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Strathdee SA, Bristow CC, Gaines T, Shoptaw S. Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States. Sex Transm Dis 2021; 48:466-473. [PMID: 33315749 PMCID: PMC8184578 DOI: 10.1097/olq.0000000000001341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Associations between substance use disorders and outbreaks of HIV and acute viral hepatitis have received considerable attention, but less research has focused on links between substance use disorders and sexually transmitted infections, apart from alcohol misuse. This narrative review describes the history of this public health crisis in the United States and direct and indirect effects opioids and specific stimulants have on high-risk sexual behaviors. We also review the epidemiology of sexually transmitted infections associated with opioids and stimulants in the United States and discuss opportunities for integrated interventions.
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Affiliation(s)
- Steffanie Ann Strathdee
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Claire C Bristow
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Tommi Gaines
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Steven Shoptaw
- Department of Family Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Huckabay L, Fisher DG, Reynolds GL, Rannalli D, Erlyana E. Gender differences in risk taking behaviors for Chlamydia trachomatis. Health Care Women Int 2020; 41:1147-1165. [PMID: 32701401 DOI: 10.1080/07399332.2020.1797037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chlamydia trachomatis (CT) is a global problem. We compared the risk taking behaviors for CT infection between men and women. Adults (2299 females, 5559 males) were administered the Risk Behavior Assessment. In women, CT was associated with candidiasis, in men with gonorrhea, genital warts, and syphilis. Risk factors for both genders were trading sex for money, use of marijuana for women, and use of Ecstasy and Viagra for men. Those with CT had higher risk perception for HIV infection and were more likely to obtain HIV testing. Patient teaching and concurrent testing for HIV and CT are imperative.
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Affiliation(s)
- Loucine Huckabay
- School of Nursing, California State University, Long Beach, Long Beach, California, USA
| | - Dennis G Fisher
- Department of Psychology and Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, California, USA
| | - Grace L Reynolds
- Department of Health Care Administration and Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, California, USA
| | - Debby Rannalli
- School of Nursing, California State University, Long Beach, Long Beach, California, USA
| | - Erlyana Erlyana
- Department of Health Care Administration and Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, California, USA
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Clingan SE, Fisher DG, Hardan-Khalil K, Reynolds GL, Huckabay L, Costa C, Pedersen WC, Johnson ME. Health implications of sex trading characteristics in Long Beach, California, USA. Int J STD AIDS 2019; 30:647-655. [PMID: 30961464 DOI: 10.1177/0956462419828138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the comparative health risk behaviors of women who (a) traded sex for money, (b) traded sex for drugs, (c) traded sex for both drugs and money, or (d) did not trade sex. Self-report data were collected from 2369 women who received services through HIV and sexually transmitted infection (STI) testing programs and a subset were tested for HIV, hepatitis B, hepatitis C, and syphilis. Results revealed those women who traded sex only for money used condoms, were tested for HIV, and received the HIV test results more often than the other women. Women who traded sex for both drugs and money reported a significantly higher prevalence of gonorrhea, hepatitis B, and syphilis; were more likely to test positive for hepatitis B, syphilis, and HIV; engaged more often in sex acts without condoms; and were incarcerated for significantly more days. Based on these findings, the targets with greatest potential for STI prevention interventions are female sex workers who trade sex for both drugs and money.
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Affiliation(s)
- Sara E Clingan
- 1 San Diego State University/University of California, San Diego Joint Doctoral Program, Interdisciplinary Research on Substance Use, San Diego, CA, USA
| | - Dennis G Fisher
- 2 Psychology Department, California State University, Long Beach, CA, USA.,3 Center for Behavioral Research and Services, California State University, Long Beach, CA, USA
| | | | - Grace L Reynolds
- 3 Center for Behavioral Research and Services, California State University, Long Beach, CA, USA.,5 Health Care Administration Department, California State University, Long Beach, CA, USA
| | - Loucine Huckabay
- 4 School of Nursing, California State University, Long Beach, CA, USA
| | - Christine Costa
- 4 School of Nursing, California State University, Long Beach, CA, USA
| | - William C Pedersen
- 2 Psychology Department, California State University, Long Beach, CA, USA
| | - Mark E Johnson
- 6 Office of Research, Pacific University, Forest Grove, OR, USA
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Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res 2016; 3:4. [PMID: 26877884 PMCID: PMC4752809 DOI: 10.1186/s40779-016-0074-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/28/2016] [Indexed: 11/10/2022] Open
Abstract
Bacterial vaginosis (BV) is a common vaginal disorder in women of reproductive age. Since the initial work of Leopoldo in 1953 and Gardner and Dukes in 1955, researchers have not been able to identify the causative etiologic agent of BV. There is increasing evidence, however, that BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardenella vaginalis, Mobiluncus curtisii, M. mulieris, other anaerobic bacteria and/or Mycoplasma hominis. Worldwide, it estimated that 20-30 % of women of reproductive age attending sexually transmitted infection (STI) clinics suffer from BV, and that its prevalence can be as high as 50-60 % in high-risk populations (e.g., those who practice commercial sex work (CSW). Epidemiological data show that women are more likely to report BV if they: 1) have had a higher number of lifetime sexual partners; 2) are unmarried; 3) have engaged in their first intercourse at a younger age; 4) have engaged in CSW, and 5) practice regular douching. In the past decade, several studies have provided evidence on the contribution of sexual activity to BV. However, it is difficult to state that BV is a STI without being able to identify the etiologic agent. BV has also emerged as a public health problem due to its association with other STIs, including: human immunodeficiency virus (HIV), herpes simplex virus type 2 (HSV-2), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The most recent evidence on the association between BV and CT/NG infection comes from two secondary analyses of cohort data conducted among women attending STI clinics. Based on these studies, women with BV had a 1.8 and 1.9-fold increased risk for NG and CT infection, respectively. Taken together, BV is likely a risk factor or at least an important contributor to subsequent NG or CT infection in high-risk women. Additional research is required to determine whether this association is also present in other low-risk sexually active populations, such as among women in the US military. It is essential to conduct large scale cross-sectional or population-based case-control studies to investigate the role of BV as a risk factor for CT/NG infections. These studies could lead to the development of interventions aimed at reducing the burden associated with bacterial STIs worldwide.
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Affiliation(s)
| | - Eyako Wurapa
- Walter Reed Army Institute of Research, Maryland, USA
| | | | - Sara Morris
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Jose L Sanchez
- Armed Forces Health Surveillance Center and Cherokee Nation Technology Solutions, Maryland, USA
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Bazzi AR, Rangel G, Martinez G, Ulibarri MD, Syvertsen JL, Bazzi SA, Roesch S, Pines HA, Strathdee SA. Incidence and Predictors of HIV and Sexually Transmitted Infections Among Female Sex Workers and Their Intimate Male Partners in Northern Mexico: A Longitudinal, Multilevel Study. Am J Epidemiol 2015; 181:723-31. [PMID: 25769307 PMCID: PMC4408950 DOI: 10.1093/aje/kwu340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/05/2014] [Indexed: 11/12/2022] Open
Abstract
Preventing human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs) requires an understanding of sexual relationship factors beyond the individual level. We estimated HIV/STI incidence and identified time-varying predictors of STI acquisition in a prospective cohort study of female sex workers and their intimate (noncommercial) male partners in northern Mexico. From 2010 to 2013, couples underwent behavioral and biological assessments biannually for 24 months. Among 413 initially HIV-uninfected participants, 8 seroconverted during follow-up. Incidence of HIV (1.12 cases/100 person-years (PY)), chlamydia (9.47 cases/100 PY), active syphilis (4.01 cases/100 PY), and gonorrhea (1.78 cases/100 PY) was higher among women than among men (HIV: P = 0.069; all STIs combined: P < 0.001). In multivariable conditional logistic regression with individual fixed effects and correlated error terms within couples, risk of STI acquisition was significantly higher among women who had recently used cocaine, crack, or methamphetamine (adjusted odds ratio (OR) = 2.13, 95% confidence interval (CI): 1.07, 4.28). STI risk was lower among women who reported physically assaulting their male partners (adjusted OR = 0.44, 95% CI: 0.22, 0.86) and among men whose female partners had regular sex-work clients (adjusted OR = 0.38, 95% CI: 0.14, 1.03). Improving vulnerable couples' sexual health will require addressing the contexts in which drug use, interpersonal conflict, and economic vulnerability converge.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steffanie A. Strathdee
- Correspondence to Dr. Steffanie A. Strathdee, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507 (e-mail: )
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Robertson AM, Syvertsen JL, Ulibarri MD, Rangel MG, Martinez G, Strathdee SA. Prevalence and correlates of HIV and sexually transmitted infections among female sex workers and their non-commercial male partners in two Mexico-USA border cities. J Urban Health 2014; 91:752-67. [PMID: 24488651 PMCID: PMC4134454 DOI: 10.1007/s11524-013-9855-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Female sex workers (FSWs) acquire HIV and other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424), prevalence of HIV was 2.6 % (n = 11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, p < 0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.
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Affiliation(s)
- Angela M. Robertson
- />Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- />The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215 USA
| | - Jennifer L. Syvertsen
- />Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210 USA
| | - Monica D. Ulibarri
- />Department of Psychiatry, University of California at San Diego, 9500 Gilman Drive, Mail Code 0603, La Jolla, CA 92093-0603 USA
| | - M. Gudelia Rangel
- />Department of Population Studies, El Colegio de La Frontera Norte, Carretera Escénica Tijuana-Ensenada, Km 18.5, San Antonio del Mar, 22560 Tijuana, Baja California Mexico
| | - Gustavo Martinez
- />Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón No. 788 Col. Centro C.P., 32000 Ciudad Juárez, Chihuahua Mexico
| | - Steffanie A. Strathdee
- />Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA 92093-0507 USA
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Radfar SR, Rawson RA. Current research on methamphetamine: epidemiology, medical and psychiatric effects, treatment, and harm reduction efforts. ADDICTION & HEALTH 2014; 6:146-54. [PMID: 25984282 PMCID: PMC4354220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/21/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Methamphetamine (MA) which is known as "shisheh" in Iran is a drug that widely is used in many parts of the world and it is near to a decade that is available for the most drug users and has a considerable prevalence of use. Due to high abuse prevalence and very new challenging phenomenon, it is very important that researchers and treatment providers become more familiar with different aspects of MA. DISCUSSION It has multiple neurobiological impacts on the nervous system, some of which are transitory and some longer lasting. MA activates the reward system of the brain and produces effects that are highly reinforcing, which can lead to abuse and dependence. Routes of administration that produce rapid onset of the drug's effects (i.e., smoking and injection) are likely to lead to more rapid addiction and more medical and psychiatric effects. No effective pharmacotherapies have been developed for the treatment of MA dependence; although, this is an area of very active research. Several behavioral treatments have been shown to reduce MA use, but better treatments are needed. CONCLUSION Harm reduction strategies for non-treatment seeking MA users are needed to reduce the risk of human immunodeficiency virus and other medical risks. The research agenda for MA is substantial, with development of effective pharmacotherapies as one of the most important priorities. Appropriate and effective response for prevention, treatment and harm reduction services due to increasing problems regarding MA in Iran and some other countries in the region.
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Affiliation(s)
- Seyed Ramin Radfar
- NIDA/IAS Fellowship Student, UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA,Correspondence to: Seyed Ramin Radfar MD, MPH,
| | - Richard A. Rawson
- Professor, Department of Psychiatry, UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Rawson RA. Current research on the epidemiology, medical and psychiatric effects, and treatment of methamphetamine use. J Food Drug Anal 2013; 21:S77-S81. [PMID: 25214749 DOI: 10.1016/j.jfda.2013.09.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Methamphetamine (MA) is a drug that is widely used in many parts of the world. It has multiple neurobiological impacts on the nervous system, some of which are transitory and some more long lasting. MA activates the reward system of the brain and produces effects that are highly reinforcing, which can lead to abuse and dependence. Routes of administration that produce rapid onset of the drug's effects (i.e., smoking and injection) are likely to lead to more rapid addiction and more medical and psychiatric effects. The medical effects of MA use are extensive, and chronic use of MA can produce significant neurological damage as well as damage to cardiovascular, pulmonary, and other organ systems. Both acute and chronic MA use can lead to extreme paranoia, anxiety, and depression, and following discontinuation of MA use, cognitive deficits and anhedonia can persist for months. No effective pharmacotherapies have been developed for the treatment of MA dependence, although this is an area of very active research. Several behavioral treatments have been shown to reduce MA use, but better treatments are needed. The research agenda for MA is substantial, with development of effective pharmacotherapies as one of the most important priorities.
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Affiliation(s)
- Richard A Rawson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA
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Chen NE, Strathdee SA, Uribe-Salas FJ, Patterson TL, Rangel MG, Rosen P, Brouwer KC. Correlates of STI symptoms among female sex workers with truck driver clients in two Mexican border towns. BMC Public Health 2012; 12:1000. [PMID: 23164289 PMCID: PMC3528625 DOI: 10.1186/1471-2458-12-1000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers (FSW) are at increased risk for HIV and other STI due to occupation-related risks and exposures. Long-distance truck drivers have been implicated in the spread of HIV, but less is known about HIV/STI risks of FSW servicing truck drivers, especially in North America. As part of an international collaborative pilot study, we interviewed FSWs servicing truck driver clients along two major transportation corridors to explore factors associated with recent STI symptoms. Methods A cross-sectional study of 200 FSW was conducted in Mexico: 100 from Nuevo Laredo (U.S. border); 100 from Ciudad Hidalgo (Guatemalan border). Eligibility criteria included age ≥18 years, speaking English or Spanish, and having ≥1 truck driver client in the past month. The main outcome was reporting any recent STI symptoms, defined as experiencing genital/anal warts, genital ulcers/sores, genital itching, or abnormal vaginal discharge in the past 6 months. Logistic regression was used to identify correlates of recent STI symptoms. Results Median age of FSW was 29 years, 74% were single, 87% had <9th grade education, and median income was 4000 pesos/month ($300 USD). Sex work occurred at a bar/cantina for 70%. One-quarter had never been tested for HIV, 53% reported lifetime drug use, 22% reported drinking alcohol before/during transactional sex and 17% reported recent STI symptoms. After controlling for age and study site, factors associated with STI symptoms were lifetime drug use (AOR 2.9, 95% CI 1.2-6.9), drug use before/during sex (AOR 2.8, 95% CI 1.1-7.1), alcohol use before/during sex (AOR 5.2, 95% CI 2.2, 12.6), forced sex ever (AOR 2.6, 95% CI 1.1-6.1), lifetime history of arrest (AOR 2.3, 95% CI 1.0-5.0), and being surveyed in Nuevo Laredo rather than Ciudad Hidalgo (AOR 4.8, 95% CI 2.0-10.0). Conclusions The associations we observed between recent STI symptoms and drug and alcohol use suggest that interventions are needed that promote consistent and effective safer sex practices, especially while under the influence of alcohol or other substances.
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Affiliation(s)
- Nadine E Chen
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
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Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS 2012; 7:326-31. [PMID: 22498480 DOI: 10.1097/coh.0b013e3283536ab2] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies. RECENT FINDINGS Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs. SUMMARY HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.
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Current World Literature. Curr Opin Obstet Gynecol 2011; 23:396-400. [DOI: 10.1097/gco.0b013e32834b7ee5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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