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Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat 2022; 133:108539. [PMID: 34175174 PMCID: PMC8674383 DOI: 10.1016/j.jsat.2021.108539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
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Affiliation(s)
- Jeremy D Kidd
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Margaret M Paschen-Wolff
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, USA.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
| | - Laurie A Drabble
- San Jose State University, College of Health and Human Sciences, One Washington Square, San Jose, CA 95191, USA.
| | - Tonda L Hughes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
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2
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Pan Y, Metsch LR, Wang W, Philbin M, Kyle TL, Gooden LK, Feaster DJ. The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors Among People Currently Seeking or Receiving Services in Substance Use Disorder Treatment Programs. J Prim Prev 2020; 41:363-382. [PMID: 32617888 PMCID: PMC7384551 DOI: 10.1007/s10935-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although HIV risk behaviors such as substance use and condomless sex are prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population have not been well studied. We examined the associations between housing status, substance use and HIV-related sexual risk behaviors among 1281 participants from 12 US community-based SUD programs. In addition, substance use was examined as a potential mediator of the relationship between housing status and sexual risk behaviors. We conducted Chi-square, univariate and multivariate logistic regression models on data from the National Drug Abuse Treatment Clinical Trials Network HIV Rapid Testing and Counseling study. Path analysis was used to test the mediation and indirect effects. Unstable housing was significantly associated with having multiple concurrent condomless sex partners, condomless sex with non-primary partners, and partners of unknown HIV serostatus. Homelessness was significantly associated with condomless vaginal sex and condomless sex with any substance use. The path between unstable housing and sexual risk behaviors was mediated by problematic drug use, particularly by cocaine, opioids, and marijuana use. Because housing status impacts HIV risk behaviors for individuals in SUD treatment programs, both housing status and substance use behaviors should be assessed upon program entry in order to identify and mitigate risk behaviors.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Center for Research on US Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Morgan Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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3
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Wang Z, Yang X, Mo PKH, Fang Y, Ip TKM, Lau JTF. Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study. J Med Internet Res 2020; 22:e17894. [PMID: 32706705 PMCID: PMC7414399 DOI: 10.2196/17894] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/16/2020] [Accepted: 06/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population. Objective This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period. Methods Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted. Results At Month 6, 6.9% (28/407) and 4.4% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU (β=.04; B=.002, 95% CI 0.001-0.01). Conclusions Social media and gay social networking apps may be a major source of influence on MSM’s perceptions and actual behaviors related to SDU.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Xue Yang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yuan Fang
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Tsun Kwan Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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4
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Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. JOURNAL OF SEX RESEARCH 2020; 57:681-708. [PMID: 32077326 PMCID: PMC7457381 DOI: 10.1080/00224499.2020.1728514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.
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Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | - Hamish A Gunn
- Department of Psychology, University of Massachusetts Boston
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5
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Wang Z, Mo PKH, Ip M, Fang Y, Lau JTF. Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year. BMC Infect Dis 2020; 20:299. [PMID: 32321442 PMCID: PMC7178573 DOI: 10.1186/s12879-020-05024-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023] Open
Abstract
Background Sexualized drug use (SDU) refers to use of any psychoactive substance before/during sexual intercourse. Chemsex is a subset of SDU, which is defined as the use of some specific psychoactive substances (methamphetamine, mephedrone, γ-hydroxybutyrate, ketamine and cocaine) before/during sexual intercourse. SDU and chemsex are prevalent among gay, bisexual and other men who have sex with men (GBMSM). This study investigated uptake and willingness to use pre-exposure prophylaxis (PrEP) among a sample of GBMSM in Hong Kong with experience of SDU in the past year. Methods A total of 600 GBMSM were recruited by convenient sampling through outreaching in gay venues, online recruitment and peer referral. Participants completed a cross-sectional anonymous telephone interview. This study was based on a subsample of 580 GBMSM self-reported as HIV negative/unknown sero-status. Results Of the participants, 82 (14.1%) and 37 (6.4%) had experience of SDU and chemsex in the past year. The prevalence of PrEP uptake was 4.0% among all participants and 14.6% among those with experience of SDU in the past year. Among GBMSM with experience of SDU in the past year who were not on PrEP (n = 70), 67.1% were willing to use daily oral PrEP in the next 6 months. Multivariate logistic regression models showed that positive attitudes toward PrEP (AOR: 2.37, 95%CI: 1.47, 3.82), perceived support from significant others to use PrEP (AOR: 9.67, 95%CI: 2.95, 31.71), and perceived behavioral control of using PrEP (AOR: 19.68, 95%CI: 5.44, 71.26) were significantly associated with higher willingness to use PrEP. Conclusion GBMSM with experience of recent SDU are potentially good candidates of PrEP implementation. This group of GBMSM reported high prevalence of uptake and willingness to use PrEP. Perceptions related to PrEP based on the Theory of Planned Behavior were significantly associated with willingness to use PrEP.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong SAR, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Hirshfield S, Downing MJ, Chiasson MA, Yoon IS, Houang ST, Teran RA, Grov C, Sullivan PS, Gordon RJ, Hoover DR, Parsons JT. Evaluation of Sex Positive! A Video eHealth Intervention for Men Living with HIV. AIDS Behav 2019; 23:3103-3118. [PMID: 31011912 DOI: 10.1007/s10461-019-02498-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sex Positive![+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3 months for 1 year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39-0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.
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Affiliation(s)
- Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Martin J Downing
- Department of Psychology, Lehman College, City University of New York (CUNY), Bronx, NY, USA
| | | | - Irene S Yoon
- Gartner L2, Research and Advisory, New York, NY, USA
| | - Steven T Houang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard A Teran
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Rachel J Gordon
- Departments of Medicine and Epidemiology, Division of Infectious Diseases, Columbia University, New York, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Graduate Center, City University of New York (CUNY), New York, NY, USA
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7
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Chiou PY, Liao PH, Liu CY, Hsu YT. Effects of mobile health on HIV risk reduction for men who have sex with men. AIDS Care 2019; 32:316-324. [PMID: 31558040 DOI: 10.1080/09540121.2019.1668531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mobile health (M-Health) has become a novel method for HIV prevention and the effects need to be promoted. The study purpose was to exam how a smartphone application (app) reduces HIV risky behaviour in men who have sex with men (MSM). The Safe Behaviour and Screening (SBS) app was developed, and included five features: record, output, and resources connection; information provision; testing services; interaction; and online statistics. A random assignment was used. The experimental group used the SBS app for six months. The control group did not use any intervention. There were 130 participants in the experimental group, and 135 in the control group. The average age of all subjects was 27.38 (SD = 5.56). Compared to the control group, the experimental group had significantly higher mean score of safe behaviour knowledge, motivation, and skills; percentage of condom use during anal intercourse; frequency of searching for testing resources and getting HIV and syphilis tests. The frequency of anal intercourse and recreational drug usage were significantly lower in the experimental group. The SBS app could decrease the HIV risky behaviour among MSM and be applied to HIV prevention and nursing intervention.
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Affiliation(s)
- Piao-Yi Chiou
- Department of Nursing, Medical College, National Taiwan University, Taipei City, Taiwan (R.O.C)
| | - Pei-Hung Liao
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan (R.O.C.)
| | - Chieh-Yu Liu
- Department of Speech language pathology and audiology, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan (R.O.C.)
| | - Yu-Tz Hsu
- Department of Infection, Mackay Memorial Hospital, Taipei City, Taiwan (R.O.C.)
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8
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Elkbuli A, Polcz V, Dowd B, McKenney M, Prado G. HIV prevention intervention for substance users: a review of the literature. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:1. [PMID: 30606266 PMCID: PMC6318880 DOI: 10.1186/s13011-018-0189-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022]
Abstract
Background Behavioral Interventions are needed to prevent HIV in substance users, which is associated with higher risk for contracting HIV via unprotected sexual intercourse or syringe-based exposure. We reviewed universal HIV prevention interventions targeting intravenous drug users (IDUs) and non-IDUs (NIDUs) to identify which prevention interventions are the most effective at reducing HIV transmission risk among IDU’s and NIDU’s and identify gaps in the literature. Methods A PubMed literature review (1998–2017), limiting studies to universal HIV prevention interventions targeting adult HIV-negative substance users. Interventions were compared across sample sizes, sociodemographic, intervention setting, study design, use of theoretical models, and intervention effects. Results Of 1455 studies identified, 19 targeted IDUs (n = 9) and NIDUs (n = 10). Both IDU and NIDU studies were conducted in substance use treatment centers and included both group (44% vs. 73%) and individual-based (56% vs. 27%) methods; only one NIDU study used a couple-based intervention. All IDU, and 89% of NIDU, studies used explanatory and behavior-change theoretical models to guide selection of intervention mechanisms. Reduction in frequency of risky sexual behaviors were observed in 33% IDU and 64% NIDU studies, where 56% of IDU studies effectively increased drug use-related hygiene and 67% decreased frequency of injections. Eight studies included start-of-study HIV testing and five examined HIV seroconversion. Conclusion The interventions reviewed demonstrate promising results for decreasing risky sexual practices for NIDUs and reducing high-risk drug practices for IDUs, thereby reducing HIV transmission risk. Future studies should include HIV testing and measurement of HIV seroconversion to fully elucidate intervention effects.
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Affiliation(s)
- Adel Elkbuli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. .,Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.
| | - Valerie Polcz
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Florida International University, Miami, Florida, USA
| | - Brianna Dowd
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Florida International University, Miami, Florida, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Department of Surgery, University of South Florida, Tampa, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
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Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mangine C, Kukk A, Noormets H, Jänes J, Rüütel K. Internet recruitment for sexually transmitted infection screening among men who have sex with men in Eastern Europe. Int J STD AIDS 2017; 29:237-243. [PMID: 28776464 DOI: 10.1177/0956462417722477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Men who have sex with men (MSM) face negative health outcomes such as sexually transmitted infections (STIs) at disproportionate rates. Nonetheless, infections may be underestimated due to limited uptake in testing. To increase testing, screening interventions have been utilized in the past; however, some have resulted in limitations such as poor recruitment. To increase recruitment for screening of MSM in Estonia, two different recruitment strategies were examined. Recruitment was separated into two promotional periods: passive and active. Passive consisted of banners on gay-related sites, while active also placed banners on websites to the general public such as Facebook linked to specific thematic pages and users self-identifying as men. More men were recruited during the active period of five weeks (n = 134) than the passive period of 46 weeks (n = 126). Active promotion was so successful in that the number of home sampling kit orders far exceeded what was projected, forcing promotion to the general public to be closed after 13 days. Recruiting MSM through a combination of general public and gay-related websites and applications has the ability to quickly recruit for testing interventions. This method can recruit a large number in a short amount of time; therefore, a budget must be planned accordingly to support testing for all that participate.
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Affiliation(s)
- Cara Mangine
- 1 Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Aigi Kukk
- 2 Communication Department, National Institute for Health Development, Tallinn, Estonia
| | - Helen Noormets
- 2 Communication Department, National Institute for Health Development, Tallinn, Estonia
| | | | - Kristi Rüütel
- 4 Infectious Diseases and Drug monitoring Department, National Institute for Health Development, Tallinn, Estonia
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11
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Brown RE, Turner C, Hern J, Santos GM. Partner-level substance use associated with increased sexual risk behaviors among men who have sex with men in San Francisco, CA. Drug Alcohol Depend 2017; 176:176-180. [PMID: 28549302 DOI: 10.1016/j.drugalcdep.2017.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substance use is highly prevalent among men who have sex with men (MSM) and is associated with individual-level sexual risk behaviors. However, few studies have explored the relationship between substance use and HIV risk behaviors within partnerships. METHODS We examined partner-level data between MSM participants (n=23) and their sexual partners (n=52). We used multivariable generalized estimating equations (GEE) logistic regression to assess the relationship between partner-level substance use during their last sexual encounter with each partner, and engaging in condomless anal intercourse (CAI) and serodiscordant CAI. RESULTS In multivariable analyses, participants had significantly higher adjusted odds ratio (AOR) of CAI when the participant (AOR=22.2, 95%CI=2.5-199.5) or their partners used any drugs (AOR=21.8, 95%CI=3.3-144.3); their partners (AOR=5.7, 95%CI=1.7-19.3) or both participant and partner had concordant use of methamphetamine (AOR=10.5, 95%CI=2.2-50.6); or when both used poppers (AOR=11.4, 95%CI=1.5-87). There were higher odds of SDCAI if the participant binge drank (AOR=4, 95%CI=1.01-15.8), used more than one substance (AOR=15.8, 95%CI=1.9-133), or used other drugs (AOR=4.8, 95%CI=1.3-18.4); if their partner used poppers (AOR=7.6, 95%CI=1.5-37.6), or used more than one substance (AOR=7.9, 95%CI=1.9-34.1); and when both participant and partner had concordant use of poppers (AOR=4.4, 95%CI=1.2-16.8). CONCLUSIONS This study observed significant relationship between substance use and HIV risk behaviors within partnerships. Specifically, when either the participant, the partner, or both used any drugs there was an increased odds of sexual risk behaviors. Findings suggest that partner-level substance use behaviors should be taken in account when developing sexual risk reduction interventions.
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Affiliation(s)
- Robert E Brown
- Substance Use Research Unit, Center for Public Health Research Branch, Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; School of Public Health, University of California, 100 Academic Hall # 1234, Berkeley, CA 94720, USA.
| | - Caitlin Turner
- Substance Use Research Unit, Center for Public Health Research Branch, Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA
| | - Jaclyn Hern
- Substance Use Research Unit, Center for Public Health Research Branch, Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA
| | - Glenn-Milo Santos
- Substance Use Research Unit, Center for Public Health Research Branch, Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; Department of Community Health Systems, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA
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12
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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13
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Flores JM, Santos GM, Makofane K, Arreola S, Ayala G. Availability and Use of Substance Abuse Treatment Programs Among Substance-Using Men Who Have Sex With Men Worldwide. Subst Use Misuse 2017; 52:666-673. [PMID: 28139146 DOI: 10.1080/10826084.2016.1253744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM. OBJECTIVES We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use. METHODS This is a cross-sectional study of a multi-region, online sample of substance-using MSM. RESULTS In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48-6.89), mental health services (aOR = 2.53; CI = 1.32-4.83), and medical care (aOR = 2.32; CI = 1.12-4.80); less than college-level education (aOR = 0.32; CI = 0.18-0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30-2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22-6.22). CONCLUSION In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings.
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Affiliation(s)
- Juan M Flores
- a Columbia University Mailman School of Public Health , New York , USA
| | - Glenn-Milo Santos
- b Center for Public Health Research , San Francisco Department of Public Health , San Francisco , California , USA.,c Department of Community Health Systems , University of California San Francisco , San Francisco , California , USA
| | | | - Sonya Arreola
- d The Global Forum on MSM & HIV , Oakland , California , USA
| | - George Ayala
- d The Global Forum on MSM & HIV , Oakland , California , USA
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Feasibility, Acceptability, and Tolerability of Targeted Naltrexone for Nondependent Methamphetamine-Using and Binge-Drinking Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2016; 72:21-30. [PMID: 26674372 DOI: 10.1097/qai.0000000000000922] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are no effective pharmacologic strategies for nondependent methamphetamine (meth)-using and binge-drinking men who have sex with men (MSM) at high-risk for HIV. We sought to determine the feasibility of enrolling and retaining this population in a pharmacologic trial; the acceptability of pharmacotherapy study procedures; and the tolerability of targeted naltrexone versus placebo. METHODS Thirty meth-using and binge-drinking MSM were randomly assigned 1:1 to 50 mg naltrexone or placebo for 8 weeks for targeted administration (ie, during craving or in anticipation of meth or alcohol use). Substance use counseling and behavioral assessments were conducted every 2 weeks. Medication use was measured using WisePill dispensers. RESULTS Trial completion was 93%; visit completion rate was 95%. Mean weekly number of medication pills taken was 2.1 and was similar between arms. Participant satisfaction rate was 96%. There were neither serious adverse events nor differences in adverse event rates between arms. In exploratory intention-to-treat analyses, there were no differences in meth use and drinking. Naltrexone participants had greater reductions in serodiscordant receptive anal intercourse [incident rate ratio (IRR) = 0.15; 95% CI = 0.05 to 0.42] and serodiscordant condomless receptive anal intercourse (IRR = 0.11; 95% CI = 0.03 to 0.37), compared with placebo. In subgroup analyses among frequent meth users, naltrexone participants had greater reductions in meth-using days (IRR = 0.78; 95% CI = 0.62 to 0.99). In as-treated analyses, frequent study medication users in the naltrexone arm had greater reductions in binge drinking days (IRR = 0.72; 95% CI = 0.54 to 0.97). CONCLUSIONS Targeted naltrexone is a feasible, acceptable, and tolerable intervention strategy for nondependent meth-using and binge-drinking MSM. Naltrexone was associated with significant sexual risk reductions; and for some individuals, naltrexone was associated with meth and binge-drinking reductions.
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15
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Kazdin AE. Treatment as usual and routine care in research and clinical practice. Clin Psychol Rev 2015; 42:168-78. [DOI: 10.1016/j.cpr.2015.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/27/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
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16
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Tross S, Feaster DJ, Thorens G, Duan R, Gomez Z, Pavlicova M, Hu MC, Kyle T, Erickson S, Spector A, Haynes L, Metsch LR. Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients. J Addict Med 2015; 9:457-63. [PMID: 26501786 PMCID: PMC4779311 DOI: 10.1097/adm.0000000000000162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. METHODS Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). RESULTS Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. CONCLUSIONS Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.
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Affiliation(s)
- Susan Tross
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Daniel J. Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Gabriel Thorens
- Department of Mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Rui Duan
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Zoilyn Gomez
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
| | - Mei Chen Hu
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | | | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Anya Spector
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Louise Haynes
- Medical University of South Carolina, Charleston, South Carolina
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
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17
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Abstract
Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.
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18
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Buttram ME, Kurtz SP. A Qualitative Study of African American/Black MSM's Experiences of Participating in a Substance Use and Sexual Risk Reduction Intervention. Am J Mens Health 2015; 11:1155-1161. [PMID: 25957249 DOI: 10.1177/1557988315584157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The majority of new HIV infections in the United States are among men who have sex with men (MSM), and African American/Black MSM are especially affected. Employing a grounded theory approach, this study presents qualitative data from 21 African American/Black MSM who participated in a substance use and sexual risk reduction intervention trial (Project ROOM [men Reaching Out to Other Men]) in South Florida. African American/Black MSM from Project ROOM reduced their substance use and sexual risk behaviors at a faster rate than other men in the study. The present study examines how the experiences of participation in Project ROOM influenced the behavior change among African American/Black MSM. In-depth interviews indicate that study assessments enhanced African American/Black men's mindfulness and self-realization of behaviors leading to behavior modification and changes in social relationships. Furthermore, these findings suggest that interventions tailored to the social environment of HIV transmission and substance use behaviors are key to reducing risk behaviors among this population.
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19
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Wray TB, Grin B, Dorfman L, Glynn TR, Kahler CW, Marshall BDL, van den Berg JJ, Zaller ND, Bryant KJ, Operario D. Systematic review of interventions to reduce problematic alcohol use in men who have sex with men. Drug Alcohol Rev 2015; 35:148-57. [PMID: 25866929 DOI: 10.1111/dar.12271] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/01/2015] [Indexed: 12/11/2022]
Abstract
ISSUES Rates of heavy drinking, alcohol problems and alcohol-related disorders are high among men who have sex with men (MSM) and are an important public health issue. Associations between heavy drinking and human immunodeficiency virus (HIV) acquisition among MSM also suggest that drinking may have more severe and chronic consequences for this population relative to others. Consequently, effective interventions to reduce heavy drinking and alcohol-related risk factors among MSM are needed. APPROACH We conducted a systematic review of randomised controlled trials of interventions to reduce heavy drinking and/or alcohol-related problems among MSM. We searched five electronic databases, screened 3722 records and identified 5 studies involving 1022 participants that satisfied inclusion criteria, which included having: (i) incorporated a comparison condition; (ii) randomised participants to groups; and (iii) reported quantitative outcomes. KEY FINDINGS The methodological quality of studies varied, and meta-analysis was not conducted because of heterogeneity in intervention approaches and outcomes. Studies provided preliminary support for the use of motivational interviewing/motivational enhancement-based interventions (MI) and hybrid MI and cognitive behavioural therapy treatments for heavy drinking among MSM over no treatment. Perhaps the most important conclusion of this review, however, is that well-designed, theoretically informed research focused on establishing the efficacy of interventions for hazardous drinking and alcohol use disorders among MSM is alarmingly scarce. CONCLUSIONS Effective interventions to reduce hazardous drinking among MSM and prevent key alcohol-related outcomes, including risk for HIV transmission and health problems among HIV-positive MSM, are needed to mitigate health disparities in this population.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Benjamin Grin
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Leah Dorfman
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Tiffany R Glynn
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Jacob J van den Berg
- Division of Infectious Diseases, The Miriam Hospital, The Warren Alpert School of Brown University, Providence, USA
| | - Nickolas D Zaller
- Division of Infectious Diseases, The Miriam Hospital, The Warren Alpert School of Brown University, Providence, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, USA
| | - Don Operario
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
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20
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A roadmap for adapting an evidence-based HIV prevention intervention: personal cognitive counseling (PCC) for episodic substance-using men who have sex with men. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:364-75. [PMID: 23412947 DOI: 10.1007/s11121-013-0364-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85%), use of poppers (36%), methamphetamine (20%) and cocaine (12%). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.
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21
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Depressive Symptoms by HIV Serostatus Are Differentially Associated With Unprotected Receptive and Insertive Anal Sex Among Substance-Using Men Who Have Sex With Men in the United States. J Acquir Immune Defic Syndr 2015; 68:e13-6. [DOI: 10.1097/qai.0000000000000396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Mansergh G, Spikes P, Flores SA, Koblin BA, McKirnan D, Hudson SM, Colfax GN. Internalised homophobia is differentially associated with sexual risk behaviour by race/ethnicity and HIV serostatus among substance-using men who have sex with men in the United States. Sex Transm Infect 2014; 91:324-8. [PMID: 25512667 DOI: 10.1136/sextrans-2014-051827] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/22/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There is a continuing need to identify factors associated with risk for HIV transmission among men who have sex with men (MSM), including a need for further research in the ongoing scientific debate about the association of internalised homophobia and sexual risk due partly to the lack of specificity in analysis. We assess the association of internalised homophobia by race/ethnicity within HIV serostatus for a large sample of substance-using MSM at high risk of HIV acquisition or transmission. METHODS Convenience sample of substance-using (non-injection) MSM reporting unprotected anal sex in the prior 6 months residing in Chicago, Los Angeles, New York and San Francisco. The analytic sample included HIV-negative and HIV-positive black (n=391), Latino (n=220), and white (n=458) MSM. Internalised homophobia was assessed using a published four-item scale focusing on negative self-perceptions and feelings of their own sexual behaviour with men, or for being gay or bisexual. Analyses tested associations of internalised homophobia with recent risk behaviour, stratified by laboratory-confirmed HIV serostatus within race/ethnicity, and controlling for other demographic variables. RESULTS In multivariate analysis, internalised homophobia was inversely associated (p<0.05) with recent unprotected anal sex among black MSM, and not significantly associated with sexual risk behaviour among white and Latino MSM. CONCLUSIONS More research is needed to further identify nuanced differences in subpopulations of MSM, but these results suggest differentially targeted intervention messages for MSM by race/ethnicity.
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Affiliation(s)
| | - Pilgrim Spikes
- CDC Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Grant N Colfax
- San Francisco Department of Public Health, San Francisco, California, USA
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23
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Mitchell JW, Boyd C, McCabe S, Stephenson R. A cause for concern: male couples' sexual agreements and their use of substances with sex. AIDS Behav 2014; 18:1401-11. [PMID: 24584415 DOI: 10.1007/s10461-014-0736-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substance use is strongly associated with HIV risk among gay men. Many gay couples establish sexual agreements. However, little is known about gay couples' use of substances with sex, and whether substance use is associated with couples' agreements. The present study assessed whether gay couples' use of substances with sex was associated with their establishment of, type of, and adherence to, a sexual agreement. Dyadic data from 275 HIV-negative US gay couples were collected online in a nation-wide, cross-sectional study, and analyzed at the couple-level. Findings revealed that couples with an established agreement, and a recently broken agreement, were more likely to have used amyl nitrates and marijuana with sex within their relationship. This same trend was also noted, but for alcohol use with sex outside of couples' relationships. Further research is urgently needed to examine the fluidity of HIV-negative gay male couples' sexual agreements and substance use with sex.
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Affiliation(s)
- Jason W Mitchell
- School of Nursing, University of Michigan, 400 N. Ingalls, Office 3343, Ann Arbor, MI, 48109-5482, USA,
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24
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Coffin PO, Santos GM, Colfax G, Das M, Matheson T, DeMicco E, Dilley J, Vittinghoff E, Raiford JL, Carry M, Herbst JH. Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: a randomized controlled trial. AIDS Behav 2014; 18:1390-400. [PMID: 24510401 DOI: 10.1007/s10461-014-0712-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34-0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence.
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25
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Kalichman SC, Zohren L, Eaton LA. Setting the bar high or setting up to fail? Interpretations and implications of the EXPLORE Study (HPTN 015). AIDS Behav 2014; 18:625-33. [PMID: 23989823 DOI: 10.1007/s10461-013-0603-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Controlled studies show that HIV risk reduction counseling significantly increases condom use, reduces unprotected sex and prevents sexually transmitted infections. Nevertheless, without evidence of reducing HIV incidence, these interventions are generally discarded. One trial, the EXPLORE study, was designed to test whether ten sessions of risk reduction counseling could impact HIV incidence among men who have sex with men in six US cities. Based on epidemiologic models to define effective HIV vaccines, a 35 % reduction in HIV incidence was set a priori as the benchmark of success in this behavioral intervention trial. Results demonstrated a significant effect of the intervention, with more than a 35 % reduction in HIV incidence observed during the initial 12-18 months following counseling. Over an unprecedented 48-month follow-up, however, the effect of counseling on HIV incidence declined to 18 %. The current review examined how the scientific literature has thus far judged the outcomes of the EXPLORE study as well as the policy implications of these judgments. We identified 127 articles that cited the EXPLORE study since its publication. Among articles that discuss the HIV incidence outcomes, 20 % judged the intervention effective and 80 % judged the intervention ineffective. The overwhelmingly negative interpretation of the EXPLORE study outcomes is reflected in public policies and prevention planning. We conclude that using a vaccine standard to define success led to a broad discrediting of the benefits of behavioral counseling and, ultimately, adversely impacted policies critical to the field of HIV prevention.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
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26
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Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:99-106. [PMID: 24243002 PMCID: PMC4532732 DOI: 10.1007/s10508-013-0208-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Men who have sex with men (MSM) remain at great risk of HIV in the United States, representing 65 % of incident HIV infections. One factor contributing to the high rate of HIV infection among MSM is use of "recreational" drugs that are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis (PrEP) is a novel biomedical HIV prevention strategy that has the potential to reduce HIV transmission in MSM. Main and casual sex partners play a role in HIV prevention efforts for MSM. The study aimed to qualitatively explore the perceived influences of sexual relationships on promoting and inhibiting PrEP use among high-risk MSM who report regular drug use. Semi-structured qualitative interviews were conducted with 40 participants recruited in Boston, Massachusetts. Data were analyzed using descriptive qualitative analysis. Casual partners presented a distinct set of concerns from primary partnerships. MSM generally viewed main partners as a potential source of support for taking PrEP. Given their informal and often temporary nature, PrEP disclosure to casual partners was considered unnecessary. HIV-related stigma and substance use were also perceived as barriers to discussing PrEP use with casual partners. MSM articulated a high degree of personal agency regarding their ability to take PrEP. Findings suggest that behavioral interventions to improve PrEP utilization and adherence for high-risk MSM should be tailored to sex partner type and the parameters established between sex partners. Approaches to PrEP disclosure and partner engagement should be informed by the relative benefits and limitations characterized by these different types of relationships.
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Affiliation(s)
- Matthew J Mimiaga
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol 2013; 82:9-18. [PMID: 24364800 DOI: 10.1037/a0035311] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Young gay and bisexual men (YGBM) are disproportionally at risk of HIV infection due to sexual risk behaviors, which are often exacerbated by recreational drug use. However, there have been no evidence-based interventions targeting substance-using YGBM. This study was designed to test a brief motivational interviewing (MI) intervention to reduce both risky sex and drug use among HIV-negative YGBM. METHOD A total of 143 non-treatment-seeking YGBM (ages 18-29 years) who reported recent unprotected anal intercourse (UAI) and recreational drug use were randomized to 4 sessions of MI or 4 sessions of content-matched education. Participants were followed every 3 months for 1 year, and behavior change was examined across conditions and time for aggregated and day-level drug use and UAI. RESULTS Regardless of condition, participants reported significant reductions in UAI and substance use over time. However, YGBM in the MI condition were 18% less likely to use drugs and 24% less likely to engage in UAI than YGBM in the education condition. CONCLUSIONS The results support the utility of MI, compared with a content-matched education condition, to significantly reduce both UAI and drug use among YGBM. Interventions may benefit from an emphasis on substance use reductions, which might indirectly lead to less frequent UAI. Future research efforts should examine whether this type of brief MI intervention is effective when delivered by clinic or community settings utilized by YGBM.
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Affiliation(s)
- Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Corina Lelutiu-Weinberger
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Michael Botsko
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York
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Melendez-Torres GJ, Bonell C. Systematic review of cognitive behavioural interventions for HIV risk reduction in substance-using men who have sex with men. Int J STD AIDS 2013; 25:627-35. [PMID: 24352122 DOI: 10.1177/0956462413515638] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/04/2013] [Indexed: 11/16/2022]
Abstract
Men who have sex with men (MSM) experience disproportionately high rates of HIV and substance use. Though interventions based on cognitive behavioural therapy (CBT) are effective for many psychiatric disorders, systematic reviews of CBT for substance use present mixed results and CBT has not been systematically reviewed for HIV risk reduction in MSM. Randomised controlled trials (RCTs) of non-pharmacological CBT for substance-using MSM were systematically reviewed to assess the evidence for these interventions' impact on unprotected anal intercourse (UAI). We searched 20 databases on 22 September 2012. Of the 2801 records identified, both authors separately assessed 70 full-text articles for inclusion. In three included RCTs, one RCT compared CBT against non-treatment control and two RCTs compared CBT against CBT variants. Across studies, CBT led to UAI reductions, though at one-year follow-up, these reductions were generally not greater than in other trial arms. This evidence of moderate quality indicates that while CBT may reduce UAI in substance-using MSM, it is unclear if CBT is more effective than mere assessment. All RCTs tested intensive, clinic-based interventions requiring sustained participant commitment, indicating a need for research into briefer interventions, with particular focus on episodic substance use and effectiveness trials.
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Affiliation(s)
- G J Melendez-Torres
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Chris Bonell
- Social Science Research Unit, Institute of Education, University of London, London, UK
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Abstract
Substance-using men who have sex with men (MSM) are among the groups at highest risk for HIV infection in the United States. We report the results of a randomized trial testing the efficacy of a small group sexual and substance use risk reduction intervention based on empowerment theory compared to an enhanced efficacious control condition among 515 high risk not-in-treatment MSM substance users. Effect sizes for sexual risk and substance use outcomes were moderate to large: HIV transmission risk frequency, d = 0.71 in the control versus 0.66 in the experimental group; number of anal sex partners, d = 1.04 versus 0.98; substance dependence symptoms, d = 0.49 versus 0.53; significant differences were not observed between conditions. Black MSM reduced their risks at a greater rate than White or Latino men. The findings point to a critically important research agenda to reduce HIV transmission among MSM substance users.
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Metsch LR, Feaster DJ, Gooden L, Schackman BR, Matheson T, Das M, Golden MR, Huffaker S, Haynes LF, Tross S, Malotte CK, Douaihy A, Korthuis PT, Duffus WA, Henn S, Bolan R, Philip SS, Castro JG, Castellon PC, McLaughlin G, Mandler RN, Branson B, Colfax GN. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA 2013; 310:1701-10. [PMID: 24150466 PMCID: PMC4110051 DOI: 10.1001/jama.2013.280034] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To increase human immunodeficiency virus (HIV) testing rates, many institutions and jurisdictions have revised policies to make the testing process rapid, simple, and routine. A major issue for testing scale-up efforts is the effectiveness of HIV risk-reduction counseling, which has historically been an integral part of the HIV testing process. OBJECTIVE To assess the effect of brief patient-centered risk-reduction counseling at the time of a rapid HIV test on the subsequent acquisition of sexually transmitted infections (STIs). DESIGN, SETTING, AND PARTICIPANTS From April to December 2010, Project AWARE randomized 5012 patients from 9 sexually transmitted disease (STD) clinics in the United States to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both baseline and 6-month follow-up. INTERVENTIONS Participants randomized to counseling received individual patient-centered risk-reduction counseling based on an evidence-based model. The core elements included a focus on the patient's specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps. All participants received a rapid HIV test. MAIN OUTCOMES AND MEASURES The prespecified outcome was a composite end point of cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis. RESULTS There was no significant difference in 6-month composite STI incidence by study group (adjusted risk ratio, 1.12; 95% CI, 0.94-1.33). There were 250 of 2039 incident cases (12.3%) in the counseling group and 226 of 2032 (11.1%) in the information-only group. CONCLUSION AND RELEVANCE Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect STI acquisition among STD clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01154296.
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Affiliation(s)
- Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Daniel J. Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Bruce R. Schackman
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Tim Matheson
- HIV Prevention and Research Section, San Francisco Department of Public Health, San Francisco, CA
| | - Moupali Das
- HIV Prevention and Research Section, San Francisco Department of Public Health, San Francisco, CA
- University of California, San Francisco, San Francisco, CA
| | - Matthew R. Golden
- Center for AIDS and STD, University of Washington, Seattle, WA and Public Health—Seattle & King County, Seattle, WA
| | - Shannon Huffaker
- HIV Prevention and Research Section, San Francisco Department of Public Health, San Francisco, CA
| | - Louise F. Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC
| | - Susan Tross
- Columbia University College of Physicians and Surgeons, New York, NY, and HIV Center For Clinical and Behavioral Studies, New York, NY
| | - C. Kevin Malotte
- Center for Health Care Innovation and Department of Health Science, California State University, Long Beach, Long Beach, CA
| | | | - P. Todd Korthuis
- Department of Medicine and Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
| | - Wayne A. Duffus
- Division of Infectious Diseases, Department of Medicine, University of South Carolina School Of Medicine, Columbia, SC
| | - Sarah Henn
- Elizabeth Taylor Medical Center, Whitman-Walker Health, Washington, DC
| | - Robert Bolan
- Jeffrey Goodman Special Care Clinic, Los Angeles Gay & Lesbian Center, Los Angeles, CA
| | - Susan S. Philip
- STD Prevention and Control, San Francisco Department of Public Health, San Francisco, CA
| | - Jose G. Castro
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Pedro C. Castellon
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Raul N. Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Bernard Branson
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Grant N. Colfax
- HIV Prevention and Research Section, San Francisco Department of Public Health, San Francisco, CA
- University of California, San Francisco, San Francisco, CA
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Higa DH, Crepaz N, Marshall KJ, Kay L, Vosburgh HW, Spikes P, Lyles CM, Purcell DW. A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM). AIDS Behav 2013; 17:1231-44. [PMID: 23397183 DOI: 10.1007/s10461-013-0418-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples.
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Affiliation(s)
- Darrel H Higa
- Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Correlates of unprotected vaginal or anal intercourse with women among substance-using men who have sex with men. AIDS Behav 2013; 17:889-99. [PMID: 23229336 DOI: 10.1007/s10461-012-0357-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % (n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW.
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Abstract
OBJECTIVE Attention control (AC) conditions are used to balance nonspecific attention in randomized trials of behavioral interventions. Very little guidance about which behavioral interventions and outcomes merit AC is available in the literature. The primary aim of the present study is to demonstrate a scenario in which use of AC in a behavioral randomized trial was unnecessary and possibly detrimental. METHODS Exploratory analyses were performed in a randomized controlled trial that tested whether a patient-centered counseling intervention reduced low-density lipoprotein cholesterol levels in 355 participants with peripheral arterial disease, compared with AC and usual care (UC) conditions. The patient-centered counseling intervention was designed to activate participants to ask their physician for lipid-lowering medication and/or increase dose intensity, increase medication adherence, and reduce fat intake. The AC condition involved attention-matched telephone-delivered health education, and the UC condition consisted of an educational pamphlet. RESULTS At 12-month follow-up, the mean low-density lipoprotein cholesterol changes were -11.1 and -6.8 mg/dL in the UC and AC conditions, respectively (p=.17). The proportion of participants who increased the use or dose intensity of medication was significantly lower in AC than in UC: 17.5% versus 30.5% (p=.03). No significant difference in other outcomes was observed between AC and UC. CONCLUSIONS AC has significantly worse medication outcomes, and there is no indication of a therapeutic effect on other end points. Implications for the use of AC in behavioral randomized trials are discussed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00217919.
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Recruiting drug using men who have sex with men in behavioral intervention trials: a comparison of internet and field-based strategies. AIDS Behav 2013; 17:688-99. [PMID: 22684657 DOI: 10.1007/s10461-012-0231-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although online and field-based samples of men who have sex with men (MSM) have been compared on a variety of markers, differences in drug use have not been well examined. In addition, generalization from studies comparing recruitment methods is often limited by a focus on either HIV seropositive or seronegative MSM. We compared two New York City-based samples of MSM recruited simultaneously between July 2009 and January 2010-one sample recruited in the field (n = 2,402) and one sample recruited via the Internet (n = 694). All recruitment efforts targeted men without restriction on age or self-reported HIV status. Our results show marked differences in drug and alcohol use between online and field-based samples of MSM. Specifically, men surveyed online were significantly more likely to have tried a variety of drugs, including methamphetamine, cocaine, and ecstasy. Men recruited online were also more likely to report older age, HIV positive serostatus, and "never" using condoms. Internet-based recruitment was found to be more cost-effective in terms of recruitment yield than was field-based recruitment.
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Mayer KH, Bekker LG, Stall R, Grulich AE, Colfax G, Lama JR. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet 2012; 380:378-87. [PMID: 22819653 PMCID: PMC5603076 DOI: 10.1016/s0140-6736(12)60835-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information.
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Affiliation(s)
- Kenneth H Mayer
- Fenway Health, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. khmayer@gmail
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Small E, Weller BE. Profiles of Malawian adolescents at risk for HIV infections: Implications for targeted prevention, policy, and practices. AIDS Care 2012; 25:289-95. [PMID: 22835268 DOI: 10.1080/09540121.2012.701720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eusebius Small
- a Department of Social Work , University of Texas , Arlington , TX , USA
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Carrico AW, Pollack LM, Stall RD, Shade SB, Neilands TB, Rice TM, Woods WJ, Moskowitz JT. Psychological processes and stimulant use among men who have sex with men. Drug Alcohol Depend 2012; 123:79-83. [PMID: 22088656 PMCID: PMC3494990 DOI: 10.1016/j.drugalcdep.2011.10.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. METHODS A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. RESULTS Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (β(indirect)=0.11, p<.001) and depressed mood (β(indirect)=0.13, p<.001) with stimulant use. CONCLUSIONS Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA 94105, USA.
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Huang ZJ, He N, Nehl EJ, Zheng T, Smith BD, Zhang J, McNabb S, Wong FY. Social network and other correlates of HIV testing: findings from male sex workers and other MSM in Shanghai, China. AIDS Behav 2012; 16:858-71. [PMID: 22223298 PMCID: PMC8080277 DOI: 10.1007/s10461-011-0119-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among "money boys" and general MSM in Shanghai. Overall, 28.5% of "money boys" and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.
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Affiliation(s)
- Z Jennifer Huang
- Department of International Health, Georgetown University School of Nursing and Health Studies, Washington, DC 20057, USA.
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Abstract
OBJECTIVE To test a new behavioral intervention for black MSM in reducing sexual risk and increasing social support and intentions to use condoms. DESIGN A single-site, unblinded randomized trial in New York City with 3-month follow-up. METHODS Participants (n = 283) reporting at least two sexual partners and unprotected anal intercourse with a man in the past 3 months were enrolled and randomized to a social-cognitive theory-based intervention or control comparison. Men in the intervention group participated in five 2-h group sessions focused on creating a group environment with sexual risk-reduction information and exercises woven into joint meal preparation and sharing activities, while exploring self-efficacy perceptions and outcome expectancies. Intervention (n = 142) and control (n = 141) groups received standard HIV counseling and testing at baseline. RESULTS No significant differences were found between study arms at 3 months in number of male partners, number of unprotected anal intercourse partners, proportion reporting unprotected sex, number of acts protected by condoms, self-efficacy, condom attitudes, condom intentions, social isolation and psychological distress. In both arms combined, declines from baseline to 3 months were observed in sexual risk behaviors, social isolation and psychological distress, whereas self-efficacy, condom attitudes and condom intentions improved. CONCLUSION As the HIV epidemic continues to have a dramatic impact on black MSM in the USA, the urgency to design innovative interventions continues.
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Condom-use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX. J Acquir Immune Defic Syndr 2011; 58:319-27. [PMID: 21765363 DOI: 10.1097/qai.0b013e31822b76d2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine condom-use decision making in the context of hypothetical pre-exposure prophylaxsis (PrEP) efficacy among men who have sex with men who use alcohol and other substances during sex. METHODS Substance-using men who have sex with men were recruited in 4 US cities for a behavioral intervention trial. Three groups were defined as follows: men who indicated that to not use a condom for receptive/insertive unprotected anal intercourse (UAI) while using PrEP, PrEP would need to be: (1) "almost always or always" effective (high efficacy); (2) effective "at least half the time or more but not almost always or always" (mid-range efficacy corresponding to recent PrEP trial results); (3) effective "less than half the time" (low efficacy). The mid-range efficacy group was compared with the low-efficacy group (as the reference) and to the-high efficacy group (as the reference). RESULTS Among 630 men who never used PrEP, 15.2% were in the mid-range efficacy group for receptive UAI and 34.1% in the mid-range efficacy group for insertive UAI. Scores on difficulty communicating about safer sex while high were significantly higher in the mid-range efficacy group compared with each of the other groups for both receptive and insertive UAI. Men who seemed to be differentiating PrEP use by anal sex role also scored higher on communication difficulties, although scoring lower on condom intentions. CONCLUSIONS Communication about safer sex while under the influence of alcohol or other substances and condom intentions are important factors to consider for HIV prevention interventions for PrEP users.
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Abstract
PURPOSE OF REVIEW The present review discusses the recent finding on behavioral risk factors for HIV transmission from cohort studies in MSM. RECENT FINDINGS HIV incidence among MSM has been increasing in many countries around the world. Some data support early detection and widespread use of antiretroviral treatment (ART) to decrease HIV incidence. However, suboptimal ART adherence could lead to relapse of viremia and new transmission events. Condom use for unprotected anal sex among MSM remains an important prevention tool, but use remains low in many parts of the world. Seroadaptive behaviors by MSM, such as serosorting, may also decrease condom use. However, when serosorting is practiced by MSM who receive frequent HIV testing, the risk of HIV acquisition is reduced. Serosorting and other characteristics of sexual networks, such as concurrency, may be major determinants of transmission for HIV and sexually transmitted infections among MSM. Worldwide, detailed evaluation of the factors related to rising MSM HIV incidence, as well as access to testing and care, is limited by stigma and criminalization of HIV and homosexuality. SUMMARY Cohort studies of MSM remain an important strategy to characterize the behavioral factors that drive HIV transmission and how use of ART for prevention and treatment may affect both the risk of HIV transmission and acquisition by MSM.
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Santos GM, Das M, Colfax GN. Interventions for non-injection substance use among US men who have sex with men: what is needed. AIDS Behav 2011; 15 Suppl 1:S51-6. [PMID: 21404011 PMCID: PMC3064889 DOI: 10.1007/s10461-011-9923-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Glenn-Milo Santos
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Moupali Das
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Grant Nash Colfax
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
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