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Burlew AK, McCuistian C, Lanaway D. Culturally adapted safer sex skills building: development and initial testing of an HIV prevention intervention for Black women using substances in the United States. HEALTH EDUCATION RESEARCH 2023; 38:527-536. [PMID: 37791870 DOI: 10.1093/her/cyad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Black women who use substances in the United States face unique human immunodeficiency virus (HIV) risk factors. However, interventions addressing cultural factors relevant for preventing HIV risk behaviors among Black women are limited. This project aimed to develop and initially test the effectiveness of a culturally adapted version of safer sex skills building (SSSB), an evidence-based HIV prevention intervention for reducing HIV risk among Black women who use substances. The cultural adaptation procedures involved (i) review of existing literature, (ii) use of Delphi process and theater testing to generate an adapted version, (iii) theater testing of the culturally adapted version and (iv) initial testing. Forty-eight Black women recruited from a substance use treatment clinic in the United States participated in three 2.5-h sessions of a culturally adapted or a generic version of the intervention. More (48%) women in the culturally adapted version self-reported condom use with casual partners compared to women in the generic (29%) version at a 6-week follow-up. The two groups did not differ on self-reported condom use with main partners. The culturally adapted SSSB offers a promising intervention for sexual risk reduction among Black women who use substances. Moreover, the findings advance the field by illustrating a concrete methodology for cultural adaptation.
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Affiliation(s)
- A K Burlew
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - C McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., San Francisco, CA 94110, USA
| | - D Lanaway
- Department of Psychiatry, University of Texas Southwestern, 5161 Harry Hines Blvd., Dallas, TX 75390, USA
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Argenyi MS, Evans JK, Veach LJ, McNeil CJ. Comfort Levels of Outpatient Health Care Professionals When Asking About Substance Use-Related Sexual Activity: A Pilot Survey. Sex Transm Dis 2023; 50:810-815. [PMID: 37756312 PMCID: PMC10840966 DOI: 10.1097/olq.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention for substance use. Health care professionals may not receive SBIRT training or know of substance use's intersection with sexual activity. This pilot survey inquired about SBIRT training history, attitudes, and comfort among outpatient health care professionals, including assessing sexual activity-related use. METHODS We conducted a snowball cross-sectional survey of outpatient health care professionals at a large southeastern academic medical center in June 2021 with 4-point Likert questions covering demographics, substance use attitudes, SBIRT training history, and comfort implementing SBIRT. Analysis used descriptive statistics and stratification by demographic and practice characteristics. RESULTS Seventy-three professionals responded, of whom 82% were White and 66% were female. Forty-seven percent were 30 to 39 years old, 33% were internal medicine professionals, and 59% reported previous SBIRT training. All participants reported believing substance use is a significant health issue. Most reported that they were comfortable or somewhat comfortable assessing patients for substance use (85%), dropping to 60% discussing sexual activity. Advanced practice providers and physicians identified more comfort with rapport building around substance use than other health care respondents. Professionals in infectious diseases and psychiatry reported the greatest comfort assessing substance use with concurrent sexual activity. CONCLUSIONS There are gaps in SBIRT training and beliefs among health care professionals. Although health care workers report that assessing substance use is important, some professionals endorsed more comfort discussing substance use with patients than others, especially when inquiring about sexual activity. Future work could replicate the pilot to inform increasing comfort through training in the intersection of substance use and sexuality.
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Affiliation(s)
| | | | - Laura J Veach
- Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Candice J McNeil
- From the Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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3
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Delaney DJ, Stein LAR, Bassett SS, Clarke JG. Motivational interviewing for family planning and reducing risky sexual behavior among incarcerated men nearing release: A randomized controlled pilot study. Psychol Serv 2023; 20:538-552. [PMID: 34735198 PMCID: PMC10354667 DOI: 10.1037/ser0000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Incarcerated men are at high risk for sexually transmitted infections (STIs) and unintended partner pregnancy postrelease. Limited research has been invested in developing and testing treatments targeting risky sexual behavior and unwanted pregnancy for this at-risk population. Motivational interviewing (MI) is a promising behavioral intervention for decreasing risky sexual behaviors. This study assessed the feasibility and acceptability of MI for family planning and risky sexual behaviors with incarcerated men nearing release. Preliminary efficacy of the MI intervention was also compared to an educational control group. Thirty-two men were assessed at baseline and randomized to one 90-min session. Assessment occurred 2 months after release. MI was feasibly administered, and participants were highly satisfied with both treatments. In addition, those who received MI reported higher rates of condom use with casual partners, higher rates of partner use of hormonal contraceptives, and slightly higher rates of sex that was protected against pregnancy. Increases are readiness to discuss family planning with sexual partners, as well as reported frequency of these discussions, and increases in family planning knowledge were also found in those randomized to MI. The findings from this study indicate the need to further assess MI with this population with a full-scale clinical trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel J Delaney
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - L A R Stein
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Shayna S Bassett
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Jennifer G Clarke
- Center for Primary Care and Prevention, Memorial Hospital, Brown University
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Fujiwara R, Journey M, Al-Doori F, Bell P, Judge B, Miracle K, Ito K, Jones S. Potential neonatal toxicity of new psychoactive substances. Pharmacol Ther 2023; 248:108468. [PMID: 37290575 DOI: 10.1016/j.pharmthera.2023.108468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
Cannabis, cocaine, 3,4-methylenedioxymethamphetamine, and lysergic acid diethylamide are psychoactive substances with a significant increase in consumption during the 21st century due to their popularity in medicinal and recreational use. New psychoactive substances (NPSs) mimic established psychoactive substances. NPSs are known as being natural and safe to consumers; however, they are neither natural nor safe, causing severe adverse reactions, including seizures, nephrotoxicity, and sometimes death. Synthetic cannabinoids, synthetic cathinones, phenethylamines, and piperazines are all examples of NPSs. As of January 2020, nearly 1000 NPSs have become documented. Due to their low cost, ease of availability, and difficulty of detection, misuse of NPSs has become a familiar and growing problem, especially in adolescents and young adults in the past decade. The use of NPSs is associated with higher risks of unplanned sexual intercourse and pregnancy. As many as 4 in 100 women seeking treatment for substance abuse are pregnant or nursing. Animal studies and human clinical case reports have shown that exposure to certain NPSs during lactation periods has toxic effects on neonates, increasing various risks, including brain damage. Nevertheless, neonatal toxicity effects of NPSs are usually unrecognized and overlooked by healthcare professionals. In this review article, we introduce and discuss the potential neonatal toxicity of NPSs, emphasizing synthetic cannabinoids. Utilizing the established prediction models, we identify synthetic cannabinoids and their highly accumulative metabolites in breast milk.
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Affiliation(s)
- Ryoichi Fujiwara
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH, USA.
| | - Megan Journey
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Fatimah Al-Doori
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paris Bell
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Brahmjot Judge
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kamille Miracle
- College of Graduate Studies, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kousei Ito
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan.
| | - Sabrina Jones
- Department of Physics, University of Arkansas Fayetteville, Fayetteville, AR, USA
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Ssekamatte T, Nalugya A, Mugambe RK, Wagaba B, Nakalembe D, Mutebi A, Bagonza RA, Tigaiza A, Kansiime WK, Ssempala R, Wafula ST, Isunju JB, Buregyeya E. Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. BMC Public Health 2023; 23:801. [PMID: 37131127 PMCID: PMC10152422 DOI: 10.1186/s12889-023-15679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. METHODS A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered. RESULTS About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04-1.34), being 20-24 years of age (PR: 1.22, 95% CI: 1.04-1.44), being married (PR 1.15, 95% CI: 1.01-1.31) or divorced/separated (PR 1.43, 95% CI: 1.26-1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99-1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79-1.03) and using alcohol (PR 1.43, 95% CI: 1.25-1.69), marijuana (PR 1.16, 95% CI: 1.02-1.31) and khat (PR 1.25, 95% CI: 1.10-1.42) in the last 30 days. CONCLUSION The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20-24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.
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Affiliation(s)
- Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Richard K. Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Brenda Wagaba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Doreen Nakalembe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.o Box 7072, Kampala, Uganda
| | - Richard Asaba Bagonza
- School of Women & Gender Studies, College of Humanities and Social Sciences, Makerere University, P.o Box 7062, Kampala, Uganda
| | - Arnold Tigaiza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Winnifred K. Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Richard Ssempala
- Department of Economic Theory and Analysis, School of Economics, College of Business and Management Sciences, Makerere University, P.o Box 7062, Kampala, Uganda
| | - Solomon T. Wafula
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
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Jennings Mayo-Wilson L, Yen BJ, Nabunya P, Bahar OS, Wright BN, Kiyingi J, Filippone PL, Mwebembezi A, Kagaayi J, Tozan Y, Nabayinda J, Witte SS, Ssewamala FM. Economic Abuse and Care-seeking Practices for HIV and Financial Support Services in Women Employed by Sex Work: A Cross-Sectional Baseline Assessment of a Clinical Trial Cohort in Uganda. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1920-NP1949. [PMID: 35510547 PMCID: PMC9636073 DOI: 10.1177/08862605221093680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Economic hardship is a driver of entry into sex work, which is associated with high HIV risk. Yet, little is known about economic abuse in women employed by sex work (WESW) and its relationship to uptake of HIV prevention and financial support services. This study used cross-sectional baseline data from a multisite, longitudinal clinical trial that tests the efficacy of adding economic empowerment to traditional HIV risk reduction education on HIV incidence in 542 WESW. Mixed effects logistic and linear regressions were used to examine associations in reported economic abuse by demographic characteristics, sexual behaviors, HIV care-seeking, and financial care-seeking. Mean age was 31.4 years. Most WESW were unmarried (74%) and had less than primary school education (64%). 48% had savings, and 72% had debt. 93% reported at least one economic abuse incident. Common incidents included being forced to ask for money (80%), having financial information kept from them (61%), and being forced to disclose how money was spent (56%). WESW also reported partners/relatives spending money needed for bills (45%), not paying bills (38%), threatening them to quit their job(s) (38%), and using physical violence when earning income (24%). Married/partnered WESW (OR = 2.68, 95% CI:1.60-4.48), those with debt (OR = 1.70, 95% CI:1.04-2.77), and those with sex-work bosses (OR = 1.90, 95% CI:1.07-3.38) had higher economic abuse. Condomless sex (β = +4.43, p < .05) was higher among WESW experiencing economic abuse, who also had lower odds of initiating PrEP (OR = .39, 95% CI:.17-.89). WESW experiencing economic abuse were also more likely to ask for cash among relatives (OR = 2.36, 95% CI:1.13-4.94) or banks (OR = 2.12, 95% CI:1.11-4.03). The high prevalence of HIV and economic abuse in WESW underscores the importance of integrating financial empowerment in HIV risk reduction interventions for WESW, including education about economic abuse and strategies to address it. Programs focusing on violence against women should also consider economic barriers to accessing HIV prevention services.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- University of North Carolina Gillings School
of Global Public Health, Chapel Hill,
NC, USA
- Community, Global and Public Health
Division, Johns
Hopkins University School of Nursing,
Baltimore, MD, USA
| | - Bing-Jie Yen
- Department of Applied Health
Science, Center for Sexual Health Promotion, Indiana University School of Public
Health, Bloomington, IN, USA
| | - Proscovia Nabunya
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | - Brittanni N. Wright
- Department of Applied Health
Science, Center for Sexual Health Promotion, Indiana University School of Public
Health, Bloomington, IN, USA
| | - Joshua Kiyingi
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | | | - Abel Mwebembezi
- International Center for Child Health and
Development, Masaka, Uganda
- Reach the Youth
Uganda, Kampala, Uganda
| | | | - Yesim Tozan
- New York University College of Global Public
Health, New York, NY, USA
| | - Josephine Nabayinda
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
| | | | - Fred M. Ssewamala
- Washington University in St. Louis, Brown
School, St. Louis, MO, USA
- International Center for Child Health and
Development, Masaka, Uganda
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Knowledge and attitude on sexually transmitted infections and contraceptive use among university students in Bhutan. PLoS One 2022; 17:e0272507. [PMID: 35921369 PMCID: PMC9348698 DOI: 10.1371/journal.pone.0272507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB).
Methods
This was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion.
Result
A total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2–20) and 12 (range 2–14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants.
Conclusion
Students reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.
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Rowell-Cunsolo TL, Mkuu RS, Bellerose M, Haile R, Wechsberg W. "I Said Maybe We Should Use a Condom, and Then that Just Went South": Exploring Condomless Sex among Formerly Incarcerated Black Men in New York City, USA. JOURNAL OF SEX RESEARCH 2022; 59:662-670. [PMID: 34854792 PMCID: PMC9118125 DOI: 10.1080/00224499.2021.2004083] [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: 05/03/2023]
Abstract
More than 600,000 incarcerated individuals are released annually in the United States; a large proportion are Black men incarcerated for drug-related offenses, including drug use and possession. Formerly incarcerated Black men report elevated rates of condomless sex and sexually transmitted infections, including human immunodeficiency virus (HIV). The purpose of this study was to explore condom usage among Black men who were formerly incarcerated for drug-related offenses and living in New York City (NYC). Using a semi-structured interview guide, in-depth interviews were conducted with 26 formerly incarcerated Black men. Interviews were audio-recorded, transcribed, and entered into NVivo, then manually coded utilizing thematic analysis methods. The following four themes were identified: partner type and length of the relationship affected condom use; diminished pleasure was a barrier for condom use; challenges with ill-fitting and poor-quality condoms; and the withdrawal method was used as an HIV prevention technique. Our findings suggest that formerly incarcerated Black men are engaging in condomless sex post-incarceration. Greater exposure to prevention messages and targeted interventions with content that includes interpersonal and condom use skill-building, methods to increase pleasurable condom use, information on HIV and STI transmission modes, and access to pre-exposure prophylaxis (PrEP) may be beneficial for this population.
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Affiliation(s)
| | | | | | - Rahwa Haile
- Health & Society, State University of New York - College at Old Westbury
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Saing CH, Chhoun P, Chann N, Uk P, Mun P, Tuot S, Yi S. Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1461-1470. [PMID: 35194721 PMCID: PMC8917026 DOI: 10.1007/s10508-021-02243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/01/2021] [Accepted: 11/20/2021] [Indexed: 05/20/2023]
Abstract
Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the influence of drugs and its correlates among people who use drugs (PWUD) in Cambodia. We included 1147 PWUD from 12 provinces in this study. A multiple logistic regression analysis was conducted to identify factors associated with sex under the influence of drugs. Of the total, 39.7% reported having had sex under the influence of drugs in the past three months. After adjustment, sex under the influence of drugs was significantly associated with living in urban areas (AOR 2.97, 95% CI 1.68-5.27), having two to three (AOR 2.48, 95% CI 1.76-3.49) and four or more sexual partners (AOR 6.46, 95% CI 4.24-9.85), engaging in transactional sex (AOR 1.69, 95% CI 1.19-2.39), using methamphetamine (AOR 2.97, 95% CI 2.06-4.31), using drugs for three years or longer (AOR 1.67, 95% CI 1.15-2.41), having been to a drug rehabilitation center (AOR 1.77, 95% CI 1.18-2.41), having a network of ten or more PWUD (AOR 1.82, 95% CI 1.25-2.66), and having high psychological distress (AOR 1.66, 95% CI 1.25-2.22). This study documents the high prevalence of sex under the influence of drugs and its risk factors among male and female PWUD in Cambodia. These findings point to the need for integrating HIV and harm-reduction programs using innovative approaches to address the overlapping risks in this key population.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Center for Global Health Research, Touro University California, Vallejo, CA, USA.
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10
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Berry MS, Bruner NR, Herrmann ES, Johnson PS, Johnson MW. Methamphetamine administration dose effects on sexual desire, sexual decision making, and delay discounting. Exp Clin Psychopharmacol 2022; 30:180-193. [PMID: 32986459 PMCID: PMC8862632 DOI: 10.1037/pha0000398] [Citation(s) in RCA: 8] [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] [Indexed: 11/08/2022]
Abstract
Correlational evidence has linked methamphetamine use and HIV sexual risk behavior, but the direct effects of methamphetamine on sexual desire and sexual decision making in humans have not been tested. This study was designed to test the effect of methamphetamine administration on sexual desire and hypothetical condom-use decisions as measured by the Sexual Delay Discounting Task. Recreational stimulant users (n = 19) participated in this within-subject, placebo-controlled study comparing the effects of 0 mg, 20 mg, and 40 mg of oral methamphetamine. Compared to placebo, methamphetamine caused dose-related and time-related increases in a single-item sexual desire rating and some standard stimulant abuse liability ratings, as well as dose-related increases in the Sexual Arousal and Desire Inventory (SADI; a multidimensional scale capturing positive and negative aspects of desire/arousal). However, methamphetamine caused no significant mean differences in likelihood of condom use within the Sexual Delay Discounting Task or the Monetary Discounting Task. SADI scores were negatively correlated with change from placebo in condom use likelihood in the Sexual Delay Discounting Task for some partner conditions (i.e., decreased reported likelihood of condom use in participants who experienced increased desire/arousal and vice versa). These mixed results may be consistent with methamphetamine's role as both a treatment for attention-deficit/hyperactivity disorder and as a drug of abuse associated with increased delay discounting, and they suggest that methamphetamine's effects on discounting may be modulated by the reinforcing properties of what is being discounted. Delay discounting may be an understudied element of risky sexual decision making, particularly among individuals who use methamphetamine. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Meredith S. Berry
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Natalie R. Bruner
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Evan S. Herrmann
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Patrick S. Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Matthew W. Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Gray S, Kirby AV, Graham Holmes L. Autistic Narratives of Sensory Features, Sexuality, and Relationships. AUTISM IN ADULTHOOD 2021; 3:238-246. [PMID: 36605373 PMCID: PMC8992905 DOI: 10.1089/aut.2020.0049] [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: 01/09/2023]
Abstract
Background Research about the experience of sexuality and intimacy for autistic people has largely excluded the potential influences of autistic sensory features, which are highly common. The aim of this study was to explore how autistic sensory features influence autistic people's experiences of sexuality and relationships, including the impact of low and high neurological threshold sensory patterns and regarding specific sensory modalities. Methods Utilizing a qualitative approach, we explored autistic people's perspectives about the influences of sensory features on their experiences of sexuality and relationships through existing publicly available narratives (5 books and 13 online forums containing messages from 72 unique usernames) and responses to an open-ended survey question (N = 49). We used deductive coding based on Dunn's model of sensory processing, as well as inductive coding to identify additional themes about autistic sensory features and sexuality. Results Our findings indicated that sexual and relationship experiences were related to both sensory sensitivity and sensation seeking (i.e., low and high threshold sensory patterns) across several sensory modalities, including touch, sight, sound, and smell. Sensory features influenced autistic people's sexual and relationship experiences in both positive and negative ways. Examined narratives revealed adaptations and strategies used by autistic people to enhance or enable engagement in sexual activity as well as implications for their sexual identity. Conclusions Sensory features and their impact on the sexuality and relationship experiences of autistic people should be considered in clinical practice and educational programming. More research is needed to further understand the impact of autistic sensory features on experiences of sexuality and relationships, and to develop effective strategies to promote safe and satisfying engagement, when desired. Lay summary Why was this study done?: Autistic people often respond to sensations differently than other people, including being more sensitive to sensations and/or wanting more intense sensations (called "autistic sensory features" in this study). Many aspects of sexuality and relationships involve sensory input. However, we do not know much about how autistic sensory features influence sexuality and relationships for autistic people.What was the purpose of this study?: The purpose of this study was to explore how autistic sensory features influence autistic people's experiences of sexuality and relationships.What did the researchers do?: For this study, we used two different sources of data. The first was existing publicly available things written by autistic people, including books and posts on online forums. The second was answers provided on a survey question asking about autistic sensory features and sexuality. Overall, we looked at things written by over 120 autistic people. We reviewed all the information to explore what kinds of sensory responses (e.g., sensitivities and sensation seeking) and sensory modalities (e.g., touches, sights, sounds, and smells) they wrote about. We also looked more generally to see how autistic people described the ways that autistic sensory features influenced their sexuality and relationship experiences.What were the results of the study?: Our findings show that in the information we accessed, autistic people did write about how sensory features influence their sexual and relationship experiences. Some people who have sensory sensitivities described confusion, distress, and frustration with sexual experiences. Despite wanting to participate, people with sensitivities described negative reactions to many of the sights, sounds, smells, and textures that were involved in dating and sexual activities. Other people indicated that they avoided sexual activity because of their sensory features. However, we also found that some autistic people seek out more intense sensations in their sexual activities, and others that enjoy intimacy that promotes calming and self-regulation. People wrote about strategies they use in response to their autistic sensory features, such as communication with partners and the use of substances to dull sensations.What do these findings add to what was already known?: There has not been much published research on this topic, so this study is a starting place. In books, as well as in online discussion boards, autistic people have been discussing the importance of sensory features to their sexuality and relationships. We accessed that information, and used theory and clinical experience to analyze their writings and help identify what other research is needed.What are potential weaknesses in the study?: We used text already written by autistic people and responses on one survey question for this study. Therefore, we may not have gained a complete understanding of the ways that autistic sensory features influence sexuality and relationship experiences.How will these findings help autistic adults now or in the future?: This study contributes to greater understanding of how autistic traits affect sexuality and relationships for autistic people. That information can be used to develop effective education and resources for autistic people, families, and service providers.
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Affiliation(s)
- Sarah Gray
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, Utah, USA
| | - Anne V. Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, Utah, USA.,Address correspondence to: Anne V. Kirby, PhD, OTR/L, Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Laura Graham Holmes
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa. AIDS Behav 2021; 25:2755-2766. [PMID: 33950340 DOI: 10.1007/s10461-021-03178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission data explores self-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol and other drug use. SACENDU data from 2012 to 2017 was analyzed using chi-square test of independence and logistic regression to examine associations between HTS, demographic characteristics and substances of use. Of 87,339 treatment admissions, 47.5% (n = 41,481) of patients had not accessed HTS in the prior 12 months. HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively). None of the substance use sub-groups reported a testing rate above 70%. Compared to specific reference groups, logistic regression showed those with lower odds of HTS were: 15-19 years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); and primarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reported HTS among sub-groups of patients in SSATCs, the integration of HIV services for PWUD should be a priority in South Africa and a focus of the national HIV strategy.
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An Analysis of Sex Practices and Behaviors Among African Americans in Sexually Concurrent and Sexually Exclusive Relationships. J Racial Ethn Health Disparities 2021; 9:1923-1931. [PMID: 34405391 DOI: 10.1007/s40615-021-01130-4] [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: 05/04/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Historically, sexually concurrent relationships have been associated with increased risk for sexually transmitted infections (STIs), including HIV. Due to socio-structural factors, African Americans (AAs) have higher rates of STIs compared to other racial groups and are more likely to engage in sexually concurrent (SC) relationships. Current research has challenged the assumption that SC is the only risky relationship type, suggesting that both SC and sexually exclusive (SE) relationships are at equal risk of STI and HIV acquisition and that both relationship types should engage in safer sex practices. This study aimed to compare sex practices and behaviors among AA men and women in SC and SE relationships (N = 652). Results demonstrate differences in sexual practices and behaviors between SC and SE men and women. Overall, SC and SE women report condom use with male partners less frequently than SC and SE men. SC men were more likely to report substance use during sex compared to SC and SE women. Pre-exposure prophylaxis (PrEP) use did not differ across groups. SE men were less likely to report STI testing and diagnosis compared to SC women. Findings support the need to focus on culturally and gender-specific safer sex interventions among AAs.
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14
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Chawla N, Verma S, Ganesh R, Sarkar S, Ambekar A. Sexual relationship, self-esteem, dysfunction, and sexual satisfaction in treatment naïve men with heroin dependence. J Psychoactive Drugs 2021; 53:364-372. [PMID: 33441051 DOI: 10.1080/02791072.2020.1870779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heroin use, a prevalent and disabling condition, affects sexual functioning and the sexual quality of life. While there is adequate literature on sexual dysfunction with heroin use, the literature is scarce on the emotional aspects of sex, like the perception of sexual relationship, self-esteem, and satisfaction amongst heroin users. The study assessed these parameters among treatment-naïve, sexually active, married, male patients with heroin dependence. We interviewed 63 treatment-naïve men seeking treatment for heroin dependence using Self-esteem and Relationship Questionnaire (SEAR), New Sexual Satisfaction Scale-Short form (NSSS-S), Sexual Quality of Life Questionnaire-Male (SQoL-M), Index of Premature Ejaculation (IPE), and International Index of Erectile Function (IIEF). Overall scores in SEAR, NSSS-S, SQoL-M, IIEF, and IPE were low, suggesting poor self-esteem and relationship, poor sexual quality of life and sexual satisfaction, higher premature ejaculation, and erectile dysfunction. Injecting drug use was associated with lower scores on confidence domain of SEAR, partner activity focused domain of NSSS-S, intercourse-satisfaction, and overall sexual quality of life. Sexual dysfunctions, poor sexual relationship, and sexual quality of life are common among men seeking treatment for heroin dependence. Treatment strategies must not lose focus on this dimension of health during the treatment process.
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Affiliation(s)
- Nishtha Chawla
- NDDTC & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suraj Verma
- NDDTC & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ragul Ganesh
- NDDTC & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- NDDTC & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- NDDTC & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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15
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Navadeh S, Mirzazadeh A, McFarland W, Coffin P, Chehrazi M, Mohammad K, Nazemipour M, Mansournia MA, McCandless LC, Page K. Unsafe Injection Is Associated with Higher HIV Testing after Bayesian Adjustment for Unmeasured Confounding. ARCHIVES OF IRANIAN MEDICINE 2020; 23:848-855. [PMID: 33356343 PMCID: PMC9844981 DOI: 10.34172/aim.2020.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/16/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND To apply a novel method to adjust for HIV knowledge as an unmeasured confounder for the effect of unsafe injection on future HIV testing. METHODS The data were collected from 601 HIV-negative persons who inject drugs (PWID) from a cohort in San Francisco. The panel-data generalized estimating equations (GEE) technique was used to estimate the adjusted risk ratio (RR) for the effect of unsafe injection on not being tested (NBT) for HIV. Expert opinion quantified the bias parameters to adjust for insufficient knowledge about HIV transmission as an unmeasured confounder using Bayesian bias analysis. RESULTS Expert opinion estimated that 2.5%-40.0% of PWID with unsafe injection had insufficient HIV knowledge; whereas 1.0%-20.0% who practiced safe injection had insufficient knowledge. Experts also estimated the RR for the association between insufficient knowledge and NBT for HIV as 1.1-5.0. The RR estimate for the association between unsafe injection and NBT for HIV, adjusted for measured confounders, was 0.96 (95% confidence interval: 0.89,1.03). However, the RR estimate decreased to 0.82 (95% credible interval: 0.64, 0.99) after adjusting for insufficient knowledge as an unmeasured confounder. CONCLUSION Our Bayesian approach that uses expert opinion to adjust for unmeasured confounders revealed that PWID who practice unsafe injection are more likely to be tested for HIV - an association that was not seen by conventional analysis.
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Affiliation(s)
- Soodabeh Navadeh
- Global Health Sciences, University of California, San Francisco, CA, USA,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
| | - Ali Mirzazadeh
- Global Health Sciences, University of California, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA,San Francisco Department of Public Health, San Francisco, CA, USA
| | - Phillip Coffin
- San Francisco Department of Public Health, San Francisco, CA, USA,Division of HIV, ID, and Global Health, School of Medicine, University of California, San Francisco, CA, USA
| | - Mohammad Chehrazi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Mohammad Ali Mansournia; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sci-i ences, PO Box: 14155-6446, Tehran, Iran. Tel: +98-21-88989123; Fax: +98-21-88989127;
| | | | - Kimberly Page
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center
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Brown C, Eisenberg ME, McMorris BJ, Sieving RE. Parents Matter: Associations Between Parent Connectedness and Sexual Health Indicators Among Transgender and Gender-Diverse Adolescents. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:265-273. [PMID: 33410250 DOI: 10.1363/psrh.12168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 08/31/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
CONTEXT Transgender and gender-diverse youth experience significant health disparities across numerous domains of health, including sexual health. Among general populations, parent connectedness has been strongly associated with youth sexual health. METHODS The relationships between parent connectedness and sexual health indicators were investigated among 2,168 transgender and gender-diverse youth who participated in the 2016 Minnesota Student Survey, a statewide population-based survey of ninth- and 11th-grade students. Multivariate logistic regression models, stratified by sex assigned at birth, tested associations between parent connectedness-youth's perceptions of parent caring and parent-youth communication-and eight sexual health indicators: ever having had sex, having multiple sexual partners in the past year, pregnancy involvement, substance use at last sex, partner communication about STI prevention, partner communication about pregnancy prevention, condom use at last sex and pregnancy prevention methods at last sex. RESULTS The level of parent connectedness was inversely associated with ever having had sex, regardless of sex assigned at birth (odds ratios, 0.6-0.8). Although level of connectedness was inversely associated with having multiple sexual partners in the past year and pregnancy involvement among transgender and gender-diverse youth assigned male at birth (0.6-0.7), these relationships were nonsignificant among transgender and gender-diverse youth assigned female at birth. Further differences in associations between parent connectedness and four sexual risk-reduction behaviors were found between youth assigned male at birth and those assigned female. CONCLUSIONS As with other populations, parent connectedness promotes sexual health among transgender and gender-diverse youth and may provide a point of intervention.
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Affiliation(s)
- Camille Brown
- Division of General Pediatrics and Adolescent Health, Medical School, University of Minnesota, Minneapolis
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Medical School, University of Minnesota, Minneapolis
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17
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Wu TL, Ting TT, Chen CY, Su LW, Chen WJ. Early sexual initiation and risky sexual practices among alcohol- and tobacco-using young adults in Taiwan: mediation analysis of preceding-sex use of illicit drugs. BMC Public Health 2020; 20:1647. [PMID: 33143679 PMCID: PMC7641850 DOI: 10.1186/s12889-020-09777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As early sexual initiation is increasingly common in East Asia, we examined its relations to risky sexual practices in alcohol- and tobacco-using individuals in Taiwan and evaluated whether the associations were mediated through preceding-sex use of illicit drugs. METHODS Participants, recruited from alcohol- and tobacco-using adults aged 18 to 50 in Taipei through respondent-driven sampling (N = 1115), completed a computer-assisted self-interview covering questions on substance use and sexual experiences. In a subsample of 916 participants who had had sexual experience (median age 27), we examined the relations of early sexual initiation (< 16 years) to multiple sexual partners, casual sex, group sex, and rare condom use. Causal mediation analyses were conducted to examine whether illicit drug use preceding sex mediated these associations. RESULTS Around 9.3% reported early sexual initiation and the prevalence of risky sexual practices ranged from 7% (group sex) to 47% (rare condom use). Early initiators had a higher prevalence of regular binge drinking, illicit drug use, and risky sexual practices. In the multivariable analyses, higher odds of multiple sexual partners, casual sex, and group sex were consistently associated with early sexual initiation, gender, and their interaction. Mediation through preceding-sex use of illicit drugs was found between early sexual initiation and the three risky sexual practices, with the proportions mediated ranging from 17 to 19%. CONCLUSIONS Early sexual initiators were more likely to engage in risky sexual practices and preceding-sex use of illicit drugs partially explained this relationship, calling for more attention to this population's sexual health.
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Affiliation(s)
- Tat Leong Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Te-Tien Ting
- School of Big Data Management, Soochow University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Lien-Wen Su
- Kunming Prevention and Control Center, Taipei City Hospital, Taipei, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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18
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Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study. Sex Med 2020; 8:608-614. [PMID: 32994156 PMCID: PMC7691979 DOI: 10.1016/j.esxm.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Most studies investigate sexual dysfunction in drug abusers; however, there are no data available about the pattern of drug abuse in patients with lifelong premature ejaculation (PE). Aim To assess the pattern of drug abuse in patients with lifelong PE and to evaluate its potential effect on their hormonal profile. Methods A cross-sectional study included patients with lifelong PE (n = 76) with no prescribed medications for 1 month and age-matched control without PE (n = 48). Participants were evaluated by history, examination, Arabic index of PE, and hormonal profile. A urine sample was screened by dipstick kits for the following drug abuse tramadol, opiate, tetrahydrocannabinol (cannabis), amphetamine, barbiturate, cocaine, and benzodiazepines. Positive results were confirmed with a immunoassay drug analyzer. Main outcome measures The outcomes of this study are positive and negative drug abuse and hormonal profile changes. Results Control patients and patients with PE showed median (interquartile range) of age 43 (33–46.8) and 38.5 (31–45) years, respectively. Drug abuse testing results showed significantly high positive drug abuse in patients with PE, 26 of 76 (34.2%), in comparison with control, 9 of 48 (19.1%) (P = .05). The most commonly abused drug was tetrahydrocannabinol in control, 3 of 9 (33.3%), and tramadol, 12 of 26 (46.2%), in patients with PE. Control patients and patients with PE with positive drug abuse had significantly higher smoking percent (P < .0001) and higher positive drug abuse history (P < .0001). However, there was no relationship between drug abuse and PE severity, and there were no significant changes in their hormonal profile. Conclusions Drug abuse is high among patients with lifelong PE in Upper Egypt, with tramadol being the comment drug. Drug abuse is common among smokers. However, no hormonal disturbance could be shown in drug abuse patients. Drug abuse might be considered in the evaluation of patients with PE. Mohammed SA, Abdelhamed A, El Sayed RM. Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study. Sex Med 2020;8:608–614.
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Tam CC, Benotsch EG, Li X. Sexual enhancement expectancy, non-medical use of prescription drugs, and sexual risk behaviors in college students. Subst Abus 2020; 42:577-586. [DOI: 10.1080/08897077.2020.1803177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Eric G. Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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20
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Otiniano Verissimo AD, Dyer TP, Friedman SR, Gee GC. Discrimination and sexual risk among Caribbean Latinx young adults. ETHNICITY & HEALTH 2020; 25:639-652. [PMID: 29495893 DOI: 10.1080/13557858.2018.1444148] [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: 10/29/2016] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Discrimination, such as being treated unfairly due to race, contributes to stress. Individuals may cope with this by engaging in risky behaviors. Consistent with this premise, prior studies found that discrimination is associated with substance use. Research has also shown that sex while 'high' on alcohol and drugs is associated with increased risk for HIV and other STIs. The present study examines the relationship between discrimination and sexual risk. We investigate whether discrimination is associated with sex while high on alcohol and drugs. Design: Analyses focus on a sample of 356 Caribbean Diasporic young adults, primarily Caribbean Latinx, aged 18 to 25 who participated in the Drug Use and HIV Risk among Youth Survey carried out from 1997 to 2000 in Brooklyn, New York. Logistic regression examined the association between self-reported discrimination and sex while high. Results: More than half (52.3%) of respondents reported moderate discrimination. Sex while high was also reported: 35.7% for alcohol, 43.3% for marijuana, and 32.6% for heroin/cocaine. Discrimination was associated with increased risk of sex while high on (1) marijuana and (2) heroin/cocaine, but was not with alcohol. Conclusions: Discrimination may be a risk factor for engaging in sex while high on drugs, which may put individuals at risk for HIV as well as other STIs. Future research should explore relationships between discrimination and sex while high on alcohol and drugs among various racial/ethnic groups and Diasporas, while also assessing how this relationship may contribute to HIV incidence.
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Affiliation(s)
| | - Typhanye Penniman Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, The University of Maryland, College Park, MD, USA
| | - Samuel R Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, New York, NY, USA
| | - Gilbert C Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
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21
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Skryabin VY, Khoryaev D, Torrado M. Changes in sexual behavior patterns due to stimulants use: three case reports. J Addict Dis 2020; 38:375-379. [PMID: 32500822 DOI: 10.1080/10550887.2020.1771236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The paper describes three case reports of changes in sexual behavior patterns in male patients who use stimulants (amphetamine and mephedrone). Two of them demonstrate that the consumption of stimulants may lead to hypersexuality and excessive masturbation. Case report three shows that mephedrone use results in such typical stimulant-related subjective effects as the intensification of sensory experiences and sexual arousal. It leads to the loss of interest in sex without mephedrone. In light of the popularity of sex under the influence of drugs, clinicians should be aware of this phenomenon, since it is associated with high-risk sexual behavior. The description of clinical cases on the link between sex and drugs expands our knowledge in this area, leading to more effective treatment interventions.
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Affiliation(s)
| | - Denis Khoryaev
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Marco Torrado
- Faculty of Medicine, ISAMB (Instituto de Saúde Ambiental), University of Lisbon, Lisboa, Portugal
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Jennings Mayo-Wilson L, Benotsch EG, Grigsby SR, Wagner S, Timbo F, Poteat T, Cathers L, Sawyer AN, Smout SA, Zimmerman RS. Combined effects of gender affirmation and economic hardship on vulnerability to HIV: a qualitative analysis among U.S. adult transgender women. BMC Public Health 2020; 20:782. [PMID: 32456674 PMCID: PMC7249630 DOI: 10.1186/s12889-020-08902-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Transgender women (“trans women”), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition. Methods We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of trans women were racial/ethnic minorities with mean age of 26.3 years. Gender-affirming behaviors varied with 58% of trans women having legally changed their name and gender marker; 79% having initiated hormone therapy; and 11% having not initiated any medical or legal changes. None had undertaken surgical changes. Findings suggested that the process of gender transitioning resulted in both increasing and decreasing HIV risk. The high need for gender affirmation by male sex partners contributed to trans women’s exposure to sexual objectification, sexual risk behaviors, and conflicting interests in HIV prevention messaging. Loss of housing and employment due to transition along with the high costs of transition products and medical visits increased reliance on sex work and created new obstacles in accessing HIV services. Trans women experienced lower HIV risk as they acquired legal and medical transition services, reshaped interactions with sex partners, and received gender-affirming support by others, including health providers, employers, peers, and housing professionals. Sexual abstinence was viewed as a negative consequence of incomplete transition, although characterized as a period of low HIV risk. Conclusions Structural and policy initiatives that promote safe gender transition and economic stability in trans women may play a critical role in reducing HIV in this population. Addressing the harmful pressures for U.S. trans women to conform to perceived feminine stereotypes may also serve an important role.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA.
| | - Eric G Benotsch
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Sheila R Grigsby
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Sarah Wagner
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Fatmata Timbo
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Tonia Poteat
- University of North Carolina, Department of Social Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Lauretta Cathers
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Ashlee N Sawyer
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Shelby A Smout
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Louisiana State University Health New Orleans School of Nursing, 1900 Gravier Street, Room 5B14, New Orleans, LA, 70112, USA
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Abstract
California has a large population of people experiencing homelessness (PEH) that is characterised by a high proportion of people who are unsheltered and chronically homeless. PEH are at increased risk of communicable diseases due to multiple, intersecting factors, including increased exposures, comorbid conditions including substance use disorder and mental illness and lack of access to hygiene and healthcare facilities. Data available for several communicable diseases show that PEH in California experiences an increased burden of communicable diseases compared to people not experiencing homelessness. Public health agencies face unique challenges in serving this population. Efforts to reduce homelessness, increase access to health care for PEH, enhance data availability and strengthen partnerships among agencies serving PEH can help reduce the disparity in communicable disease burden faced by PEH.
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Su S, Fairley CK, Mao L, Medland NA, Jing J, Cheng F, Zhang L. Estimates of the national trend of drugs use during 2000-2030 in China: A population-based mathematical model. Addict Behav 2019; 93:65-71. [PMID: 30685570 DOI: 10.1016/j.addbeh.2019.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND The use of synthetic drugs has exceeded heroin to become a major public health concern in China. We aimed to estimate the trend of heroin-only, synthetic drug-only and poly-drug (heroin and synthetic drug) use during 2000-2030 period in China using existing data. METHODS We used data from the Annual Report on Drug Control in China and peer-reviewed publications. We constructed a mathematical model to estimate the drug use trend based on Monte Carlo simulations. RESULTS The best calibrated model estimated that the number of drug users would increase from 0.86 million to 3,120,059 (95% CI 2,669,214-3,570,904) during 2000-2030 period. The proportion of heroin-only users among the total drug users will decrease from 96.8% (95% CI, 96.6-97.1%) in 2000 to 36.9% (30.1-40.8%) in 2030, while the proportion of synthetic drug-only users will increase from 1.1% (0.9-1.3%) in 2000 to 57.7% (51.7-65.6%) in 2030. In contrast, the proportion of poly-drug users shared an increasing trend during 2000-2016 (from 2.1% (1.5-2.8%) to 15.1 (13.8-17.1%)) but declined to 5.5% (3.4-7.2%) in 2030. Estimated 46,370 (41,634-51,106) heroin-only users and 3767 (3481-4053) synthetic drug only users initiated poly-drug use in 2000. We observed a cross-over in 2012 where more synthetic drug-only users were initiating heroin use than heroin-only users initiating synthetic drug use. There will be estimated 2,094,052 (1,819,830-2,368,274) synthetic drug-only users and poly-drug users 211,407 (177,150-245,664) in 2030. CONCLUSIONS Synthetic drug use will become dominant in drug users in China, but poly-drug use of both heroin and synthetic drugs will remain substantial.
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Celio MA, Mastroleo NR, Barnett NP, Colby SM, Kahler CW, Operario D, Monti PM. Mechanisms of behavior change in a brief dual-target motivational intervention: Reduction in alcohol use mediates intervention effects on risky sex. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:349-359. [PMID: 30958012 DOI: 10.1037/adb0000461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To examine the mechanisms underlying the efficacy of a dual-target motivational intervention (MI) to reduce heavy drinking and risky sex. A priori hypotheses were that: increases in alcohol-related readiness to change (RTC) and self-efficacy would mediate the effect of MI on alcohol use; increases in sex-related RTC and self-efficacy would mediate the effect of MI on risky sex; and reductions in alcohol use would mediate reductions in risky sex. Patients in Emergency Departments who screened positive for heavy drinking and risky sex were randomly assigned to receive MI or brief advice. RTC and self-efficacy were assessed at baseline and immediately postintervention. Alcohol use and sexual behavior was assessed at baseline, 3-, 6-, and 9-month follow up. Single- and serial-mediation models were tested. Patients who received MI had higher postintervention RTC and self-efficacy, but neither mechanism mediated the effects of MI on behavioral outcomes. Reduction in heavy drinking mediated the effect of MI on frequency of sex under the influence (SUI). Further, the effect of MI on condomless sex was mediated by an indirect path in which reductions in heavy drinking at 3 months predicted less SUI at 6 months, which in turn predicted reduction in condomless sex at 9-months. Although some effect of dual-target MI on risky sex is independent of drinking, treatment-related reduction in heavy drinking does account for a significant portion of reduction in risky sex, providing support for the utility of this intervention in patient populations where heavy drinking and risky sex co-occur. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Nadine R Mastroleo
- College of Community and Public Affairs, Binghamton University, State University of New York
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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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Jones AA, Dyer TV, Das A, Lasopa SO, Striley CW, Cottler LB. Risky Sexual Behaviors, Substance Use, and Perceptions of Risky Behaviors Among Criminal Justice Involved Women Who Trade Sex. JOURNAL OF DRUG ISSUES 2019; 49:15-27. [PMID: 33828337 PMCID: PMC8022863 DOI: 10.1177/0022042618795141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined risky sexual behaviors, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-defined alcohol and substance use disorders, and perceptions of risky behaviors among community released, justice-involved women, who are currently trading sex (CTS), formerly traded sex (FTS), or have never traded sex. Data were derived from 266 sexually active women recruited from a Municipal Drug Court System in St. Louis, Missouri. In an adjusted multinomial regression model, being dependent on alcohol and cocaine was the most robust correlate of sex-trading status (adjusted odds ratio [AOR]: CTS = 4.21, FTS = 4.66). Perceptions of sexual risk and HIV were significantly associated with CTS (AOR = 3.39), however, not FTS. Other significant correlates of sex trading status included age, lifetime injection drug use, lower education, child sexual abuse, and unstable housing. Gender-specific interventions tailored toward currently and formerly sex-trading women are needed.
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Affiliation(s)
- Abenaa A. Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T. V. Dyer
- University of Maryland, College Park, USA
| | - A. Das
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S. O. Lasopa
- Sir Thutob Namgyal Memorial Hospital, Gangtok, India
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Bosma-Bleeker MH, Blaauw E. Substance use disorders and sexual behavior; the effects of alcohol and drugs on patients' sexual thoughts, feelings and behavior. Addict Behav 2018; 87:231-237. [PMID: 30077915 DOI: 10.1016/j.addbeh.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/28/2018] [Accepted: 07/05/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hardly any research exists on the relationship between substance use and sexual behaviors in patients with a substance use disorder. This study aimed to examine this relation by looking into perceived positive effects on sexual behavior, perceived negative effects and risky sexual behavior due to substance use in patient groups of users of alcohol, stimulants, sedatives and Gamma hydroxybutyrate (GHB). In addition, the current study aimed to address the question whether sexual behavior (e.g. number of sexual partners, sexual activity) differs between these patient groups. METHOD A total of 180 patients with a substance use disorder (i.e. alcohol, amphetamine, cannabis, cocaine, GHB and opiates) participated. A self-report questionnaire was administered with questions on substance use, sexual behaviors (e.g. sexual activity, masturbation, use of pornography) and statements about the perceived changes in sexual functioning and behavior under influence of the primary substance of abuse. RESULTS All four groups reported changes in sexual thoughts, feelings and behavior due to the use of their primary substance. More than half of the patients reported enhancements in sexual domains (i.e. sexual pleasure, sexual arousal, sexual behavior), but also decrements or risky behaviors and about a quarter stated that their sexual thoughts, feelings and behaviors were often associated with the use of their primary substance of abuse. Patients with a GHB use disorder reported the strongest relation between drug use and sexual behavior. Users of GHB not only reported more enhancement in several sexual domains, but also less decline in sexual domains compared to the other patient groups and more risky behavior or more sexual activity than some of the other groups of patients. CONCLUSIONS The results underline the importance of addressing the relationship between substance use and sexual behavior in treatment programs, as patients may be hesitant to stop their use of substances when they experience many positive effects in their sexual behavior. Future research directions are suggested.
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Affiliation(s)
| | - Eric Blaauw
- Verslavingszorg Noord Nederland, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen, the Netherlands
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Newville H, Sorensen JL, Hatch-Maillette M, Calsyn DA. Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment. JOURNAL OF SEX RESEARCH 2018; 55:1056-1064. [PMID: 28513227 PMCID: PMC5916504 DOI: 10.1080/00224499.2017.1321101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index-Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.
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Affiliation(s)
- Howard Newville
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
| | - James L. Sorensen
- Department of Psychiatry, University of California, San Francisco, San Francisco CA
| | - Mary Hatch-Maillette
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
| | - Donald A. Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
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Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics. J Addict Med 2018; 11:350-356. [PMID: 28590392 DOI: 10.1097/adm.0000000000000327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services. METHODS We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up. RESULTS In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01). CONCLUSIONS SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.
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Su S, Mao L, Zhao J, Chen L, Jing J, Cheng F, Zhang L. Epidemics of HIV, HCV and syphilis infection among synthetic drugs only users, heroin-only users and poly-drug users in Southwest China. Sci Rep 2018; 8:6615. [PMID: 29700352 PMCID: PMC5919913 DOI: 10.1038/s41598-018-25038-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4]; 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9]; 3.9, [1.8–5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Limin Mao
- Center for Social Research in Health, Arts and Social Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Jinxian Zhao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
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32
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Guimarães RA, Monteiro LH, Teles SA, Fernandes IL, Rodovalho AG, Silva GC, Lucchese R, Vera I, Silva AC, Gregório VD, Ferreira PM, de Almeida MM, Guimarães VA, Amorim TA, de Souza MR. Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study. Int J STD AIDS 2018; 29:658-664. [PMID: 29393006 DOI: 10.1177/0956462417750332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The objective of this study was to investigate risk behaviors for sexually transmitted infections (STIs) in noninjecting drug users (NIDUs), using STI diagnosis history as an indicator. A cross-sectional study was conducted in 323 NIDUs of two facilities for alcohol and/or drug dependence treatment in the Goiás State, Central Brazil. All participants were interviewed about risk behaviors and STI history. Multivariable analysis was performed in order to identify predictors of STIs. Adjusted prevalence ratio (APR) with confidence intervals of 95% was obtained using a Poisson regression model. Prevalence of self-reported STIs in the previous 12 months was 25.4% (95% confidence interval [95% CI]: 21.0-30.4%). A multivariable model verified that age (APR: 1.01; 95% CI: 1.00-1.01), sexual contact with partners diagnosed with STIs (APR: 1.27; 95% CI: 1.12-1.45) and injecting drug users (IDUs) (APR: 1.14; 95% CI: 1.14; 95% CI: 1.01-1.31), exchange sex for money and/or drugs (APR: 1.12; 95% CI: 1.02-1.21), and a history of sexual violence (APR: 1.04; 95% CI: 1.04-1.32) were predictors of STIs. Elevated rates of STI history and risk behaviors were observed in NIDUs, supporting the vulnerability of this group for these infections. Public policies and health outreach should be intensified in this population, principally regular STI testing of individuals in treatment for drug dependence and their sexual partners.
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Affiliation(s)
- Rafael A Guimarães
- 1 Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Luiz Hb Monteiro
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Sheila A Teles
- 3 Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - Inaina L Fernandes
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Aurélio G Rodovalho
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil.,4 Municipal Secretary of Health, Catalão, Goiás, Brazil
| | - Graciele C Silva
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Roselma Lucchese
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Ivânia Vera
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Andrécia C Silva
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | - Valéria D Gregório
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
| | | | | | | | - Thiago A Amorim
- 2 Institute of Biotechnology, Federal University of Goiás, Catalão, Brazil
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Goyette M, Flores-Aranda J, Bertrand K, Pronovost F, Aubut V, Ortiz R, Saint-Jacques M. Links SU-Sex: development of a screening tool for health-risk sexual behaviours related to substance use among men who have sex with men. Sex Health 2018; 15:160-166. [DOI: 10.1071/sh17134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022]
Abstract
Background
Men who have sex with men (MSM) have distinctive substance use (SU), which is more often linked to a sexual context than it is for their heterosexual peers. Screening of MSM’s SU, its sexual contexts and the associated risks, is of clinical and public health concern. This paper aims to describe the preliminary development of a screening tool for health-risk sexual behaviours related to SU and to make recommendations for its potential use. Methods: Community-based participatory research and transdisciplinary approaches guided the development process. The Links SU-Sex screening tool is the result of the integration of findings from a scoping review and from four meetings among SU and sexual health experts (n = 19), consisting of researchers, community stakeholders, as well as substance-using MSM. Results: The Links SU-Sex questionnaire consists of 64 items divided into 13 components that focus on the links between SU and sexual health. It addresses the contexts in which SU occurs, its frequency, its perceived influence, as well as MSM’s concerns about these various links. In accordance with current knowledge, the interpretation of the instrument offers feedback that is based on the respondents’ answers to the various components assessed. Conclusions: The Links SU-Sex represents a potential screening tool that rests on a robust development process supporting its content validity that aims to identify MSM at risk or with concerns surrounding the influence of their SU on their sexual health. The psychometric qualities and the interpretation validity both remain to be established.
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Rodriguez-Seijas C, Arfer KB, Thompson RG, Hasin DS, Eaton NR. Sex-related substance use and the externalizing spectrum. Drug Alcohol Depend 2017; 174:39-46. [PMID: 28301821 DOI: 10.1016/j.drugalcdep.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Substance use before and during sexual activity is associated with many negative health outcomes. Estimates suggest that at least 4.3 million American adults annually engage in regular sex-related alcohol consumption, indicating that the intersection of substance use and sexual behavior is of public health concern. However, it is likely that when considering broader sex-related substance use, estimates would be notably higher. While substance use disorders and antisocial personality disorder have been associated with sex-related alcohol consumption, no study has investigated how regular sex-related substance use is associated with the broader transdiagnostic externalizing spectrum. Further, no studies have assessed whether or not sexual risk-taking behaviors can be integrated into the externalizing spectrum. METHODS In a large internet sample (N=936), we used confirmatory factor analysis, item response theory, and logistic regression to link sex-related alcohol and drug use to an externalizing latent variable; identified psychometric characteristics of these behaviors; and determined the extent to which one's externalizing level was associated with changes in odds of regular sex-related substance use. We then replicated these findings in a nationally representative sample (N=34,653). RESULTS Results highlighted the close association between sex-related substance use and externalizing, with externalizing increases being associated with significantly increased odds of regular sex-related substance use. CONCLUSIONS These findings bear notable implications for conceptualization and treatment of sex-related substance use. Transdiagnostic intervention can be an efficient means of addressing this problematic behavior as well as other comorbid presentations. Results expand the current conceptualization of the externalizing spectrum.
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Affiliation(s)
| | - Kodi B Arfer
- UCLA Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA, USA
| | - Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA; New York State Psychiatric Institute, NY, USA
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Gordon KS, Edelman EJ, Justice AC, Fiellin DA, Akgün K, Crystal S, Duggal M, Goulet JL, Rimland D, Bryant KJ. Minority Men Who Have Sex with Men Demonstrate Increased Risk for HIV Transmission. AIDS Behav 2017; 21:1497-1510. [PMID: 27771818 DOI: 10.1007/s10461-016-1590-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Black and Hispanic (minority) MSM have a higher incidence of HIV than white MSM. Multiple sexual partners, being under the influence of drugs and/or alcohol during sex, having a detectable HIV-1 RNA, and non-condom use are factors associated with HIV transmission. Using data from the Veterans Aging Cohort Study, we consider minority status and sexual orientation jointly to characterize and compare these factors. White non-MSM had the lowest prevalence of these factors (p < 0.001) and were used as the comparator group in calculating odds ratios (OR). Both MSM groups were more likely to report multiple sex partners (white MSM OR 7.50; 95 % CI 5.26, 10.71; minority MSM OR 10.24; 95 % CI 7.44, 14.08), and more likely to be under the influence during sex (white MSM OR 2.15; 95 % CI 1.49, 3.11; minority MSM OR 2.94; 95 % CI 2.16, 4.01). Only minority MSM were more likely to have detectable HIV-1 RNA (OR 1.87; 95 % CI 1.12, 3.11). Both MSM groups were more likely to use condoms than white non-MSM. These analyses suggest that tailored interventions to prevent HIV transmission among minority MSM are needed, with awareness of the potential co-occurrence of risk factors.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA.
| | - E Jennifer Edelman
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | - David A Fiellin
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520, USA
| | - Kathleen Akgün
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | | | - Mona Duggal
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
| | - Joseph L Goulet
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | - David Rimland
- Atlanta Veterans Affairs Medical Center, Decatur, GA, 30033, USA
- Emory University School of Medicine, Atlanta, GA, 30303, USA
| | - Kendall J Bryant
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
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Saw YM, Saw TN, Wai KM, Poudel KC, Win HH. Correlates of sex trading among male non-injecting drug users in Myanmar: a cross-sectional study. Harm Reduct J 2016; 13:34. [PMID: 27919289 PMCID: PMC5139087 DOI: 10.1186/s12954-016-0123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex trading is a recognized risk factor for human immune deficiency virus infection and other sexually transmitted infections among non-injecting drug users (NIDUs). However, very little research has addressed the factors associated with sex trading among male NIDUs in Myanmar. METHODS A cross-sectional study was conducted from January to February 2010 using the respondent-driven sampling method. In total, 210 NIDUs aged between 18 and 49 years, with no history of injecting drug use, and who used non-injected illicit drugs in the last 6 months were recruited. Face-to-face interviews were conducted using a structured questionnaire to collect information on participants' sexual and drug use behaviors. Binary and multivariate logistic regressions were applied to analyze the resulting data. RESULTS Of 210 NIDUs, 84 (40%) reported involvement in the sex trade during the last 3 months. In the adjusted model, factors associated with sex trade involvement included homosexual preference (adjusted odds ratio [AOR] 4.90; 95% confidence interval [CI] 1.61-14.95), having more than two partners (AOR = 3.88; 95% CI 1.55-9.72), had a regular job (AOR = 5.10; 95% CI 1.65-15.72), use of stimulant drugs rather than opiate (AOR = 2.38; 95% CI 1.10-5.15), and who used drugs more than twice per day. CONCLUSIONS More than one third of NIDUs were involved in sex trading. This study suggested that further comprehensive intervention programs that aim to reduce risk factors of trading sex among NIDUs may consider including NIDUs who used stimulant drugs, had regular/full-time jobs, used drugs more than twice per day, and had homosexual preferences.
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Affiliation(s)
- Yu Mon Saw
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, 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
| | - Kyi Mar Wai
- Department of Human Ecology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
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Gooden L, Metsch LR, Pereyra MR, Malotte CK, Haynes LF, Douaihy A, Chally J, Mandler RN, Feaster DJ. Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups. AIDS Behav 2016; 20:1893-906. [PMID: 26837631 PMCID: PMC4970956 DOI: 10.1007/s10461-016-1300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).
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Affiliation(s)
- Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA
| | - C Kevin Malotte
- Department of Health Science, California State University, Long Beach, CA, USA
| | - Louise F Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack Chally
- Johns Hopkins University, Baltimore, MD, USA
- EMMES Corporation, Inc., Rockville, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Alves Guimarães R, Lucchese R, Lara Fernandes I, Vera I, Goulart Rodovalho A, Alves Guimarães V, Cristina Silva G, Lopes de Felipe R, Alexandre de Castro P, Martins Ferreira P. HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors. Jpn J Infect Dis 2016; 70:340-346. [PMID: 27357979 DOI: 10.7883/yoken.jjid.2015.490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to estimate the prevalence of and identify factors associated with lifetime testing for the human immunodeficiency virus (HIV) in non-injection drug users (NIDU). A cross-sectional study was conducted with 323 individuals in clinics for chemical dependency in the state of Goiás in the Central-West region of Brazil. Logistic regression analysis was used to identify factors associated with lifetime HIV testing. Testing for HIV was associated with age, female gender, crack use, history of sexually transmitted infections, acquaintance with people living with HIV/AIDS and/or who had died from AIDS, and history of having received some instruction on HIV/AIDS prevention methods. It was found that only 26.6% reported having access to the HIV rapid test. We concluded determinants for HIV testing must be taken into account when planning prevention and programming strategies. These include the widening of testing coverage among NIDU, educational health actions, establishment of links between sexually transmitted infection prevention services and addiction treatment services, and the use of rapid tests to help people who are in contact with the virus learn about their HIV status, enter treatment, and improve their quality of life.
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Acheampong AB, Striley CW, Cottler LB. Prescription opioid use, illicit drug use, and sexually transmitted infections among participants from a community engagement program in North Central Florida. JOURNAL OF SUBSTANCE USE 2016; 22:90-95. [PMID: 29515331 PMCID: PMC5836499 DOI: 10.3109/14659891.2016.1144805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this analysis was to determine the intersection between prescription opioid use, illicit drug use and STIs amongst Alachua County participants. METHODS Cross-sectional data come from 2,194 Alachua County community members interviewed by Community Health Workers (CHWs) from HealthStreet, a community engagement program of the University of Florida. Demographic characteristics, health risk factors and health conditions were obtained. RESULTS Among participants, 9.3% reported ever having an STI, 40% reported lifetime use of prescription opioids, and 53% reported ever using an illicit drug. Persons who reported using an illicit drug or an illicit drug plus prescription were 2.89 and 4.12 times as likely to report one or more STIs respectively, compared to those who never used these drugs. Prescription opioid use alone was not statistically related to STIs though female gender (AOR 3.75), lower education (AOR 1.45) and food insecurity (AOR 1.52) were. DISCUSSION Those who report a history illicit drug use with or without prescription opioid use are at increased risk for STIs and could benefit from prevention programs. Those with factors that are proxies for other disparities (lower education, food insecurity) are especially important targets for intervention among women.
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Affiliation(s)
- Abenaa B Acheampong
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Safi MH, Younesi SJ, Dadkhah A, Farhoudian A, Fallahi-Khoshknab M, Azkhosh M. The Role of Sexual Behaviors in the Relapse Process in Iranian Methamphetamine Users: A Qualitative Study. ADDICTION & HEALTH 2016; 8:242-251. [PMID: 28819555 PMCID: PMC5554804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The awareness of sexual experiences could be an effective factor in preventing high-risk sexual behavior pertaining to relapse during the recovery period of substances. This research explored the role of sexual behaviors among Iranian methamphetamine (MA) users in relapse process. METHODS The study was conducted with a qualitative approach using content analysis method. 28 participants were selected through purposeful and theoretical sampling. Data were collected based on face-to-face, in-depth, semi-structured interviews based on open-ended questions. Interviews continued until the data saturation had occurred. All interviews were examined in four stages of codes, sub-categories, categories and themes according to the content analysis of explanations and descriptions of sexual behaviors. FINDINGS Two main themes were emerged from the analysis of interviews, including extreme pleasure seeking (including the main categories of sexual tunnel vision and sexual totalitarianism) and comprehended threat (including the main categories of internal conflict and external disorganization) as well as 10 subcategories. CONCLUSION The results indicated that sexual behaviors played an important role in relapse process among Iranian MA users and needed to be considered and managed properly in the planning of prevention, treatment, and rehabilitation.
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Affiliation(s)
- Mohammad Hadi Safi
- PhD Student, Department of Counseling AND Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyyed Jalal Younesi
- Associate Professor, Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Correspondence to: Seyyed Jalal Younesi PhD,
| | - Asghar Dadkhah
- Professor, Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Farhoudian
- Assistant Professor, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Fallahi-Khoshknab
- Associate Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Manoochehr Azkhosh
- Assistant Professor, Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mimiaga MJ, Biello K, Reisner SL, Crane HM, Wilson J, Grasso C, Kitahata MM, Mathews WC, Mayer KH, Safren SA. Latent class profiles of internalizing and externalizing psychosocial health indicators are differentially associated with sexual transmission risk: Findings from the CFAR network of integrated clinical systems (CNICS) cohort study of HIV-infected men engaged in primary care in the United States. Health Psychol 2015; 34:951-9. [PMID: 25642839 DOI: 10.1037/hea0000189] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine whether latent class indicators of negative affect and substance use emerged as distinct psychosocial risk profiles among HIV-infected men, and if these latent classes were associated with high-risk sexual behaviors that may transmit HIV. METHODS Data were from HIV-infected men who reported having anal intercourse in the past 6 months and received routine clinical care at 4 U.S. sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort (n = 1,210). Latent class membership was estimated using binary indicators for anxiety, depression, alcohol and/or drug use during sex, and polydrug use. Generalized estimating equations modeled whether latent class membership was associated with HIV sexual transmission risk in the past 6 months. RESULTS Three latent classes of psychosocial indicators emerged: (a) internalizing (15.3%; high probability of anxiety and major depression); (b) externalizing (17.8%; high probability of alcohol and/or drug use during sex and polydrug use); (c) low psychosocial distress (67.0%; low probability of all psychosocial factors examined). Internalizing and externalizing latent class membership were associated with HIV sexual transmission risk, compared to low psychosocial class membership; externalizing class membership was also associated with higher sexual transmission risk compared to internalizing class membership. CONCLUSIONS Distinct patterns of psychosocial health characterize this sexually active HIV-infected male patient population and are strongly associated with HIV sexual transmission risk. Public Health intervention efforts targeting HIV sexual risk transmission may benefit from considering symptom clusters that share internalizing or externalizing properties.
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Sutton KS, Stratton N, Pytyck J, Kolla NJ, Cantor JM. Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases. JOURNAL OF SEX & MARITAL THERAPY 2014; 41:563-580. [PMID: 25032736 DOI: 10.1080/0092623x.2014.935539] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals. Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic adulterers reported premature ejaculation and later onset of puberty. Designated patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this article nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively.
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Affiliation(s)
- Katherine S Sutton
- a Centre for Addiction and Mental Health, Sexual Behaviours Clinic , Toronto , Ontario , Canada
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Thompson RG, Eaton NR, Hu MC, Grant BF, Hasin DS. Regularly drinking alcohol before sex in the United States: effects of relationship status and alcohol use disorders. Drug Alcohol Depend 2014; 141:167-70. [PMID: 24950638 PMCID: PMC4110894 DOI: 10.1016/j.drugalcdep.2014.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/12/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drinking alcohol before sex increases the likelihood of engaging in sexual risk behaviors and risk for HIV infection. Relationship status (single versus partnered) and alcohol use disorders (AUD) are associated with each other and sexual risk behaviors, yet have not been examined as predictors of drinking alcohol before sex, using national data. This study examined whether relationship status and AUD increased the likelihood of regularly drinking alcohol before sex in a nationally representative sample. METHODS The main and additive interaction effects of relationship status and AUD on regularly drinking alcohol before sex were analyzed among sexually active drinkers (N=17,491) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Regularly drinking alcohol before sex was defined as drinking alcohol most or all of the time before sex. RESULTS After adjustment for controls, relationship status (AOR=3.51; CI=2.59-4.75) and AUD (AOR=6.24; CI=5.16-7.53) increased the likelihood of regularly drinking alcohol before sex and interacted to differentially increase this risk, with the effect of being single on the likelihood of regularly drinking alcohol before sex increased among participants with AUD (p<.001). CONCLUSIONS This study reinforces the importance of relationship status and AUD to the risk for regularly drinking alcohol before sex. Public health efforts should target alcohol and HIV prevention messages to single adults, particularly those with AUD, highlighting their risk for regularly drinking alcohol before sex.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA.
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York 11794, USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Sexual risk behaviors among club drug users in Shanghai, China: prevalence and correlates. AIDS Behav 2013; 17:2439-49. [PMID: 23247360 DOI: 10.1007/s10461-012-0380-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We surveyed 276 club drug users in Shanghai, China. Overall, 43.8 % reported ≥2 sex partners in the past 30 days, and 48.9 % reported having sex with non-regular partners, 67.4 % of whom had unprotected sex. Having ≥2 recent sex partners was associated with being 35 years or older, male, living with friends or others, introduced to club drug use by non-regular sex partners, using methamphetamine recently, self-identified as gay/lesbian or bisexual, had sexual debut before 20 years old, and recently had sex under the influence of drugs. Having unprotected sex with non-regular partners in the past 30 days was associated with lower education levels, having sex to obtain drugs, and lower levels of HIV/AIDS knowledge. Club drug users should be targeted for intervention programs. Future research needs to identify other protective and risk factors for sexual risk behaviors and design interventions to reduce club drug use and associated sexual risk behaviors.
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Caldwell DH, Jan G. Computerized assessment facilitates disclosure of sensitive HIV risk behaviors among African Americans entering substance abuse treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:365-9. [PMID: 22506839 DOI: 10.3109/00952990.2012.673663] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Individuals entering substance abuse treatment are at elevated risk for HIV infection, and clinicians must generally rely on patient self-report to gauge their involvement in risk behaviors. Strategies to improve accurate reporting of personally sensitive or stigmatizing risk behaviors are needed. OBJECTIVE This study compared computerized and face-to-face interview methods in eliciting self-disclosure of HIV risk behaviors among a high-risk sample of urban African Americans entering substance abuse treatment (N = 146). METHODS Participants completed a standardized HIV risk behavior screening as a face-to-face interview. Several days later, the same participants completed a computerized self-interview with the same measure, covering the same time frame. RESULTS Disclosure rates for many sensitive risk behaviors were considerably higher on the computerized interview. Participants had significantly higher odds of disclosure on the computerized interview compared to the face-to-face interview on 2 of 6 drug risk behaviors examined (ORs between 2.75 and 3.15) and 9 of 13 sex risk behaviors examined (ORs between 1.60 and 6.45). The advantage of the computerized interview was most evident for highly stigmatized behaviors, such as unprotected sex with someone other than a spouse or main partner (OR = 3.93; p < .001), unprotected sex during a commercial sex transaction (OR = 5.63; p < .001), unprotected anal sex (OR = 6.45; p < .001), and using unsterilized syringes (OR = 3.15; p < .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings support the utility of computerized risk behavior assessment with African Americans entering substance abuse treatment. Computerized assessment of HIV risk behaviors may be clinically useful in substance abuse treatment and other healthcare venues serving high-risk populations.
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Quinn C, Happell B. Getting BETTER: breaking the ice and warming to the inclusion of sexuality in mental health nursing care. Int J Ment Health Nurs 2012; 21:154-62. [PMID: 22145637 DOI: 10.1111/j.1447-0349.2011.00783.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Discussing sexual issues with consumers is considered a nursing role, yet it is commonly avoided. Research suggests that sexual issues and difficulties are particularly evident in mental health settings, and failure to address these issues represents a significant gap in care and treatment. Specific models for raising sexual issues have been used in oncology and cardiac care settings to assist clinicians. A descriptive, exploratory study was conducted with mental health nurses from Queensland, Australia. The aim of this research was to explore whether a specific model, the BETTER model (bring up, explain, tell, time, educate, record) was useful in assisting mental health nurses in raising the topic of sexuality with consumers. In-depth interviews explored participants' attitudes and experiences of discussing sexuality. Participants were introduced to the BETTER model, and were asked to trial the approach with consumers. They were then interviewed a second time. Two main themes emerged: greater awareness and becoming part of practice. Participants described a transformation of their practice from one of avoiding issues of sexuality with consumers, to a position of inclusion, which became embedded within practice. Participants did not tend to use the model in a structured way, and it appears that knowledge and awareness were more useful than the model itself.
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Affiliation(s)
- Chris Quinn
- Institute for Health and Social Science Research and School of Nursing and Midwifery, CQUniversity Australia, Rockhampton, QLD.
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47
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Johnson ME, Hanson BL, Metzger JS, Brems C, Dewane SL. Changes in sexual activity following substance dependence treatment. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.587093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Calsyn DA, Baldwin H, Niu X, Crits-Christoph P, Hatch-Maillette MA. Sexual risk behavior and sex under the influence: an event analysis of men in substance abuse treatment who have sex with women. Am J Addict 2011; 20:250-6. [PMID: 21477053 DOI: 10.1111/j.1521-0391.2011.00123.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine if there is evidence for a causative link between sex under the influence of drugs or alcohol and risky sex for men in substance abuse treatment. Men in treatment participating in a multisite HIV prevention protocol who reported on baseline, 3, or 6 months computerized assessments the details of their most recent sexual events, and who reported having sexual events under the influence and not under the influence, and who reported most recent events that did and did not include condom use served as participants (n = 37). Safe sex was not significantly more likely to happen when participants were under the influence of drugs or alcohol during their most recent sexual event (48.3%) than when they were not under the influence (49%, p = .82). In this high-risk in treatment sample, a causative link between sex under the influence of drugs or alcohol and sexual risk behavior was not supported.
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Guerrero EG, Cederbaum JA. Adoption and utilization of sexually transmitted infections testing in outpatient substance abuse treatment facilities serving high risk populations in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:41-8. [PMID: 20970314 DOI: 10.1016/j.drugpo.2010.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/29/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although adoption and utilization of sexually transmitted infection (STI) testing is a cost effective public health intervention, it is inconsistently offered or referred out for by outpatient substance abuse treatment (OSAT) programs where at-risk racial/ethnic and sexual minorities receive services. METHODS We explored the organizational adoption and client utilization of STI testing using a nationally representative sample of OSAT facilities in the U.S. in 2005 (N=566). Data missing at random was imputed and the resulting database was analysed using multivariate Tobit and logistic regressions. RESULTS The analyses suggest that private non-profit facilities, which are the largest providers of OSAT treatment are less likely than public facilities to offer STI testing or to report adequate client utilization rates. Higher utilization was instead associated with professionally accredited facilities, and with facilities whose majority of clients were Latino/a, reported a history of treatment, stayed in treatment longer, or received case management. CONCLUSION While OSAT facilities are poised to be primary intervention points for diagnosis and treatment of STIs, only a segment of these facilities provide this preventive practice or manage to refer clients out. As such, U.S. health care policy should ensure the adoption and comprehensive utilization, particularly among high risk clients, of this cost-effective prevention strategy in OSAT admission protocols.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089-041, USA.
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Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatment. Addiction 2010; 105:100-8. [PMID: 20078464 PMCID: PMC2808629 DOI: 10.1111/j.1360-0443.2009.02812.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. DESIGN Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. PARTICIPANTS The participants were assigned randomly to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI) or human immunodeficiency virus (HIV) education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. FINDINGS Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (t(intervention) = -2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. CONCLUSIONS Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up.
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Affiliation(s)
- Donald A. Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Mary A. Hatch-Maillette
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Yong S. Song
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
| | - Susan Coyer
- Prestera Center for Mental Health Services Inc., Huntington, WV
| | - Sara Pelta
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
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