1
|
Artenie A, Stone J, Facente SN, Fraser H, Hecht J, Rhodes P, McFarland W, Wilson E, Hickman M, Vickerman P, Morris MD. Impact of HCV Testing and Treatment on HCV Transmission Among Men Who Have Sex With Men and Who Inject Drugs in San Francisco: A Modelling Analysis. J Infect Dis 2023; 228:662-673. [PMID: 37486337 PMCID: PMC10503949 DOI: 10.1093/infdis/jiad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/26/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Men who have sex with men who ever injected drugs (ever MSM-IDU) carry a high hepatitis C virus (HCV) burden. We estimated whether current HCV testing and treatment in San Francisco can achieve the 2030 World Health Organization (WHO) HCV elimination target on HCV incidence among ever MSM-IDU. METHODS A dynamic HCV/HIV transmission model among MSM was calibrated to San Francisco data, including HCV antibody (15.5%, 2011) and HIV prevalence (32.8%, 2017) among ever MSM-IDU. MSM had high HCV testing (79%-86% ever tested, 2011-2019) and diagnosed MSM had high HCV treatment (65% ever treated, 2018). Following coronavirus disease 2019 (COVID-19)-related lockdowns, HCV testing and treatment decreased by 59%. RESULTS Among all MSM, 43% of incident HCV infections in 2022 were IDU-related. Among ever MSM-IDU in 2015, HCV incidence was 1.2/100 person-years (95% credibility interval [CrI], 0.8-1.6). Assuming COVID-19-related declines in HCV testing/treatment persist until 2030, HCV incidence among ever MSM-IDU will decrease by 84.9% (95% CrI, 72.3%-90.8%) over 2015-2030. This decline is largely attributed to HCV testing and treatment (75.8%; 95% CrI, 66.7%-89.5%). Slightly greater decreases in HCV incidence (94%-95%) are projected if COVID-19 disruptions recover by 2025 or 2022. CONCLUSIONS We estimate that HCV incidence will decline by >80% over 2015-2030 among ever MSM-IDU in San Francisco, achieving the WHO target.
Collapse
Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shelley N Facente
- School of Public Health, University of California Berkeley, Berkeley, California, USA
- Facente Consulting, Richmond, California, USA
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jennifer Hecht
- San Francisco AIDS Foundation, San Francisco, California, USA
- Springboard HealthLab, Berkeley, California, USA
| | - Perry Rhodes
- Facente Consulting, Richmond, California, USA
- University of California San Francisco Alliance Health Project, San Francisco, California, USA
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Phan TC, Singson GMS, Pamintuan CGN, Francisco JR, Chau B, Do AM, Lou M, Church T. LGBTQ
+ Cultural Sensitivity in Pharmacy Education: A
Co‐Curricular
Training Event to Improve Pharmacy Students’ Knowledge and Motivation in Caring for Sexual and Gender Minorities. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tam C. Phan
- USC School of Pharmacy University of Southern California Los Angeles California
| | | | | | | | - Brandon Chau
- Keck School of Medicine University of Southern California Los Angeles California
| | - Allison M. Do
- USC School of Pharmacy University of Southern California Los Angeles California
| | - Mimi Lou
- USC School of Pharmacy University of Southern California Los Angeles California
| | - Terry Church
- USC School of Pharmacy University of Southern California Los Angeles California
| |
Collapse
|
3
|
Ryus CR, Samuels EA, Wong AH, Hill KA, Huot S, Boatright D. Burnout and Perception of Medical School Learning Environments Among Gay, Lesbian, and Bisexual Medical Students. JAMA Netw Open 2022; 5:e229596. [PMID: 35486396 PMCID: PMC9055452 DOI: 10.1001/jamanetworkopen.2022.9596] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.
Collapse
Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen Huot
- Office of Graduate Medical Education, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Lopez M, Bu J, Mendoza MD. Culture, Race, and Ethnicity Issues in Health Care. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Kelley J. Stigma and Human Rights: Transgender Discrimination and Its Influence on Patient Health. Prof Case Manag 2021; 26:298-303. [PMID: 34609343 DOI: 10.1097/ncm.0000000000000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES Transgender patients encounter barriers to accessing medical treatment. Although the medical field has made strides to improve transgender patients' health care experiences, programs that provide support in navigating existing obstacles are lacking. As integrated care becomes more prevalent, primary care settings have the potential to become medical havens for vulnerable patient populations. Enlisting support of professional case managers to connect transgender patients to services to meet their physical and behavioral health needs could increase health care utilization and decrease disparities. FINDINGS/CONCLUSIONS Because of their gender identities, transgender individuals experience high rates of discrimination within health care settings. There are also inequities that limit their access to quality treatment. These, combined with the fear of discrimination, contribute to an avoidance of medical care that negatively impacts the physical and mental health of transgender patients. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Transgender discrimination in health care settings is pervasive and has detrimental effects on patients' well-being. Future research should foster collaboration between health care administrators, professional case managers, primary care providers, behavioral health consultants, and transgender patients to remove existing barriers and increase access to care. Until these changes occur, programs need to be designed for case managers to assist transgender patients in navigating the health care system and connecting to affirming providers. PRIMARY PRACTICE SETTINGS Health care systems and integrated primary care settings.
Collapse
Affiliation(s)
- Jennifer Kelley
- Jennifer Kelley, MS, LPC , is a student of the Doctor of Behavioral Health program at the Cummings Graduate Institute. Currently, Jennifer works with patients within integrated care and hospital settings in Pennsylvania. She is most passionate about ensuring that all patients have access to quality treatment and finding interventions to reduce health disparities among patient populations
| |
Collapse
|
6
|
Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2825-2841. [PMID: 33483851 PMCID: PMC8295412 DOI: 10.1007/s10508-020-01850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 05/10/2023]
Abstract
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
Collapse
Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Anthony J Maiolatesi
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
7
|
Crowe S, Barker E, Roberts M, Lloyd L, de Barros CM, Rebelo-Harris B, Meads C, Saunders CL. Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:64. [PMID: 34556178 PMCID: PMC8460395 DOI: 10.1186/s40900-021-00298-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Conversations about research priorities with members of the public are rarely designed specifically to include people who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers. METHODS Generally, to address this gap, and specifically, to inform future research for CLS, we carried out a rapid review of published research priority sets covering LGBTQ+ topics, and an online workshop to prioritise identified themes. RESULTS Rapid review: results. The rapid review identified 18 LGBTQ+ research priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five addressed transgender and gender non- conforming populations. All of the research priority sets originated from English-speaking, high and middle-income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Prioritization approaches were wide-ranging from personal commentary to expert workshops and surveys. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in this review were then grouped into themes which were prioritised during the workshop. Workshop: results. For the workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert to a public involvement in research matching website to take part in an online discussion workshop. Those that took part were offered payment for their time in preparing for the workshop and taking part. Participants personal priorities and experiences contributed to a consensus development process and a final ranked list of seven research themes and participants' experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units added additional context. CONCLUSIONS From the workshop the three research themes prioritised were: healthcare services delivery, prevention, and particular challenges / intersectionality of multiple challenges for people identifying as LGBTQ+. Research themes interconnected in many ways and this was demonstrated by the comments from workshop participants. This paper offers insights into why these priorities were important from participants' perspectives and detail about how to run an inclusive and respectful public involvement research exercise. On a practical level these themes will directly inform future research direction for CLS.
Collapse
Affiliation(s)
| | | | | | - Lucy Lloyd
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, East Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | | | | | - Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Catherine L Saunders
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, East Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| |
Collapse
|
8
|
Morse AML, Wax A, Malmquist EJ, Hopmeyer A. Protester, Partygoer, or Simply Playing It Down? The Impact of Crowd Affiliations on LGBT Emerging Adults' Socioemotional and Academic Adjustment to College. JOURNAL OF HOMOSEXUALITY 2021; 68:752-776. [PMID: 31441393 DOI: 10.1080/00918369.2019.1657752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although peer crowd affiliations have been studied among emerging adults in college, this work has yet to focus in on LGBT-identifying students. Accordingly, the current study a) surveyed the peer crowd landscape using a sample of 234 LGBT students (Mage = 19.89, SD = 1.55; 70.51% female, 18.38% male, 11.11% other) at a small, private, liberal arts college in Southern California, and b) explored the relationships between self-reported peer crowd affiliations and LGBT students' adjustment (i.e., loneliness, belongingness, and academic-, alcohol-, drug-, and sex-risk behaviors). Results point to the existence of four underlying peer crowd dimensions among LGBT students: protester, nonvocal, social, and athletic. Furthermore, affiliation with these peer crowds was found to relate to students' self-reported loneliness and academic-, drug-, and sex-risk behaviors.
Collapse
Affiliation(s)
- Alexis M L Morse
- Department of Psychology, Occidental College, Los Angeles, California, USA
| | - Amy Wax
- Department of Psychology, California State University, Long Beach, California, USA
| | - Eric J Malmquist
- Department of Psychology, Occidental College, Los Angeles, California, USA
| | - Andrea Hopmeyer
- Department of Psychology, Occidental College, Los Angeles, California, USA
| |
Collapse
|
9
|
Kuitunen-Paul S, Roessner V, Basedow LA, Golub Y. Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use. Subst Abus 2020; 42:13-32. [PMID: 32870121 DOI: 10.1080/08897077.2020.1806183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.
Collapse
Affiliation(s)
- Sören Kuitunen-Paul
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A Basedow
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Research Group Stress and Addiction, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
10
|
Mannes ZL, Dunne EM, Ferguson EG, Cook RL, Ennis N. Symptoms of generalized anxiety disorder as a risk factor for substance use among adults living with HIV. AIDS Care 2020; 33:623-632. [PMID: 32835502 DOI: 10.1080/09540121.2020.1808163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examined the association between symptoms of generalized anxiety disorder (GAD) and substance use among 932 people living with HIV (PLWH) in Florida. PLWH completed a 45-minute questionnaire assessing demographics, symptoms of GAD and depression, and use of substances including alcohol, cigarettes, marijuana, crack/cocaine, and injection drugs. The GAD-7 measured symptoms of anxiety and participants were categorized as experiencing none/mild anxiety (score 0-9) or moderate/severe symptoms (score ≥10). Adjusted binary logistic regressions assessed the association between moderate-severe GAD symptoms and substance use while controlling for covariates, including depressive symptoms. Approximately one-third (31.4%) of the sample reported experiencing moderate/severe symptoms of GAD. After controlling for covariates, PLWH with moderate/severe symptoms of GAD had greater odds of reporting current cigarette use (AOR = 1.70, 95% CI = 1.18-2.45 p = 0.004), past 30-day hazardous alcohol consumption (AOR = 1.50, 95% CI = 1.04-2.16, p = 0.028), and past 12-month non-injection crack/cocaine use (AOR = 1.75, 95% CI = 1.13-2.69, p = 0.011) compared to PLWH reporting none/mild symptoms. Findings demonstrate that moderate/severe GAD symptoms were common among this sample of PLWH in Florida and were associated with use of cigarettes, crack/cocaine, and hazardous alcohol consumption. Future studies should explore interventions to reduce comorbid anxiety and substance use.
Collapse
Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Alpert Medical School, Brown University, Providence, RI, United States
| | - Erin G Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, United States
| |
Collapse
|
11
|
Walters SM, Coston B, Neaigus A, Rivera AV, Starbuck L, Ramirez V, Reilly KH, Braunstein SL. The role of syringe exchange programs and sexual identity in awareness of pre-exposure prophylaxis (PrEP) for male persons who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102671. [PMID: 32092665 DOI: 10.1016/j.drugpo.2020.102671] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Male persons who inject drugs (male PWID) are at heightened risk for HIV, particularly if they also have sex with men. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for this population, but PrEP awareness within different sexual identities among male PWID is not well-understood. We report factors associated with greater awareness among male PWID to identify efficient means of awareness dissemination. METHODS Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Log-linked Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios and determine differences in awareness of PrEP. RESULTS Among a sample of 332 male PWID (i.e., PWID who identified as male, not transgender) we find awareness of PrEP to be low (23%) among male PWID despite 68% reporting condomless vaginal/anal sex and 32% reporting injection equipment sharing in the last twelve months. Multivariable analysis found greater PrEP awareness associated with gay or bisexual identity (aPR: 2.77, 95% CI: 1.81-4.24) and having a conversation about HIV prevention at a syringe exchange program (SEP) (aPR: 2.71, 95% CI: 1.87-3.94) to be associated with increased PrEP awareness. CONCLUSION We found low rates of PrEP awareness among male PWID. However, our findings provide insight into information diffusion that can be utilized to increase PrEP awareness among male PWID and among all PWID. We suggest that gay and bisexual social networks and syringe exchange programs are diffusing PrEP awareness among male PWID and can be harnessed to increase PrEP awareness among male PWID.
Collapse
Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States.
| | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Alan Neaigus
- Department of Epidemiology Joseph L. Mailman School of Public Health, Columbia University, NY, United States
| | - Alexis V Rivera
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Lila Starbuck
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Valentina Ramirez
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| |
Collapse
|
12
|
Culture, Race, and Ethnicity Issues in Health Care. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_3-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Whaibeh E, Mahmoud H, Vogt EL. Reducing the Treatment Gap for LGBT Mental Health Needs: the Potential of Telepsychiatry. J Behav Health Serv Res 2019; 47:424-431. [DOI: 10.1007/s11414-019-09677-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
14
|
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.
Collapse
|
15
|
Prangnell A, Imtiaz S, Karamouzian M, Hayashi K. Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies. Drug Alcohol Rev 2019; 39:71-82. [PMID: 31758602 DOI: 10.1111/dar.13001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/29/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022]
Abstract
ISSUES Childhood abuse is a public health challenge with lifelong impacts, including future drug use. However, previous research has been mixed regarding impacts on injection drug use. This systematic review examines the impact of childhood abuse (sexual, physical and emotional) on adult injection drug use. APPROACH We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and grey literature to identify relevant studies from database inception to 26 September 2018. Studies were eligible if: (i) they were empirical original research published in English; (ii) considered childhood abuse as potential risk factors for lifetime history of injection drug use; and (iii) included adult participants. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. KEY FINDINGS Of the 1994 articles screened, 17 studies met the inclusion criteria. Most studies were conducted in the USA and utilised cross-sectional research designs. All of the 17 studies measured sexual abuse, six studies measured physical abuse and three studies measured emotional abuse; most (N = 11) of which reported a statistically significant and positive association between at least one sub-scale of childhood abuse and injection drug use. IMPLICATIONS Our findings highlight the need for devising interventions to reduce the harms associated with childhood abuse. CONCLUSIONS The evidence base suggests a significant positive association between experiences of childhood physical abuse and elevated risks of injection drug initiation with mixed results for sexual and emotional abuse.
Collapse
Affiliation(s)
- Amy Prangnell
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sameer Imtiaz
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada.,HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| |
Collapse
|
16
|
Zhao M, Liu B, Zheng T, Xu J, Hao Y, Wang J, Zhang X, Nie W, Wang C, Wang F, Jiao M, Wu Q, Liang L. Factors associated with hostility among people living with HIV/AIDS in Northeast China: a cross-sectional study. BMC Public Health 2019; 19:1189. [PMID: 31464596 PMCID: PMC6716866 DOI: 10.1186/s12889-019-7526-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hostility can result in negative outcomes in people living with HIV/AIDS (PLWHA); however, previous research on this topic is far from adequate. To contribute to existing knowledge on this aspect of PLWHA, the current study examined the prevalence of hostility and its potential influencing factors among PLWHA. Methods A cross-sectional questionnaire survey was undertaken on 218 HIV patients in Heilongjiang Province of China between March and August in 2013. A multiple logistic regression analysis was performed to identify factors associated with hostility. Results The prevalence of hostility was 17.0% among the participants. The three most alarming types of hostility included desiring to kill the person who infected them, blaming the infection on the society, and abandoning themselves to despair. A multiple logistic regression model identified that depression (OR = 3.845, 95% CI = 1.309–9.229), perceived stigma (OR = 3.281, 95% CI = 1.109–7.711), and fear of dying (OR = 2.710, 95% CI = 1.068–6.881) were the risk factors for hostility, while higher levels of trust-in-doctor (OR = 0.176, 95% CI = 0.060–0.517) and per capita household income (OR = 0.344, 95% CI = 0.119–0.991) were protective factors. Conclusions Our findings highlight the prominent influence of psychological, healthcare, and social factors on hostility among PLWHA. Interventions specifically targeted to reduce hostility should be provided, including incorporating psychological service into HIV management guidelines, enhancing PLWHA’s trust-in-doctor, establishing comprehensive services for PLWHA, reducing the social stigma against PLWHA, and paying more attention to PLWHA with financial problems. These interventions may improve the management and control of HIV/AIDS.
Collapse
Affiliation(s)
- Miaomiao Zhao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China.,Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Chongchuan District, Nantong, 226019, Jiangsu, China
| | - Baohua Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Tong Zheng
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Jiao Xu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Jiahui Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Xin Zhang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Wanling Nie
- The Second Affiliated Hospital of Harbin Medical University, 247 Xuefu Road, Nangang District, Harbin, 150001, Heilongjiang, China
| | - Chao Wang
- The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Road, Nangang District, Harbin, 150001, Heilongjiang, China
| | - Fuxiang Wang
- The Third People's Hospital of Shenzhen, 29 Bulan Road, Longgang District, Shenzhen, 518100, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China.
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang, China.
| |
Collapse
|
17
|
Race K, Lea T, Murphy D, Pienaar K. The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men. Sex Health 2019; 14:42-50. [PMID: 27712616 DOI: 10.1071/sh16080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation - and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.
Collapse
Affiliation(s)
- Kane Race
- Gender & Cultural Studies, University of Sydney, SOPHI A14, University of Sydney, Sydney, NSW 2006, Australia
| | - Toby Lea
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Dean Murphy
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Kiran Pienaar
- National Drug Research Institute, Curtin University, Suite 6, 19-35 Gertrude Street, Fitzroy, Vic. 3065, Australia
| |
Collapse
|
18
|
Abaver DT, Cishe EN. Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector. SAHARA J 2018; 15:60-70. [PMID: 30025496 PMCID: PMC6060376 DOI: 10.1080/17290376.2018.1492960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of sexually transmitted diseases and infections (particularly Human Immunodeficiency Virus (HIV)/AIDS) even when discrimination based on sexual orientation was outlawed by South African’s post-apartheid constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17–38 years. About 70.5% of the participants witnessed physical attack as a form of violence against people in same-gender relationship; 47.7% disagreed that violent targeted at this sexually minority group is justified. The LGBTI face challenges which include verbal insults (937, 32.4%), bullying (532, 18.4%) and name-calling (1389, 48%). Discrimination against members of the LGBTI sector was witnessed in various forms: non-acceptance (981, 33.9%), disapproval of act of homosexuals (1308, 45.2) and denial of rights (327, 11.3). Violence, abuse and discrimination which constitute stigmatisation among the LGBTI sector are received with mix feeling. Some respondents justified the use of one or more of these key elements of stigmatisation against the LGBTI (6.6%, supports violence), others condemned these acts of stigmatisation (28.8%), against discrimination). Social stigma which resulted from violence, abuse and discrimination exist in this institution and is responsible for the unwillingness of disclosure of sexual orientation among the LGBTI members. An enabling environment should be created where the LGBTI members could come out freely to access programmes targeted at the prevention and control of HIV/AIDS.
Collapse
Affiliation(s)
- Dominic Targema Abaver
- a Division of Academic Affairs and Research, Directorate of Research, Innovation and Development , Walter Sisulu University, NMD , Mthatha , South Africa
| | - Elphina Nomabandla Cishe
- b Directorate of Research Innovation and Development , Walter Sisulu University , Nelson Mandela Drive, Mthatha , Eastern Cape
| |
Collapse
|
19
|
Roth EA, Cui Z, Wang L, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Jollimore J, Howard T, Olarewaju G, Moore DM, Hogg RS. Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study. Am J Mens Health 2018; 12:1759-1773. [PMID: 30024296 PMCID: PMC6142133 DOI: 10.1177/1557988318786872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 01/25/2023] Open
Abstract
Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance use levels. This interpretation is not clear-cut because studies may combine bisexual men and women, use different dimensions of sexual orientation to define bisexuality, and/or not consider number of sexual partners as a possible confounding factor. This study conducted separate bivariate and multivariate analyses comparing gay to bisexual Momentum Study participants based on self-identity, sexual attraction, and sexual behavior, while controlling for number of sexual partners and sociodemographic, psychosocial, and sexual behavior measures. The study hypothesized that, regardless of definition, bisexual men feature higher substance use levels compared to gay men. Bivariate analyses revealed significantly higher ( p < .05) use among bisexual men for multiple substances in all samples. Nonprescription stimulants and heroin were significant in all multivariate logistic regression models. In contrast, all bisexual samples reported lower use of erectile dysfunction drugs and poppers, substances associated with anal sex among gay men. Subsequent analysis linked these results to lower levels of anal sex in all bisexual samples. Bivariate analyses also revealed that bisexual men featured significantly lower educational levels, annual incomes, and Social Support Scales scores and higher Anxiety and Depression Sub-Scale Scores. In summary, findings revealed bisexual men's distinctive substance use, sexual behavior, psychosocial, and sociodemographic profiles, and are important for tailoring specific health programs for bisexual men.
Collapse
Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ashleigh J. Rich
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kiffer G. Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Jody Jollimore
- Executive Director, Community Based Research Centre for Gay Men’s Health, Vancouver, BC, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
20
|
Lesko CR, Keil AP, Moore RD, Chander G, Fojo AT, Lau B. Measurement of Current Substance Use in a Cohort of HIV-Infected Persons in Continuity HIV Care, 2007-2015. Am J Epidemiol 2018; 187:1970-1979. [PMID: 29701832 PMCID: PMC6118067 DOI: 10.1093/aje/kwy092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 01/02/2023] Open
Abstract
Accurate, routine measurement of recent illicit substance use is challenging. The Johns Hopkins Human Immunodeficiency Virus Clinical Cohort (Baltimore, Maryland) collects 2 imperfect but routine measurements of recent substance use: medical record review and self-interview. We used Bayesian latent class modeling to estimate sensitivity and specificity of each measurement as well as prevalence of substance use among 2,064 patients engaged in care during 2007-2015. Sensitivity of medical record review was higher than sensitivity of self-interview for cocaine and heroin use; posterior estimates ranged from 44% to 76% for cocaine use and from 39% to 67% for heroin use, depending on model assumptions and priors. In contrast, sensitivity of self-interview was higher than sensitivity of medical record review for any alcohol use, hazardous alcohol use, and cigarette smoking. Posterior estimates of sensitivity of self-interview were generally above 80%, 85%, and 87% for each substance, respectively. Specificity was high for all measurements. From one model, we estimated prevalence of substance use in the cohort to be 12.5% for cocaine, 9.3% for heroin, 48.5% for alcohol, 21.4% for hazardous alcohol, and 55.4% for cigarettes. Prevalence estimates from other models were generally comparable. Measurement error of substance use is nontrivial and should be accounted for in subsequent analyses.
Collapse
Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Richard D Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anthony T Fojo
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Babowitch JD, Vanable PA, Carey MP. Gender Moderates the Association of Depressive Symptoms to Sexual Risk Behavior Among HIV-Positive African-American Outpatients. AIDS Behav 2018; 22:1430-1434. [PMID: 29185079 DOI: 10.1007/s10461-017-1981-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous research has reported an association between depressive symptoms and sexual risk behavior. The purpose of this study was to explore whether gender moderates this association in a sample of HIV-positive African-Americans. Participants (N = 93) self-reported depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D), and sexual risk behavior for the past 4 months. Analyses revealed that the depressive symptoms-by-gender interaction was associated with condomless sex and substance use proximal to sex. When analyses were stratified by gender, depressive symptoms were associated with condomless sex and frequency of substance use only for women. We conclude that depressive symptoms may be a more powerful sexual risk factor among women relative to men.
Collapse
Affiliation(s)
- Jacklyn D Babowitch
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University, Providence, RI, USA
| |
Collapse
|
23
|
Moody RL, Starks TJ, Grov C, Parsons JT. Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1133-1144. [PMID: 28608294 PMCID: PMC5726951 DOI: 10.1007/s10508-017-1009-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 05/04/2023]
Abstract
The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.
Collapse
Affiliation(s)
- Raymond L. Moody
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
| | - Tyrel J. Starks
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- CUNY School of Public Health, New York, NY
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
- CUNY School of Public Health, New York, NY
| |
Collapse
|
24
|
Brandt C, Zvolensky MJ, Woods SP, Gonzalez A, Safren SA, O'Cleirigh CM. Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature. Clin Psychol Rev 2017; 51:164-184. [PMID: 27939443 PMCID: PMC5195877 DOI: 10.1016/j.cpr.2016.11.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 09/09/2016] [Accepted: 11/04/2016] [Indexed: 12/21/2022]
Abstract
There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.
Collapse
Affiliation(s)
- Charles Brandt
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd. Houston, Texas, 77030, United States
| | - Steven P Woods
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33124, United States
| | - Conall M O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 701, Boston Ma, 02114, United States
| |
Collapse
|
25
|
Damon W, Callon C, Wiebe L, Small W, Kerr T, McNeil R. Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers. Soc Sci Med 2017; 176:85-92. [PMID: 28135693 DOI: 10.1016/j.socscimed.2017.01.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 12/16/2022]
Abstract
Community-based participatory research (CBPR) has become an increasingly common approach to research involving people who use(d) drugs (PWUD), who are often employed as peer researchers on these projects. This paper seeks to understand the impact of CBPR on PWUD, particularly those living in heavily researched and stigmatized neighbourhoods where CBPR projects are often located. This study draws on 14 in-depth interviews with PWUD who had previous experience as both peer researchers and research participants in CBPR projects conducted between July 2010 and February 2011. The study employed a CBPR approach in its study design, recruitment, interviewing, and analysis. Our analysis indicates that participants were supportive of CBPR in principle and described the ways in which it helped contest stigmatizing assumptions and researcher bias. Participants also reported positive personal gains from participation in CBPR projects. However, many participants had negative experiences with CBPR projects, especially when CBPR principles were implemented in a superficial or incomplete manner. Participants emphasized the importance of inclusiveness and active deconstruction of hierarchy between researchers and community members to successful CBPR among drug using populations. CBPR has been widely adopted as a research approach within marginalized communities but has often been implemented inconsistently. Still, CBPR can empower communities to contest forms of social stigma that are often reproduced through academic research on marginalized communities. Our findings describe how the benefits of CBPR are maximized when CBPR principles are consistently applied and when community-based researchers are supported in ways that reduce power hierarchies. This suggests a need for capacity building within affected communities to develop independent support, training, and grievance processes for peer researchers.
Collapse
Affiliation(s)
- Will Damon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Cody Callon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lee Wiebe
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
26
|
Culture, Race, and Ethnicity Issues in Health Care. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Understanding the HIV/AIDS Epidemic in the United States—The Role of Syndemics in Shaping the Public’s Health. SOCIAL DISPARITIES IN HEALTH AND HEALTH CARE 2016. [DOI: 10.1007/978-3-319-34004-3_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
28
|
The Role of Syndemic in Explaining Health Disparities Among Bisexual Men: A Blueprint for a Theoretically Informed Perspective. SOCIAL DISPARITIES IN HEALTH AND HEALTH CARE 2016. [DOI: 10.1007/978-3-319-34004-3_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
29
|
Gay Men and Men Who Have Sex with Men: Intersectionality and Syndemics. SOCIAL DISPARITIES IN HEALTH AND HEALTH CARE 2016. [DOI: 10.1007/978-3-319-34004-3_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
30
|
Boroughs MS, Valentine SE, Ironson GH, Shipherd JC, Safren SA, Taylor SW, Dale SK, Baker JS, Wilner JG, O'Cleirigh C. Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1891-902. [PMID: 26159863 PMCID: PMC4853755 DOI: 10.1007/s10508-015-0546-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 05/16/2023]
Abstract
Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46 %. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections, and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR 2.64: CI 1.24-5.63), two times higher odds of substance use disorder (OR 2.1: CI 1.02-2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04-7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56-6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16-6.36), and a greater number of casual sexual partners (p = 0.02). Both CSA with Physical Injury (OR 4.05: CI 1.9-8.7) and CSA with Intense Fear (OR 5.16: CI 2.5-10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including post-traumatic stress disorder, substance use, and sexual risk taking, and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.
Collapse
Affiliation(s)
- Michael S. Boroughs
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | | | - Jillian C. Shipherd
- VA Boston Healthcare System, National Center for PTSD – Women's Health Sciences Division and Boston University School of Medicine
| | - Steven A. Safren
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- The Fenway Institute, Fenway Health
| | | | - Sannisha K. Dale
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | | | | | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- The Fenway Institute, Fenway Health
| |
Collapse
|
31
|
Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2015; 35:477-83. [PMID: 26369759 DOI: 10.1111/dar.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Gay and other homosexually active men (hereafter 'gay men') are at elevated risk of becoming infected with hepatitis C virus (HCV) via injecting drug use and sexual risk practices. This paper aimed to measure HCV knowledge among gay men in Australia and whether knowledge differed according to HCV risk. DESIGN AND METHODS In 2013, a cross-sectional, online survey of 405 Australian gay men explored the social aspects of HCV. Bivariate and multivariate linear regressions were used to examine factors associated with higher HCV knowledge. RESULTS The mean age of respondents was 39.2 years (SD = 13.3), and most men (75.3%) were born in Australia. According to self-report, 32.1% were HIV-positive, 3.0% were HCV-positive and 8.9% were HIV/HCV co-infected. The mean number of correct HCV knowledge items was 8.2 (SD = 3.9; range 0-15). In a multivariate analysis, higher HCV knowledge was associated with higher educational attainment, being HCV-positive, being HIV-positive and injecting drug use. DISCUSSION AND CONCLUSIONS HCV knowledge among gay men was moderately good, although knowledge of testing, treatment and natural history of HCV was generally quite poor. Encouragingly, higher knowledge was reported among men at highest HCV risk. Viral hepatitis and HIV organisations, together with general practitioners and other health services, should continue to target gay men at a high risk of acquiring HCV with education and health promotion. [Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2016;35:477-483].
Collapse
Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| |
Collapse
|
32
|
Abstract
This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.
Collapse
|
33
|
Culture, Race, and Ethnicity Issues in Healthcare. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_3-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
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.
Collapse
|
35
|
Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquir Immune Defic Syndr 2014; 66:213-20. [PMID: 24662298 PMCID: PMC4030741 DOI: 10.1097/qai.0000000000000143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. METHODS Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. RESULTS MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). DISCUSSION Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.
Collapse
Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Pamela J. Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
| |
Collapse
|
36
|
Buttram ME, Kurtz SP, Surratt HL, Levi-Minzi MA. Health and social problems associated with prescription opioid misuse among a diverse sample of substance-using MSM. Subst Use Misuse 2014; 49:277-84. [PMID: 23971894 PMCID: PMC3947231 DOI: 10.3109/10826084.2013.828754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/13/2022]
Abstract
This study examines associations between prescription opioid misuse and demographics, substance use, sexual behavior, and related health and social problems. Baseline data were collected between 2008 and 2010 from 515 high risk men who have sex with men, ages 18-55, in the Miami-Ft. Lauderdale metropolitan area who reported heavy substance use and HIV risk in the past 90 days. Prescription opioid misuse was associated with other substance use, drug injection, substance dependence, and history of arrest. Implications, limitations, and directions for future study are discussed.
Collapse
Affiliation(s)
- Mance E. Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
| | - Steven P. Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
| | - Hilary L. Surratt
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
| | - Maria A. Levi-Minzi
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
| |
Collapse
|
37
|
Young SD, Shoptaw S. Stimulant use among African American and Latino MSM social networking users. J Addict Dis 2013; 32:39-45. [PMID: 23480246 DOI: 10.1080/10550887.2012.759859] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High stimulant-using and at-risk HIV populations, such as African American and Latino men who have sex with men (MSM), are increasingly using social networking technologies. However, no known research has explored associations between stimulant use, sexual risk behaviors, and social networking among these populations. Participants were recruited using the Facebook Connect software application, which narrowed the sample to 118 (primarily African American and Latino MSM) active Facebook users. Participants completed demographic, Internet and social media use, and drug use survey items. Participants reported high rates of cocaine and methamphetamine use (both more than 15% within the past 12 months). More than 70% of participants reported using social networking technologies to meet people, and more than 30% used them to find sexual partners. A multivariate logistic regression showed that (1) participants using social networks to find sexual partners were more likely to have used methamphetamines within the past 12 months and (2) those who were more comfortable talking online compared to face-to-face had over 4 times the odds of methamphetamine use and over 6 times the odds of cocaine use within the past 12 months. Minority MSM who used social networks to meet men and find sexual partners had high risk for stimulant use. Understanding drug use among minority social networking users will provide insights to incorporate these technologies into drug prevention interventions.
Collapse
Affiliation(s)
- Sean D Young
- Department of Family Medicine, Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California 90024, USA.
| | | |
Collapse
|
38
|
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.
Collapse
|
39
|
Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav 2012; 16:1394-410. [PMID: 22323004 DOI: 10.1007/s10461-011-0131-8] [Citation(s) in RCA: 252] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the United States, there continues to be high incidence of HIV infection among men who have sex with men (MSM), who represent 57% of new infections in 2009. While many studies report associations between non-injection substance use and sexual risk behavior among MSM, overall results are mixed. Summarizing these studies is difficult because researchers have used a variety of assessment periods for substance use and sexual behavior. We review the scientific literature on event-level measures, which assess substance use and sexual risk behavior immediately before or during a sexual encounter and provide the most precise link between these two behaviors. From January 2009 through March 2010, we searched four databases: Ovid (MEDLINE and PsycINFO), Web of Knowledge, and Sociofile. Across studies, results varied by substance with little within substance consistency or a lack of research except for two notable exceptions: methamphetamine and binge alcohol use. The findings underscore the importance of providing HIV risk-reduction interventions for substance-using MSM.
Collapse
Affiliation(s)
- H Waverly Vosburgh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
40
|
Chen MH, Su TP, Chen TJ, Cheng JY, Wei HT, Bai YM. Identification of psychiatric disorders among human immunodeficiency virus-infected individuals in Taiwan, a nine-year nationwide population-based study. AIDS Care 2012; 24:1543-9. [DOI: 10.1080/09540121.2012.672716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mu-Hong Chen
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Tung-Ping Su
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
| | - Tzeng-Ji Chen
- b Department of Family Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- d Institute of Hospital and Health Care Administration , National Yang-Ming University , Taipei , Taiwan
| | - Ju-Yin Cheng
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
| | - Han-Ting Wei
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Ya-Mei Bai
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
| |
Collapse
|
41
|
Mental health and HIV sexual risk behavior among patrons of alcohol serving venues in Cape Town, South Africa. J Acquir Immune Defic Syndr 2011; 57:230-7. [PMID: 21372724 DOI: 10.1097/qai.0b013e3182167e7a] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Alcohol-serving venues in South Africa provide a location for HIV prevention interventions due to risk factors of patrons in these establishments. Understanding the association between mental health and risk behaviors in these settings may inform interventions that address alcohol use and HIV prevention. METHODS Participants (n = 738) were surveyed in 6 alcohol-serving venues in Cape Town to assess post-traumatic stress disorder (PTSD) and depression symptoms, traumatic experiences, sexual behavior, and substance use. Logistic regression models examined whether traumatic experiences predicted PTSD and depression. Generalized linear models examined whether substance use, PTSD, and depressive symptoms predicted unprotected sexual intercourse. Men and women were analyzed separately. RESULTS Participants exhibited high rates of traumatic experiences, PTSD, depression, alcohol consumption, and HIV risk behaviors. For men, PTSD was associated with being hit by a sex partner, physical child abuse, sexual child abuse and HIV diagnosis; depression was associated with being hit by a sex partner, forced sex and physical child abuse. For women, both PTSD and depression were associated with being hit by a sex partner, forced sex, and physical child abuse. Unprotected sexual intercourse was associated with age, frequency and quantity of alcohol use, drug use, and PTSD for men and frequency and quantity of alcohol use, depression, and PTSD for women. CONCLUSION Mental health in this setting was poor and was associated with sexual risk behavior. Treating mental health and substance-use problems may aid in reducing HIV infection. Sexual assault prevention and treatment after sexual assault may strengthen HIV prevention efforts.
Collapse
|
42
|
High-risk behaviors associated with injection drug use among recently HIV-infected men who have sex with men in San Diego, CA. AIDS Behav 2011; 15:1561-9. [PMID: 21607643 DOI: 10.1007/s10461-011-9970-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The contribution of injection drug use to HIV risk among men who have sex with men (MSM) is understudied. MSM infected with HIV within the prior 12 months completed a questionnaire assessing sociodemographic, sexual, drug use, and social factors. Analyses were performed to identify factors associated with lifetime history of injection drug use. Among 212 participants, the mean age was 33.8 years, 72% were White, 89% had attended college, and 9.4% reported ever injecting drugs. In multivariable logistic regression analysis, ever trading sex and using methamphetamine during sex with at least one of their last three partners were associated with injection drug use. Adjusting for these variables, in separate models, ever perpetrating violence against others (Adjusted Odds Ratio [AOR] = 3.16), having physically abusive sexual partners (AOR = 3.08), or physically abusing sexual partners (AOR = 10.17) were significantly (P < 0.05) associated with injection drug use. These findings suggest that violence is more common among MSM who inject drugs, which should be considered in HIV prevention efforts.
Collapse
|
43
|
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.
Collapse
|
44
|
Abdala N, White E, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov AP, Heimer R. Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia. BMC Public Health 2010; 10:676. [PMID: 21054855 PMCID: PMC2988741 DOI: 10.1186/1471-2458-10-676] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 11/05/2010] [Indexed: 11/24/2022] Open
Abstract
Background To date, the great majority of Russian HIV infections have been diagnosed among IDUs and concerns about the potential for a sexual transmission of HIV beyond the IDU population have increased. This study investigated differences in the prevalence of sexual risk behaviors between IDUs and non-IDUs in St. Petersburg, Russia and assessed associations between substance use patterns and sexual risks within and between those two groups. Methods Cross-sectional survey data and biological test results from 331 IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate regression was employed to calculate measures of associations. Results IDUs were less likely than non-IDUs to report multiple sexual partners and unprotected sex with casual partners. The quantity, frequency and intensity of alcohol use did not differ between IDUs and non-IDUs, but non-IDUs were more likely to engage in alcohol use categorized as risky per the alcohol use disorders identification test (AUDIT-C). Risky sexual practices were independently associated with monthly methamphetamine injection among IDUs and with risky alcohol use among non-IDUs. Having sex when high on alcohol or drugs was associated with unprotected sex only among IDUs. Conclusions Greater prevalence of sexual risk among non-IDUs who have IDU sex partners compared to IDUs suggests the potential for sexual transmission of HIV from the high-prevalence IDU population into the general population. HIV prevention programs among IDUs in St. Petersburg owe special attention to risky alcohol use among non-IDUs who have IDU sex partners and the propensity of IDUs to have sex when high on alcohol or drugs and forgo condoms.
Collapse
Affiliation(s)
- Nadia Abdala
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Nakamura N, Semple SJ, Strathdee SA, Patterson TL. Methamphetamine initiation among HIV-positive gay and bisexual men. AIDS Care 2010; 21:1176-84. [PMID: 20024778 DOI: 10.1080/09540120902729999] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study describes factors associated with methamphetamine initiation in a racially diverse sample of 340 methamphetamine-using, HIV-positive gay and bisexual men. A factor analysis was conducted on reasons for initiation, and four factors were identified: to party, to cope, for energy, and to improve self-esteem. Methamphetamine to party accounted for more than one-third of the variance in the factor analysis. Methamphetamine to cope captured almost 9% of the variance, methamphetamine for energy accounted for approximately 8% of the variance, and methamphetamine for self-esteem accounted for approximately 7% of the variance. Regression analyses revealed differential associations between methamphetamine-initiation factors and HIV-risk behaviors. Methamphetamine for self-esteem predicted binge methamphetamine use, while methamphetamine to cope was associated with injecting methamphetamine. Using methamphetamine for energy was associated with number of illicit drugs-used and using methamphetamine to party was associated with having a greater number of sexually transmitted infections. These findings suggest that methamphetamine initiation among gay and bisexual men is multifaceted, which could have implications for intervention development.
Collapse
Affiliation(s)
- Nadine Nakamura
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | | | | | | |
Collapse
|
47
|
Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress. J Behav Med 2009; 32:466-77. [PMID: 19526337 DOI: 10.1007/s10865-009-9217-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 05/09/2009] [Indexed: 10/20/2022]
Abstract
This study examined the relationship of post-traumatic and depressive symptom severity with measures of health-related quality of life (HRQOL), and health care utilization in a sample of 503 HIV-infected men who have sex with men (MSM) recruited in their primary HIV care setting. Participants completed computer assisted assessments of mood and anxiety, HRQOL, and HIV treatment. Peripheral blood CD4 (T helper) lymphocyte count, plasma HIV RNA concentration, and number of medical appointments were extracted from an electronic medical record. Controlling for demographics, disease stage, and antiretroviral medication, post-traumatic stress and depression symptoms accounted for significant variation in general health estimates, and in pain, role, and work-related impairment. Additionally, in multivariable models, post-traumatic stress and depression severity accounted for significant variation in health care utilization whereas symptoms and indices of HIV disease progression did not. These results extend the current research by providing evidence of the relationship between post-traumatic stress and depression symptom severity with measures of functional impairment and health care utilization in a relatively healthy, urban cohort of HIV-infected MSM.
Collapse
|
48
|
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.
Collapse
Affiliation(s)
- A Cloete
- Human Sciences Research Council of South Africa, Social Aspects of HIV/AIDS and Health, Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
49
|
Chintalova-Dallas R, Case P, Kitsenko N, Lazzarini Z. Boltushka: a homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:347-51. [PMID: 18976896 DOI: 10.1016/j.drugpo.2008.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 09/03/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Homemade amphetamine-type stimulants (ATSs) have been reported in Russia and Eastern Europe for decades. Recipes differ geographically and over time producing differing active ingredients. Vint and jeff (active ingredients methamphetamine and methcathinone, respectively) are two such homemade ATSs originally produced from over-the-counter cold medications and household chemicals. METHODS During a Rapid Policy Assessment and Responses (RPAR) project in Odessa, Ukraine, researchers found use of boltushka, a novel homemade ATS. Fourteen supplemental qualitative interviews were conducted, including ten interviews with boltushka injectors and four interviews with pharmacists. We report patterns of boltushka use among local injection drug users (IDUs) as well as the role of laws, regulations, and current pharmacy practices. RESULTS Legal restrictions on over-the-counter cold medicines in Ukraine led to products containing phenylpropanolamine (PPA), which oxidised with KMnO(4) (potassium permanganate), produces a weak ATS, cathinone, called boltushka. Boltushka's ingredients are easily available in pharmacies or on the black market. IDUs reported a mean age at first use of 16 years old (range 12-21). While published data are scant, anecdotal evidence reported here include amphetamine-like effects on energy and appetite, binging patterns of use, and some reports of shaking and other neurological damage consistent with earlier reports from exposure to KMnO(4). Users reported sharing syringes and other non-sterile injection practices. No users reported specific treatment or prevention programs for boltushka users. CONCLUSIONS Although Ukrainian government regulations have limited access to precursor chemicals, IDUs have continued to make and use boltushka. The actual extent and demographics of boltushka use are unknown. Besides risk of bloodborne disease, the health effects of injected homemade ATSs and their constituent chemicals are poorly documented. Interventions beyond available harm reduction efforts may be required. Education/treatment specific to boltushka users and screening for other physical harms are critical interventions.
Collapse
|
50
|
Abstract
Effective secondary prevention programs to reduce HIV transmission risk-relevant behaviors among HIV-infected individuals must go beyond the traditional, common sense prevention components to develop biomedically and epidemiologically informed behavioral interventions as part of comprehensive, integrated, multidisciplinary HIV care. Incorporating and expanding on the Serostatus Approach to Fighting the Epidemic, a five-pronged strategy set forth by the Centers for Disease Control and Prevention in 2001, we discuss recent findings from the biomedical sciences on viral and host factors that influence infectiousness to support the idea that the most proactive prevention programs will explicitly integrate biomedical interventions and approaches designed to reduce infectiousness, and thus the sexual transmission of HIV. Based on studies of emerging and spreading drug-resistant HIV variants, we have posited the potential development of biodisparity as the biological entrenchment of disparities in socioeconomic status, access to care, and HIV risk-relevant behaviors that differentially affect minorities living with HIV in the US. It is clear that creative approaches based on an expanded behavioral medicine interface with the latest HIV biomedical and epidemiological research are needed to enhance the efficacy of HIV secondary prevention.
Collapse
|