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Erath TG, LaCroix R, O'Keefe E, Higgins ST, Rawson RA. Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont. Harm Reduct J 2024; 21:76. [PMID: 38580997 PMCID: PMC10998322 DOI: 10.1186/s12954-024-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/31/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Understanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision. METHODS Between March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher's exact test. RESULTS Most participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant's primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits). CONCLUSIONS Findings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs-including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment.
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Affiliation(s)
- Tyler G Erath
- Vermont Center on Behavior and Health, Burlington, VT, USA.
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA.
| | | | - Erin O'Keefe
- Howard Center Safe Recovery, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA
- Center on Rural Addictions, University of Vermont, Burlington, VT, USA
| | - Richard A Rawson
- Vermont Center on Behavior and Health, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, University Health Center, 1 S. Prospect St., Burlington, VT, 05401, USA
- Center on Rural Addictions, University of Vermont, Burlington, VT, USA
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Rosen JG, Knox JR, Rucinski KB, Mcingana M, Mulumba N, Comins CA, Shipp L, Makama S, Beckham SW, Hausler H, Baral SD, Schwartz SR. Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis. J Acquir Immune Defic Syndr 2024; 95:222-230. [PMID: 38032752 PMCID: PMC10922222 DOI: 10.1097/qai.0000000000003356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. SETTING A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). METHODS We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). RESULTS Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). CONCLUSION HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Justin R. Knox
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Katherine B. Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - Carly A. Comins
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lillian Shipp
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Siyanda Makama
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry Hausler
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheree R. Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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Temple J, Ferretti ML, Reis-Bergan M, Irons JG. Initial Validity Evidence for a Measure of Transactional Sex in a U.S. College Student Sample. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 38240631 DOI: 10.1080/00224499.2024.2302501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The current study provides initial validity evidence for a measure of Transactional Sex (TS). Participants (N = 269) were recruited from a Northeastern University in the United States and consisted of undergraduate and graduate students. Participants completed an online survey through QuestionPro that contained the Transactional Sex Measure (TSM) as well as measures of depression, anxiety, and stress, condom use negotiation self-efficacy and sexual risk, alcohol and drug use, and materialism. Construct and criterion validity were examined. Findings revealed that the TSM provided good criterion validity evidence but the construct validity evidence was minimal. Further studies on the conceptualization of TS and distribution of the TSM across a variety of diverse samples can provide more validity evidence.
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Affiliation(s)
- Jasmine Temple
- Department of Psychological Science, University of North Carolina at Charlotte
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Darlington CK, Lipsky RK, Teitelman AM, Koblin BA, Davis A, Walcott M, Compton PA, Tieu HV. HIV risk perception, pre-exposure prophylaxis (PrEP) awareness, and PrEP initiation intention among women who use drugs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209119. [PMID: 37451517 PMCID: PMC10529693 DOI: 10.1016/j.josat.2023.209119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Women who use drugs (WWUD) are prime candidates for pre-exposure prophylaxis (PrEP) due to their elevated risk of acquiring HIV through biological, behavioral, and contextual factors. However, PrEP uptake among WWUD remains low. The relationship between unhealthy drug use and correlates of PrEP uptake in this vulnerable population is not well defined. The purpose of this study is to characterize the relationships between specific types and routes of drug use and several precursors of PrEP uptake among WWUD. METHODS The study collected data via a computer-based survey from 233 women living in New York City and Philadelphia who participated in a study designed to develop and pilot a women-focused intervention for PrEP uptake. The sample of cisgender, HIV-negative women were not currently taking PrEP but considered PrEP eligible. This analysis is focused on women's HIV risk perception, PrEP awareness, PrEP initiation intention, and any use of the following drugs: barbiturates, benzodiazepines, crack cocaine, powder cocaine, hallucinogens, heroin, methamphetamines, and prescription opioids. RESULTS Within the three months prior to study enrollment, 63.1 % of participants reported any drug use; 42 % reported polydrug use; 19.8 % had injected drugs; 75 % reported getting high or drunk before sex; and 44 % had been enrolled in drug treatment. Of our total sample, 41.2 % perceived themselves at risk for HIV infection, 41.6 % were aware of PrEP prior to the study, and 62.7 % intended to initiate PrEP after they were informed. When compared to other PrEP-eligible women, women who reported prescription opioid use and polydrug use perceived themselves at higher risk for HIV infection and had higher intention to start PrEP. However, they and women who reported injecting drugs also reported lower awareness of PrEP. CONCLUSION These findings have implications for increasing education about PrEP and the various modes of HIV exposure to support PrEP uptake in this vulnerable population.
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Affiliation(s)
| | | | - Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | | | - Annet Davis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Peggy A Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Dickson MF, Tillson M, Calvert JM, Staton M. Transactional sex among rural, justice-involved Appalachian women who use drugs. J Rural Health 2023; 39:789-794. [PMID: 36648452 PMCID: PMC10350464 DOI: 10.1111/jrh.12741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Transactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high-risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice-involved Appalachian women who use drugs. METHODS Participants (N = 400) were randomly selected, screened, and interviewed face-to-face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex. FINDINGS On average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration. CONCLUSIONS Results suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice-involved and may signal other HIV-related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk-reduction interventions, including jail-based interventions, to educate vulnerable, hard-to-reach populations on the risks associated with HIV.
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Affiliation(s)
- Megan F. Dickson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Joseph M. Calvert
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
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Rosen JG, Schneider KE, Allen ST, Morris M, Urquhart GJ, Rouhani S, Sherman SG. Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland. Harm Reduct J 2022; 19:115. [PMID: 36242081 PMCID: PMC9569095 DOI: 10.1186/s12954-022-00697-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men's selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. METHODS Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. RESULTS Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81-7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05-3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02-3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. CONCLUSIONS Synergistic sources of social and structural marginalization-from sexuality to hunger, homelessness, and injection drug use-are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Glenna J Urquhart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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