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Deaterly CD, Varma DS, Li Y, Manavalan P, Cook RL. Mental health, substance use, and risky sexual behaviors among women living with HIV. J Nurs Scholarsh 2023; 55:751-760. [PMID: 37132071 PMCID: PMC10626942 DOI: 10.1111/jnu.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Risky sexual behavior has been explored in women living with HIV (WLHIV) internationally but is not well studied in WLHIV in the United States (U.S.). This merits further investigation due to the negative reproductive and HIV health outcomes associated with risky sexual behavior, such as the increased risk for HIV transmission and infertility from sexually transmitted infections (STIs). The aims of this study are to (1) describe sexual behaviors in a cohort of WLHIV in Florida, (2) determine whether demographic characteristics, substance use, and mental health symptoms are associated with risky sexual behavior in a cohort of WLHIV in Florida, and (3) explore whether the relationship between substance use and mental health symptoms and risky sexual behavior differs in reproductive-age (age 18-49), compared to non-reproductive-age WLHIV (age 50+). DESIGN This was a cross-sectional analysis of data from a multisite cohort study done in Florida. METHODS Data were collected from a sample of 304 participants who were recruited into the Florida Cohort Study from 9 clinical and community sites in Florida between 2014 to 2017. The predictor variables of interest were mental health symptoms, substance use, and demographic variables. The outcome variable of interest was risky sexual behavior which was defined as reporting ≥1 of the following: (1) at least one STI diagnosis in the past 12 months, (2) two or more sexual partners in the past 12 months, or (3) any inconsistent condom use in the past 12 months. Descriptive statistics, bivariate analysis, and logistic regression (p < 0.1) were conducted on the variables of interest. RESULTS The mean age of the sample was 47.8 years, and approximately half (51.6%) of the sample was of reproductive-age. Reporting ≥1 risky sexual behavior was reported in over half (51.6%) of the reproductive-age WLHIV in the sample and 32% of the non-reproductive-age WLHIV in the sample. Binge drinking, alcohol-related problems, marijuana use, and age were all significantly associated with self-reporting ≥1 risky sexual behaviors in all WLHIV. Self-reporting binge drinking, marijuana use, and a high alcohol-related problems score respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior in all WLHIV. Neither mental health symptoms nor race/ethnicity or education were significantly associated with self-reporting ≥1 risky sexual behavior in all WLHIV. Self-reporting severe anxiety symptoms and high alcohol-related problems scores respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior only in reproductive-age WLHIV from the sample. CONCLUSION Marijuana use, binge drinking, and alcohol-related problems appear to have a relationship with risky sexual behavior in WLHIV regardless of age. Reproductive-age also appears to influence risky sexual behavior in WLHIV, and specific reporting severe anxiety symptoms and high alcohol-related problems in reproductive-age WLHIV increases the odds of engaging in risky sexual behavior. CLINICAL SIGNIFICANCE This study holds clinical significance for nurses and other clinicians working in reproductive health settings and clinics with WLHIV. Results indicate that it could be beneficial to do more screening for mental health symptoms (particularly anxiety) and alcohol use in younger reproductive-age WLHIV.
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Affiliation(s)
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yancheng Li
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Preeti Manavalan
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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Justice AC, Goetz MB, Stewart CN, Hogan BC, Humes E, Luz PM, Castilho JL, Nash D, Brazier E, Musick B, Yiannoutsos C, Malateste K, Jaquet A, Cornell M, Shamu T, Rajasuriar R, Jiamsakul A, Althoff KN. Delayed presentation of HIV among older individuals: a growing problem. Lancet HIV 2022; 9:e269-e280. [PMID: 35218732 PMCID: PMC9128643 DOI: 10.1016/s2352-3018(22)00003-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Late presentation for care is a major impediment to the prevention and effective treatment of HIV infection. Older individuals are at increased risk of late presentation, represent a growing proportion of people with late presentation, and might require interventions tailored to their age group. We provide a summary of the literature published globally between 2016-21 (reporting data from 1984-2018) and quantify the association of age with delayed presentation. Using the most common definitions of late presentation and older age from these earlier studies, we update this work with data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, focusing on data from 2000-19, encompassing four continents. Finally, we consider how late presentation among older individuals might be more effectively addressed as electronic medical records become widely adopted.
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Affiliation(s)
- Amy C Justice
- VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, West Haven, CT, USA.
| | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Cameron N Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brenna C Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paula M Luz
- Affiliation Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jessica L Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Denis Nash
- City University of New York Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Karen Malateste
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Antoine Jaquet
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinei Shamu
- Graduate School of Health Sciences, Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Reena Rajasuriar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Awachana Jiamsakul
- Biostatistics and Databases Program, The Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Hoffman KA, Baker R, Fanucchi LC, Lum PJ, Kunkel LE, Ponce Terashima J, McCarty D, Jacobs P, Korthuis PT. Perspectives on extended-release naltrexone induction among patients living with HIV and opioid use disorder: a qualitative analysis. Addict Sci Clin Pract 2021; 16:67. [PMID: 34758887 PMCID: PMC8579672 DOI: 10.1186/s13722-021-00277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The CHOICES study randomized participants with HIV and opioid use disorder (OUD) to HIV clinic-based extended-release naltrexone (XR-NTX), which requires complete cessation of opioid use, versus treatment-as-usual (i.e., buprenorphine, methadone). Study participants randomized to XR-NTX were interviewed to assess their experiences with successful and unsuccessful XR-NTX induction. METHODS Semi-structured qualitative interviews were completed with a convenience sample of study participants with HIV and OUD (n = 37) randomized to XR-NTX in five HIV clinics between 2018 and 2019. All participants approached agreed to be interviewed. Interviews were digitally recorded, professionally transcribed, and analyzed using thematic analysis. RESULTS Participants included women (43%), African Americans (62%) and Hispanics (16%), between 27 to 69 years of age. Individuals who completed XR-NTX induction (n = 20) reported experiencing (1) readiness for change, (2) a supportive environment during withdrawal including comfort medications, and (3) caring interactions with staff. Four contrasting themes emerged among participants (n = 17) who did not complete induction: (1) concern and anxiety about withdrawal including past negative experiences, (2) ambivalence about or reluctance to stop opioids, (3) concerns about XR-NTX effects, and (4) preferences for other medications. CONCLUSIONS The results highlight opportunities to improve initiation of XR-NTX in high-need groups. Addressing expectations regarding induction may enhance XR-NTX initiation rates. Trial Registration ClinicalTrials.gov: NCT03275350. Registered September 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03275350?term=extended+release+naltrexone&cond=Opioid+Use .
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Affiliation(s)
- Kim A Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Robin Baker
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | | | - Paula J Lum
- Department of Medicine, Division of HIV, ID & Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lynn E Kunkel
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Dennis McCarty
- Department of Medicine, Division of HIV, ID & Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Petra Jacobs
- National Institute on Drug Abuse, Center for the Clinical Trials Network, North Bethesda, MD, USA
| | - P Todd Korthuis
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA.,Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
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4
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Eyawo O, Deng Y, Dziura J, Justice AC, McGinnis K, Tate JP, Rodriguez-Barradas MC, Hansen NB, Maisto SA, Marconi VC, O'Connor PG, Bryant K, Fiellin DA, Edelman EJ. Validating Self-Reported Unhealthy Alcohol Use With Phosphatidylethanol (PEth) Among Patients With HIV. Alcohol Clin Exp Res 2021; 44:2053-2063. [PMID: 33460225 DOI: 10.1111/acer.14435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We sought to compare self-reported alcohol consumption using Timeline Followback (TLFB) to biomarker-based evidence of significant alcohol use (phosphatidylethanol [PEth] > 20 ng/ml). Using data from patients with HIV (PWH) entering a clinical trial, we asked whether TLFB could predict PEth > 20 ng/ml and assessed the magnitude of association between TLFB and PEth level. METHODS We defined unhealthy alcohol use as any alcohol use in the presence of liver disease, at-risk drinking, or alcohol use disorder. Self-reported alcohol use obtained from TLFB interview was assessed as mean number of drinks/day and number of heavy drinking days over the past 21 days. Dried blood spot samples for PEth were collected at the interview. We used logistic regression to predict PEth > 20 ng/ml and Spearman correlation to quantify the association with PEth, both as a function of TLFB. RESULTS Among 282 individuals (99% men) in the analytic sample, approximately two-thirds (69%) of individuals had PEth > 20 ng/ml. The proportion with PEth > 20 ng/ml increased with increasing levels of self-reported alcohol use; of the 190 patients with either at-risk drinking or alcohol use disorder based on self-report, 82% had PEth > 20 ng/ml. Discrimination was better with number of drinks per day than heavy drinking days (AUC: 0.80 [95% CI: 0.74 to 0.85] vs. 0.74 [95% CI: 0.68 to 0.80]). The number of drinks per day and PEth were significantly and positively correlated across all levels of alcohol use (Spearman's R ranged from 0.29 to 0.56, all p values < 0.01). CONCLUSIONS In this sample of PWH entering a clinical trial, mean numbers of drinks per day discriminated individuals with evidence of significant alcohol use by PEth. PEth complements self-report to improve identification of self-reported unhealthy alcohol use among PWH.
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Affiliation(s)
- Oghenowede Eyawo
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada.,Veterans Aging Cohort Study Coordinating Center, (OE, ACJ, KM, JPT), West Haven VA Healthcare System, West Haven, Connecticut
| | - Yanhong Deng
- Yale Center for Analytic Sciences, (YD, JD), Yale University School of Public Health, New Haven, Connecticut
| | - James Dziura
- Yale Center for Analytic Sciences, (YD, JD), Yale University School of Public Health, New Haven, Connecticut
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, (OE, ACJ, KM, JPT), West Haven VA Healthcare System, West Haven, Connecticut.,Yale School of Medicine, (ACJ, JPT, PGO, DAF, EJE), New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, (ACJ, NBH, DAF, EJE), Yale School of Public Health, New Haven, Connecticut
| | - Kathleen McGinnis
- Veterans Aging Cohort Study Coordinating Center, (OE, ACJ, KM, JPT), West Haven VA Healthcare System, West Haven, Connecticut
| | - Janet P Tate
- Veterans Aging Cohort Study Coordinating Center, (OE, ACJ, KM, JPT), West Haven VA Healthcare System, West Haven, Connecticut.,Yale School of Medicine, (ACJ, JPT, PGO, DAF, EJE), New Haven, Connecticut
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, (ACJ, NBH, DAF, EJE), Yale School of Public Health, New Haven, Connecticut.,College of Public Health, (NBH), University of Georgia, Athens, Georgia
| | - Stephen A Maisto
- Department of Psychology, (SAM), Syracuse University, Syracuse, New York
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center, (VCM), Emory University School of Medicine, Atlanta, Georgia
| | - Patrick G O'Connor
- Yale School of Medicine, (ACJ, JPT, PGO, DAF, EJE), New Haven, Connecticut
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, (KB), Bethesda, Maryland
| | - David A Fiellin
- Yale School of Medicine, (ACJ, JPT, PGO, DAF, EJE), New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, (ACJ, NBH, DAF, EJE), Yale School of Public Health, New Haven, Connecticut
| | - E Jennifer Edelman
- Yale School of Medicine, (ACJ, JPT, PGO, DAF, EJE), New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, (ACJ, NBH, DAF, EJE), Yale School of Public Health, New Haven, Connecticut
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Hoffman KA, Baker R, Kunkel LE, Waddell EN, Lum PJ, McCarty D, Korthuis PT. Barriers and facilitators to recruitment and enrollment of HIV-infected individuals with opioid use disorder in a clinical trial. BMC Health Serv Res 2019; 19:862. [PMID: 31752905 PMCID: PMC6868733 DOI: 10.1186/s12913-019-4721-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study. MAIN TEXT Methods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study staff that encourage eligible patient participation. Interviews were transcribed and thematically analyzed using a content analysis approach. RESULTS All respondents reported that barriers to recruitment and enrollment included challenging patient social and structural factors (e.g., homelessness or living environments with high substance use, criminal justice involvement), difficulty locating patients with unsuppressed HIV viral load and OUD within the HIV clinic, time-consuming study enrollment processes, and stigma around HIV and OUD which inhibited treatment seeking. Some respondents observed that distrust of research and researchers impeded recruitment activities in the community. A specific medication-related barrier was patient fear of opioid abstinence required prior to XR-NTX induction. Facilitators of recruitment included use of trusted peer outreach/recruitment workers in the community, hospitalizations that offered windows of opportunities for screening and XR-NTX induction, providing participant transportation, and partnerships with harm reduction organizations for referrals. CONCLUSIONS Though study personnel encountered barriers to recruitment in the CHOICES study, persons with untreated HIV and OUD can be enrolled in multisite clinical trials by using enhanced recruitment strategies that extend outside of the HIV clinic. Employing peer outreach workers and collaborating with syringe service programs may be especially helpful in facilitating recruitment and merit inclusion in similar study protocols.
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Affiliation(s)
- Kim A. Hoffman
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
| | - Robin Baker
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
| | - Lynn E. Kunkel
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
| | - Elizabeth Needham Waddell
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
| | - Paula J. Lum
- Department of Medicine, University of California-San Francisco, San Francisco, CA USA
| | - Dennis McCarty
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
| | - P. Todd Korthuis
- Oregon Health and Science University- Portland State University, School of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239-3088 USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR USA
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Combellick JL, Dziura J, Portnoy GA, Mattocks KM, Brandt CA, Haskell SG. Trauma and Sexual Risk: Do Men and Women Veterans Differ? Womens Health Issues 2019; 29 Suppl 1:S74-S82. [PMID: 31253246 DOI: 10.1016/j.whi.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Trauma has been associated with risky sexual behavior in diverse populations. However, little is known about this association among men and women veterans. This study hypothesized that 1) a history of trauma would be associated with risky sexual behavior among men and women veterans, 2) interpersonal trauma would predict risky sexual behavior among women, whereas noninterpersonal trauma would predict risky sexual behavior among men, and 3) military-related trauma would constitute additional risk. Using data from 567 women and 524 men veterans enrolled at the Veterans Health Administration, this study investigated the association between trauma-related experiences and risky sexual behavior in the last 12 months. Risk and protective factors that have been frequently associated with sexual behavior in previous research were also included in the model. METHODS This study was drawn from the Women Veterans Cohort Study, a national survey of veterans. Bivariate and multivariate analyses were performed after multiple imputation for missing data. RESULTS Predictive factors associated with risky sexual behavior differed between men and women veterans. Among women, childhood sexual victimization and intimate partner violence were associated with risky sexual behavior. Among men, binge drinking was the single significant risk factor. Military exposures were not significantly associated with risky sexual behavior in either men or women. CONCLUSIONS This study lays the groundwork for theory-generating research into the psychological underpinnings of noted associations and underscores the importance of integrated health services to address the range of issues affecting sexual behavior and related health outcomes.
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Affiliation(s)
- Joan L Combellick
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Midwifery, Yale School of Nursing, Orange, Connecticut.
| | - James Dziura
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Northampton, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Edelman EJ, Lunze K, Cheng DM, Lioznov DA, Quinn E, Gnatienko N, Bridden C, Chaisson CE, Walley AY, Krupitsky EM, Raj A, Samet JH. HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking. AIDS Behav 2017. [PMID: 28634662 DOI: 10.1007/s10461-017-1832-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The link between HIV stigma with substance use is understudied. We characterized individuals with high HIV stigma and examined whether HIV stigma contributes to substance use among HIV-positive Russians reporting risky alcohol use. We analyzed data from HERMITAGE, a randomized controlled trial of 700 people living with HIV/AIDS (PLWHA) with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007-2011). Participants who were female and reported depressive symptoms and lower social support were more likely to endorse high HIV stigma (all p's < 0.001). In adjusted models, high HIV stigma was not significantly associated with the primary outcome unhealthy substance use and was not consistently associated with secondary substance use outcomes. Interventions to enhance social and mental health support for PLWHA, particularly women, may reduce stigma, though such reductions may not correspond to substantial decreases in substance use among this population.
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT, 06520-8088, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Karsten Lunze
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Debbie M Cheng
- Boston University School of Public Health, Boston, MA, USA
| | - Dmitry A Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Emily Quinn
- Boston University School of Public Health, Boston, MA, USA
| | - Natalia Gnatienko
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Carly Bridden
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | | | - Alexander Y Walley
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Evgeny M Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- St.-Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation
| | - Anita Raj
- University of California - San Diego, San Diego, CA, USA
| | - Jeffrey H Samet
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O'Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA. The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for Three Parallel Multi-Site Stepped Care Effectiveness Studies for Unhealthy Alcohol Use in HIV-Positive Patients. Contemp Clin Trials 2016; 52:80-90. [PMID: 27876616 DOI: 10.1016/j.cct.2016.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/20/2023]
Abstract
Unhealthy alcohol use is common among HIV-positive patients, yet effective evidence-based treatments are rarely provided in clinical settings providing HIV care. Further, given patient variability in response to initial treatments, stepped care approaches may be beneficial. We describe the rationale, aims and study design for the current StartingTreatment forEthanol inPrimary care Trials (STEP Trials); three parallel randomized controlled effectiveness trials being conducted in five Infectious Disease Clinics. Participants meeting criteria for: 1) at-risk drinking, 2) moderate alcohol use with liver disease (MALD), or 3) alcohol use disorder (AUD) are randomized to integrated stepped care versus treatment as usual. For those with at-risk drinking or MALD, integrated stepped care starts with a one session brief intervention and follow-up 2-week telephone booster. Based on pre-specified nonresponse criteria, participants may be "stepped up" at week 4 to receive four sessions of motivational enhancement therapy (MET) and "stepped up" again at week 12 for addiction physician management (APM) and consideration of alcohol pharmacotherapy. For those with AUD, integrated stepped care begins with APM. Non-responders may be "stepped up" at week 4 to receive MET and again at week 12 for a higher level of care (e.g. intensive outpatient program). The primary outcome is alcohol consumption assessed at 24weeks, and secondary outcome is the VACS Index, a validated measure of HIV morbidity and mortality risk. Results from the STEP Trials should inform future research and the implementation of interventions to address unhealthy alcohol use among HIV-positive individuals.
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States; College of Public Health, University of Georgia, Athens, GA 30602, United States
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT 06511, United States
| | - Lynn E Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX 75216, United States
| | - Cynthia Gibert
- D.C. Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, D.C. 20422, United States
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas Houston, TX 77030, United States
| | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, United States
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT 06510, United States; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD 20892-7003, United States
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
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Chronic Binge Alcohol Administration Dysregulates Hippocampal Genes Involved in Immunity and Neurogenesis in Simian Immunodeficiency Virus-Infected Macaques. Biomolecules 2016; 6:biom6040043. [PMID: 27834864 PMCID: PMC5197953 DOI: 10.3390/biom6040043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/23/2016] [Accepted: 10/28/2016] [Indexed: 01/10/2023] Open
Abstract
Alcohol use disorders (AUD) exacerbate neurocognitive dysfunction in Human Immunodeficiency Virus (HIV+) patients. We have shown that chronic binge alcohol (CBA) administration (13–14 g EtOH/kg/wk) prior to and during simian immunodeficiency virus (SIV) infection in rhesus macaques unmasks learning deficits in operant learning and memory tasks. The underlying mechanisms of neurocognitive alterations due to alcohol and SIV are not known. This exploratory study examined the CBA-induced differential expression of hippocampal genes in SIV-infected (CBA/SIV+; n = 2) macaques in contrast to those of sucrose administered, SIV-infected (SUC/SIV+; n = 2) macaques. Transcriptomes of hippocampal samples dissected from brains obtained at necropsy (16 months post-SIV inoculation) were analyzed to determine differentially expressed genes. MetaCore from Thomson Reuters revealed enrichment of genes involved in inflammation, immune responses, and neurodevelopment. Functional relevance of these alterations was examined in vitro by exposing murine neural progenitor cells (NPCs) to ethanol (EtOH) and HIV trans-activator of transcription (Tat) protein. EtOH impaired NPC differentiation as indicated by decreased βIII tubulin expression. These findings suggest a role for neuroinflammation and neurogenesis in CBA/SIV neuropathogenesis and warrant further investigation of their potential contribution to CBA-mediated neurobehavioral deficits.
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McGinnis KA, Tate JP, Williams EC, Skanderson M, Bryant KJ, Gordon A, Kraemer KL, Maisto SA, Crystal S, Fiellin DA, Justice AC. Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend 2016; 168:196-202. [PMID: 27694059 PMCID: PMC5086273 DOI: 10.1016/j.drugalcdep.2016.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. METHODS Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. RESULTS Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa=0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa=0.46). Moderate agreement was consistent across subgroups. CONCLUSIONS EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.
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Affiliation(s)
- Kathleen A. McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT
| | - Janet P. Tate
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
| | - Emily C. Williams
- Health Services Research & Development; Veterans Affairs Puget Sound Health Care System, Seattle, WA, Department of Health Services, University of Washington, Seattle, WA
| | - Melissa Skanderson
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT
| | | | - Adam Gordon
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Kevin L. Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Steven Crystal
- Health Services Research, Rutgers University, New Brunswick, NJ
| | - David A. Fiellin
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
| | - Amy C. Justice
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
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Abstract
The impact of HIV and its treatment on the effects of alcohol remain unclear. Blood alcohol concentrations have been noted to be higher in HIV infected individuals prior to antiretroviral initiation. Our goal was to compare number of drinks to "feel a buzz or high" among HIV infected and uninfected men, stratified by viral load (VL) suppression. Data includes 1478 HIV infected and 1170 uninfected men in the veterans aging cohort study who endorsed current drinking. Mean (SD) number of drinks to feel a buzz was 3.1 (1.7) overall. In multivariable analyses, HIV infected men reported a lower mean number of drinks to feel a buzz compared to uninfected men (coef = -14 for VL < 500; -34 for VL ≥ 500; p ≤ .05). Men with HIV, especially those with a detectable VL, reported fewer drinks to feel a buzz. Future research on the relationship between alcohol and HIV should consider the role of VL suppression.
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Edelman EJ, Hansen NB, Cutter CJ, Danton C, Fiellin LE, O'Connor PG, Williams EC, Maisto SA, Bryant KJ, Fiellin DA. Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics. Addict Sci Clin Pract 2016; 11:1. [PMID: 26763048 PMCID: PMC4711105 DOI: 10.1186/s13722-015-0048-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022] Open
Abstract
Background
Effective counseling and pharmacotherapy for unhealthy alcohol use are rarely provided in HIV treatment settings to patients. Our goal was to describe factors influencing implementation of a stepped care model to address unhealthy alcohol use in HIV clinics from the perspectives of social workers, psychologists and addiction psychiatrists. Methods We conducted two focus groups with Social Workers (n = 4), Psychologists (n = 2), and Addiction Psychiatrists (n = 4) involved in an ongoing randomized controlled trial evaluating the effectiveness of integrated stepped care for unhealthy alcohol use in HIV-infected patients at five Veterans Health Administration (VA) HIV clinics. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) domains, with a focus on the three domains which we considered to be most relevant: intervention characteristics (i.e. motivational interviewing, pharmacotherapy), the inner setting (i.e. HIV clinics), and characteristics of individuals (i.e. the providers). A multidisciplinary team used directed content analysis to identify major themes. Results From the providers’ perspective, the major implementation themes that emerged by CFIR domain included: (1) Intervention characteristics: providers valued tools and processes for facilitating patient motivation for treatment of unhealthy alcohol use given their perceived lack of motivation, but expressed a desire for greater flexibility; (2) Inner setting: treating unhealthy alcohol use in HIV clinics was perceived by providers to be consistent with VA priorities; and (3) Characteristics of individuals: there was high self-efficacy to conduct the intervention, an expressed need for more consistent utilization to maintain skills, and consideration of alternative models for delivering the components of the intervention. Conclusions Use of the CFIR framework reveals that implementation of integrated stepped care for unhealthy alcohol use in HIV clinics is facilitated by tools to help providers enhance patient motivation or address unhealthy alcohol use among patients perceived to be unmotivated. Implementation may be facilitated by its consistency with organizational values and existing models of care and attention to optimizing provider self-efficacy and roles (i.e. approaches to treatment integration).
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Nathan B Hansen
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA. .,College of Public Health, University of Georgia, 131 Wright Hall, Health Sciences Campus, Athens, GA, 30602, USA.
| | - Christopher J Cutter
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Cheryl Danton
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Lynn E Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Patrick G O'Connor
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Emily C Williams
- VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA. .,Department of Health Services, University of Washington, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-664, Seattle, WA, 98195, USA.
| | - Stephen A Maisto
- Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, 5635 Fishers Lane, Bethesda, MD, 20892-7003, USA.
| | - David A Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
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13
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Kerridge BT, Tran P, Hasin DS. Intoxication at last sexual intercourse and unprotected sex among HIV-positive and HIV-negative individuals in Uganda: an event-level analysis. AIDS Behav 2015; 19:412-21. [PMID: 25074735 DOI: 10.1007/s10461-014-0854-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined, for the first time, the association between intoxication at last sexual intercourse and unprotected sex separately among HIV-positive and HIV-negative individuals. Data were derived from a nationally-representative survey of Uganda in 2011. Multivariable logistic regression analyses of the intoxication-unprotected sex association included adjustment for sociodemographic and behavioral covariates that were also examined as moderators of the association. Among HIV-positive individuals, intoxication was associated with unprotected sex, whereas among HIV-negative individuals, the intoxication-unprotected sex association was moderated by knowledge that condoms prevent HIV transmission. The odds of unprotected sex was 2.67 times greater among HIV-negative individuals who were unaware that condoms prevent HIV, an association not observed among those who possessed such knowledge. The results suggest that the intoxication-unprotected sex link be incorporated within Ugandan National HIV Prevention Strategies among HIV-positive and HIV-negative individuals. HIV-negative individuals who are unaware that condoms prevent HIV should be targeted for interventions focusing on increasing HIV transmission knowledge especially on the role of condoms in preventing the disease. The latter interventions should also identify those sociocultural and political beliefs about condom use that may serve as barriers to consistent condom use.
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Abstract
PURPOSE OF REVIEW Substance use may persist throughout the life course and has a substantial impact on health outcomes globally. As HIV-infected individuals are disproportionately impacted by substance use and living longer, it is critical that providers and researchers alike understand the impact of substance use on older, HIV-infected patients and potential treatment options. To this end, we conducted a review of the literature focusing on the most commonly used substances to outline the epidemiology, health consequences, treatment options and latest research relevant to older, HIV-infected patients. RECENT FINDINGS Substance use impacts older, HIV-infected patients with regards to HIV-related and non-HIV-related outcomes. Counseling strategies are available for marijuana and stimulant use disorders. Brief counseling is useful alongside medications for alcohol, tobacco and opioid use disorders. Many medications for alcohol, tobacco and opioid use disorders are safe in the setting of antiretroviral therapy. Unfortunately, few interventions targeting substance use in older, HIV-infected patients have been developed and evaluated. SUMMARY As older, HIV-infected patients continue to experience substance use and its related health consequences, there will be a growing need for the development of safe and effective interventions, which address the complex needs of this population.
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Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS Behav 2015; 19:1-8. [PMID: 24668254 DOI: 10.1007/s10461-014-0746-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
By 2015, one-half of all HIV-positive persons in the U.S. will be 50-plus years of age, and as many as 30 % of older adults living with HIV/AIDS continue to engage in unprotected sexual intercourse. Contemporary positive prevention models often include mental health treatment as a key component of HIV prevention interventions. This secondary data analysis characterized longitudinal patterns of sexual behavior in HIV-positive older adults enrolled in a randomized controlled trial of group mental health interventions and assessed the efficacy of psychosocial treatments that targeted depression to reduce sexual risk behavior. Participants were 295 HIV-positive adults ≥50 years of age experiencing mild to severe depressive symptoms, randomized to one of three study conditions: a 12-session coping improvement group intervention, a 12-session interpersonal support group intervention, or individual therapy upon request. Approximately one-fifth of participants reported one or more occasions of unprotected anal or vaginal intercourse with HIV-negative sexual partners or persons of unknown HIV serostatus over the study period. Changes in sexual behavior did not vary by intervention condition, indicating that standalone treatments that target and reduce depression may be insufficient to reduce sexual risk behavior in depressed HIV-positive older adults.
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Affiliation(s)
- Travis I Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA,
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16
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Fiellin DA, McGinnis KA, Maisto SA, Justice AC, Bryant K. Measuring alcohol consumption using Timeline Followback in non-treatment-seeking medical clinic patients with and without HIV infection: 7-, 14-, or 30-day recall. J Stud Alcohol Drugs 2013; 74:500-4. [PMID: 23490581 DOI: 10.15288/jsad.2013.74.500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The measurement of alcohol consumption is an essential component of research in patients at risk for or infected with HIV. Daily estimation measures such as the Timeline Followback (TLFB) have been validated, yet the optimal time window and its performance in non-treatment-seeking medical clinic subjects and among those with HIV are not known. METHOD In 1,519 HIV-infected and 1,612 uninfected men receiving medical care in general medical or infectious disease clinics, we compared the association between 7-, 14-, and 30-day TLFB reports, obtained via telephone, of alcohol consumption using Spearman's correlation coefficients. To evaluate agreement between 7-, 14-, and 30-day reports of heavy episodic drinking, we evaluated percent agreement, sensitivity, and kappa statistics, considering 30-day report as the gold standard. RESULTS The estimated prevalence of heavy episodic drinking was progressively higher for longer TLFB intervals (7 days: 6.3%; 14 days: 8.0%; 30 days: 9.5%). Correlation coefficients with 30- day TLFB were higher for 14 days (.94) than for 7 days (.86) overall (p < .001) and among HIV-infected (.94 vs. .86, p < .001) and uninfected (.95 vs. .87, p < 001). Correlations were similar by HIV status. When considered overall and by HIV status, the sensitivity, percent agreement, and kappa statistics are better for heavy episodic drinking based on 14 days compared with 7 days. CONCLUSIONS A TLFB for alcohol consumption of 14 days is preferable to 7 days for non-treatment-seeking patients in medical clinics with and without HIV infection when compared with 30 days.
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Affiliation(s)
- David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Hutton HE, McCaul ME, Chander G, Jenckes MW, Nollen C, Sharp VL, Erbelding EJ. Alcohol use, anal sex, and other risky sexual behaviors among HIV-infected women and men. AIDS Behav 2013; 17:1694-704. [PMID: 22566077 DOI: 10.1007/s10461-012-0191-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Effective sexual risk reduction strategies for HIV-infected individuals require an understanding of alcohol's influence on specific sexual behaviors. We conducted audio-computer-assisted-self-interviews on 910 patients from two HIV primary care programs. The association between alcohol use and risky sexual behaviors was examined using multivariable logistic regression adjusting for age, education, race/ethnicity and drug use. Frequent/binge drinking was associated with engaging in anal sex and having multiple sex partners among women, engaging in insertive anal sex among gay/bisexual men, and was unrelated to risky sexual behaviors among heterosexual men. Infrequent drinkers did not differ in sexual risk behaviors from abstainers among women or men. Finally, there was no interaction effect between race/ethnicity and alcohol use on the association with sexual risk behaviors. The study has yielded important new findings in several key areas with high relevance to HIV care. Results underscore the importance of routinely screening for alcohol use and risky sexual behaviors in HIV primary care.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA.
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Participant characteristics and HIV risk behaviors among individuals entering integrated buprenorphine/naloxone and HIV care. J Acquir Immune Defic Syndr 2011; 56 Suppl 1:S14-21. [PMID: 21317589 DOI: 10.1097/qai.0b013e318209d3b9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study was part of a national, multisite demonstration project evaluating the impact of integrated buprenorphine/naloxone treatment and HIV care. The goals of this study were to describe the baseline demographic, clinical, and substance use characteristics of the participants and to explore HIV transmission risk behaviors in this group. METHODS Nine sites across the United States participated. Data obtained by interview and chart review included demographic information, medical history, substance use, and risk behaviors.We performed a descriptive analysis of patient characteristics at entry and used logistic regression to evaluate factors associated with 1) unprotected anal or vaginal sex; and 2) needle-sharing within the previous 90 days. RESULTS Three hundred eighty-six individuals were included in the study: 303 (78.5%) received buprenorphine/naloxone; 41 (10.6%) received methadone; and 42 (10.9%) received another form of treatment. The analysis of risk behaviors was limited to those in the buprenorphine group (n = 303). Among those reporting vaginal or anal sex in the previous 90 days, 24% had sex without a condom. Factors significantly associated with unprotected sex were: having a partner; female gender; and alcohol use in previous 30 days. A total of 8.9% of participants shared needles in the previous 90 days. Factors significantly associated with needle-sharing were: amphetamine use; marijuana use; homelessness; and anxiety. CONCLUSIONS Addressing transmission risk behaviors is an important secondary HIV prevention strategy. In addition to treatment for opioid dependence, addressing other substance use, social issues, particularly housing, and mental health may have important implications for reducing HIV transmission in HIV-infected opioid-dependent patients.
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Hurt CB, Torrone E, Green K, Foust E, Leone P, Hightow-Weidman L. Methamphetamine use among newly diagnosed HIV-positive young men in North Carolina, United States, from 2000 to 2005. PLoS One 2010; 5:e11314. [PMID: 20593025 PMCID: PMC2892509 DOI: 10.1371/journal.pone.0011314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/24/2010] [Indexed: 11/30/2022] Open
Abstract
Background Methamphetamine (MA) is a new arrival to the Southeastern United States (US). Incidence of HIV is also increasing regionally, but data are limited regarding any association between this trend and MA use. We examined behavioral data from North Carolina (NC) residents newly diagnosed with HIV, collected by the Department of Health between 2000-2005. Principal Findings Among 1,460 newly diagnosed HIV-positive young men, an increasing trend was seen from 2000-2005 in MA use (p = 0.01, total n = 20). In bivariate analyses, users of MA had significantly greater odds of reporting other substance use, including alcohol, powder or crack cocaine, marijuana, and methylenedioxymethamphetamine (MDMA, “ecstasy”). They were also more likely to have reported sexual activity while traveling outside NC; sex with anonymous partners; and previous HIV testing. In a predictive model, MA use had a negative association with nonwhite race, and strong positive associations with powder cocaine, “ecstasy,” or intravenous drug use and being a university student. Conclusions Similar to trends seen in more urban parts of the US, MA use among newly diagnosed, HIV-positive young men is increasing in NC. These data are among the first to demonstrate this relationship in a region with a burgeoning epidemic of MA use. Opportunities exist for MA-related HIV risk-reduction interventions whenever young men intersect the healthcare system.
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Affiliation(s)
- Christopher B Hurt
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
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Cook RL, McGinnis KA, Samet JH, Fiellin DA, Rodriguez-Barradas MC, Kraemer KL, Gibert CL, Braithwaite RS, Goulet JL, Mattocks K, Crystal S, Gordon AJ, Oursler KK, Justice AC, Justice AC. Erectile dysfunction drug receipt, risky sexual behavior and sexually transmitted diseases in HIV-infected and HIV-uninfected men. J Gen Intern Med 2010; 25:115-21. [PMID: 19921112 PMCID: PMC2837496 DOI: 10.1007/s11606-009-1164-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/21/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care providers may be concerned that prescribing erectile dysfunction drugs (EDD) will contribute to risky sexual behavior. OBJECTIVES To identify characteristics of men who received EDD prescriptions, determine whether EDD receipt is associated with risky sexual behavior and sexually transmitted diseases (STDs), and determine whether these relationships vary for certain sub-groups. DESIGN Cross-sectional study. PARTICIPANTS Two thousand seven hundred and eighty-seven sexually-active, HIV-infected and HIV-uninfected men recruited from eight Veterans Health Affairs outpatient clinics. Data were obtained from participant surveys, electronic medical records, and administrative pharmacy data. MEASURES EDD receipt was defined as two or more prescriptions for an EDD, risky sex as having unprotected sex with a partner of serodiscordant or unknown HIV status, and STDs, according to self-report. RESULTS Overall, 28% of men received EDD in the previous year. Eleven percent of men reported unprotected sex with a serodiscordant/unknown partner in the past year (HIV-infected 15%, HIV-uninfected 6%, P < 0.001). Compared to men who did not receive EDD, men who received EDD were equally likely to report risky sexual behavior (11% vs. 10%, p = 0.9) and STDs (7% vs 7%, p = 0.7). In multivariate analyses, EDD receipt was not significantly associated with risky sexual behavior or STDs in the entire sample or in subgroups of substance users or men who had sex with men. CONCLUSION EDD receipt was common but not associated with risky sexual behavior or STDs in this sample of HIV-infected and uninfected men. However, risky sexual behaviors persist in a minority of HIV-infected men, indicating ongoing need for prevention interventions.
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Affiliation(s)
- Robert L Cook
- Department of Epidemiology and Biostatistics, University of Florida, PO Box 100231, Gainesville, FL 32610, USA.
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Maisto SA, McGinnis K, Cook R, Conigliaro J, Bryant K, Justice AC. Factor structure of Leigh's (1990) alcohol sex expectancies scale in individuals in treatment for HIV disease. AIDS Behav 2010; 14:174-80. [PMID: 18791863 DOI: 10.1007/s10461-008-9457-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to validate the use of Leigh's (1990) alcohol sex expectancies scale among HIV-infected individuals presenting for treatment as a way to facilitate research on sexual risk reduction among individuals in that population. The participants were 944 men who presented for treatment at infectious disease or general medicine clinics across 8 different VA Medical Center sites. A total of 534 of these men were HIV-positive and 410 were HIV-negative. The total sample was randomly divided in half within each HIV group to form exploratory (Sample 1) and confirmatory (Sample 2) subsamples. A principal components factor analysis with oblique rotation of the original 13-item Leigh scale within each HIV group in Sample 1 revealed a 2-factor (7 and 4 items, respectively) solution that was consistent across both HIV groups. These factors were named "More Open to Sexual Pleasure" (Factor 1) and "Reduced Inhibitions about Sex (Factor 2)." A confirmatory factor analysis of the 11-item, 2-factor solution on the full Sample 2 showed a modest fit to the data, excellent internal consistency reliability of both factors, a high correlation between the factors, and strong evidence for construct validity. These results were interpreted as supporting the use of the 11-item, 2-factor version of Leigh's scale in studies of clinical samples of HIV-positive adults, and directions for research on further scale refinement are discussed.
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Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: review and meta-analysis. AIDS Behav 2009; 13:1021-36. [PMID: 19618261 DOI: 10.1007/s10461-009-9589-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
The present investigation attempted to quantify the relationship between alcohol consumption and unprotected sexual behavior among people living with HIV/AIDS (PLWHA). A comprehensive search of the literature was performed to identify key studies on alcohol and sexual risk behavior among PLWHA, and three separate meta-analyses were conducted to examine associations between unprotected sex and (1) any alcohol consumption, (2) problematic drinking, and (3) alcohol use in sexual contexts. Based on 27 relevant studies, meta-analyses demonstrated that any alcohol consumption (OR = 1.63, CI = 1.39-1.91), problematic drinking (OR = 1.69, CI = 1.45-1.97), and alcohol use in sexual contexts (OR = 1.98, CI = 1.63-2.39) were all found to be significantly associated with unprotected sex among PLWHA. Taken together, these results suggest that there is a significant link between PLWHA's use of alcohol and their engagement in high-risk sexual behavior. These findings have implications for the development of interventions to reduce HIV transmission risk behavior in this population.
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Zekan S, Novotny TE, Begovac J. Unsafe sexual behavior among HIV-infected patients in Croatia, 2006: prevalence and associated factors. AIDS Behav 2008; 12:S86-92. [PMID: 18543093 DOI: 10.1007/s10461-008-9420-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 05/20/2008] [Indexed: 11/24/2022]
Abstract
Information about risky sexual behavior among people living with HIV/AIDS is important to prevent the spread of the disease. Using an anonymous, self-administrated questionnaire, we surveyed 185 HIV-infected patients about risk behaviors at the University Hospital for Infectious Diseases in Croatia. Unprotected anal or vaginal sex in the preceding 6 months with partners of uninfected/unknown HIV status was reported by 20% of men who have sex with men (MSM), about half of whom reported multiple casual partners of unknown HIV status; 6% of heterosexual men; and 3% of women. Heterosexual patients were potentially more likely to expose regular partners to HIV but reported no risk behaviors with casual, non-concordant partners. MSM reported more risk behaviors, which were strongly associated with having > or = 2 sexual partners in the last 6 months and both insertive and receptive anal sex. Educational interventions in Croatia should target MSM to prevent high rates of HIV transmission.
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Affiliation(s)
- Sime Zekan
- Croatian Reference Center for AIDS, University Hospital for Infectious Diseases, Mirogojska 8, 10 000, Zagreb, Croatia.
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Metsch LR, Pereyra M, Colfax G, Dawson-Rose C, Cardenas G, McKirnan D, Eroglu D. HIV-positive patients' discussion of alcohol use with their HIV primary care providers. Drug Alcohol Depend 2008; 95:37-44. [PMID: 18243580 DOI: 10.1016/j.drugalcdep.2007.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 11/29/2007] [Accepted: 12/04/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We investigated the prevalence of HIV-positive patients discussing alcohol use with their HIV primary care providers and factors associated with these discussions. METHODS We recruited 1225 adult participants from 10 HIV care clinics in three large US cities from May 2004 to 2005. Multivariate logistic regression analysis was used to assess the associations between self-reported rates of discussion of alcohol use with HIV primary care providers in the past 12 months and the CAGE screening measure of problem drinking and sociodemographic variables. RESULTS Thirty-five percent of participants reported discussion of alcohol use with their primary care providers. The odds of reporting discussion of alcohol were three times greater for problem drinkers than for non-drinkers, but only 52% of problem drinkers reported such a discussion in the prior 12 months. Sociodemographic factors associated with discussion of alcohol use (after controlling for problem drinking) were being younger than 40, male, being non-white Hispanic (compared with being Hispanic), being in poorer health, and having a better patient-provider relationship. CONCLUSIONS Efforts are needed to increase the focus on alcohol use in the HIV primary care setting, especially with problem drinkers. Interventions addressing provider training or brief interventions that address alcohol use by HIV-positive patients in the HIV primary care setting should be considered as possible approaches to address this issue.
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Affiliation(s)
- Lisa R Metsch
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Arasteh K, Jarlais DCD, Perlis TE. Alcohol and HIV sexual risk behaviors among injection drug users. Drug Alcohol Depend 2008; 95:54-61. [PMID: 18242009 PMCID: PMC2373771 DOI: 10.1016/j.drugalcdep.2007.12.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 12/08/2007] [Accepted: 12/12/2007] [Indexed: 12/01/2022]
Abstract
We analyzed data from 6341 injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to test the hypothesis that alcohol use and intoxication is associated with increased HIV sexual risk behaviors. Two types of associations were assessed: (1) a global association (i.e., the relationship between HIV sexual risk behaviors during the 6 months prior to the interview and at-risk drinking in that period, defined as more than 14 drinks per week for males or 7 drinks per week for females), and (2) an event-specific association (i.e., the relationship between HIV sexual risk behaviors during the most recent sex episode and alcohol intoxication during that episode). Sexual risk behaviors included multiple sex partners and engaging in unprotected sex. After adjusting for the effects of other variables, at-risk-drinkers were more likely to report multiple sex partners and engaging in unprotected sex with casual sex partners (both global associations). IDUs who reported both they and their casual partners were intoxicated during the most recent sex episode were more likely to engage in unprotected sex (an event-specific association). We also observed two significant interactions. Among IDUs who did not inject cocaine, moderate-drinkers were more likely to report multiple partners. Among self-reported HIV seropositive IDUs, when both primary partners were intoxicated during the most recent sex episode they were more likely to engage in unprotected sex. These observations indicate both global and event-specific associations of alcohol and HIV sexual-risk behaviors.
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Affiliation(s)
- Kamyar Arasteh
- Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, 160 Water Street, 24th Floor, New York, NY 10038, USA.
| | - Don C Des Jarlais
- Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, 160 Water St. - 24 Floor, New York, NY 10038, USA
| | - Theresa E Perlis
- Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, 160 Water St. - 24 Floor, New York, NY 10038, USA
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Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:321-33. [PMID: 17685845 PMCID: PMC2505189 DOI: 10.1521/aeap.2007.19.4.321] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.
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Affiliation(s)
- Nina A Cooperman
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
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Conigliaro J, Justice AC, Gordon AJ, Bryant K. Role of alcohol in determining human immunodeficiency virus (HIV)-relevant outcomes: A conceptual model to guide the implementation of evidence-based interventions into practice. Med Care 2006; 44:S1-6. [PMID: 16849963 DOI: 10.1097/01.mlr.0000223659.36369.cf] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joseph Conigliaro
- Program for Quality, Safety and Patient Rights, Department of Medicine, University of Kentucky, Lexington, Kentucky 40536, USA.
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Justice AC, Erdos J, Brandt C, Conigliaro J, Tierney W, Bryant K. The Veterans Affairs Healthcare System: A unique laboratory for observational and interventional research. Med Care 2006; 44:S7-12. [PMID: 16849970 DOI: 10.1097/01.mlr.0000228027.80012.c5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Amy C Justice
- Veterans Aging Cohort Study Center, Yale University School of Medicine, New Haven, CT 06516, USA.
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Bryant KJ. Expanding research on the role of alcohol consumption and related risks in the prevention and treatment of HIV/AIDS. Subst Use Misuse 2006; 41:1465-507. [PMID: 17002990 DOI: 10.1080/10826080600846250] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article is a review of some of the major epidemiological, behavioral, biological, and integrative prevention research issues and priorities in the area of HIV/AIDS and alcohol consumption. Drinking alcohol increases both the risk for infection with HIV and related illnesses and the morbidity and mortality of patients who progress to AIDS. New and improved measurement procedures have helped in assessment of the complex patterns of alcohol use, identification of intervening explanatory mechanisms for risk behaviors and contexts, and determination of intervention outcomes. Both the direct and indirect effects of alcohol misuse appear to be major contributors to both the risk for infection with HIV and the transmission of HIV/AIDS at the individual and population levels. There is increasing evidence that perhaps no level of alcohol consumption is "safe" for those who are HIV infected and receiving antiretroviral treatment. Interdisciplinary basic behavioral and biomedical research is needed to develop comprehensive culturally appropriate strategies for programs that can be effectively delivered in community contexts in the United States and abroad and that focus on the integration of our understanding of individual behaviors, high-risk group membership, biological mechanisms, and the social and physical environments that place individuals at risk for HIV infection. High-priority topics include improving adherence to antiretroviral medications, prevention of infection in young minority women in the United States, and treatment of HIV+ pregnant women who are alcohol abusers to prevent adverse fetal outcomes, which is an international focus in under-resourced settings in Africa.
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