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Okafor CN, Yoon JH, Jean-Berluche D, Mayes TL, Shoptaw S, Trivedi MH, Potter JS, Schmitz J. Exploring the Impact of Reduction in Methamphetamine Use on Sexual Risk Behaviors Among Men Who Have Sex with Men and Women: Findings from the ADAPT- 2 Trial. Int J Behav Med 2025:10.1007/s12529-025-10364-z. [PMID: 40195262 DOI: 10.1007/s12529-025-10364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2025] [Indexed: 04/09/2025]
Abstract
BACKGROUND Methamphetamine (MA) use has been linked to engaging in sexual risk behaviors (SRBs) that are associated with HIV/STIs, particularly among men who have sex with men (MSM) and men who have sex with men and women (MSMW; hereafter MSM/W). The objectives of this analysis were to determine whether reduced MA is associated with decreases in SRBs in a sample of MSM/W. METHOD Data came from the ADAPT- 2 trial, a randomized, double-blind, two-stage sequential parallel design trial evaluating extended-release injectable naltrexone (NTX) and oral bupropion (BUP) vs. placebo for MA use disorder. In the first 6 weeks of the trial (stage 1), participants were randomized to receive NTX-BUP or placebo. In the second 6 weeks, participants in the placebo group who did not have a treatment response were rerandomized (stage 2). For this secondary analysis, the independent variable was the number of MA-negative urine drug screens (UDS). The dependent variables included three different types of SRBs. Regression models of the independent and dependent variables were adjusted for age, race/ethnicity status, marital status, treatment assignment, and baseline SRBs. RESULTS Of the 151 participants, median age was 40 years and majority were non-Hispanic white (52%) and completed more than high school education (82%). Each additional MA-negative UDS was associated with a 7% (adjusted rate ratio (aRR) = 0.93; 95% CI, 0.87, 0.99) reduction in total number of sex partners in stage 2 only. Each additional MA-negative UDS was associated with a 13% (aRR = 0.87 95%; confidence interval (CI), (0.76, 0.98)) and 9% (aRR = 0.91; 95% CI, 0.84, 0.99) reduction in number of condomless sexual encounters in stage 1 and stage 2, respectively. Lastly, each additional MA-negative UDS was associated with a 16% (aRR = 0.84; 95% (CI), 0.75, 0.94)) and 27% (aRR = 0.73; 95% CI, 0.64, 0.84) reduction in number of sexual encounters when high on MA. CONCLUSION Our analysis showed that reductions in MA use was associated with reductions in several sexual risk behaviors associated with HIV/STI. These findings provide further support for exploring reductions in sexual risk behaviors as a clinical endpoint in future treatment interventions for MA use.
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Affiliation(s)
- Chukwuemeka N Okafor
- Department of Medicine, Division of Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
- Be Well Institute for Substance Use and Related Disorders, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, San Antonio, TX, USA.
| | - Jin H Yoon
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ducel Jean-Berluche
- Be Well Institute for Substance Use and Related Disorders, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, San Antonio, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steve Shoptaw
- Department of Family Medicine, University of California los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California los Angeles, Los Angeles, CA, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer S Potter
- Be Well Institute for Substance Use and Related Disorders, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, San Antonio, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joy Schmitz
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Bazzi AR, Roth AM, Akiba CF, Huffaker SL, Patel SV, Smith J, Laurano R, Orme S, Zarkin GA, Morgan-Lopez A, Lambdin BH. A systems analysis and improvement approach to optimizing syringe services programs' delivery of HIV testing and referrals: Study protocol for a parallel-group randomized controlled trial (SAIA-SSP-HIV). PLoS One 2025; 20:e0319340. [PMID: 39999129 PMCID: PMC11856318 DOI: 10.1371/journal.pone.0319340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 01/21/2025] [Indexed: 02/27/2025] Open
Abstract
With changing drug supplies and associated drug consumption behaviors, HIV transmission has increased among people who inject drugs in the United States. HIV testing and referrals to effective prevention and treatment services are critical for individual and population health, yet multilevel barriers limit access to HIV testing for this population, even within syringe services programs (SSPs). In this organizational-level interrupted time series randomized controlled trial, we will assess the effectiveness and cost-effectiveness of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), in optimizing HIV testing and referrals to appropriate clinical services among U.S. SSPs. From 01/12/2023 to 01/07/2025, we will recruit a diverse sample of 32 SSPs nationally that directly provide HIV testing to participants. SSPs will be randomized to the active implementation arm (i.e., SAIA-SSP-HIV) or an implementation-as-usual arm (n = 16 organizations per arm). SAIA-SSP-HIV is a flexible, data-driven implementation strategy designed to help optimize SSPs' delivery of HIV testing and referrals to appropriate clinical services for HIV prevention (e.g., pre-exposure prophylaxis) and treatment. In the active implementation arm, trained SAIA specialists will guide SSPs through three cyclical steps over 12 months: (1) process mapping to identify organization-specific needs, (2) cascade analysis and prioritization of areas for improvement, and (3) testing solutions through continuous quality improvement. In both arms, we will collect outcome data over 21 months (3-month lead-in period, 12-month implementation period, 6-month sustainment period). We will assess the initial and sustained effectiveness of SAIA and calculate its cost and cost-effectiveness. This trial presents a novel opportunity to test the effectiveness of an organization-level implementation strategy for optimizing the delivery of HIV screening and referrals in community settings that are frequented by an at-risk population. If successful, SAIA-SSP-HIV could be adapted for other infectious or chronic disease care cascades within SSPs. Trial registration: ClinicalTrials.gov: NCT06025435.
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Affiliation(s)
- Angela R. Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, United States of America
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Alexis M. Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Christopher F. Akiba
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Shelby L. Huffaker
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sheila V. Patel
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Jessica Smith
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Rose Laurano
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Stephen Orme
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Gary A. Zarkin
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Antonio Morgan-Lopez
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
| | - Barrot H. Lambdin
- RTI International, Research Triangle Park, Durham, North Carolina, United States of America
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Elkrief L, Sharafi H, Bakouni H, McAnulty C, Bastien G, Dubreucq S, Garel N, Trépanier A, Ziegler D, Jutras-Aswad D. Efficacy and Safety of Modafinil for Treatment of Amphetamine-Type Stimulant Use Disorder: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials: Efficacité et innocuité du modafinil pour le traitement des troubles liés à l'usage de stimulants de type amphétamine : revue systématique et méta-analyse d'essais randomisés contrôlés par placebo. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:793-805. [PMID: 39033427 PMCID: PMC11572177 DOI: 10.1177/07067437241262967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD. METHODS A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto's odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables. RESULTS Five RCTs (N = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; p = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; p = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; p = 0.398), or treatment discontinuation due to AEs (Peto's OR = 0.48; 95% CI, 0.20 to 1.14; p = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto's OR = 4.80; 95% CI, 1.18 to 19.56, p = 0.029). CONCLUSION There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential.
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Affiliation(s)
- Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Heidar Sharafi
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Simon Dubreucq
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Nicolas Garel
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Annie Trépanier
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniela Ziegler
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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Holloway IW, Wu ESC, Boka C, Young N, Hong C, Fuentes K, Kärkkäinen K, Beikzadeh M, Avendaño A, Jauregui JC, Zhang A, Sevillano L, Fyfe C, Brisbin CD, Beltran RM, Cordero L, Parsons JT, Sarrafzadeh M. Novel Machine Learning HIV Intervention for Sexual and Gender Minority Young People Who Have Sex With Men (uTECH): Protocol for a Randomized Comparison Trial. JMIR Res Protoc 2024; 13:e58448. [PMID: 39163591 PMCID: PMC11372318 DOI: 10.2196/58448] [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: 03/15/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people. OBJECTIVE This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages. METHODS In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling. RESULTS This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025. CONCLUSIONS This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults. TRIAL REGISTRATION ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/58448.
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Affiliation(s)
- Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth S C Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Callisto Boka
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nina Young
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kimberly Fuentes
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kimmo Kärkkäinen
- Department of Computer Science, UCLA Samueli School Of Engineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mehrab Beikzadeh
- Department of Computer Science, UCLA Samueli School Of Engineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexandra Avendaño
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Juan C Jauregui
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aileen Zhang
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lalaine Sevillano
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
- School of Social Work, Portland State University, Portland, OR, United States
| | - Colin Fyfe
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cal D Brisbin
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Raiza M Beltran
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Luisita Cordero
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Majid Sarrafzadeh
- Department of Computer Science, UCLA Samueli School Of Engineering, University of California, Los Angeles, Los Angeles, CA, United States
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Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Lloyd-Smith JO, Gorbach PM. Association of current substance use treatment with future reduced methamphetamine use in an observational cohort of men who have sex with men in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209228. [PMID: 37981239 PMCID: PMC10984139 DOI: 10.1016/j.josat.2023.209228] [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: 03/10/2023] [Revised: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Methamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use. METHODS This analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use. RESULTS This analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use. CONCLUSIONS Findings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.
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Affiliation(s)
- Allison D Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Steven J Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marissa J Seamans
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Blair CS, Javanbakht M, Comulada WS, Bolan R, Shoptaw S, Gorbach PM, Needleman J. Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1102-1114. [PMID: 37328629 PMCID: PMC10795486 DOI: 10.1007/s11121-023-01561-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] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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7
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Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness. J Gen Intern Med 2023; 38:913-921. [PMID: 35614171 PMCID: PMC9132566 DOI: 10.1007/s11606-022-07672-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. METHODS To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. RESULTS Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. DISCUSSION Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Leah C Shaw
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Seamus Vahey
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Jennifer K Brody
- Boston Healthcare for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, USA
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8
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Lambert G, Cox J, Fourmigue A, Dvorakova M, Apelian H, Moodie EEM, Grace D, Skakoon-Sparling S, Moore DM, Lachowsky N, Jollimore J, Lal A, Parlette A, Hart TA. HIV incidence and related risks among gay, bisexual, and other men who have sex with men in Montreal, Toronto, and Vancouver: Informing blood donor selection criteria in Canada. Transfusion 2022; 62:2555-2567. [PMID: 36197064 PMCID: PMC10092181 DOI: 10.1111/trf.17127] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND An individualized behavior-based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada. STUDY DESIGN AND METHODS Engage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent-driven-sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood-borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS-adjusted Poisson regression. RESULTS Data on 2008 (study visits 2017-02 to 2021-08) HIV-negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person-years [95%CI:0.3, 0.6]. HIV seroconversion was associated with age <30 years: adjusted rate ratio (aRR) 9.1 [95%CI:3.2, 26.2], 6-10 and >10 anal sex partners versus 1-6 aRR: 5.3 [2.1,13.5] and 8.4 [3.4, 20.9], and use of crystal methamphetamine during sex: 4.2 [1.5, 11.6]. Applying the combined selection criteria: drug injection, ≥2 anal sex partners, and a new anal sex partner, detected all participants who seroconverted (100% sensitivity, 100% negative predictive value), and would defer 63% of study participants from donating. CONCLUSION Using three screening questions regarding drug injection and sexual behaviors in the past 6 months would correctly identify potential GBM donors at high risk of having recently contracted HIV. Doing so would reduce the proportion of deferred sexually active GBM by one-third.
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Affiliation(s)
- Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Joseph Cox
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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9
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Bazzi AR, Valasek CJ, Streuli SA, Vera CF, Harvey-Vera A, Philbin MM, Biello KB, Roth AM, Strathdee SA, Pines HA. Long-Acting Injectable Human Immunodeficiency Virus Pre-Exposure Prophylaxis Preferred Over Other Modalities Among People Who Inject Drugs: Findings from a Qualitative Study in California. AIDS Patient Care STDS 2022; 36:254-262. [PMID: 35727647 PMCID: PMC9464050 DOI: 10.1089/apc.2022.0068] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People who inject drugs (PWID) have extraordinarily low uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) despite high levels of need. Long-acting PrEP modalities hold promise for HIV prevention among PWID, but product preferences remain poorly understood. From September to November 2021, we conducted qualitative interviews with 28 HIV-negative, adult (≥18 years) PWID in San Diego County, CA, to explore their perspectives on daily oral PrEP pills and long-acting PrEP modalities (i.e., injections, implants, intravaginal rings, and broadly neutralizing antibodies), which we explained using standard scripts. Thematic analysis identified variations in PrEP modality interest and acceptability. We identified three key factors across the 28 interviews that appeared to influence PrEP modality preferences: perceived convenience of use, invasiveness, and familiarity (based on past experience). Overall, most participants preferred injectable PrEP over other modalities because they viewed injectable medications as convenient, noninvasive, and familiar. While injectable PrEP was recently approved for use in the United States and was most the acceptable PrEP modality in this sample, our findings suggest that intervention and implementation research is urgently needed to improve our understanding of strategies that could support access, uptake, and sustained adherence to longer-acting PrEP for PWID.
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Affiliation(s)
- Angela R. Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad J. Valasek
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Samantha A. Streuli
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Carlos F. Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Alicia Harvey-Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Morgan M. Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katie B. Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexis M. Roth
- Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Steffanie A. Strathdee
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Heather A. Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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10
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Understanding the Service Needs and Preferences of Men Who Have Sex with Men Who Use Crystal Methamphetamine in British Columbia, Canada: a Qualitative Study. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020712. [PMID: 35055534 PMCID: PMC8775683 DOI: 10.3390/ijerph19020712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/01/2023]
Abstract
Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10–16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41–35.95). Those who completed bachelor’s degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17–0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.
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12
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Batchelder AW, Fitch C, Feinstein BA, Thiim A, O'Cleirigh C. Psychiatric, Substance Use, and Structural Disparities Between Gay and Bisexual Men with Histories of Childhood Sexual Abuse and Recent Sexual Risk Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2861-2873. [PMID: 34676467 PMCID: PMC8761038 DOI: 10.1007/s10508-021-02037-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
Sexual minority men disproportionately experience childhood sexual abuse (CSA) compared to heterosexual men, resulting in greater risk of psychiatric and substance use diagnoses, sexual risk taking, and HIV acquisition later in life. However, little is known about psychiatric and substance use disparities between gay and bisexual men who have experienced CSA. We recruited a purposive convenience sample in Boston and Miami, involving self-report and clinical interview data from 290 sexual minority men (M age = 38.0 years) who reported CSA, defined as unwanted sexual contact before 13 years of age with an adult or person five years older, or unwanted sexual contact between 13 and 16 years of age with a person 10 years older (or any age with the threat of force or harm). We compared those who self-identified as gay (n = 199) versus bisexual (n = 64) on demographic and structural variables (i.e., government benefits, unstable housing, and neighborhood crime) as well as psychiatric and substance use diagnoses. Across 15 unique diagnoses, three were more common in bisexual men than gay men in unadjusted models: bipolar disorder (OR = 2.90, 95% CI: 1.01-8.34), obsessive compulsive disorder (OR = 2.22, 95% CI: 1.01-4.88), and alcohol use disorder (OR = 1.86, 95% CI: 1.03-3.38). Bisexual men were also more likely to meet criteria for "any substance use disorder" than were gay men (OR = 1.99, 95% CI: 1.10-3.59). However, when race, education, and income were included as covariates, the odds ratios reduced significantly (bipolar disorder: aOR = 1.98, 95% CI: 0.59-6.61; obsessive compulsive disorder: aOR = 1.56, 95% CI: 0.64-3.77; alcohol use disorder, aOR = 1.54, 95% CI: 0.80-2.98; any substance use disorder, aOR = 1.79, 95% CI: 0.93-3.45, respectively). Our results highlight the mental health needs, including problematic substance use, of bisexual men with histories of CSA, as well as the importance of accounting for potential confounding demographic variables that may influence disparities in mental health and substance use.
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Affiliation(s)
- Abigail W Batchelder
- Harvard Medical School, Boston, MA, USA.
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
- The Fenway Institute, Boston, MA, USA.
| | - Calvin Fitch
- Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute, Boston, MA, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Conall O'Cleirigh
- Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute, Boston, MA, USA
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13
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Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The Past, Present, and Future of PrEP implementation Among People Who Use Drugs. Curr HIV/AIDS Rep 2021; 18:328-338. [PMID: 33907971 PMCID: PMC8286349 DOI: 10.1007/s11904-021-00556-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Recent HIV outbreaks among people who use drugs (PWUD) necessitate additional HIV prevention tools. Pre-exposure prophylaxis (PrEP) is highly efficacious yet uptake among PWUD remains exceedingly low. To address multilevel, complex barriers to PrEP use among PWUD, a range of intervention strategies are needed. RECENT FINDINGS The literature on interventions to optimize PrEP use among PWUD is nascent, comprising small pilots and demonstration projects in early phases of intervention development. Initial studies suggest that structural, healthcare, interpersonal, and individual-level interventions can improve PrEP use for PWUD, and a number of efficacy trials are underway. Future studies are needed to optimize the use of new PrEP modalities (e.g., injectable PrEP), simultaneously target multilevel challenges to PrEP use, and evaluate the integration of PrEP into other service settings and substance use treatment modalities.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Center for LGBTQ Advocacy, Research, and Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Nimish Saxena
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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14
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Turpin RE, Salerno JP, Rosario AD, Boekeloo B. Victimization, Substance Use, Depression, and Sexual Risk in Adolescent Males Who Have Sex with Males: A Syndemic Latent Profile Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:961-971. [PMID: 32274744 PMCID: PMC10712424 DOI: 10.1007/s10508-020-01685-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 05/10/2023]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of HIV/STI acquisition compared to other adolescents, making sexual risk behaviors in this population a priority public health focus. AMSM experience more victimization (including sexual/partner violence), depression, and substance abuse than their heterosexual counterparts; these may form a syndemic associated with risky sexual behavior. We pooled data from the 2015 and 2017 Youth Risk Behavior Survey, restricted to male students who reported a previous male sexual partner (n = 448). Latent profile analysis was used to identify syndemic profiles, with log-binomial and cumulative complementary log-log models used to test associations with substance use at last intercourse, condomless sex at last intercourse, and the number of sexual partners. Nearly all measures of victimization, depression, and substance use had bivariate associations with greater substance use during sex and more sexual partners. We identified three profiles of AMSM: The profile (n = 55) with the greatest risk factors (evident of a syndemic) had substantially higher prevalence of substance use during sex (aPR = 4.74, 95% CI 3.02, 7.43) and more sexual partners (aPR = 2.45, 95% CI 1.39, 4.31) than the profile with the lowest risk factors (n = 326) after adjusting for confounders. This profile was not associated with condomless sex. We identified a syndemic characterized by victimization, depression, and substance use associated with risky sexual behaviors in a nationally representative sample of AMSM. Comprehensive sexual risk reduction interventions incorporating mental health and substance use are critically important in this population.
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Affiliation(s)
- Rodman E Turpin
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, 4200 Valley Dr., #2242, College Park, MD, 20742, USA.
| | - John P Salerno
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Andre D Rosario
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Bradley Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
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15
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Rivera AV, Harriman G, Carrillo SA, Braunstein SL. Trends in Methamphetamine Use Among Men Who Have Sex with Men in New York City, 2004-2017. AIDS Behav 2021; 25:1210-1218. [PMID: 33185774 DOI: 10.1007/s10461-020-03097-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Methamphetamine (meth) use among men who have sex with men (MSM) has been documented to be associated with HIV transmission among those who are HIV-negative and worsening HIV outcomes among those who are HIV-positive. Recent media reports have suggested recent increases in meth use in New York City (NYC), particularly among Hispanic/Latino and Black MSM. Using serial cross-sectional data from 2004 to 2017, we aim to describe trends in meth use and describe racial/ethnic patterns among MSM in NYC. Overall, we observed a decrease in meth use among MSM from 2004 to 2011 and an increase from 2011 to 2017. When stratified by race/ethnicity, use among White MSM decreased. Beginning in 2008, use among both Hispanic/Latino and Black MSM increased over time. These data provide more evidence that meth use may be increasing in Hispanic/Latino and Black MSM. Culturally-tailored and status-neutral interventions should be explored.
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16
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Gorbach PM, Javanbakht M, Ragsdale A, Bolan RB, Flynn R, Mandler R, Shoptaw S. Methamphetamine Injection Among Young Men Who Have Sex With Men: Risk for Human Immunodeficiency Virus Transmission in a Los Angeles Cohort. J Infect Dis 2021; 222:S471-S476. [PMID: 32877561 DOI: 10.1093/infdis/jiz610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevalence of methamphetamine (meth) injection and associated human immunodeficiency virus (HIV) risks among men who have sex with men (MSM) are unclear. METHODS A total of 532 MSM completed 1880 mSTUDY study visits between August 2014 and June 2018 in Los Angeles, California. Assessments every 6 months included computer-assisted self-interviews and testing for sexually transmitted infections. Analyses by person and across visits adjusted for repeated measures. RESULTS Of 532 participants, 51% (n = 276) reported meth use (past 6 months). Across 1880 visits, mutually exclusive substance use categories were as follows: 5% meth injection (5%), meth use without injection (33%), other substance use excluding meth (36%), and no substance use (26%). Comparisons across these categories respectively found that meth injectors reported higher prevalence of new sex partners (89%, 70%, 68%, and 51%, respectively), more were HIV positive (83%, 65%, 34%, and 50%), fewer were virally suppressed (53%, 48%, 61%, and 67%), and more had sexually transmitted infections (31%, 22%, 15%, and 15% (all P <.01). CONCLUSIONS Among the young MSM reporting meth injection in this Los Angeles cohort, elevated risks of acquiring or transmitting HIV suggest that they contribute significantly to sustaining the local HIV epidemic. Preventing transition to injection use has potential for HIV prevention.
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Affiliation(s)
- Pamina M Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Robert B Bolan
- Los Angeles LGBT Center, Risa Flynn, Los Angeles, California, USA
| | - Risa Flynn
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | | | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, California, USA
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17
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Fitzpatrick RE, Robinson AH, Rubenis AJ, Lubman DI, Verdejo-Garcia A. Lack of longitudinal changes in cognition in individuals with methamphetamine use disorder during the first 6 weeks after commencing treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:383-392. [PMID: 33524275 DOI: 10.1080/00952990.2020.1869243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Methamphetamine use disorder (MUD) associates with cognitive impulsivity deficits. However, few studies have examined longitudinal changes in cognition, and it remains unclear if deficits resolve during early recovery.Objectives: To compare: (1) cognitive function of individuals with MUD at treatment onset and six-weeks later with controls tested over the same period; (2) cognitive changes in MUD-individuals who remained abstinent versus relapsed.Method: We recruited 108 participants meeting DSM-IV-TR criteria for methamphetamine dependence (81 males) and 50 demographically matched controls (38 males); 77 methamphetamine- dependent participants (59 males) and 48 controls (36 males) were retained at follow-up. We administered response inhibition, delay discounting and uncertainty-based decision-making tests at both endpoints. Relapse was defined as methamphetamine concentrations >0.4 ng/mg at follow-up in hair toxicology.Results: We found a significant time-by-group interaction on uncertainty-based decision-making (effect size: η2 = .05), although post-hoc tests to disentangle this interaction yielded inconclusive results (p-range = .14-.40; BF10-range = 0.43-1.67). There were no significant time-by-group interactions on response inhibition or delay discounting, with the former likely a null effect (η2-interaction = .003 and .02; BFincl = 0.23 and 0.71). There were no significant differences in cognitive recovery between individuals who maintained abstinence (n = 12) versus relapsed (n = 65) (η2-range = .003-.04), although evidence was inconclusive toward whether findings reflected true null effects (BFincl-range = 0.33-0.75).Conclusion: We did not find evidence that MUD-related cognitive impulsivity deficits improve beyond practice effects over 6 weeks. Findings do not support previous, albeit conflicting, evidence of early recovery of cognitive deficits in MUD.
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Affiliation(s)
- Rebecca E Fitzpatrick
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Alex H Robinson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Adam J Rubenis
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Turning Point, Eastern Health, Monash University, Fitzroy, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Monash University, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Fitzroy, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Turning Point, Eastern Health, Monash University, Fitzroy, Australia
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18
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Yoosefi Lebni J, Ziapour A, Qorbani M, Khosravi B, Mirzaei A, Safari O, Mansourian M, Özdenk GD. Explaining the causes of crystal addiction in Tehran: a qualitative approach. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Ahuja N, Schmidt M, Dillon PJ, Alexander AC, Kedia S. Online Narratives of Methamphetamine Use and Risky Sexual Behavior: Can Shame-Free Guilt Aid in Recovery? ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:323-332. [PMID: 32671499 DOI: 10.1007/s10508-020-01777-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users' sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types-including meth use, and shame and guilt-few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.
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Affiliation(s)
- Nikhil Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Michael Schmidt
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Adam C Alexander
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
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Su S, Fairley CK, Mao L, Medland N, Shen M, Li Y, Zhuang G, Zhang L. Estimation of the impact of changing drug-use trend on HIV, hepatitis C and syphilis epidemics among people who use synthetic drug-only, polydrug and heroin-only during 2005-2035 in China: modelling study. Sex Transm Infect 2020; 96:608-614. [PMID: 32188771 DOI: 10.1136/sextrans-2019-054360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/17/2020] [Accepted: 02/29/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The rapid expansion of the recreational drug market becomes a global health concern. It is worrying that the bacterial and viral infection epidemics linking to drug use may worsen accordingly. This study aimed to estimate the impacts of changing trend and behaviours of using heroin only, synthetic drug (SD) only and polydrug (using SD and heroin concurrently) on HIV, hepatitis C virus (HCV) and syphilis epidemics among people who use drugs in China by 2035. METHODS We constructed a compartmental model to estimate HIV, HCV and syphilis epidemics in the dynamic drug-use trend by three scenarios: SD-only use, heroin-only use and polydrug use based on Monte Carlo simulations. The parameters for the model were collected from a comprehensive literature search. RESULTS Our model estimated that polydrug use led to the highest HIV and HCV prevalence among three drug-use patterns. The prevalences were projected to increase from 10.9% (95% CI 10.2% to 11.5%) and 61.7% (95% CI 59.4% to 62.5%) in 2005 to 19.0% (95% CI 17.3% to 20.7%) and 69.1% (95% CI 67.3% to 69.5%), respectively, in 2035 among people using polydrug. Similarly, HIV and HCV prevalence in the SD-only group were projected to increase from 0.4% (95% CI 0.3% to 0.4%) and 19.5% (95% CI 19.4% to 21.7%) to 1.8% (95% CI 1.4 to 2.1%) and 33.7% (95% CI 33.2% to 34.9%) in 2005-2035. Conversely, HIV prevalence in the heroin-only group was projected to decrease from 8.0% (95% CI 7.6% to 8.1%) to 2.2% (95% CI 2.0% to 2.3%) in 2005-2035. Syphilis prevalence was estimated to remain unchanged in all population groups within this time frame. It was projected that the proportion of HIV transmitted by sexual transmission will increase compared with unsafe injection transmission in all people who use drugs from 2005 to 2035. CONCLUSION Our modelling suggests that polydrug use is projected to lead to the highest HIV and HCV disease burden by 2035, and the proportion of HIV transmitted by sexual transmission will increase. Current HIV intervention among people using heroin seems effective according to our estimation.
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Affiliation(s)
- Shu Su
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Limin Mao
- Center for Social Research in Health, Faculty of Arts and Social Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Medland
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yan Li
- Health Policy Modeling Laboratory, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guihua Zhuang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan province, China
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Mimiaga MJ, Pantalone DW, Biello KB, White Hughto JM, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care 2019; 31:1083-1095. [PMID: 30887824 PMCID: PMC6625920 DOI: 10.1080/09540121.2019.1595518] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jackie M. White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - John Frank
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Behavioral Medicine Service, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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22
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Turning points, identity, and social capital: A meta-ethnography of methamphetamine recovery. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:79-90. [PMID: 30970290 DOI: 10.1016/j.drugpo.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the increasing prevalence and distinct nature of methamphetamine-related harms, treatment models are limited, and relapse is common. Meta-ethnography has been increasingly used to synthesise qualitative health research and develop new concepts or theories. This meta-ethnography aimed to explore methamphetamine users' experiences of cessation, recovery, and relapse, to better understand how to tailor support for this population. METHODS A systematic review was conducted of six electronic databases, supported by hand searches of leading journals and reviews of reference lists. Reports were included that used naturalistic participant observation to examine methamphetamine cessation, recovery, and relapse with at least 50% of their sample. The life course approach to drug use was used to inform the process of data analysis and interpretation. The final sample was synthesised using Reciprocal Translation supported by open and axial coding. RESULTS Nineteen sources were selected, thirteen of which were conducted in the United States. Two themes were identified: methamphetamine users are exposed to a range of relapse triggers, but also triggers for recovery, and their susceptibility to these triggers is largely determined by their social environment; and the process of recovery requires changes in personal and social identity which can be a barrier to recovery for some users. CONCLUSION These findings present the concept of recovery triggers and highlight the role of wider risk environments in determining methamphetamine recovery, and the negative potential of social capital. These themes also address the ongoing debate regarding the agency of drug users, and the impact of this debate on drug user's experiences of recovery.
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23
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Mimiaga MJ, Pantalone DW, Biello KB, Glynn TR, Santostefano CM, Olson J, Pardee DJ, Hughto JMW, Garcia Valles J, Carrico AW, Mayer KH, Safren SA. A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol. BMC Public Health 2018; 18:914. [PMID: 30045702 PMCID: PMC6060452 DOI: 10.1186/s12889-018-5856-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM. METHODS This study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits. DISCUSSION Effective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings. TRIAL REGISTRATION ClinicalTrials.gov number NCT03175159 , registered June 5, 2017.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI 02903 USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University, School of Public Health, Providence, RI USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Massachusetts, Boston, MA USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI 02903 USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University, School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | | | - Christopher M. Santostefano
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI 02903 USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University, School of Public Health, Providence, RI USA
| | - Jennifer Olson
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI 02903 USA
| | | | - Jaclyn M. W. Hughto
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI 02903 USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University, School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | | | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Medical School, Coral Gables, FL USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Miami, Coral Gables, FL USA
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24
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McKetin R, Lubman DI, Baker A, Dawe S, Ross J, Mattick RP, Degenhardt L. The relationship between methamphetamine use and heterosexual behaviour: evidence from a prospective longitudinal study. Addiction 2018; 113:1276-1285. [PMID: 29397001 DOI: 10.1111/add.14181] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 11/26/2022]
Abstract
AIMS To estimate the extent to which specific sexual behaviours (being sexually active, having multiple sex partners, casual sex, condomless casual sex, anal sex and condomless anal sex) change during periods of methamphetamine use. DESIGN Within-person estimates for the relationship between methamphetamine use and sexual behaviour were derived from longitudinal panel data from the Methamphetamine Treatment Evaluation Study (MATES) cohort (2006-10). SETTING Sydney and Brisbane, Australia. PARTICIPANTS Participants (n = 319) were recruited through treatment and other health services, self-identified as heterosexual, were aged 17-51 years, 74% were male and all were dependent on methamphetamine on study entry. MEASUREMENTS Days of methamphetamine use in the past month and sexual behaviour in the past month were both assessed using the Opiate Treatment Index. FINDINGS When using methamphetamine, participants had double the odds of being sexually active compared with when they were not using, after adjustment for demographics and other substance use [adjusted odds ratio (aOR) = 1.9, P = 0.010]. When participants were sexually active, they were more likely to have multiple sex partners (aOR = 3.3, P = 0.001), casual sex partners (aOR = 3.9, P < 0.001) and condomless casual sex (aOR = 2.6, P = 0.012) when using methamphetamine than when they were not using. During months when participants had a casual sex partner, there was no significant reduction in their likelihood of condom use when they were using methamphetamine. There was no significant change in the likelihood of having anal sex or condomless anal sex during months of methamphetamine use. CONCLUSIONS Methamphetamine use is associated with an increase in being sexually active, having multiple sex partners and casual sex partners and having condomless sex with casual partners, but it is not associated with a change in condom use per se.
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Affiliation(s)
- Rebecca McKetin
- National Drug Research institute, Curtin University, Perth, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sharon Dawe
- School of Psychology, Griffith University, Brisbane, Australia
| | - Joanne Ross
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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25
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Bryant J, Hopwood M, Dowsett GW, Aggleton P, Holt M, Lea T, Drysdale K, Treloar C. The rush to risk when interrogating the relationship between methamphetamine use and sexual practice among gay and bisexual men. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:242-248. [DOI: 10.1016/j.drugpo.2017.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
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26
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Halkitis PN, Bub K, Stults CB, Bates FC, Kapadia F. Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort Study. Subst Use Misuse 2018; 53:101-113. [PMID: 28820622 PMCID: PMC6085877 DOI: 10.1080/10826084.2017.1334067] [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: 10/19/2022]
Abstract
BACKGROUND HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use. OBJECTIVES We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era. METHODS Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status. RESULTS Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.
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Affiliation(s)
- Perry N Halkitis
- a Department of Biostatistics, School of Public Health , Rutgers University , Piscataway Township , New Jersey , USA.,b Department of Social and Behavioral Health Sciences, School of Public Health , Rutgers University , Piscataway Township , New Jersey , USA.,c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Kristen Bub
- e College of Education , University of Illinois , Chicago , Illinois , USA
| | - Christopher B Stults
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Francesca C Bates
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Farzana Kapadia
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA.,d Department of Population Health, School of Medicine , New York University
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27
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Duan C, Wei L, Cai Y, Chen L, Yang Z, Tan W, Gan Y, Au WW, Zhao J. Recreational drug use and risk of HIV infection among men who have sex with men: A cross-sectional study in Shenzhen, China. Drug Alcohol Depend 2017; 181:30-36. [PMID: 29031090 DOI: 10.1016/j.drugalcdep.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recreational drug use has increased in recent years, especially among MSM, and has been found to be associated with higher risk of HIV infection. However, there is limited information about current recreational drug use among MSM in Shenzhen which is an international gateway city to China with a rapidly expanding MSM population. METHODS A cross-sectional survey among MSM in Shenzhen was conducted and was used to collected information on demographics, sexual behavior and drug use via questionnaires. Serologic results on HIV and syphilis were obtained from laboratory assays. We performed logistic regression analysis to evaluate correlates with drug use. RESULTS Among the 1935 MSM surveyed, 12.7% reported use of recreational drugs in the past six months. Rush poppers had become the most frequently used drug (10.6%). Risk factors associated with the use of recreational drugs included being unmarried, non-Han ethnicity, having high education level, seeking male sex partners via the internet, having multiple male sex partners, performing receptive role during anal sex, and having unprotected anal intercourse. Recreational drug use was significantly associated with higher risk of both HIV and syphilis infections (aOR:1.89, 95% CI:1.28-2.79; aOR:1.79, 95% CI:1.25-2.60, respectively). CONCLUSIONS Recreational drug use is associated with increased risk of HIV and syphilis infections among MSM in Shenzhen. Rush poppers were the most popular recreational drug. This finding suggests the need for targeted prevention and behavioral intervention programs to control the recreational drug use, and to reduce HIV and other sexually transmitted diseases among MSM in Shenzhen and internationally.
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Affiliation(s)
- Chenlin Duan
- Department of Preventive Medicine and MPH Education Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Lan Wei
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - Yitian Cai
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - Lin Chen
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - Zhengrong Yang
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - Wei Tan
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - Yongxia Gan
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
| | - William W Au
- Department of Preventive Medicine and MPH Education Center, Shantou University Medical College, Shantou, Guangdong, China; University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Guangdong, China
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28
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Bastos FI, Veloso Filho CL. Critical remarks on strategies aiming to reduce drug related harm: substance misuse and HIV/AIDS in a world in turmoil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:120-30. [PMID: 26630302 DOI: 10.1590/1809-4503201500050009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/21/2015] [Indexed: 02/09/2023] Open
Abstract
In the last decades, the initiatives implemented under the conceptual umbrella of Harm Reduction have gained momentum, with a vigor and scope (both from a geographic and social perspective) never seen before. A more balanced reevaluation could and should rather say such initiatives have resumed, to a large extent, ideas and actions launched much earlier, in the first decades of the 20th century. Notwithstanding, the dissemination of HIV/AIDS in recent years conferred an exceptional visibility and legitimacy to proposals formerly viewed as subsidiary or openly neglected. Nowadays, initiatives inspired by the Harm Reduction philosophy have faced an "identity crisis", not secondary (according to our perspective) to challenges faced by its concepts and operations, but rather as consequence of a world in a turmoil. Such fast-changing dynamics have reconfigured both drug scenes and the patterns and prospects of HIV/AIDS worldwide. This article briefly summarizes some of such recent, ongoing, changes, which have been deeply affecting both concepts and practices to the point of asking for a deep reformulation of most of the initiatives implemented so far.
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29
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The Relationship Between Methamphetamine Use, Sexual Sensation Seeking and Condomless Anal Intercourse Among Men Who Have Sex With Men in Vietnam: Results of a Community-Based, Cross-Sectional Study. AIDS Behav 2017; 21:1105-1116. [PMID: 27351193 DOI: 10.1007/s10461-016-1467-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study assessed the relationship between methamphetamine use and condomless anal intercourse (CAI) among men who have sex with men (MSM) in Hanoi and Ho Chi Minh City, Vietnam. Of 622 MSM participants, 75.7% reported any CAI in the last three months, 23.2% reported engaging in sex work in the last three months, 21.1% reported group sex in the last twelve months (21.1%) and 14.3% had used methamphetamine for sex in the last three months. CAI was associated with living in Ho Chi Minh City vs. Hanoi, being versatile during anal sex, a greater degree of sexual sensation-seeking, and more strongly agreeing that withdrawal before ejaculation is effective in preventing HIV. Effect-modification analysis showed that recent sex-related methamphetamine use was related to a higher probability of CAI for men with low sexual sensationseeking scores. Methamphetamine assessment and/or interventions should be incorporated into HIV prevention and research with Vietnam's MSM population.
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30
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Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, Schneider J. Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men. AIDS Behav 2017; 21:207-216. [PMID: 27233249 PMCID: PMC5124546 DOI: 10.1007/s10461-016-1439-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91-1.00 and OR 0.50, 95 % CI 0.25-1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20-3.94) and psychological distress (OR 5.02, 95 % CI 1.54-16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.
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Affiliation(s)
- Katherine Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Kate Jaffe
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Eavou
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Klein H. Semen Arousal: Its Prevalence, Relationship to HIV Risk Practices, and Predictors among Men Using the Internet to Find Male Partners for Unprotected Sex. ACTA ACUST UNITED AC 2016; 7. [PMID: 30174982 PMCID: PMC6117121 DOI: 10.4172/2155-6113.1000546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal. Methods 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt. Results 65.1 % of the men found at least one sensory aspect of semen to be "fairly" or "very" arousing, compared to 10.2% being "not very" or "not at all" aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual "bottom," being better educated, being HIV-positive, and being more depressed. Conclusions Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.
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Gideonse TK. Pride, Shame, and the Trouble with Trying to Be Normal. ETHOS (BERKELEY, CALIF.) 2015; 43:332-352. [PMID: 30270944 PMCID: PMC6157916 DOI: 10.1111/etho.12100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
I performed 14 person-centered ethnographies with methamphetamine-using HIV-positive men who have sex with men in San Diego, California, who were all subjects of the "anti-meth apparatus," a collection of government and nongovernment organizations focused on meth use and its sequelae. The apparatus attempts to coerce addicts to develop and perform certain identities and emotions, though addicts are capable of both passive acceptance and active disruption. In my research, those who failed to become the apparatus's ideal subject felt shame, while those who succeeded expressed pride. Those hovering in the middle experienced a perpetual struggle to become normal and rarely, if ever, succeeded. [addiction, HIV/AIDS, subjectivity].
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Prescription Drug Misuse and Sexual Risk Behaviors Among Young Men Who have Sex with Men (YMSM) in Philadelphia. AIDS Behav 2015; 19:847-56. [PMID: 25240627 DOI: 10.1007/s10461-014-0898-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N = 191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6 % engaged in UAI. After adjusting for socio-demographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.
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Holtz TH, Pattanasin S, Chonwattana W, Tongtoyai J, Chaikummao S, Varangrat A, Mock PA. Longitudinal analysis of key HIV-risk behavior patterns and predictors in men who have sex with men, Bangkok, Thailand. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:341-8. [PMID: 25637308 DOI: 10.1007/s10508-014-0427-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/07/2014] [Accepted: 10/17/2014] [Indexed: 05/27/2023]
Abstract
The HIV incidence among Thai men who have sex with men (MSM) enrolled in the Bangkok MSM Cohort Study (BMCS) has remained high since its inception in 2006. The purpose of this BMCS analysis was to determine: (1) changes in three HIV-risk behaviors (unprotected anal intercourse (UAI), recreational drug use, and multiple sexual partners i.e., more than four male/transgender partner) over time; and (2) factors associated with each one separately. Thai MSM aged 18 years or older and living in Bangkok were eligible to participate in the BMCS. At each follow-up visit, participants were asked to report their sexual and drug behaviors in the previous 4 months. We conducted a longitudinal analysis using generalized estimating equations logistic regression that included 1,569 MSM who were enrolled from 2006 to 2010 and contributed at least one follow-up visit. For each four-month visit increase, we found a 2, 1, and 1 % decrease in odds for reported UAI, recreational drug use, and multiple sexual partners, respectively. We found significant predictors associated with three HIV-risk behaviors such as binge drinking, participation in group sex, and use of erectile dysfunction drugs. The statistically significant decrease in odds of HIV-risk behaviors among the participants is encouraging; however, continued vigilance is required to address the factors associated with HIV-risk behaviors through currently available interventions reaching MSM.
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Affiliation(s)
- Timothy H Holtz
- HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, P.O. Box 139, Nonthaburi, 11000, Thailand,
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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: 1.4] [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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Lelutiu-Weinberger C, Gamarel KE, Golub SA, Parsons JT. Race-based differentials in the impact of mental health and stigma on HIV risk among young men who have sex with men. Health Psychol 2014; 34:847-56. [PMID: 25545041 DOI: 10.1037/hea0000192] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the U.S., young men who have sex with men (YMSM) are disproportionately affected by HIV, with YMSM of color being the most impacted by the epidemic. METHOD To advance prevention research, we examined race-based differences in gay-related stress in conjunction with the moderating role of mental health on substance use and sexual risk among 206 high-risk YMSM, recruited September, 2007-2010. RESULTS Negative binomial regressions and 3-way interaction graphs indicated that psychological distress and acute gay-related stigma placed all participants at most risk for HIV acquisition. Low psychological distress appeared to "buffer" all YMSM against HIV risk, whereas the reverse was evidenced for those reporting low gay-related stigma and psychological distress. YMSM of color reported more risk behavior, and less decreases in risk with attenuated psychological distress, compared with White YMSM. We hypothesize these trends to be associated with experiencing multiple stigmatized identities, indicating points of intervention for YMSM of color to achieve positive identity integration. There were sharper increases in HIV risk behavior for White YMSM with increasing gay-related stigma than for YMSM of color, which could be attributed to the latter's prolonged exposure to discrimination necessitating building coping skills to manage the influx of adversity. CONCLUSIONS Emphases on: (a) identity-based interventions for YMSM of color; and (b) skills-based interventions for White YMSM should supplement existing successful HIV risk-reduction programs. Lastly, mental health needs to be a target of intervention, as it constitutes a protective factor against HIV risk for all YMSM.
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Theodore PS, Durán RE, Antoni MH. Drug use and sexual risk among gay and bisexual men who frequent party venues. AIDS Behav 2014; 18:2178-86. [PMID: 24770947 DOI: 10.1007/s10461-014-0779-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research connecting club drug use to risky sex among gay/bisexual men (GBM) contains methodological issues that have limited knowledge about the relative risks of distinct drugs. This paper reports drug use and sexual behavior data from 197 GBM who frequented at least one party venue within 3 months of participating. Alarming rates of drug use and unprotected anal intercourse (UAI) with casual sex-partners were reported in connection with time spent at a bar, club or circuit party. Structural equation modeling revealed that use of methamphetamine, gammahydroxybutrate (GHB), and/or ketamine (K), but not use of ecstasy, at a party venue helped explain likelihood of UAI with a casual sex-partner while under the influence of a drug during/following time partying (β = 0.41, p < .01). Findings suggest use of methamphetamine, GHB and/or K at party venues increases risk for subsequent UAI with casual sex-partners. Study implications, limitations, and recommendations for future research are discussed.
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Affiliation(s)
- Peter S Theodore
- Clinical Psychology PhD Program, California School of Professional Psychology (CSPP) at Alliant International University, 1000 S. Fremont Avenue, Unit 5, Alhambra, Los Angeles, CA, USA,
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Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav 2014; 18:1359-67. [PMID: 24287786 PMCID: PMC4209944 DOI: 10.1007/s10461-013-0657-z] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transgender women ("transwomen") face a disproportionate HIV disease burden; the odds of being HIV-positive are estimated to be 34.2 times higher for transwomen than the United States adult population. From January 1, 2005 through December 31, 2011, HIV prevention outreach encounters were conducted with 2,136 unique transwomen on the streets and at high-risk venues in Los Angeles County. The outreach encounters were comprised of a low-intensity health education and risk reduction intervention, which included referrals to needed services. The goal of the encounters was to assess the participant's level of substance use and sexual risk behaviors to provide appropriate risk reduction strategies and supplies. The sample evidenced high rates of recent alcohol (57.7 %), marijuana (25.6 %), and methamphetamine (21.5 %) use, lifetime injection drug or illegal hormone use (66.3 %), and recent engagement in sex work (73.3 %). Multivariate logistic regression analysis revealed that recent methamphetamine (AOR = 2.09; p ≤ 0.001) and/or crack cocaine (AOR = 2.19; p = 0.010) use, injection drug/hormone use (AOR = 1.65; p ≤ 0.001), unprotected anal intercourse during sex work (AOR = 2.24; p = 0.029), and any non-Hispanic minority racial status were all associated with increased odds of reporting a HIV-positive status. The transwomen encountered via outreach exhibited many risk co-factors for HIV infection and transmission.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA,
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Martin AM, Benotsch EG, Cejka A, Luckman D. Social responsibility, substance use, and sexual risk behavior in men who have sex with men. JOURNAL OF HOMOSEXUALITY 2014; 61:251-269. [PMID: 24383857 DOI: 10.1080/00918369.2013.839908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status-a behavior that helps men protect their partners but does not protect themselves from the virus-also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.
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Affiliation(s)
- Aaron M Martin
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
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Biomarker validation of recent unprotected sexual intercourse in a prospective study of young women engaged in sex work in Phnom Penh, Cambodia. Sex Transm Dis 2013; 40:462-8. [PMID: 23680902 DOI: 10.1097/olq.0b013e318286db8a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate measurement of unprotected sex is essential in HIV prevention research. Since 2001, the 100% Condom Use Program targeting female sex workers (FSWs) has been a central element of the Cambodian National HIV/AIDS Strategy. We sought to assess the validity of self-reported condom use using the rapid prostate-specific antigen (PSA) test among Cambodian FSWs. METHODS From 2009 to 2010, we enrolled 183 FSWs in Phnom Penh in a prospective study of HIV risk behavior. Prostate-specific antigen test results from the OneStep ABAcard were compared with self-reported condom use in the past 48 hours at quarterly follow-up visits. RESULTS Among women positive for seminal fluid at the first follow-up visit, 42% reported only protected sex or no sex in the detection period. Discordant results were more likely among brothel and street-based FSW versus entertainment (56% vs. 17%), recent (last 3 months) amphetamine-type stimulant (ATS) users (53% vs. 20%), and those with 5 or more partners in the past month (58% vs. 13%). In multivariable regression models, positive PSA results were associated with recent ATS use (adjusted risk ratio [ARR], 1.5; 95% confidence interval [CI], 1.1-2.2), having a nonpaying last sex partner (ARR, 1.7; CI, 1.2-2.5), and sex work venue (ARR, 3.0; CI, 1.4-6.5). Correspondingly, women with a nonpaying last sex partner were more likely to report unprotected sex (ARR, 1.5; CI, 1.1-2.2), but no associations were found with sex work venue or ATS use. CONCLUSIONS Results confirm the questionable validity of self-reported condom use among FSW. The PSA biomarker assay is an important monitoring tool in HIV/sexually transmitted infection research including prevention trials.
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Benotsch EG, Lance SP, Nettles CD, Koester S. Attitudes toward methamphetamine use and HIV risk behavior in men who have sex with men. Am J Addict 2013; 21 Suppl 1:S35-42. [PMID: 23786508 DOI: 10.1111/j.1521-0391.2012.00294.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Methamphetamine use has been strongly associated with high-risk sexual behaviors, and its use has been increasing among men who have sex with men (MSM). Although the behavioral implications of methamphetamine use and sexual risk have been broadly examined, fewer studies have examined attitudes about methamphetamine use. METHODS This study investigates the relationship between personal beliefs regarding methamphetamine use, patterns of use, and sexual risk behaviors within a sample of MSM attending a gay pride event (N= 342). RESULTS A minority of MSM reported lifetime (27%) or recent (7%) methamphetamine use. Only a minority of MSM who had used methamphetamine believed that it enhanced sexual pleasure (32%) or incorporated methamphetamine use into their sexual activity (31%). Individuals who used methamphetamine during sexual activity were more likely to be recent users of the drug and more likely to engage in high-risk behaviors. A significant minority of participants endorsed items assessing the disinhibiting effects of methamphetamine including being less likely to use a condom (35%) and less selective in their choice of partners (26%). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Results suggest that prevention efforts may benefit from targeting the minority of methamphetamine users who perceive methamphetamine as enhancing sexual activity and use it for this purpose.
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Affiliation(s)
- Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA.
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Klein H. Depression and HIV Risk Taking among Men Who Have Sex with Other Men (MSM) and Who Use the Internet to Find Partners for Unprotected Sex. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2013; 18:164-189. [PMID: 26877831 DOI: 10.1080/19359705.2013.834858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study examines the prevalence of depression in a sample of MSM who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors, and the factors associated with greater depressive symptomatology. METHODS The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. RESULTS Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men's attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. CONCLUSIONS Depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, 401 Schuyler Road, Silver Spring, MD 20910,
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Sexual risk behaviors among club drug users in Shanghai, China: prevalence and correlates. AIDS Behav 2013; 17:2439-49. [PMID: 23247360 DOI: 10.1007/s10461-012-0380-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We surveyed 276 club drug users in Shanghai, China. Overall, 43.8 % reported ≥2 sex partners in the past 30 days, and 48.9 % reported having sex with non-regular partners, 67.4 % of whom had unprotected sex. Having ≥2 recent sex partners was associated with being 35 years or older, male, living with friends or others, introduced to club drug use by non-regular sex partners, using methamphetamine recently, self-identified as gay/lesbian or bisexual, had sexual debut before 20 years old, and recently had sex under the influence of drugs. Having unprotected sex with non-regular partners in the past 30 days was associated with lower education levels, having sex to obtain drugs, and lower levels of HIV/AIDS knowledge. Club drug users should be targeted for intervention programs. Future research needs to identify other protective and risk factors for sexual risk behaviors and design interventions to reduce club drug use and associated sexual risk behaviors.
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Sexual healthcare preferences among gay and bisexual men: a qualitative study in San Francisco, California. PLoS One 2013; 8:e71546. [PMID: 23977073 PMCID: PMC3747218 DOI: 10.1371/journal.pone.0071546] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/29/2013] [Indexed: 01/22/2023] Open
Abstract
Background Research on gay and other men who have sex with men's (G/MSM) preferences for sexual healthcare services focuses largely on HIV testing and to some extent on sexually transmitted infections (STI). This research illustrates the frequency and location of where G/MSM interface with the healthcare system, but it does not speak to why men seek care in those locations. As HIV and STI prevention strategies evolve, evidence about G/MSM's motivations and decision-making can inform future plans to optimize models of HIV/STI prevention and primary care. Methods We conducted a phenomenological study of gay men's sexual health seeking experiences, which included 32 in-depth interviews with gay and bisexual men. Interviews were transcribed verbatim and entered into Atlas.ti. We conducted a Framework Analysis. Findings We identified a continuum of sexual healthcare seeking practices and their associated drivers. Men differed in their preferences for separating sexual healthcare from other forms of healthcare (“fragmentation”) versus combining all care into one location (“consolidation”). Fragmentation drivers included: fear of being monitored by insurance companies, a desire to seek non-judgmental providers with expertise in sexual health, a desire for rapid HIV testing, perceiving sexual health services as more convenient than primary care services, and a lack of healthcare coverage. Consolidation drivers included: a comfortable and trusting relationship with a provider, a desire for one provider to oversee overall health and those with access to public or private health insurance. Conclusions Men in this study were likely to separate sexual healthcare from primary care. Based on this finding, we recommend placing new combination HIV/STI prevention interventions within sexual health clinics. Furthermore, given the evolution of the financing and delivery of healthcare services and in HIV prevention, policymakers and clinicians should consider including more primary care services within sexual healthcare settings.
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Klein H. Condom use self-efficacy and HIV risk practices among men who use the internet to find male partners for unprotected sex. Am J Mens Health 2013; 8:190-204. [PMID: 23832954 DOI: 10.1177/1557988313492172] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research examines the levels of condom use self-efficacy in a population of men who have sex with men who are at great risk for contracting/transmitting HIV. It focuses on the relationship between condom use self-efficacy and risk involvement, and examines the factors associated with greater/lower levels of condom use self-efficacy. The data come from a national sample of men, randomly chosen, who used any of 16 websites specifically to identify other men with whom they could engage in unprotected sex. Data were collected between January 2008 and May 2009 from 332 men, via telephone interviews. Multivariate analyses and structural equation modeling were used to test a conceptual model based on syndemics theory. Overall levels of condom use self-efficacy were fairly high, and self-efficacy was related inversely to involvement in HIV risk practices. Six factors were found to be indicative of levels of condom use self-efficacy: the number of drug problems experienced, sexual role identity as a "bottom," not caring about the HIV serostatus of potential sex partners, experiencing childhood maltreatment, having confidence in HIV-related information provided in other men's online profiles, and level of HIV knowledge. Condom use self-efficacy plays an integral role in HIV risk practices among high-risk men who have sex with men. This is true despite the fact that, overall, condom use self-efficacy levels were fairly high in this population.
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Affiliation(s)
- Hugh Klein
- 1Kensington Research Institute, Silver Spring, MD, USA
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46
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Benoit E, Koken JA. Perspectives on substance use and disclosure among behaviorally bisexual black men with female primary partners. J Ethn Subst Abuse 2013; 11:294-317. [PMID: 23216438 DOI: 10.1080/15332640.2012.735165] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Black men who have sex with men and women (MSMW) are believed to be a bridge to HIV infection among heterosexual Black women, and substance use can increase the risk of infection among men. However, empirical evidence on the social context of MSMW's sexual behavior and substance use is needed. This study examines the perspectives of Black MSMW with female primary partners on the role of substance use in their sexual encounters with men and their reasons for disclosing or not disclosing this behavior to their female partners. Findings can inform culturally relevant HIV prevention interventions for this population.
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Affiliation(s)
- Ellen Benoit
- National Development and Research Institutes, Inc., New York, New York 10010, USA.
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Parsons JT, Kowalczyk WJ, Botsko M, Tomassilli J, Golub SA. Aggregate versus day level association between methamphetamine use and HIV medication non-adherence among gay and bisexual men. AIDS Behav 2013; 17:1478-87. [PMID: 23553345 DOI: 10.1007/s10461-013-0463-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Methamphetamine use is associated with HIV infection, especially among gay and bisexual men. Methamphetamine use contributes to disease progression both directly, by increasing viral load and damaging the immune system, and indirectly, by decreasing medication adherence. Research examining the association of methamphetamine use and non-adherence has traditionally compared groups of users and nonusers on adherence, compared methamphetamine use between participants above or below some threshold level of adherence (e.g. >90 % dose adherence), or examined aggregate relationships. Using Timeline Follow-back procedures, the present study examined aggregate, threshold, and day-level associations of methamphetamine use with non-adherence in 210 HIV-positive gay and bisexual methamphetamine-using men. Methamphetamine use was not associated with adherence behavior at the aggregate-level, but methamphetamine use on a given day was associated with 2.3 times the odds of non-adherence on that day. Threshold results were equivocal. These data suggest that the methamphetamine and non-adherence relationship is complicated: non-adherence is more likely to occur on days in which methamphetamine is used, but participants reported more non-adherence days in which methamphetamine was not used. This seeming paradox generates questions about the selection of analytical techniques and has important implications for behavioral interventions targeting substance use and adherence among HIV-positive individuals.
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Li S, Huang H, Xu G, Cai Y, Huang F, Ye X. Substance use, risky sexual behaviors, and their associations in a Chinese sample of senior high school students. BMC Public Health 2013; 13:295. [PMID: 23557462 PMCID: PMC3623650 DOI: 10.1186/1471-2458-13-295] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 03/25/2013] [Indexed: 11/15/2022] Open
Abstract
Background Given the higher prevalence of risky sexual behaviors and substance use, adolescents and youths are at risk for HIV. Despite its importance, however, to the best of our knowledge, there are only a few researches on risky behaviors in Chinese adolescents/youths. The present study aimed to describe the prevalence of sexual and substance use behaviors among a Chinese sample of senior high school students. And more specifically, the associations of socio-demographic factors and substance use with risky sexual behaviors were examined in the sample. Methods A cross-sectional study was conducted in 10 senior high schools. A total of 2668 senior high school students aged 15.17 to 23.42 years participated in the survey. A self-administrated questionnaire was used to collect information on sexual and substance use behaviors. Results The percentages of students who ever had sexual intercourse in lifetime or during last three months were 7.0% and 5.1%, respectively. Among the participants with sexual intercourse during last three months, 42.1% ever had unprotected sexual intercourse and 49.4% had intercourse with two or more partners. Multivariate logistic regression analyses showed that cigarette smoke and illicit drug use were related to unprotected sexual intercourse (defined as “sexual intercourse without condom use”) and younger age of first sexual intercourse was related to multiple-partner sexual intercourse. Conclusions HIV/sexual transmitted infection (STI) health education and prevention are necessary among the Chinese adolescents, particularly among those adolescents with experience of sexual intercourse and/or substance use, which has a long-term beneficial to the control of HIV/STI in China.
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Affiliation(s)
- Shenghui Li
- School of Public Health affiliated with Shangai Jiaotong University School of Medicine, Shangai, People's Republic of China.
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49
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Klein H. Involvement in Specific HIV Risk Practices among Men Who Use the Internet to Find Male Partners for Unprotected Sex. JOURNAL OF ADDICTION 2013; 2013:826039. [PMID: 24826369 PMCID: PMC4008398 DOI: 10.1155/2013/826039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/21/2013] [Indexed: 11/17/2022]
Abstract
Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man's anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while "under the influence" (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, 401 Schuyler Road, Silver Spring, MD 20910, USA
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50
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Dentato MP, Halkitis PN, Orwat J. Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior among Gay & Bisexual Men Who Use Club Drugs. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2013; 25:10.1080/10538720.2013.829395. [PMID: 24319321 PMCID: PMC3851037 DOI: 10.1080/10538720.2013.829395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Few studies have examined the impact of minority stress theory upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women, however gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. OBJECTIVE This study examined sexual risk behavior from the perspective of minority stress theory upon substance using gay and bisexual men and their partners. METHODS Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use and partner type, controlling for demographics. RESULTS 396 gay and 54 bisexual respondents, ages 18-67 reported at least one time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. CONCLUSIONS Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.
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Affiliation(s)
- Michael P Dentato
- Loyola University Chicago, School of Social Work 820 North Michigan Avenue, 12 floor Chicago, IL 60611
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