Affiliation(s)
- Lisa G Johnston
- Tulane University, School of Public Health & Tropical Medicine, Department of International Health & Development, Center for Global Health Equity, New Orleans, LA, USA.
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Long EF, Brandeau ML, Owens DK. Potential population health outcomes and expenditures of HIV vaccination strategies in the United States. Vaccine 2009; 27:5402-10. [PMID: 19591796 DOI: 10.1016/j.vaccine.2009.06.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 06/03/2009] [Accepted: 06/10/2009] [Indexed: 11/29/2022]
Abstract
Estimating the potential health benefits and expenditures of a partially effective HIV vaccine is an important consideration in the debate about whether HIV vaccine research should continue. We developed an epidemic model to estimate HIV prevalence, new infections, and the cost-effectiveness of vaccination strategies in the U.S. Vaccines with modest efficacy could prevent 300,000-700,000 HIV infections and save $30 billion in healthcare expenditures over 20 years. Targeted vaccination of high-risk individuals is economically efficient, but difficulty in reaching these groups may mitigate these benefits. Universal vaccination is cost-effective for vaccines with 50% efficacy and price similar to other infectious disease vaccines.
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Affiliation(s)
- Elisa F Long
- School of Management, Yale University, New Haven, CT, United States.
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Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: sampling methods and implications. J Urban Health 2009; 86 Suppl 1:5-31. [PMID: 19472058 PMCID: PMC2705484 DOI: 10.1007/s11524-009-9365-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 05/05/2009] [Indexed: 11/24/2022]
Abstract
The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (DU), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and DU. The goal of the sampling approach was to recruit an RDS sample of MSM, DU, and individuals who were both MSM and DU (MSM/DU), as well as a sample of sex partners of MSM, DU, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites-Los Angeles, Chicago, and Raleigh-Durham-the sample consisted of older (mean age = 41 years), primarily black MSM and DU (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age = 28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site).
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Zule WA, Bobashev GV, Wechsberg WM, Costenbader EC, Coomes CM. Behaviorally bisexual men and their risk behaviors with men and women. J Urban Health 2009; 86 Suppl 1:48-62. [PMID: 19513854 PMCID: PMC2705485 DOI: 10.1007/s11524-009-9366-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 05/05/2009] [Indexed: 11/30/2022]
Abstract
Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.
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Affiliation(s)
- William A Zule
- Substance Abuse Treatment Evaluation and Invention Research Program, RTI International, Research Triangle Park, NC 27709-2194, USA.
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Jeffries WL. Sociodemographic, sexual, and HIV and other sexually transmitted disease risk profiles of nonhomosexual-identified men who have sex with men. Am J Public Health 2009; 99:1042-5. [PMID: 19372533 DOI: 10.2105/ajph.2007.125674] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
I examined sociodemographic, sexual, and HIV and other sexually transmitted disease risk differences among homosexual- and nonhomosexual-identified men who have sex with men (MSM) in the United States. Non-Mexican Latino ethnicity, marriage or cohabitation, religiosity, and incarceration history were positively associated with being nonhomosexual identified. Being nonhomosexual identified was associated with some risk (e.g., more sexual intercourse while intoxicated) and protective (e.g., fewer male partners) behaviors. Probabilistic sampling strategies may be useful in future research and intervention efforts.
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Affiliation(s)
- William L Jeffries
- Department of Sociology, University of Florida, Gainesville, 32611-7330, USA.
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Gyarmathy VA, Neaigus A. The relationship of sexual dyad and personal network characteristics and individual attributes to unprotected sex among young injecting drug users. AIDS Behav 2009; 13:196-206. [PMID: 17690975 PMCID: PMC2651987 DOI: 10.1007/s10461-007-9285-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
We examine in the heterosexual partnerships (dyads) of IDUs the correlates of engaging in unprotected sex on three levels: individual attributes, social network characteristics, and dyad characteristics. Unprotected sex was significantly less likely to occur in dyads where the participant injected daily or had high safe-sex attitude scores, and in dyads where both members encouraged each other to use condoms. Unprotected sex was significantly more likely to occur in dyads that smoked crack together, shared needles with each other, and where the participant knew that the sex partner had concurrent sex partners. In the sexual dyads of IDUs there is a combined risk of unsafe injecting and unsafe sex. Both injecting and sexual risk, and their combination need to be addressed in interventions that target the sexual partnerships of IDUs. Such interventions should also aim to reduce injected and non-injected crack and other stimulant use associated with high-risk sex.
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Affiliation(s)
- V Anna Gyarmathy
- National Development and Research Institutes, Inc., 71 W 23rd St., 8th Floor, New York, NY 10010, USA.
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Tobin KE, Latkin CA. An examination of social network characteristics of men who have sex with men who use drugs. Sex Transm Infect 2009; 84:420-4. [PMID: 19028939 DOI: 10.1136/sti.2008.031591] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The purpose of this study was to compare the social network characteristics of men who have sex with men (MSM) to men who did not have sex with men (NMSM) in a sample of predominately African-American drug users. Specifically, we were interested in examining the differences in structure of the networks and drug and sexual risk partners within the network. METHODS Data came from 481 male participants who reported having > or =1 sex partner in the past 90 days. MSM were defined as having sex with a male. Data on social network composition were collected using a Social Network Inventory. RESULTS Of 481 men, 7% (n = 32) were categorised as MSM. Nearly two-thirds of MSM did not identify as gay. MSM were more likely to be HIV positive compared with NMSM. Social networks of MSM were younger and a greater proportion was HIV positive. After adjusting for HIV status, networks of MSM were less dense indicating fewer connections among network members. Among injection drug using men in the sample, MSM reported a greater number of needle sharing networks than NMSM. CONCLUSIONS These findings underscore the importance of including social network factors in investigations of HIV risk among MSM. Further studies should focus on dynamics within a network and how they may operate to affect behaviour and health.
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Affiliation(s)
- K E Tobin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, Baltimore, Maryland 21205, USA.
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Cloete A, Simbayi LC, Kalichman SC, Strebel A, Henda N. Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care 2008; 20:1105-10. [PMID: 18608067 PMCID: PMC3320098 DOI: 10.1080/09540120701842720] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the primary mode of HIV transmission in sub-Saharan Africa is heterosexual, research focusing on the sexual behaviour of men who have sex with men (MSM) is scant. Currently it is unknown how many people living with HIV in South Africa are MSM and there is even less known about the stigmatisation and discrimination of HIV-positive MSM. The current study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa. Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others. HIV-positive MSM reported experiencing greater social isolation and discrimination resulting from being HIV-positive, including loss of housing or employment due to their HIV status, however these differences were not significant. Mental health interventions, as well as structural changes for protection against discrimination, are needed for HIV-positive South African MSM.
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Affiliation(s)
- A Cloete
- Human Sciences Research Council of South Africa, Social Aspects of HIV/AIDS and Health, Cape Town, South Africa.
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