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Yan X, Ni Y, Lu Y, Wang Q, Tang W, Tan RKJ, Tucker JD, Hall BJ, Baral S, Song H, Zhou Y, Wu D. Homoprejudiced Violence Experiences and High-Risk Sexual Behaviors among Chinese Men Who Have Sex with Men: Depression Severity and Recreational Drug Usage as Potential Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1265-1276. [PMID: 38172350 DOI: 10.1007/s10508-023-02775-4] [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: 01/18/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
Homoprejudiced violence is a type of aggression against an individual or a community based on their actual or perceived sexual orientation. It may be linked to risks of acquiring HIV/STI via psychosocial variables. This study explored the association between homoprejudiced violence experiences and high-risk sexual behaviors, and potential psychosocial mediators. Using cross-sectional survey data collected in China through Blued among men who have sex with men (MSM) in January 2021, this study conducted multiple mediation analyses. Standard instruments were used to collect data on depressive symptoms in the last two weeks (PHQ-9), recreational drug usage in the last three months, and ever experiencing homoprejudiced violence (12-item survey instrument). Dependent variables were having condomless anal sex and having three or more sexual partners in the last three months. Among 1828 MSM, nearly half (847, 46%) had experienced homoprejudiced violence. Twenty-three percent (427) reached a score that suggested moderate or severe depression and 35% (644) had used recreational drugs. In the last three months, 40% (731) had condomless anal sex and 34% (626) had three or more sexual partners. The indirect mediational coefficients through depression on condomless anal sex and multiple sexual partners were 0.04 (95% CI: [0.02, 0.07]) and 0.02 (95% CI: [0.001, 0.05]), respectively. The indirect mediational coefficient of homoprejudiced violence experience on multiple sexual partners through recreational drug use was 0.05 (95% CI: [0.03, 0.08]). These findings suggest that more comprehensive interventions are needed to address the syndemic of homoprejudiced violence, mental health issues, and HIV/STI-related risks.
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Affiliation(s)
- Xumeng Yan
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, No. 101 Longmian Avenue Nanjing, Nanjing, 211166, Jiangsu, China
- University of North Carolina Project-China, Guangzhou, China
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Yuxin Ni
- University of North Carolina Project-China, Guangzhou, China
- Department of Health Law Policy and Management, Boston University, Boston, MA, USA
| | - Ying Lu
- University of North Carolina Project-China, Guangzhou, China
| | - Qianyun Wang
- University of North Carolina Project-China, Guangzhou, China
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rayner Kay Jin Tan
- University of North Carolina Project-China, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yi Zhou
- Department of HIV/AIDS Prevention and Control, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, No. 101 Longmian Avenue Nanjing, Nanjing, 211166, Jiangsu, China.
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Chiang C, Gessner N, Burli A, Liszewski W, Mansh M, Nguyen CV, Yeung H, Trinidad JC. Poppers Dermatitis: A Systematic Review on a Unique Form of Contact Dermatitis in the MSM Community. Dermatitis 2023. [PMID: 37788394 DOI: 10.1089/derm.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
There are certain demographic characteristics that may serve as risk factors for exposure to a contact allergen. Volatile alkyl nitrites, colloquially known as "poppers," are commonly inhaled by men who have sex with men (MSM) for their psychoactive and muscle-relaxing effects. They have been reported to cause either allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD), termed "poppers dermatitis." We searched PubMed, Embase, and Web of Science to understand the patient population, clinical presentation, diagnosis, and clinical course of poppers dermatitis. Our search returned 13 articles detailing 18 patients total. Most patient cases were male (n = 13/15; 87%), of whom 5 were MSM. The reports on the remaining 8 men did not disclose their sexual behaviors. The chemicals deemed responsible for adverse cutaneous side effects included amyl nitrite (6/18; 33%), butyl nitrite (3/18; 167%), isobutyl nitrite (2/18; 11%), and an unspecified alkyl nitrite (7/18, 39%). The most common diagnosis was ICD (10/18; 56%). Only 3 patients underwent alkyl nitrite patch testing, with 2 testing positive for ACD. The most commonly involved anatomic sites were perinasal (13/18; 72%) and perioral regions (10/18; 56%). Rash morphology has been described as yellow crusting, impetigo-like, eczematous, vesicular, edematous, and erythematous. Ulceration can occur with direct skin contact to concentrated nitrite solution. Poppers dermatitis was often self-limited with complete resolution. Dermatologists should consider poppers dermatitis in those presenting with a characteristic midfacial rash, especially in MSM.
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Affiliation(s)
- Chavy Chiang
- From the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Nicholas Gessner
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anuk Burli
- Department of Dermatology, Stanford University, Palo Alto, California, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Mansh
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Trinidad
- Department of Dermatology, Massachusetts General Hospital, Cambridge, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Cambridge, Massachusetts, USA
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Wang H, Jonas KJ, Guadamuz TE. Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis. Drug Alcohol Depend 2023; 243:109741. [PMID: 36630807 PMCID: PMC10435892 DOI: 10.1016/j.drugalcdep.2022.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom, Thailand; John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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Haase S, Müller A, Zweigenthal V. Sexual health behavior, health status, and knowledge among queer womxn and trans men in Kenya: An online cross-sectional study. PLoS One 2022; 17:e0268298. [PMID: 35714150 PMCID: PMC9205489 DOI: 10.1371/journal.pone.0268298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Little research has been conducted on the sexual health needs and risk behaviors of queer womxn and trans men, making it difficult to identify specific health needs and disparities. This is especially the case in the Global South, where their needs are poorly understood. This study presents findings on demographics, sources of information, sexual (risk) behaviors, and substance use in Kenyan queer womxn and trans men. Methods An online survey among 335 Kenyan queer womxn and trans men was used to collect data on sexual health, risk behavior, health information sources, and substance use. The participants needed to have had at least one self-identified female sexual partner. Results The sample presented young, highly-educated queer womxn and trans men. A high incidence of childhood sexual trauma found was found. Risk behaviors included sexual activities with partners of multiple genders, violence, and low use of barrier methods. One in three participants had been treated for an STD in the previous year. The incidences of smoking and drinking were high, and a quarter of participants indicated having taken drugs at least once a month or more. The internet was either the first or second most important source of sexual health information for 44.1% of the participants, followed by schools (30.9%). Discussion and conclusion Our findings indicate that queer womxn and trans men are at risk of negative sexual health outcomes due to a lack of appropriate information, risk behavior, substance use, and low uptake of sexual health services. Kenya’s Penal Code still criminalizes consensual same-sex activities and may play a role in perpetuating barriers that prohibit them from making healthier choices. Developing tailored programming and policies require local, national, and global stakeholders to engage with the inclusion of queer womxn and trans men’s sexual health needs within strategic planning and healthcare delivery.
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Affiliation(s)
- Stephanie Haase
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Alex Müller
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Virginia Zweigenthal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Changes in substance use among HIV-negative MSM: A longitudinal analysis, 1995-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103748. [PMID: 35649313 DOI: 10.1016/j.drugpo.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research suggests shifting patterns of recreational drug consumption among MSM in recent decades. The present study evaluates population-level mean trajectories of substance use among HIV-negative MSM from 1995 to 2019. METHODS Using open cohort study data following MSM in the Netherlands (n=1495) since 1995, we applied generalized estimating equations to examine population-averaged estimates of five substances - alcohol, cannabis, ecstasy, cocaine, and poppers - from 1995 to 2019, as well as their use during sexual encounters. RESULTS Recent alcohol use decreased; predicted probabilities declined from 1995 to 2019 (.96 to .87). During the same period, cocaine and poppers use increased - (.10 to .23 and .37 to .47, respectively) and use during sex also increased (.05 to .16, and .32 to .41, respectively). Ecstasy use increased over time (.23 to .38), although not during sex. No significant changes in cannabis use occurred. CONCLUSIONS While changes in use of various substances were mixed, increases in cocaine and poppers use during sexual encounters occurred among HIV-negative MSM over time. Efforts to intervene on substance use in connection with sex remain critical for health promotion.
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Restar AJ, Quilantang MIN, Surace A, Ogunbajo A, Chan R, Adia A, Cu-Uvin S, Operario D. Characterizing Problematic Drug Use Among Transgender Women and Cisgender Men During the Emerging HIV Crisis in the Philippines: Implications for Policy Research. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:116-130. [PMID: 35438540 PMCID: PMC10442844 DOI: 10.1521/aeap.2022.34.2.116] [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] [Indexed: 06/14/2023]
Abstract
Drug use and HIV are key issues for public health interventions in the Philippines. We examined associations of problematic drug use among 320 Filipinx transgender women (trans-WSM) and cisgender men who have sex with men (cis-MSM). The prevalence of exhibited problematic drug use in this sample was 29.38%. Greater odds of problematic drug use were observed among Filipinx participants who recently engaged in sex work (adjusted OR [aOR] = 2.79, 95% CI [1.08, 7.18]), reported having HIV positive and unknown status vs. negative status (aOR = 3.61, 95% CI [1.39, 9.39], and aOR = 13.99, 95% CI [2.04, 29.69], respectively), exhibited low HIV knowledge (aOR = 4.15, 95% CI [1.82, 9.44]), and displayed hazardous drinking (aOR = 2.77, 95% CI [1.21, 6.33]). Given its correlates of HIV-related indicators, integration of HIV and harm reduction services as a public health intervention could potentially decrease problematic drug use.
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Affiliation(s)
- Arjee J Restar
- University of Washington School of Public Health, Seattle, Washington and Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- Brown University School of Public Health, Providence, Rhode Island
| | - Ma Irene N Quilantang
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- University of Philippines, Manila, Philippines
| | - Anthony Surace
- Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Alexander Adia
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| | - Susan Cu-Uvin
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- Providence-Boston Center for AIDS Research, Providence, Rhode Island, and the Department of Medicine Miriam Hospital, Providence, Rhode Island
| | - Don Operario
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
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Coyer L, Boyd A, Davidovich U, van Bilsen WPH, Prins M, Matser A. Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV-negative men who have sex with men. Addiction 2022; 117:656-665. [PMID: 34402120 PMCID: PMC9292014 DOI: 10.1111/add.15666] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). DESIGN Open prospective cohort study. SETTING Public Health Service of Amsterdam, the Netherlands. PARTICIPANTS A total of 976 HIV-negative MSM, aged ≥ 18 years. MEASUREMENTS Self-reported RDU and sexual behaviour in the past 6 months. Laboratory-confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end-points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. FINDINGS Median age of participants in 2008 was 33.2 years (interquartile range = 27.8-40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03-1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07-1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71-2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19-1.55), HIV (aOR = 5.86; 95% CI = 2.39-14.4) and STI (aOR = 2.31; 95% CI = 1.95-2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37-1.81), HIV (aOR = 6.30; 95% CI = 3.28-12.1) and STI (aOR = 2.15; 95% CI = 1.81-2.55). CONCLUSIONS Among human immunodeficiency virus (HIV)-negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections.
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Affiliation(s)
- Liza Coyer
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Stichting HIV MonitoringAmsterdamthe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Social PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ward P. H. van Bilsen
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AII), Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Amy Matser
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
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Schwartz C, Tooley L, Knight R, Steinberg M. Queering poppers literature: A critical interpretive synthesis of health sciences research on alkyl nitrite use and Canadian policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103546. [PMID: 34920219 DOI: 10.1016/j.drugpo.2021.103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Poppers (alkyl nitrites) are vasodilators used by many gay, bisexual, and other men who have sex with men (GBMSM) to relieve pain, enhance pleasure, and facilitate penetration during sex. In 2013, the Canadian government cracked down on the sale of poppers products, however prevalence of poppers use among GBMSM in Canada remains high. Poppers have been studied by medical researchers since the 1980s, yet qualitative and community-based research to inform federal policy, remains somewhat less common. METHODS We conducted a critical interpretive synthesis (CIS) to better understand poppers health literature using the medical model of health as a point of reference. Analysis was performed using inductive and deductive methods including reflexive note-taking, mind-mapping, and close coding. 153 publications were identified to inform this review of which 5 were chosen for coding based on a purposive sampling framework. RESULTS Our findings are unified within a theoretical construct we term responsibility. Responsibility is a construct we use to describe the bias we identified in health sciences literature regarding poppers use that tends to exaggerate the necessity for poppers cessation, and devalue both the benefits of poppers use and the perspectives and experiences of people who use poppers. The emphasis on individual behavior change within the literature appears to be motivated less by objective measures or assessments of health risks and outcomes, and more by harmful stereotypes that position gay men and people who use drugs as inherently irresponsible. CONCLUSION We conclude by discussing how these findings have important implications for the review of current policy on poppers sales in Canada which remains influenced by a literature base prejudiced by factors such as homophobia, heteronormativity, and drug stigma, and recommend areas for future work.
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Affiliation(s)
- Cameron Schwartz
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada; Community-Based Research Centre, 1007-808 Nelson St, Vancouver, BC V6Z 2H2, Canada.
| | - Len Tooley
- Community-Based Research Centre, 1007-808 Nelson St, Vancouver, BC V6Z 2H2, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Malcolm Steinberg
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
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Petrova M, Miller-Perusse M, Hirshfield S, Carrico A, Horvath K. The Beat Goes On: Stimulant Use and HIV in the Era of COVID-19. JMIR Form Res 2021; 6:e30897. [PMID: 35275839 PMCID: PMC9159464 DOI: 10.2196/30897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Background Evidence suggests that economic, social, and psychological circumstances brought about by the COVID-19 pandemic may have a serious impact on behavioral health. Men who have sex with men (MSM) are disproportionally impacted by HIV and stimulant use, the co-occurrence of which heightens HIV transmission risk and undermines nationwide treatment strategies as prevention efforts for ending the HIV epidemic. There is a paucity of information regarding the potential impact of the COVID-19 pandemic on the substance use and HIV medication adherence in this key vulnerable population—MSM who use stimulants and are living with HIV. Objective The aim of this qualitative study was to identify ways in which the COVID-19 pandemic has affected stimulant use and antiretroviral therapy (ART) adherence among a sample of MSM living with HIV. Methods Two focus groups were conducted in August 2020 via videoconferencing technology compliant with the Health Insurance Portability and Accountability Act. Potential participants from an established research participant registry at State University of New York Downstate Health Sciences University were invited and screened for study participation on the basis of inclusion criteria. A semistructured interview guide was followed. A general inductive approach was used to analyze the data. Findings in two general areas of interest, the impact of the COVID-19 pandemic on stimulant use and ART adherence, emerged directly from the raw data. Results A total of 12 ethnically diverse participants over the age of 25 years took part in the study. Results were heterogeneous in terms of the effects of the pandemic on both stimulant use and ART adherence among MSM living with HIV. Some men indicated increased or sustained stimulant use and ART adherence, and others reported decreased stimulant use and ART adherence. Reasons for these behavioral changes ranged from concerns about their own health and that of their loved ones to challenges brought about by the lack of daily structure during the lockdown phase of the pandemic and emotion regulation difficulties. Conclusions The COVID-19 pandemic has had a differential impact on stimulant use and ART medication adherence among MSM living with HIV. The reasons for behavioral change identified in this study may be salient intervention targets to support ART medication adherence and lower stimulant use among MSM in the aftermath of the of the COVID-19 pandemic, as well as beyond.
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Affiliation(s)
- Mariya Petrova
- Miller School of Medicine, University of Miami, 1120 N.W. 14th StreetOffice 1085, Miami, US
| | | | | | - Adam Carrico
- Miller School of Medicine, University of Miami, 1120 N.W. 14th StreetOffice 1085, Miami, US
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Xavier Hall CD, Morgan E, Bundy C, Foran JE, Janulis P, Newcomb ME, Mustanski B. Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV. AIDS Behav 2021; 25:3303-3315. [PMID: 33582890 DOI: 10.1007/s10461-021-03179-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n = 163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (< 40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.
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Affiliation(s)
- Casey D Xavier Hall
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Ethan Morgan
- Infectious Disease Institute, College of Nursing, Ohio State University, Columbus, OH, USA
| | - Camille Bundy
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - James E Foran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
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Park JW, Dobs AS, Ho KS, Palella FJ, Seaberg EC, Weiss RE, Detels R. Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2887-2896. [PMID: 34590217 PMCID: PMC8563532 DOI: 10.1007/s10508-021-02065-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 06/02/2023]
Abstract
We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998-2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p < .001). Associations among MSM without HIV were similar, with average marijuana use (r = .19) and stimulant use (r = .22) being positively correlated with average ED drug use, and were also correlated with having multiple partners (r = .36), insertive anal intercourse with condom (r = .22), and insertive anal intercourse without condom (r = .18) over time. Positive within-individual associations between ED drug use and multiple partners and insertive anal intercourse with and without condom were observed regardless of HIV serostatus. This study showed that MSM who reported use of ED drugs were also, on average, more likely to use recreational drugs and engage in sexual activities, such as having multiple partners and insertive anal intercourse. Within individuals, average ED drug use was also positively correlated with sexual behaviors.
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Affiliation(s)
- Jee Won Park
- Department of Epidemiology, 71-269 CHS, Fielding School of Public Health, University of California, Los Angeles, CA, 90095-1772, USA
| | - Adrian S Dobs
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ken S Ho
- Department of Medicine, University of Pittsburg, Pittsburgh, PA, USA
| | - Frank J Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Roger Detels
- Department of Epidemiology, 71-269 CHS, Fielding School of Public Health, University of California, Los Angeles, CA, 90095-1772, USA.
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12
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Nigro SE, Wu M, C Juliano A, Flynn B, Lu LH, Landay AL, French AL, Yang S. Effects of cocaine and HIV on decision-making abilities. J Neurovirol 2021; 27:422-433. [PMID: 33978905 PMCID: PMC8380473 DOI: 10.1007/s13365-021-00965-1] [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: 09/12/2020] [Revised: 01/24/2021] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
Our study aimed to understand the impact of cocaine dependence on high-risk decision-making abilities in individuals with the human immunodeficiency virus (HIV) and individuals with cocaine dependence. We recruited 99 participants (27 HIV/Cocaine, 20 HIV Only, 26 Cocaine Only, and 26 Healthy Controls). The Iowa Gambling Task (IGT) was applied to assess decision-making abilities. Independent and interactive effects of HIV status and cocaine dependence were examined using 2 × 2 factorial ANCOVA with premorbid IQ (WRAT-4: WR) as the covariate. We found cocaine dependence had a significant adverse effect on overall IGT performance (p = 0.015). We also found individuals who were HIV-positive tended to have less total money at the end of the game than individuals who were HIV-negative (p = 0.032), suggesting individuals living with HIV had less focus on long-term gains and more focus on short-term gains. Our findings highlight the significant impact of cocaine dependence on decision-making abilities and the difficulty individuals with HIV have in adequately weighing the cost and benefits of their decisions and making appropriate changes for the future.
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Affiliation(s)
- Sarah E Nigro
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Minjie Wu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony C Juliano
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Brendan Flynn
- Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa H Lu
- General Dynamics Information Technology, San Antonio, TX, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Audrey L French
- Department of Medicine, CORE Center, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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13
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Tan RKJ, O'Hara CA, Koh WL, Le D, Tan A, Tyler A, Tan C, Kwok C, Banerjee S, Wong ML. Delineating patterns of sexualized substance use and its association with sexual and mental health outcomes among young gay, bisexual and other men who have sex with men in Singapore: a latent class analysis. BMC Public Health 2021; 21:1026. [PMID: 34059021 PMCID: PMC8166008 DOI: 10.1186/s12889-021-11056-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young gay, bisexual, and other men who have sex with men (YMSM) are vulnerable to the risks associated with sexualized substance use. This is a novel study in Singapore that aims to classify patterns of sexualized substance use among YMSM, and investigate its association with sexual and mental health outcomes. METHODS In this cross-sectional study among 570 YMSM aged 18 to 25 years old, latent class analysis (LCA) conducted to identify classes with similar patterns of sexualized substance use, across which measures of inconsistent condom use, recent STI diagnoses, past suicide ideation and depression severity were compared. RESULTS LCA revealed three classes of YMSM based on types of substances ever used in sexualized contexts, which we labelled as 'substance-naive', 'substance-novice', and 'chemsex'. Substance-naive participants (n = 404) had only ever used alcohol, while substance-novice participants (n = 143) were primarily amyl nitrite users with a small proportion who reported using chemsex-related drugs. Chemsex participants (n = 23) comprised individuals who had mostly used such drugs. Those in the chemsex group were more likely to report recent unprotected anal sex with casual partners (aPR = 3.28, 95%CI [1.85, 5.79]), depression severity (aβ = 3.69, 95%CI [0.87, 6.51]) and a history of suicide ideation (aPR = 1.64, 95%CI [1.33, 2.03]). CONCLUSIONS Findings of this study highlight how the use of varying substances in sexualized contexts may be classified and characterized by different sexual and mental health outcomes. Health promotion efforts should be differentiated accordingly to address the risks associated with sexualized substance use among YMSM.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore.
| | - Caitlin Alsandria O'Hara
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Wee Ling Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
| | - Daniel Le
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Avin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Adrian Tyler
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Calvin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Chronos Kwok
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Sumita Banerjee
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
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14
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Storholm ED, Mutchler MG, Ghosh-Dastidar B, Balan E, Mokhbat J, Kegeles SM, Wagner GJ. Gearing up for PrEP in the Middle East and North Africa: An Initial Look at Willingness to Take PrEP among Young Men Who Have Sex with Men in Beirut, Lebanon. Behav Med 2021; 47:111-119. [PMID: 31851587 PMCID: PMC7299800 DOI: 10.1080/08964289.2019.1661822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/03/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.
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Affiliation(s)
| | - Matt G Mutchler
- Urban Community Research Center, California State University
| | | | - Elie Balan
- Arab Foundation for Freedom and Equality
| | - Jacques Mokhbat
- Department of Medicine, Lebanese American University School of Medicine
| | - Susan M Kegeles
- School of Medicine, Division of Prevention Science, University of California, San Francisco
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15
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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: 1.0] [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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16
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Tan RKJ, O'Hara CA, Koh WL, Le D, Tan A, Tyler A, Tan C, Kwok C, Banerjee S, Wong ML. Social capital and chemsex initiation in young gay, bisexual, and other men who have sex with men: the pink carpet Y cohort study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:18. [PMID: 33608005 PMCID: PMC7893730 DOI: 10.1186/s13011-021-00353-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
Background Young gay, bisexual, and other men who have sex with men (YMSM) are especially vulnerable to the risks associated with sexualized substance use, or ‘chemsex’. Engaging in chemsex established as a major risk factor for Human Immunodeficiency Virus (HIV) acquisition, and is thus a public health issue of increasing urgency. This paper attempts to explore the association between measures of social capital and patterns of sexualized substance use among a sample of YMSM in Singapore. Methods Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study in Singapore, comprising a sample of 570 HIV-negative YMSM aged 18 to 25 years old. Latent class analysis was employed to identify classes with similar patterns of sexualized substance use, and multinomial logistic regression was employed to examine associations between class membership and proxy measures of social capital, including age of sexual debut, bonding and bridging social capital, connectedness to the lesbian, gay, bisexual and transgender community, and outness. Results Latent class analysis revealed three classes of YMSM based on their histories of sexualized substance use, which we labelled as ‘alcohol’, ‘poppers’, and ‘chemsex’. Multivariable analyses revealed that participants who were older (aOR = 1.19, p = 0.002) and who identified as gay (aOR = 2.43, p = 0.002) were more likely to be in the poppers class compared to the alcohol class. Participants with a later age of sexual debut were increasingly less likely to be in the poppers (aOR = 0.93, p = 0.039) and chemsex classes (aOR = 0.85, p = 0.018), compared to the alcohol class. Conclusions Varying measures of social capital such as an earlier age of exposure to sexual networks may predispose YMSM to greater opportunities for sexualized substance use. Future interventions should target YMSM who become sexually active at an earlier age to reduce the risks associated with sexualized substance use.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore.
| | - Caitlin Alsandria O'Hara
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Wee Ling Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
| | - Daniel Le
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Avin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Adrian Tyler
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Calvin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Chronos Kwok
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Sumita Banerjee
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
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17
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Glick SN, Klein KS, Tinsley J, Golden MR. Increasing Heroin-Methamphetamine (Goofball) Use and Related Morbidity Among Seattle Area People Who Inject Drugs. Am J Addict 2020; 30:183-191. [PMID: 33301230 DOI: 10.1111/ajad.13115] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Methamphetamine use is increasing in the United States, potentially including the simultaneous injection of methamphetamine with heroin (goofball). We compared demographic, behavioral, contextual, and health factors among people who inject drugs (PWID) in the Seattle area and who reported that their main drug was goofball, heroin, or methamphetamine. METHODS We used data from 2017 and 2019 cross-sectional surveys of clients at Public Health-Seattle & King County's syringe services program (N = 792). RESULTS Among PWID participants, 55.3% reported using goofball in the last 3 months, and the proportion reporting goofball as their main drug doubled between 2017 (10.3%) and 2019 (20.1%, P < .001). The goofball group had the highest proportions of people who were aged less than 30, women, homeless or unstably housed, and recently incarcerated. PWID whose main drug was goofball reported considerable health risks and morbidity. Witnessing an opioid overdose was most commonly reported by participants whose main drug was goofball. This group also reported naloxone possession and use in an overdose situation more than other participants. The majority of participants were interested in reducing or stopping their opioid and stimulant use. DISCUSSION AND CONCLUSIONS Among PWID, using goofball as a main drug doubled over 2 years and was characterized by contextual and individual factors that increase the risk of morbidity and mortality. SCIENTIFIC SIGNIFICANCE This is the first study to characterize goofball use as a main drug. Clinical and public health efforts to diminish morbidity associated with opioid use need to integrate interventions that address the co-use of methamphetamine. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Sara N Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington.,Public Health-Seattle & King County, HIV/STD Program, Seattle, Washington
| | - Kathryn S Klein
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Joe Tinsley
- Public Health-Seattle & King County, HIV/STD Program, Seattle, Washington
| | - Matthew R Golden
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington.,Public Health-Seattle & King County, HIV/STD Program, Seattle, Washington
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18
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Passaro RC, Chávez-Gomez S, Castañeda-Huaripata A, Gonzales-Saavedra W, Beymer MR, Segura ER, Nanclares F, Dilley J, Cabello R, Clark JL. Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial. AIDS Behav 2020; 24:3205-3214. [PMID: 32418164 DOI: 10.1007/s10461-020-02882-6] [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: 10/24/2022]
Abstract
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
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19
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Philbin MM, Greene ER, Martins SS, LaBossier NJ, Mauro PM. Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender. Am J Prev Med 2020; 59:686-696. [PMID: 32981768 PMCID: PMC7577928 DOI: 10.1016/j.amepre.2020.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations. METHODS Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only. RESULTS Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use. CONCLUSIONS Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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20
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The Healthy Young Men's Cohort: Health, Stress, and Risk Profile of Black and Latino Young Men Who Have Sex with Men (YMSM). J Urban Health 2020; 97:653-667. [PMID: 32864727 PMCID: PMC7560671 DOI: 10.1007/s11524-019-00398-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Young men who have sex with men (YMSM), especially YMSM of color, are at increased risk for a wide range of threats to their health and well-being. In this study, we recruited and surveyed an urban sample of 448 young African American/Black (Black), Hispanic/Latino (Latino), and multi-racial/ethnic YMSM, ages 16-24 years (mean = 22.3 years), about stressful life events, their health and mental health, their access to and utilization of care, and their involvement in risk-related behaviors. We found that the majority reported experiences of racism (87%) and homophobia (76%). A high percentage reported food insecurity/hunger (36%), residential instability (15%), financial hardship (63%), and conflict with family/friends (62%). The prevalence of risk behaviors was also high, including recent use of tobacco (46%), alcohol (88%), and marijuana (72%), and 41% tested positive for 1+ drugs. Furthermore, 26% tested positive for 1+ sexually transmitted infections (STIs). Over half (56%) reported being worried about their health, 33% reported having a chronic health condition and 31% a mental health condition, and 45% had wanted/needed mental health services during the past year. Further, 17% reported suicidal ideation/had planned a suicide attempt and 26% had ever engaged in self-injurious behaviors. Significant differences by race/ethnicity and HIV status included residential status/food insecurity, type of racism/homophobia, drug use, and STIs. These findings demonstrate how vulnerable this population is with respect to a wide range of structural and social determinants of health that may be important drivers of behavioral, health, mental health outcomes, and potentially long-term health disparities.
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21
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Binge Drinking, Non-injection Drug Use, and Sexual Risk Behaviors among Adolescent Sexual Minority Males, 3 US Cities, 2015. J Urban Health 2020; 97:739-748. [PMID: 32918154 PMCID: PMC7560636 DOI: 10.1007/s11524-020-00479-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
In 2016, more than 90% of HIV diagnoses among young men aged 13-19 years were attributed to male-male sexual contact. Little is known about how binge drinking and non-injection drug use may be associated with risky sexual behavior among adolescent sexual minority males (ASMM). Using data from the National HIV Behavioral Surveillance, we examined how binge drinking and non-injection drug use may be associated with sexual risk among ASMM. ASMM were recruited for interviews in 3 cities: Chicago, New York City, and Philadelphia. Among 16-18-year-olds (N = 488), we evaluated the association between binge drinking (≥ 5 drinks in one sitting in the past 30 days), non-injection drug use (past 12-month use of methamphetamines, powder cocaine, downers, painkillers, ecstasy, poppers, and "other"), and two past 12-month sexual risk outcomes: condomless anal intercourse with a casual partner and having multiple sex partners. We used log-linked Poisson regression models with robust standard errors to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Overall, 26% of 16-18-year-old ASMM binge drank, and 21% reported non-injection drug use. Among ASMM who binge drank, 34% reported condomless anal intercourse with a casual partner compared with 22% of those who did not (PR: 1.53, 95% CI: 1.04-2.26). Similarly, 84% of ASMM who binge drank reported having multiple partners compared with 61% of those who did not (PR: 1.38, 95% CI: 1.09-1.76). Among ASMM who used non-injection drugs, 37% reported condomless anal intercourse compared with 22% of those who did not (PR: 1.70, 95% CI 1.09-2.50), while 86% of those who used non-injection drugs had multiple partners compared with 62% of those who did not (PR: 1.40, 95% CI: 1.06-1.80). Our findings suggest that the prevalence of substance misuse is high among sexual minority youth and is associated with sexual risk in this population. Our findings highlight the need for high-quality HIV prevention programs for ASMM especially as HIV prevention programs for this population are scarce.
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Kumar P, Aridoss S, Mathiyazhakan M, Balasubramanian G, Jaganathasamy N, Natesan M, V.M. P, David JK, Rajan S, Adhikary R, Arumugam E. Substance use and risk of HIV infection among Men who have Sex with Men in India: Analysis of National IBBS data, India. Medicine (Baltimore) 2020; 99:e21360. [PMID: 32871863 PMCID: PMC7458168 DOI: 10.1097/md.0000000000021360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
HIV prevalence is higher among Men who have Sex with Men (MSM), owing to their unsafe sexual behavior. Further, MSM indulge in behaviors such as consumption of alcohol/oral drugs and/or injecting during/before sex that poses the risk of unsafe behaviors, thereby increasing their vulnerability to HIV. The study aims to analyze the factors associated with HIV infection among the multi-risk MSM using any substances with those MSM who do not use substances.Community-based cross-sectional survey design using probability-based sampling between October 2014 and November 2015.For the nation-wide Integrated Biological and Behavioral Surveillance (IBBS), 23,081 MSM were recruited from 4067 hotspots in 108 districts across India. Information on demographics, sexual behaviors, substance use, sexual partners, and awareness on HIV and its management was collected from the consented respondents using computer-assisted personal interview (CAPI) by trained personnel. Blood samples were tested for HIV. Statistical analyses were done, to study the associations between substance use and its influence on high-risk sexual behaviors and HIV infection.One in 3 MSM (33.88%) in India were substance users, thus exhibiting "multi-risk" (MR) behaviors. Significantly higher HIV prevalence (3.8%, P < .05) was reported among MR-MSM, despite 97.2% of them being aware of HIV. Higher HIV prevalence among MSM exhibiting homosexual behavior for ≤1 year is of specific concern, as this accounts to recent infections and indicates the increased vulnerability of the infection among the new entrants.Substance-use resulting in high-risk sexual behavior was significantly associated with higher HIV prevalence among MR-MSM. Integrated targeted interventions focusing on safe sex and safe-IDU practices among MR-MSM are required to end the disease transmission.
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Affiliation(s)
- Pradeep Kumar
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi
| | - Santhakumar Aridoss
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
| | | | - Nagaraj Jaganathasamy
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
| | - Manikandan Natesan
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
| | - Padmapriya V.M.
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
| | - Joseph K. David
- Procrea Fertility Centre, 955 Major Mackenzie Drive West, Vaughan, Ontario, Canada
| | - Shobini Rajan
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi
| | | | - Elangovan Arumugam
- ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India
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Le A, Yockey A, Palamar JJ. Use of "Poppers" among Adults in the United States, 2015-2017. J Psychoactive Drugs 2020; 52:433-439. [PMID: 32669067 DOI: 10.1080/02791072.2020.1791373] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We sought to estimate the prevalence as well as demographic and drug use-related correlates of poppers use among adults in the United States. Data were analyzed from adult participants (ages 18-64) in the 2015-2017 National Survey on Drug Use and Health (N = 115,744), a nationally representative survey of non-institutionalized adults in the US. An estimated 3.3% of adults have ever used poppers. Over a third (35.1%) of gay men are estimated as having ever used poppers. Estimates were lower for heterosexual (3.7%) and bisexual males (11.3%), and for heterosexual (1.8%), bisexual (4.8%), and lesbian women (6.3%). In the multivariable model, compared to male heterosexuals, gay men were at increased odds for reporting lifetime popper use (aOR = 24.64, p<.001), and bisexual men (aOR = 3.55, p <.001), lesbian women (aOR = 1.86, p =.010), and bisexual women (aOR = 1.33, p =.049) were at increased odds for lifetime use. Having a college degree was associated with increased odds for use, and lifetime use of marijuana, ecstasy/MDMA/Molly, cocaine, LSD, methamphetamine, tranquilizers, and/or opioids were associated with higher odds for use. Gay men in particular are at high risk for use. Results can help inform prevention efforts, particularly in sexual minority populations.
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Affiliation(s)
- Austin Le
- Department of Population Health, New York University Grossman School of Medicine , New York, NY, USA.,College of Dentistry, New York University , New York, NY, USA
| | - Andrew Yockey
- School of Human Services, University of Cincinnati , Cincinnati, OH, USA
| | - Joseph J Palamar
- Department of Population Health, New York University Grossman School of Medicine , New York, NY, USA
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Vaccher SJ, Hammoud MA, Bourne A, Lea T, Haire BG, Holt M, Saxton P, Mackie B, Badge J, Jin F, Maher L, Prestage G. Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102659. [PMID: 31927224 DOI: 10.1016/j.drugpo.2019.102659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. METHODS Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. RESULTS Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them. CONCLUSIONS Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
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Affiliation(s)
- Stefanie J Vaccher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Toby Lea
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Konrad-Adenauer-Ufer 79-81, 50668 Cologne, Germany; Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Bridget G Haire
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Brent Mackie
- ACON, 414 Elizabeth St, Surry Hills, NSW 2010, Australia.
| | - Joshua Badge
- School of Humanities and Social Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
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Abstract
PURPOSE OF REVIEW This paper reports on the results of a study comparing two behavioral treatments for methamphetamine users. The outcome was the effectiveness of the interventions in reducing meth use. The interventions were contingency management (CM) and contingency management plus strengths-based case management (CM/SBCM). RECENT FINDINGS CM/SBCM was found to be associated with attending more sessions for people who reported being in a couple. Also, participants who earned more money in the first part of the study were more likely to have more clean urinalysis in the second part of the study. Latent class analysis identified a class of participants who were in a couple, without sexual abuse history, and less meth use at baseline. This class tended to have more clean urinalysis in the CM/SBCM intervention. These results indicate that incentive-based interventions with case management may be useful for helping meth users reduce their drug use.
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Teran RA, Carrico AW, Horvath KJ, Downing MJ, Chiasson MA, Walters SM, Hirshfield S. Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:195-209. [PMID: 31630286 PMCID: PMC7018572 DOI: 10.1007/s10508-019-01515-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 05/05/2023]
Abstract
Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.
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Affiliation(s)
- Richard A Teran
- Department of Epidemiology, Columbia University Irving Medical Center, 722 West 168th Street, 7th Floor, New York, NY, 10032, USA.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Martin J Downing
- Department of Psychology, School of Natural and Social Sciences, Lehman College, Bronx, NY, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Irving Medical Center, 722 West 168th Street, 7th Floor, New York, NY, 10032, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Sabina Hirshfield
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Storholm ED, Huang W, Siconolfi DE, Pollack LM, Carrico AW, Vincent W, Rebchook GM, Huebner DM, Wagner GJ, Kegeles SM. Sources of Resilience as Mediators of the Effect of Minority Stress on Stimulant Use and Sexual Risk Behavior Among Young Black Men who have Sex with Men. AIDS Behav 2019; 23:3384-3395. [PMID: 31273490 PMCID: PMC6919270 DOI: 10.1007/s10461-019-02572-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The greatest proportion of new HIV infections among men who have sex with men (MSM) is occurring among young Black MSM (YBMSM) ages 13-24. Consequently, research is needed to understand the psychosocial pathways that influence HIV risk and resilience in YBMSM. Minority Stress Theory proposes that the stigma, prejudice, and discrimination facing sexual and racial minorities are chronic stressors that lead to increased engagement in risk behaviors. The present study examined whether minority stress is associated with stimulant use and sexual risk behaviors by depleting psychosocial resilience. We recruited 1817 YBMSM, ages 18-29, from multiple venues in two major cities in Texas for participation in a brief survey. Results from structural equation modeling indicated that decreased resilience partially mediated the association of minority stress with sexual risk behavior. Resilience was also negatively associated with stimulant use. Interventions focused on cultivating psychosocial resilience could mitigate the deleterious consequences of minority stress and reduce stimulant use in YBMSM.
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Affiliation(s)
- Erik D Storholm
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA.
| | - Wenjing Huang
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Daniel E Siconolfi
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | | | - Wilson Vincent
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | - Gregory M Rebchook
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | - David M Huebner
- School of Public Health, George Washington University, Washington, DC, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
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Noroozi M, Noroozi A, Sharifi H, Harouni GG, Marshall BDL, Ghisvand H, Qorbani M, Armoon B. Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran. Int J Behav Med 2019; 26:50-58. [PMID: 30460445 DOI: 10.1007/s12529-018-9758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many studies have found significant differences in HIV risk at the community and socioeconomic levels. However, few have considered variations in needle and syringe program (Jin et al., Oral Dis. 1;22(7):609-19) coverage and other community characteristics on HIV risk behaviors among people who inject drugs (PWIDs). Our objective was to study the relationship between individual factors and city-level characteristics (such as the city's coverage of harm reduction programs) on HIV risk behavior among PWID residing in two cities in Iran. METHODS The study was conducted from March to August 2016 in Tehran and Kermanshah provinces. One thousand PWID were recruited by a convenience sampling recruitment at local NSP Drop-in Centers (DIC) and through "snowball sampling" (i.e., using peers to refer participants to the study). We first examined associations between individual-level variables and HIV risk behaviors in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Next, multi-level models were constructed to determine the amount of variability in HIV risk behavior that could be accounted for by individual- and community-level characteristics. Variables with p value < 0.2 were included in the multiple logistic regression model. RESULTS The results of the multilevel modeling showed that 32% of the variability in HIV risk behaviors among PWID could be explained by factors that differed between the two cities. When individual factors including higher HIV knowledge, access to NSP, higher HIV risk perception, and methamphetamine use were all included in the final model, 22% of the variability in HIV risk behaviors could be explained to city-level variables. CONCLUSION Findings suggest that expanding the accessibility (i.e., hours and venues) and community-level coverage of NSP services by establishing programs where PWID congregate might reduce HIV risk behavior among PWID.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Hesam Ghisvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran. .,, Tehran-Saveh freeway, Kaveh Industrial Estate company, Saveh, 3914334911, Iran.
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29
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Taggart TC, Rodriguez-Seijas C, Dyar C, Elliott JC, Thompson RG, Hasin DS, Eaton NR. Sexual orientation and sex-related substance use: The unexplored role of bisexuality. Behav Res Ther 2019; 115:55-63. [PMID: 30594299 PMCID: PMC6409130 DOI: 10.1016/j.brat.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023]
Abstract
Using alcohol and drugs in sexual contexts is associated with negative health consequences, including increased risk for HIV/STIs, sexual victimization, unplanned pregnancies, and overdose. Evidence suggests millions of adults regularly use alcohol in sexual contexts, thus increasing their risk for these consequences. However, no nationally representative estimates exist for rates of regular alcohol and/or drug use in sexual contexts. Additionally, previous studies suggest sexual minority individuals are more likely to use substances in sexual contexts than heterosexuals; however, none of these studies examined for multiple dimensions or subgroups of sexual orientation. Thus, using two distinct datasets-one large, nationally representative sample (N = 17,491) and an Internet-collected convenience sample (N = 1001)-we explored the associations between sexual orientation (dimensions and subgroups) and rates of regular sex-related alcohol and/or drug use in American adults. Results showed that sexual minority individuals were significantly more likely to report regularly using substances in sexual contexts compared to heterosexuals; however, results varied based on dimension of sexual orientation and by sex. Across both samples, bisexual individuals exhibited the highest rates of regular sex-related substance use. Findings suggest that sexual minorities, and bisexual individuals in particular, may be at increased risk for regular sex-related substance use and its associated negative health consequences. Future research should include nuanced and multidimensional assessments of sexual orientation to investigate sex-related alcohol and/or drug use and its associated risks, as well as examine the potential direct and indirect pathways by which these disparities may be conferred.
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Affiliation(s)
- Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | | | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Well-being, Northwestern University, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention. J Am Acad Dermatol 2019; 80:591-602. [PMID: 30744875 PMCID: PMC6375301 DOI: 10.1016/j.jaad.2018.02.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Brian A Ginsberg
- Department of Dermatology, Mount Sinai Hospital, New York, New York
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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Currin JM, Hubach RD, Croff JM. Sex, drugs, & rurality: A brief qualitative analysis of rural gay and bisexual men’s substance use sex expectancies. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1581284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joseph M. Currin
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Julie M. Croff
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Parent MC, Arriaga AS, Gobble T, Wille L. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress 2019; 10:100146. [PMID: 30937352 PMCID: PMC6430403 DOI: 10.1016/j.ynstr.2018.100146] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/23/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.
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Affiliation(s)
- Mike C. Parent
- University of Texas at Austin, Department of Educational Psychology, Sanchez 262H, Austin, TX, 78749, USA
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Pepper N, Zúñiga ML, Reed MB. Prevalence and correlates of "popper" (amyl nitrite inhalant) use among HIV-positive Latinos living in the U.S.-Mexico border region. J Ethn Subst Abuse 2019; 19:435-452. [PMID: 30614780 DOI: 10.1080/15332640.2018.1540955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Poppers (nitrite inhalants) are legal, commonly used by men who have sex with men, and associated with HIV acquisition, yet research is lacking on popper use and associated adverse outcomes. People living with HIV (PLWH) in the U.S.-Mexico border region lead binational lives, including accessing care and having sex and drug use partners on both sides of the border, with broad personal and public health implications. Understanding popper use provides crucial information to guide policy and develop targeted interventions for binational PLWH. We examine prevalence and correlates of popper use among HIV-positive Latinos in the border region, an underserved population at risk for poor health outcomes. This cross-sectional study recruited a convenience sample from agencies in San Diego and Tijuana to complete quantitative surveys. Participants (N = 121) were primarily male (82.6%) and gay/bisexual (62%). Lifetime substance use (excluding cannabis) was reported by 72% of participants, and 25.6% reported lifetime popper use. Individuals recruited in the U.S. were significantly more likely to report use of poppers than were participants recruited in Mexico. Our regression model found that identifying as gay/bisexual and having bought, sold, or traded sex for money, drugs, or other goods were independently associated with popper use. Findings shed light on the profile of individuals who use poppers and lay the foundation for further research to understand the context of popper use as it relates to high-risk behavior among PLWH in this region of high transborder mobility. Binational collaborative approaches are needed to improve regional HIV care outcomes and reduce transmission risk.
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Affiliation(s)
- Nicole Pepper
- School of Social Work, San Diego State University, San Diego, California
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California
| | - Mark B Reed
- School of Social Work, San Diego State University, San Diego, California
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Anderson-Carpenter KD, Fletcher JB, Swendeman D, Reback CJ. Associations between sociodemographic characteristics and substance use disorder severity among methamphetamine-using men who have sex with men. Subst Use Misuse 2019; 54:1763-1773. [PMID: 31075997 PMCID: PMC6644069 DOI: 10.1080/10826084.2019.1610445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Men who have sex with men (MSM) have elevated rates of substance use disorders (SUDs) and differences across sociodemographic sub-groups of MSM are associated with a greater risk of deleterious outcomes. Although studies have shown that MSM report greater rates of polysubstance use relative to other adult populations, the associations between sociodemographic characteristics and both acute substance use and substance use severity among methamphetamine-using MSM are unknown. Objectives: The present study examines associations between sociodemographic characteristics and (a) recent substance use and (b) SUD severity. Method: From March 2014 to January 2016, 286 methamphetamine-using MSM were recruited to complete a baseline Audio Computer-Assisted Self-Interview (ACASI) assessment and the SCID MINI. Multivariable analyses employed generalized structural equation modeling given the non-continuous nature of the endogenous variables. Results: All measured sociodemographic characteristics except gay self-identification were significantly associated with recent substance use (all ps ≤ .05), and all characteristics except current homelessness were significantly associated with diagnostic SUD severity (all ps ≤ .05). However, nuanced risks were observed in participants' use of specific substances regarding recent substance use and substance use severity. Conclusion: These results suggest that multiple factors contribute to the risks of SUD severity among methamphetamine-using MSM. As such, these results are useful in the tailoring of clinical and psychosocial intervention strategies that serve this and other high-risk populations.
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Affiliation(s)
- Kaston D Anderson-Carpenter
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,b Department of Psychology , Michigan State University , East Lansing , MI , USA
| | | | - Dallas Swendeman
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,d Development Core, Center for HIV Identification, Prevention, and Treatment Services, University of California , Los Angeles , CA , USA
| | - Cathy J Reback
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,c Friends Research Institute, Inc ., Los Angeles , CA , USA.,e Center for HIV Identification, Prevention and Treatment Services, University of California , Los Angeles , CA , USA
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Poppers and PrEP: Use of Pre-exposure Prophylaxis Among Men Who Have Sex with Men Who Use Inhaled Nitrites. AIDS Behav 2018; 22:3658-3672. [PMID: 29744767 DOI: 10.1007/s10461-018-2139-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Men who have sex with men (MSM) commonly use inhaled nitrites, or poppers, though their use is a risk factor HIV seroconversion. Pre-exposure prophylaxis, or PrEP, is effective for HIV prevention, but is not widely used, and little is known regarding PrEP use and acceptability among MSM who use inhaled nitrites. We surveyed 580 MSM in Paris, France in 2016 about popper use, sexual behaviors including condomless anal intercourse (CAI), serosorting, and sexual positioning, PrEP use, PrEP candidacy, and interest in alternate PrEP delivery modalities. We included 444 HIV negative participants for the current study. 46.2% reported popper use in the prior 3 months. Using multivariate adjusted logistic regression, we found that popper users were more likely than non-users to consider themselves candidates for PrEP [adjusted relative risk ratio (aRRR) = 2.73; 95% CI 1.54-4.83], but they were not more likely to be current (aRRR = 1.54; 95% CI 0.71-3.33) or past (aRRR = 1.37; 95% CI 0.44-4.28) PrEP users. Mediation analyses indicated that increased CAI and serosorting partly explained the relationship between popper use and PrEP candidacy. There was considerable interest in alternate proposed PrEP delivery modalities, particularly long-acting injectable PrEP [adjusted risk ratio (aRR) = 1.43; 95% CI 1.15-1.79].
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Wilkerson JM, Noor SW, Rhoton JM, Li D, Rosser BRS. Differentially classified methamphetamine-using men who have sex with men: A latent class analysis. Drug Alcohol Depend 2018; 192:129-136. [PMID: 30248559 PMCID: PMC6746229 DOI: 10.1016/j.drugalcdep.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 12/19/2022]
Abstract
CONTEXT Substance use interventions for methamphetamine-using men who have sex with men (MSM) are limited by the assumption that they are a uniform group. We hypothesized that an LCA would identify distinct patterns of substance use and demographic and psychosocial variables associated with different substance-using groups would aid in understanding distinctions. Using cross-sectional data from 343 methamphetamine-using MSM, we conducted an LCA to model the patterns of polysubstance use then examined how the classes varied on psychosocial variables defined by the Information-Motivation-Behavioral Skills (IMB) model. FINDINGS Because we were interested in identifying patterns of polysubstance use (PSU) among our sample, we identified four classes: minimal PSU, marijuana PSU, cocaine/hallucinogens PSU, and designer drugs/heroin PSU. Men in the marijuana PSU class were less likely to have positive attitudes towards methamphetamine than participants in the other three classes. Men in the Cocaine and Hallucinogens PSU class were more likely to have higher PANAS scores (OR = 13.00 [3.25, 52.07]) compared to the other classes, and they were more likely to have higher self-efficacy to enact safer substance use strategies (OR = 10.72 [3.23, 35.47]). MSM in the Designer Drug and Heroin PSU class were more likely to have a diagnosis of Hepatitis B (OR = 4.07 [0.86, 19.36] despite having higher knowledge of sexual health practices (OR = 0.55 [0.36, 0.84]. CONCLUSIONS Differential classification for methamphetamine-using MSM suggests an opportunity for tailored interventions and secondary prevention programs. By understanding how men vary on illicit substance use, interventionists can routinely screen and link men before they potentially progress to another classification.
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Affiliation(s)
- J. Michael Wilkerson
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 7000 Fannin St #1200, Houston, TX, 77030, USA
| | - Syed W. Noor
- Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada
| | - Jayson M. Rhoton
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 7000 Fannin St #1200, Houston, TX, 77030, USA
| | - Dennis Li
- Northwestern University, 633 Clark St., Evanston, IL, 60208, USA
| | - B. R. Simon Rosser
- University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN 55455, USA
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Rowell-Cunsolo TL, Long Y, Szeto B, Mkuu R, El-Bassel N. Examining factors associated with unprotected sexual behavior among Black Americans postrelease from incarceration in New York City. JOURNAL OF OFFENDER REHABILITATION 2018; 57:330-342. [PMID: 31649474 PMCID: PMC6812487 DOI: 10.1080/10509674.2018.1487899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 07/05/2017] [Accepted: 12/27/2017] [Indexed: 06/10/2023]
Abstract
Black Americans are overrepresented among incarcerated individuals and those infected with sexually transmitted infections. We assessed unprotected sexual behavior among 165 formerly incarcerated Black Americans in New York City, New York. Most participants (63%) reported engaging in unprotected sexual behavior post-incarceration. According to our regression results, less time spent in jail and reporting multiple sexual partnerships were associated with a greater likelihood of engaging in unprotected sexual behavior. High rates of unprotected sexual behavior may place formerly incarcerated Black Americans at risk for sexually transmitted infections. Discharge planning programs that include STI/HIV prevention information and education may be useful for this population.
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Affiliation(s)
- Tawandra L. Rowell-Cunsolo
- corresponding author Tawandra L. Rowell-Cunsolo
PhD, Assistant Professor of Social Welfare Science, Columbia University, School
of Nursing, 617 West 168th Street, New York, NY 10032, 212-305-8611 (Phone),
212-543-6003 (Fax),
| | - Yue Long
- Columbia University, Quantitative Methods in the Social Sciences,
New York, NY
| | - Betsy Szeto
- Columbia University, College of Physicians & Surgeons, New
York, NY
| | - Rahma Mkuu
- Texas A & M University, College Station, TX
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Nerlander LMC, Hoots BE, Bradley H, Broz D, Thorson A, Paz-Bailey G. HIV infection among MSM who inject methamphetamine in 8 US cities. Drug Alcohol Depend 2018; 190:216-223. [PMID: 30055426 DOI: 10.1016/j.drugalcdep.2018.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Men who have sex with men (MSM) and inject drugs are at risk for HIV infection. Although research exists on non-injection methamphetamine (meth) use and sexual risk among MSM, less is known about meth injection and its association with HIV infection among MSM who inject drugs. METHODS We analyzed data from men aged ≥18 years who reported injecting drugs and male-to-male sexual contact. Men were recruited using respondent-driven sampling, interviewed, and tested for HIV during the 2012 and 2015 cycles of National HIV Behavioral Surveillance among persons who inject drugs. We included data from 8 cities where ≥10 MSM reported meth as the primary drug injected. We assessed differences in demographic characteristics, past 12 months risk behaviors, and HIV infection between MSM who primarily injected meth and those who primarily injected another drug. RESULTS Among 961 MSM, 33.7% reported meth as the drug they injected most often. Compared to MSM who primarily injected other drugs, MSM who primarily injected meth were more likely to have had ≥5 condomless anal sex partners, have been diagnosed with syphilis, and were less likely to report sharing syringes. In multivariable analysis, injecting meth was associated with being HIV-positive (adjusted prevalence ratio 1.48; 95% confidence interval 1.08-2.03). Including number of condomless anal sex partners in mediation analysis rendered this association no longer significant. CONCLUSIONS HIV prevalence among MSM who primarily injected meth was almost 50% higher than among MSM who primarily injected other drugs, and this association was mediated by sexual risk.
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Affiliation(s)
- Lina M C Nerlander
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA; Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Brooke E Hoots
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Heather Bradley
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Dita Broz
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Anna Thorson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Gabriela Paz-Bailey
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
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Luo W, Hong H, Wang X, McGoogan JM, Rou K, Wu Z. Synthetic drug use and HIV infection among men who have sex with men in China: A sixteen-city, cross-sectional survey. PLoS One 2018; 13:e0200816. [PMID: 30063747 PMCID: PMC6067707 DOI: 10.1371/journal.pone.0200816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/03/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Increasing evidence suggests an association between synthetic drug use and HIV infection among men who have sex with men (MSM). The aim of this study was to evaluate synthetic drug use prevalence, describe characteristics of synthetic drug users, and investigate whether synthetic drug use is associated with HIV infection among Chinese MSM. Methods A cross-sectional survey was conducted in 16 Chinese cities among males >18 years old who reported having had sex with men in the prior 3 months, but did not already have a known HIV-positive serostatus. Participants were grouped according to lifetime synthetic drug use and characteristics were compared using Chi-square test. Determinants of HIV infection were assessed using univariate and multivariate regression. Results Among 3,135 participants, 1,249 reported lifetime synthetic drug use, for a prevalence of 39.8%. Nearly all users (96.3%) reported using inhaled alkyl nitrites (“poppers”). Synthetic drug users were more likely to be younger (<30 years, p<0.001), single (p<0.001), and more educated (p<0.001), and were more likely to engage in higher risk sexual behavior compared to non-drug users. Overall HIV prevalence was 7.8% (246/3,135). However, prevalence among synthetic drug users was 10.6% (132/246) compared to 6.0% (114/246) for non-drug users (p<0.001). Factors associated with an increased odds of HIV infection included inconsistent condom use with male partners (adjusted odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.64–2.91) and synthetic drug use (adjusted OR = 2.04, CI = 1.56–2.70). Conclusion Prevalence of synthetic drug use, especially poppers use, prevalence was high in our study, and users had 2-fold greater odds of HIV acquisition. It is clear that there is an urgent need for increased prevention, testing, and treatment interventions for this key, dual-risk population in China. Moreover, we call on the Chinese Government to consider regulating poppers so that users can be properly warned about their associated risks.
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Affiliation(s)
- Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Hang Hong
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xiaofang Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Jennifer M. McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- * E-mail: ,
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Brooks RA, Nieto O, Landrian A, Donohoe TJ. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care 2018; 31:427-435. [PMID: 30021456 DOI: 10.1080/09540121.2018.1499864] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Centers for Disease Control and Prevention (CDC) estimates the lifetime HIV risk is one in four for Latino men who have sex with men (MSM). Pre-Exposure Prophylaxis (PrEP) is an efficacious biomedical prevention strategy to help prevent the acquisition of HIV. At present, there has been limited uptake of PrEP by Latino MSM. Unfortunately, the negative perceptions and social stigma surrounding PrEP and those who use it may deter uptake of this novel prevention strategy, particularly among high-risk Latino MSM. In this qualitative study, we explore the experiences of using PrEP among Latino MSM. Participants were recruited using gay-oriented social and sexual networking apps to complete an interviewer-administered, semi-structured qualitative interview. Thematic analysis was used to identify emerging themes relating to perceptions of PrEP users and PrEP as an HIV prevention strategy. Major themes included: feelings of protection and sexual freedom; negative and stigmatizing labels associated with PrEP use; assumptions about sexual behaviors and perceptions of sexual risk taking and irresponsibility; and attitudes related to PrEP use in relationships. A striking but not prevalent theme was the perception reported by participants that monolingual Spanish-speaking Latino MSM are skeptical about the effectiveness of PrEP. These findings suggest that efforts are needed to address the stigmatizing and negative perceptions of PrEP that persist in the gay community that may deter adoption among Latino MSM.
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Affiliation(s)
- Ronald A Brooks
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
| | - Omar Nieto
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
| | - Amanda Landrian
- a Department of Family Medicine , University of California , Los Angeles , CA , USA.,b Department of Community Health Sciences , Fielding School of Public Health, University of California , Los Angeles , CA , USA
| | - Thomas J Donohoe
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
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Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, Desai M. Sexualised drug use in the United Kingdom (UK): A review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:131-148. [PMID: 29625796 DOI: 10.1016/j.drugpo.2018.02.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sexualised drug use (SDU) refers to the use of drugs in a sexual context. This includes 'Chemsex'- the use of drugs (specifically crystal methamphetamine, GHB/GBL and mephedrone) before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience. Here we aimed to synthesise available UK prevalence data for Chemsex, SDU and the use of Chemsex drugs in an undefined context (CDU) in men who have sex with men (MSM). METHODS Papers published between January 2007 and August 2017 reporting Chemsex, SDU and/or Chemsex drug use (CDU) prevalence in MSM were identified through PubMed. Citations were searched for further eligible publications. We also conducted a review of national surveillance data, extracting prevalence data for Chemsex, SDU or CDU. Synthesized data were then assessed to determine the time at which these drugs were taken, in this case just prior to or during sexual activity (event-level). RESULTS Our search identified 136 publications, of which 28 were included in the final data synthesis. Three of the four surveillance systems assessed provided SDU or CDU data in MSM. Few publications included event-level data for Chemsex (n = 4), with prevalence estimates ranging from 17% among MSM attending sexual health clinics (SHC) to 31% in HIV-positive MSM inpatients. Prevalence estimates for SDU (n = 7 publications) also varied considerably between 4% in MSM receiving HIV care to 41% among MSM attending SHC for HIV post-exposure prophylaxis (PEP). Eighteen publications provided data for CDU. CONCLUSION Prevalence estimates varied considerably due to differences in the definition used and population assessed. Standardised definitions and studies with representative national samples of MSM are required to improve our understanding of the extent of Chemsex and its associated risks. Longitudinal event-level data for SDU and Chemsex are needed to monitor impact of interventions.
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Affiliation(s)
- Claire Edmundson
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Ellen Heinsbroek
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Rachel Glass
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Vivian Hope
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Public Health Institute, Liverpool John Moores University, 2nd Floor Henry Cotton Campus, 15-21 Webster Street, Liverpool L3 2ET, United Kingdom
| | - Hamish Mohammed
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Martin White
- Alcohol, Drugs and Tobacco, Health Improvement, Public Health England, Skipton House, 80 London Road, London SE1 6LH, United Kingdom
| | - Monica Desai
- National Institute for Health and Care Excellence, Level 1A, City Tower, Picadilly Plaza, Manchester M1 4BT, United Kingdom
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Swartz JA, McCarty-Caplan D. A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM. AIDS Behav 2018; 22:1395-1409. [PMID: 29248970 DOI: 10.1007/s10461-017-2008-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.
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Saw YM, Saw TN, Chan N, Cho SM, Jimba M. Gender-specific differences in high-risk sexual behaviors among methamphetamine users in Myanmar-China border city, Muse, Myanmar: who is at risk? BMC Public Health 2018; 18:209. [PMID: 29390989 PMCID: PMC5796492 DOI: 10.1186/s12889-018-5113-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/23/2018] [Indexed: 01/15/2023] Open
Abstract
Background Methamphetamine (MA) use is a significant public health concern due to its negative effects on health. However, to date, no epidemiological research has examined high-risk sexual behaviors (inconsistent condom use, having multiple sexual partners and having a history of sexually transmitted infections) among MA users. This topic is particularly important in Myanmar, which is recognized as one of the key MA production countries in the Southeast Asia region. Therefore, this study examined factors associated with high-risk sexual behaviors among MA users in Muse city, Myanmar. Methods A community-based cross-sectional study was conducted from January to March 2013 in Muse city, Northern Shan State, Myanmar. In total, 1183 MA users (772 male; 411 female) were recruited using respondent-driven sampling and a computer assisted self-interviewing method. Generalized estimating equation models were used to examine factors associated with high-risk sexual behaviors. Results A large proportion of MA users engaged in high-risk sexual behaviors (inconsistent condom use: males, 90.7%, females, 85.2%; multiple sexual partners: males, 94.2%, females, 47.2%; and history of STIs: males, 55.7%, females, 56.0%). Among males, being a multiple stimulants drug user (adjusted odds ratio [AOR] =1.77; 95% confidence interval [CI] =1.30–2.41) and being a client of sex workers (AOR = 1.41; 95% CI = 1.08–1.83) were risk factors for engaging in high-risk sexual behaviors. Among females, being a migrant worker (AOR = 2.70; 95% CI = 1.86–3.93) and being employed (AOR = 1.57; 95% CI = 1.13–2.18) were risk factors for engaging in high-risk sexual behaviors as well. Conclusions High-risk sexual behaviors were particularly pronounced among both male and female MA users. MA prevention programs that reflect gender considerations should be developed to pay more attention to vulnerable populations such as migrants, clients of sex workers, and less educated female MA users.
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Affiliation(s)
- Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Thu Nandar Saw
- Myanma Perfect Research, Yangon, Myanmar.,Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nyein Chan
- Department of Social Research, Defence Services Medical Research Centre, Tatkone Township, Nay Pyi Taw, Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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: 1.2] [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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Noor SW, Adam BD, Brennan DJ, Moskowitz DA, Gardner S, Hart TA. Scenes as Micro-Cultures: Examining Heterogeneity of HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in Toronto, Canada. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:309-321. [PMID: 28429157 DOI: 10.1007/s10508-017-0948-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 12/10/2016] [Accepted: 01/19/2017] [Indexed: 06/07/2023]
Abstract
Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo-Mendel-Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.
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Affiliation(s)
- Syed W Noor
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David A Moskowitz
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA
| | | | - Trevor A Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Bohora S, Chaffin M, Shaboltas A, Bonner B, Isurina G, Batluk J, Bard D, Tsvetkova L, Skitnevskaya L, Volkova E, Balachova T. Latent Class Analysis of HIV Risk Behaviors Among Russian Women at Risk for Alcohol-Exposed Pregnancies. AIDS Behav 2017; 21:243-252. [PMID: 29047000 DOI: 10.1007/s10461-017-1929-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.
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Risky Trade: Individual and Neighborhood-Level Socio-Demographics Associated with Transactional Sex among Urban African American MSM. J Urban Health 2017; 94:676-682. [PMID: 28766241 PMCID: PMC5610129 DOI: 10.1007/s11524-017-0187-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a clear, persistent association between poverty and HIV risk and HIV infection. Low educational attainment, neighborhood disadvantage, and residential instability are ways in which poverty is instrumentally experienced in urban America. We investigated the role of lived poverty at both the individual and neighborhood levels in transactional sex behavior among African American men who have sex with men (MSM) residing in urban neighborhoods. Using population-averaged models estimated by generalized estimating equation (GEE) models, we identified individual-level and neighborhood-level factors that are associated with exchanging sex for drugs and/or money. We tested the association between neighborhood and individual-level socioeconomic status and HIV risk behavior by combining area-based measures of neighborhood quality from the US Census with individual survey data from 542 low-income African American MSM. The primary outcome measure was self-reported transactional sex defined as exchanging sex for drugs or money. Individual-level covariates included high school non-completion, income, and problem drug use. Neighborhood-level covariates were high school non-completion and poverty rates. The findings suggested that educational attainment is associated with both the individual level and neighborhood level. Participants were more likely to engage in transactional sex if they did not complete high school (OR = 1.78), and similarly if their neighbors did not complete high school (OR = 7.70). These findings suggest potential leverage points for both community-level interventions and advocacy for this population, particularly related to transactional sex and education, and will aid HIV prevention efforts that seek to address the contextual constraints on individual risk behavior.
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Zhang Z, Zhang L, Zhou F, Li Z, Yang J. Knowledge, attitude, and status of nitrite inhalant use among men who have sex with men in Tianjin, China. BMC Public Health 2017; 17:690. [PMID: 28870186 PMCID: PMC5584038 DOI: 10.1186/s12889-017-4696-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Nitrite inhalants have become popular as recreational drugs among the homosexual population in some developed countries since the 1980s. These drugs, also called RUSH in China, have become attractive among Chinese men who have sex with men (MSM) in the past few years. The aim of this cross-sectional study was to understand the knowledge, attitude, and status of nitrite inhalant use among Chinese MSM. Methods The study participants were recruited from Tianjin, China between April and August 2012. Information, including demographics, sexual behavior, and RUSH use, was obtained through structured interviewer questionnaires. Blood samples were also collected to identify the status of HIV, HSV, and syphilis infections. Results A total of 500 participants were interviewed. Of the participants, 64.0% knew that RUSH could increase sexual pleasure and 38.6% of the participants had used RUSH at least once. The mean duration of RUSH use was 1.5 years. Among the participants who were familiar with RUSH, 60.0% had heard of RUSH for the first time after 2011, 55% received information about RUSH via the internet, and only 42.2% knew the side effects of RUSH. RUSH users were more likely to work in companies (Odds ratio [OR]: 2.61; 95% CI: 1.65–4.12), live with homosexual partners (OR: 1.88; 95% CI: 1.19–2.92), not live alone (OR: 2.26; 95% CI: 1.29–3.96), smoke cigarettes (OR: 1.49; 95% CI: 1.02–2.17), use alcohol (OR: 1.63; 95% CI: 1.12–2.39), and seek sexual partners on the internet (OR: 2.59; 95% CI: 1.50–4.50). Conclusions The impact of RUSH abuse on the expanding HIV epidemic among MSM has been demonstrated in China. Our findings suggest that the communication and awareness of health hazard of recreational drugs should be reinforced in HIV prevention education, especially through new media. Future research is needed to further explore how integrative strategies should be used to reduce the substance abuse and risky sexual behaviors.
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Affiliation(s)
- Zheng Zhang
- Chaoyang Center for Diseases Control and Prevention, Beijing, 100021, China
| | - Li Zhang
- Beijing Center for Diseases Prevention and Control, Beijing Research Center of Preventive Medicine, Room 205, No.16 Hepingli Middle Street, Beijing, 100013, China
| | - Feng Zhou
- Beijing Center for Diseases Prevention and Control, Beijing Research Center of Preventive Medicine, Room 205, No.16 Hepingli Middle Street, Beijing, 100013, China. .,School of Public Health, Capital Medical University, Beijing, 100069, China.
| | - Zhen Li
- Chaoyang Center for Diseases Control and Prevention, Beijing, 100021, China
| | - Jie Yang
- Tianjin Deep Blue Volunteers Workgroup, Tianjin, 300131, China
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Abstract
There is a strong push to conduct large-scale randomized controlled study designs in HIV prevention studies. In these randomized controlled studies, the primary research objective is typically to determine the treatment effect based on some biological outcome (eg, HIV infection). But many unused self-reported outcomes are also being collected. We illustrate the extent of this problem using the EXPLORE data as an example.
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Kelly PJ, Robinson LD, Baker AL, Deane FP, McKetin R, Hudson S, Keane C. Polysubstance use in treatment seekers who inject amphetamine: Drug use profiles, injecting practices and quality of life. Addict Behav 2017; 71:25-30. [PMID: 28242532 DOI: 10.1016/j.addbeh.2017.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/21/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The injection of amphetamine is becoming increasingly common. However, there has been a lack of research examining people who inject amphetamine as the primary drug of use, limiting the potential to ensure services address the unique needs of this group. The current study used latent class analysis to identify classes of polydrug use among people who report injecting amphetamine during the past 12months. It also examined differences between classes and drug use patterns, injecting practices, quality of life and psychological distress. METHODS Participants who were attending non-government specialist alcohol and other drug treatment across New South Wales, Australia and had identified amphetamine as their principle drug of concern and reported injecting amphetamine in the previous 12months were included in the current study (N=827). Latent class analysis was performed to identify polydrug profiles of participants. RESULTS The large majority of people in the current study (85%) demonstrated low probability of heroin or other opiate use. Three distinct classes of polydrug use were identified: (1) Low-polydrug (n=491), (2) Opiates-polydrug (n=123), and (3) Alcohol-polydrug (n=213). There was a trend for the Low-polydrug class to demonstrate better functioning and safer injecting practices than the Opiates-polydrug and Alcohol-polydrug classes. CONCLUSION The results suggest that the majority of people accessing treatment who inject amphetamine as their primary drug of choice have a low probability of heroin or other opiate use. It is important that future research consider whether traditional harm minimisation strategies are appropriate for people who primarily inject amphetamine.
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Centre for Health Initiatives, University of Wollongong, Australia.
| | - Laura D Robinson
- Centre for Health Initiatives, University of Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia
| | - Rebecca McKetin
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Suzie Hudson
- Network of Alcohol and other Drugs Agencies (NADA), Australia
| | - Carol Keane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Centre for Health Initiatives, University of Wollongong, Australia
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