Reducing Opioid Mortality in Illinois (ROMI): A case management/peer recovery coaching critical time intervention clinical trial protocol

Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.

#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign

Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago's PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.

Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries

BACKGROUND

Upwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown.

METHODS

We investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities.

RESULTS

Findings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis.

CONCLUSIONS

Our findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.

Medical, therapeutic, and recreational use of cannabis among young men who have sex with men living with HIV

Cannabis plays a role in symptoms management in HIV, especially the alleviation of pain and nausea and stimulation of appetite, and prevalence of cannabis use in HIV-positive populations exceeds that of the general U.S. population. Previous research has described an "overlap" between medical and recreational cannabis use among persons living with HIV. To understand better the motives associated cannabis use among young men who have sex with men living with HIV (HIV+ YMSM), we conducted semi-structured interviews with 30 HIV+YMSM in Denver and Chicago. Interviews were audio-recorded, transcribed, and coded by a diverse team of analysts. In addition to findings that mapped onto previously identified medical motives and recreational motives, we identified several themes that straddled medical and recreational use in a domain we describe as therapeutic. Themes identified in this therapeutic domain of cannabis use include (a) enhanced introspection among individuals that promotes psychological adjustment to an HIV diagnosis, improved medical management, and future orientation; (b) reflection processes that mitigate interpersonal conflict and improve interpersonal communication; and (c) a social-therapeutic phenomena of cannabis use among young persons with living HIV that is characterized by both enhanced introspection and improved interpersonal communication. Our findings suggest a spectrum of cannabis use among HIV+ YMSM that may be characterized not only by an overlap between medical and recreational use, but also by a distinct therapeutic domain that incorporates stress alleviation and cognitive expansion processes to improve focus on HIV management and self-care.

Methodological Considerations for Advancing Research on the Health and Wellbeing of Sexual and Gender Minority Youth

Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools.

Dynamic social support networks of younger black men who have sex with men with new HIV infection

Rising rates of HIV infection among younger black men who have sex with men (YBMSM) in the USA have generated a public health emergency. Living with HIV requires deep and persistent social support often available only from close confidants. Enlisting endogenous support network members into the care of HIV-infected YBMSM may help shape sustainable supportive environments, leading to long-term improvements in mental and HIV-specific health outcomes. The present study examined trends in support network change over time after new HIV diagnoses among 14 YBMSM. Participants completed a social network survey that utilized sociograms to record support confidants (SCs) preceding HIV diagnosis and at one and nine months postdiagnosis. Reported SCs included family of origin, friends, sex partners, and other associates. Analysis revealed three distinct patterns of change: high gain, high turnover, and stable networks. These patterns offer valuable insights into the social support of YBMSM during the period following diagnosis. This research underscores a growing movement to embrace key support figures in the lives of YBMSM, who may be critical to promoting overall health and adherence to HIV-care.