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Stanton AM, Boyd RL, O’Cleirigh C, Olivier S, Dolotina B, Gunda R, Koole O, Gareta D, Modise TH, Reynolds Z, Khoza T, Herbst K, Ndung’u T, Hanekom WA, Wong EB, Pillay D, Siedner MJ. HIV, multimorbidity, and health-related quality of life in rural KwaZulu-Natal, South Africa: A population-based study. PLoS One 2024; 19:e0293963. [PMID: 38381724 PMCID: PMC10880982 DOI: 10.1371/journal.pone.0293963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/23/2023] [Indexed: 02/23/2024] Open
Abstract
Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. In a secondary analysis of cross-sectional data from the Vukuzazi ("Wake up and know ourselves" in isiZulu) study, which identified the prevalence and overlap of non-communicable and infectious diseases in the uMkhanyakunde district of KwaZulu-Natal, we (1) evaluated the impact of multimorbidity on HRQoL; (2) determined the relative associations among infectious diseases, non-communicable diseases (NCDs), and HRQoL; and (3) examined the effects of controlled versus non-controlled disease on HRQoL. HRQoL was measured using the EQ-5D-3L, which assesses overall perceived health, five specific domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and three levels of problems (no problems, some problems, and extreme problems). Six diseases and disease states were included in this analysis: HIV, diabetes, stroke, heart attack, high blood pressure, and TB. After examining the degree to which number of conditions affects HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added. A total of 14,008 individuals were included in this analysis. Having more conditions adversely affected perceived health (r = -0.060, p<0.001, 95% CI: -0.073 to -0.046) and all HRQoL domains. Infectious conditions were related to better perceived health (r = 0.051, p<0.001, 95% CI: 0.037 to 0.064) and better HRQoL, whereas non-communicable diseases (NCDs) were associated with worse perceived health (r = -0.124, p<0.001, -95% CI: 0.137 to -0.110) and lower HRQoL. Particular combinations of NCDs were detrimental to perceived health, whereas HIV, which was characterized by access to care and suppressed viral load in the large majority of those affected, was counterintuitively associated with better perceived health. With respect to disease control, unique combinations of uncontrolled NCDs were significantly related to worse perceived health, and controlled HIV was associated with better perceived health. The presence of controlled and uncontrolled NCDs was associated with poor perceived health and worse HRQoL, whereas the presence of controlled HIV was associated with improved HRQoL. HIV disease control may be critical for HRQoL among people with HIV, and incorporating NCD prevention and attention to multimorbidity into healthcare strategies may improve HRQoL.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Ryan L. Boyd
- The Obelus Institute, Washington, DC, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Zahra Reynolds
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), South African Medical Research Council, Durban, South Africa
| | - Thumbi Ndung’u
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Willem A. Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Wirtz MR, Stanton AM, Manohar R, Labbe AK, Zvolensky MJ, Smits JAJ, Hoeppner B, O’Cleirigh C. The Relationship Between Cigarette Dependence and Cessation Methods: Implications for Smoking Cessation Among People With HIV. J Stud Alcohol Drugs 2023; 84:772-780. [PMID: 37219036 PMCID: PMC10600974 DOI: 10.15288/jsad.22-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE These analyses investigate how dependence may be related to cessation method choice and how this relationship may vary by subpopulation among people with HIV (PWH) who smoke cigarettes. METHOD PWH who smoke (N = 71) were recruited from clinics in Boston, MA. The Fagerström Test for Nicotine Dependence (FTND) and Smoking History Questionnaire (SHQ) were completed to assess for cigarette dependence, past-week cigarettes per day (CPD), and past cessation method use. Logistic regression examined the association between dependence and previous cessation methods for the whole sample, and moderation analyses assessed this relationship by age and race. RESULTS Higher FTND was associated with less use of behavioral modification methods (odds ratio [OR] = 0.658, 95% CI [0.435, 0.994], p = .047). Higher past-week CPD was associated with use of the American Cancer Society/American Lung Association (ACS/ALA) programs (OR = 1.159, 95% CI [1.011, 1.328], p = .035) and telephone counselling (OR = 1.142, 95% CI [1.006, 1.295], p = .040]). Older participants with more past-week CPD were more likely to have used the ACS/ALA programs (B = 0.0169, 95% CI [0.0008, 0.0331], p = .0401), and White participants with more past-week CPD were less likely to have tried to quit "cold turkey" (B = 0.1676, 95% CI [0.0027, 0.3326], p = .0464). CONCLUSIONS These preliminary results suggest that there is likely not a "one-size-fits-all" approach to cessation for PWH who smoke, especially within subpopulations (i.e., age and race). Implications include ensuring access to multiple cessation methods, identifying methods that could be culturally appropriate outside of the clinical intervention setting, and providing education and support on cessation methods offered.
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Affiliation(s)
- Megan R. Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Graduate Center, City University of New York, New York, New York
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
| | - Rohin Manohar
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison K. Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- HEALTH Institute, University of Houston, Houston, Texas
| | | | - Bettina Hoeppner
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska J. Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder. AIDS Behav 2023; 27:2681-2694. [PMID: 36708417 PMCID: PMC10338393 DOI: 10.1007/s10461-023-03992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
Depression and cognitive impairment, which commonly coexist in people with HIV (PWH), have been identified as potential barriers to optimal antiretroviral therapy (ART) adherence. We investigated associations between cognitive performance, depression (as well as other sociodemographic, psychosocial and psychiatric variables) and ART adherence in a South African cohort of PWH with comorbid major depressive disorder (MDD). Cognitive performance and ART adherence were assessed at two time points 8 months apart (Nbaseline = 105, Nfollow-up = 81). Adherence was indicated by self-report, objective measures (Wisepill usage and plasma tenofovir-diphosphate levels), and HIV viral suppression. Mixed-effects regression models examined associations across both time points. Univariate models detected no significant associations between cognitive performance (globally and within-domain) and ART adherence. Multivariate modelling showed increased depression severity (β = - 0.54, p < 0.001) and problematic alcohol use (β = 0.73, p = 0.015) were associated with worse adherence as measured subjectively. Being female (OR 0.27, p = 0.048) and having better global cognitive performance (OR 1.83, p = 0.043) were associated with better adherence as indicated by viral suppression. This study identifies poor global cognitive performance, as well as depression and problematic alcohol use, as potential barriers to optimal ART adherence in PWH and comorbid MDD. Hence, clinicians could consider assessing for cognitive deficits, depression, and problematic alcohol use, and should endeavour to provide the appropriate support so as to improve adherence.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Conall O’Cleirigh
- Department of Psychology, Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Ganapathi L, McFall AM, Greco KF, Srikrishnan AK, Suresh Kumar M, Mayer KH, O’Cleirigh C, Mehta SH, Lucas GM, Solomon SS. Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India. Drug Alcohol Depend 2023; 246:109839. [PMID: 37031487 PMCID: PMC10416117 DOI: 10.1016/j.drugalcdep.2023.109839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND India is facing overlapping opioid injection and HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide single-venue HIV and substance use services to PWID. We evaluated PWID engagement in daily observed buprenorphine treatment at 7 ICCs to inform interventions. METHODS We analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January - 31 December 2018, evaluating receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days with subsequent re-engagement), and drop-out (no buprenorphine receipt for 60 consecutive days without re-engagement). Using descriptive statistics, we explored differences between ICCs in the opioid-endemic Northeast region and ICCs in the emerging opioid epidemic North/Central region. We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months. RESULTS 1312 PWID initiated buprenorphine (76% North/Central ICCs vs. 24% Northeast ICCs). 31% of PWID in North/Central, and 25% in Northeast ICCs experienced ≥ 1 treatment interruption in 1 year. Over 6 months, 48% of PWID in North/Central vs. 60% in Northeast ICCs received buprenorphine ≤ 2 times/week (p < 0.0001). A third of PWID in North/Central vs. half in Northeast ICCs experienced treatment drop-out by 6 months (p < 0.001). In the multivariable model, living in Northeast cities was associated with increased odds of drop-out while counseling receipt was associated with decreased odds. CONCLUSIONS Retention among PWID initiating buprenorphine at ICCs was comparable to global reports. However, regional heterogeneity in retention, and low daily buprenorphine receipt suggest patient-centered interventions adapted to regional contexts are urgently needed.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, Massachusetts 02114
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, Massachusetts 02114
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
| | - Allison M. McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, Maryland 21205
| | - Kimberly F. Greco
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, 21 Autumn Street, Boston, Massachusetts 02215
| | - Aylur K. Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, India 600010
| | - Muniratnam Suresh Kumar
- YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, India 600010
| | - Kenneth H. Mayer
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215
- The Fenway Institute, 1340 Boylston Street, Boston, Massachusetts 02215
| | - Conall O’Cleirigh
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Shruti H. Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, Maryland 21205
| | - Gregory M. Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, Maryland 21205
| | - Sunil S. Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, Maryland 21205
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Taylor SW, McKetchnie SM, Batchelder AW, Justice A, Safren SA, O’Cleirigh C. Chronic pain and substance use disorders among older sexual minority men living with HIV: Implications for HIV disease management across the HIV care continuum. AIDS Care 2023; 35:614-623. [PMID: 35653300 PMCID: PMC9715850 DOI: 10.1080/09540121.2022.2076801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
HIV continues to be a critical health issue for sexual minority men (SMM) in the USA. Chronic pain is common in individuals with HIV, including older SMM, and is associated with substance use behaviors. This cross-sectional study sought to address a gap in the literature by characterizing interrelationships among chronic pain, substance use disorders (SUDs), medication adherence, and engagement in HIV care among older (≥50) SMM living with HIV and chronic pain (N = 63). The unadjusted relationship between an opioid use disorder and pain indicated that participants with an opioid use disorder reported higher pain ratings than those without. Presence of alcohol use disorder was significantly associated with missed HIV-care appointments due to chronic pain or substance use, showing that individuals with an alcohol use disorder reported more missed appointments in the past year. Higher pain was significantly associated with the same missed appointments variable, such that those reporting higher pain ratings also reported more missed appointments in the past year. These findings provide preliminary evidence of the interrelationships among chronic pain, SUDs, and engagement in HIV care among older SMM living with HIV and suggest that pain management in this population might support fuller engagement in HIV care.
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Affiliation(s)
- S. Wade Taylor
- Boston University School of Social Work, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M. McKetchnie
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail W. Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Amy Justice
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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6
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska JA. Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder. J Int Assoc Provid AIDS Care 2023; 22:23259582231203192. [PMID: 37787183 PMCID: PMC10548808 DOI: 10.1177/23259582231203192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, , Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
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7
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Sullivan MC, Wirtz MR, McKetchnie SM, Hart TA, Fitch C, Lazkani S, Boroughs MS, O’Cleirigh C. The impact of depression and post-traumatic stress symptoms on physical health perceptions and functional impairment among sexual minority men living with HIV with histories of trauma. AIDS Care 2022; 34:1288-1296. [PMID: 34403289 PMCID: PMC8850536 DOI: 10.1080/09540121.2021.1967852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mental health symptoms may compromise health-related quality of life (HRQOL), including among men who have sex with men (MSM) living with HIV, who experience high rates of trauma and other stressors. This study sought to examine the relative contributions of post-traumatic stress disorder (PTSD) symptoms, depression symptoms, and biological indices of HIV disease status on HRQOL in this population. Participants were 79 MSM with HIV (49% White; 35% Black; 8% Hispanic/Latinx) with trauma histories (52% met current PTSD diagnostic criteria). HRQOL outcomes were general perceptions of health (0-100 visual analog scale) and functional disability (WHODAS 2.0). Dominance analysis was applied to examine the relative share of variance in these outcomes accounted for by PTSD symptom severity, depression symptom severity, viral suppression status, and CD4 count. Depression symptom severity accounted for 70% and 92% of variance in perceived health, respectively, across models (p's < 0.05). Both PTSD symptom severity (45%) and depression symptom severity (43%) scores also accounted for significant variance in functional disability (p's < 0.05). Medical indices of HIV disease progression did not explain significant variance in HRQOL in any model. A trauma-informed approach may aid clinicians in interpreting reports of health and physical functioning in MSM with HIV.
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Affiliation(s)
- Matthew C. Sullivan
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA,Harvard Medical School, Boston, MA
| | - Megan R. Wirtz
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA
| | - Samantha M. McKetchnie
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA
| | - Trevor A. Hart
- Ryerson University, Department of Psychology, Toronto, ON,University of Toronto, Dalla Lana School of Public Health, Toronto, ON
| | - Calvin Fitch
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA
| | - Samer Lazkani
- Ryerson University, Department of Psychology, Toronto, ON
| | | | - Conall O’Cleirigh
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA,Harvard Medical School, Boston, MA
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Goodman GR, Kikut A, Bustamante MJ, Mendez L, Mohamed Y, Shachar C, Cohen IG, Gerke S, Boyer EW, Rosen RK, Mayer KH, O’Cleirigh C, Chai PR. "I'd feel like someone was watchin' me… watching for a good reason": perceptions of data privacy, access, and sharing in the context of real-time PrEP adherence monitoring among HIV-negative MSM with substance use. AIDS Behav 2022; 26:2981-2993. [PMID: 35303187 DOI: 10.1007/s10461-022-03614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/01/2022]
Abstract
Once-daily oral tenofovir/emtricitabine is highly effective as pre-exposure prophylaxis (PrEP) against HIV but is dependent on adherence, which may be challenging for men who have sex with men (MSM) and use substances. Digital pill systems (DPS) permit the direct, real-time measurement of adherence, though user perceptions of data privacy in this context are unknown. Thirty prospective DPS users - HIV-negative MSM with non-alcohol substance use - completed in-depth qualitative interviews exploring preferences around privacy, access, and sharing of DPS adherence data. Participants discussed some concerns about the impact of DPS use on personal privacy, and emphasized the need for robust data protections in the technology. Participants were interested in having on-demand access to their adherence data, and were most willing to share data with primary care providers and long-term relationship partners. Future investigations exploring bioethical frameworks around DPS use are warranted, and user preferences should inform best practices for protecting DPS data.
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Batchelder AW, Burgess C, Perlson J, O’Cleirigh C. Age and Year of HIV Diagnosis are Associated with Perceptions of Discrimination and Internalized Stigma Among Sexual Minority Men Who Use Substances. AIDS Behav 2022; 26:125-137. [PMID: 34117966 PMCID: PMC8665940 DOI: 10.1007/s10461-021-03333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
Discrimination and internalized stigma are barriers to engagement in HIV self-care among men who have sex with men (MSM) living with HIV. However, differences in perceptions of discrimination and internalized stigmas by age, year of HIV-diagnosis, and race are poorly understood. We assessed differences in reported discrimination related to HIV, race, sexual orientation, and substance use and internalized stigmas among 202 MSM living with HIV who use substances. Younger participants reported higher levels of all types of discrimination and internalized stigmas (p-values < 0.001-0.030). Those diagnosed after the advent of antiretrovirals reported higher levels of discrimination related to HIV, sexual orientation, and substance use, as well as internalized stigma related to HIV and substance use (p-values 0.001-0.049). We explored perceived community HIV stigma, which accounted for associations involving age and year of diagnosis. Age, year of diagnosis, and race should be considered when assessing and intervening with stigma.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA,Corresponding Author: Abigail Batchelder, Ph.D., M.P.H., One Bowdoin Square, 7th Floor, Boston, MA 02114; Phone: 617-643-0387; Fax: 617-536-8602;
| | - Claire Burgess
- Department of Psychiatry, Harvard Medical School, Boston, MA,VA Boston Healthcare System, Boston, MA
| | - Jacob Perlson
- The Fenway Health Institute, Fenway Health, Boston, MA,Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA
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10
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Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, Myers B, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc 2021; 24 Suppl 2:e25720. [PMID: 34164935 PMCID: PMC8222840 DOI: 10.1002/jia2.25720] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low-resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. METHODS A pilot randomized hybrid type 1 effectiveness-implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task-shared, peer-delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on-site AOD treatment. Implementation outcomes, defined by Proctor's model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post-treatment (three months) measured via real-time electronic adherence monitoring, and AOD measured using biomarker and self-report assessments over six months. Data collection was conducted from August 2018 to April 2020. RESULTS AND DISCUSSION Ninety-one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment-by-time interaction for ART adherence (estimate = -0.287 [95% CI = -0.507, -0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self-reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow-back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). CONCLUSIONS Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non-adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task-sharing models for behavioral health in resource-limited, global settings.
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Affiliation(s)
| | - John A Joska
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | - Lena S Andersen
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilDivision of Addiction PsychiatryDepartment of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Sybil Majokweni
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | - Conall O’Cleirigh
- Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
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11
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Batchelder AW, Safren S, Coleman J, Boroughs M, Thiim A, Ironson G, Shipherd JC, O’Cleirigh C. Indirect Effects From Childhood Sexual Abuse Severity to PTSD: The Role of Avoidance Coping. J Interpers Violence 2021; 36:NP5476-NP5495. [PMID: 30246600 PMCID: PMC6785355 DOI: 10.1177/0886260518801030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Men who have sex with men (MSM) disproportionately experience childhood sexual abuse (CSA) compared with heterosexual men, often resulting in continued trauma-related sequelae, including symptoms of posttraumatic stress disorder (PTSD) such as avoidance. The variability in trauma-related sequelae may be associated with chronicity or duration of CSA. The relationship between duration of CSA and later PTSD symptom severity is not well understood, including the extent coping strategies account for these relationships. We used linear regression to examine these relationships and to assess the indirect effects of avoidance (behavioral disengagement and denial) and adaptive coping strategies on the relationship between CSA duration and adult PTSD symptom severity on a diverse sample included 290 MSM with a history of CSA. In adjusted models, CSA duration was significantly associated with adult PTSD symptom severity (standardized β = .23, p < .000) and with avoidance coping (standardized β = .19, p = .002). Separating this out, behavioral disengagement was significantly associated with CSA duration (standardized β = .20, p = .001) but denial was not. In adjusted analyses assessing indirect effects, avoidance coping partially accounted for the relationship between CSA duration and total trauma symptom severity (standardized β reduced from .23 to .17; Sobel = 2.90, p = .004). Similarly, behavioral disengagement partially accounted for the association between CSA duration and total symptoms (standardized β reduced from .23 to .18; Sobel = 2.68, p = .007). Avoidance coping, and behavioral disengagement specifically, may play a role in the severity of PTSD symptoms experienced by MSM with CSA histories. This work emphasizes the need for clinicians to consider behavioral disengagement in understanding PTSD symptom severity among MSM with histories of CSA.
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Affiliation(s)
- A. W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
| | - S. Safren
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL 33146
| | - J.N. Coleman
- Department of Psychology and Neuroscience & Duke Global Health Institute, Duke University, NC 27710
| | - M.S. Boroughs
- University of Windsor, 401 Sunset Ave, Windsor, ON N9B 3P4, Canada
| | - A. Thiim
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
| | - G. Ironson
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL 33146
| | - J. C Shipherd
- Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration, 810 Vermont Avenue, NW Washington, DC 20420
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130
- Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118
| | - C. O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
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12
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Safren SA, Devaleenal B, Biello KB, Rawat S, Thomas BE, Regenauer KS, Balu V, Bedoya CA, Dange A, Menon S, O’Cleirigh C, Baruah D, Anand V, Hanna LE, Karunaianantham R, Thorat R, Swaminathan S, Mimiaga MJ, Mayer KH. Geographic and behavioral differences associated with sexually transmitted infection prevalence among Indian men who have sex with men in Chennai and Mumbai. Int J STD AIDS 2021; 32:144-151. [PMID: 33323073 PMCID: PMC9528997 DOI: 10.1177/0956462420943016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = -11.8, 95% CI: -14.6, -9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p < .0001) revealed that in Chennai, higher rates of CAS were not associated with STI prevalence, but in Mumbai they were (PR = 2.49, 95% CI: 1.65, 3.76, p < .0001). The higher prevalence of bacterial STIs but lower frequency of CAS in Mumbai (versus Chennai), along with the significant interaction of CAS with city on STI rates, suggests that there are either differences in disease burden or differences by city with respect to self-reported assessment of CAS. Regardless, the high prevalence rates of untreated STIs and condomless sex among MSM suggest the need for additional prevention intervention efforts for MSM in urban India.
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Affiliation(s)
- Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL
- The Fenway Institute, Fenway Health, Boston, MA
| | - Bella Devaleenal
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
| | - Katie B. Biello
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI
| | | | - Beena E. Thomas
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
| | | | - Vinoth Balu
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
| | - C. Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Luke Elizabeth Hanna
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
| | - Ramesh Karunaianantham
- Indian Council of Medical Research (ICMR) - National Institute for Research in Tuberculosis, Chennai, India
| | | | - Soumya Swaminathan
- The Fenway Institute, Fenway Health, Boston, MA
- World Health Organization, Geneva, Switzerland
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Harvard Medical School, Boston, MA
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13
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Stanton AM, Batchelder AW, Kirakosian N, Scholl J, King D, Grasso C, Potter J, Mayer KH, O’Cleirigh C. Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. PLoS One 2021; 16:e0245872. [PMID: 33493207 PMCID: PMC7833136 DOI: 10.1371/journal.pone.0245872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Mental health disparities among transgender and gender diverse (TGD) populations have been documented. However, few studies have assessed differences in mental health symptom severity, substance use behavior severity, and engagement in care across TGD subgroups. Using data from the electronic health record of a community health center specializing in sexual and gender minority health, we compared the (1) severity of self-reported depression, anxiety, alcohol use, and other substance use symptoms; (2) likelihood of meeting clinical thresholds for these disorders; and (3) number of behavioral health and substance use appointments attended among cisgender, transgender, and non-binary patients. Participants were 29,988 patients aged ≥18 who attended a medical appointment between 2015 and 2018. Depression symptom severity (F = 200.6, p < .001), anxiety symptom severity (F = 102.8, p < .001), alcohol use (F = 58.8, p < .001), and substance use (F = 49.6, p < .001) differed significantly by gender. Relative to cisgender and transgender individuals, non-binary individuals are at elevated risk for depression, anxiety, and substance use disorders. Gender was also associated with differences in the number of behavioral health (χ2 = 51.5, p < .001) and substance use appointments (χ2 = 39.3, p < .001) attended. Engagement in treatment among certain gender groups is poor; cisgender women and non-binary patients assigned male at birth were the least likely to have attended a behavioral health appointment, whereas transgender men and cisgender women had attended the lowest number of substance use appointments. These data demonstrate the importance of (1) assessing gender diversity and (2) addressing the barriers that prevent TGD patients from receiving affirming care.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James Scholl
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Psychiatry, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
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14
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Magidson JF, Joska JA, Myers B, Belus JM, Regenauer KS, Andersen LS, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa. Implement Sci Commun 2020; 1:23. [PMID: 32607502 PMCID: PMC7326344 DOI: 10.1186/s43058-020-00004-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population. METHODS Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patient-level effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome. DISCUSSION Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Affiliation(s)
- Jessica F. Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Kristen S. Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sybil Majokweni
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, USA
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15
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Mimiaga MJ, Pantalone DW, Biello KB, White Hughto JM, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care 2019; 31:1083-1095. [PMID: 30887824 PMCID: PMC6625920 DOI: 10.1080/09540121.2019.1595518] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jackie M. White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - John Frank
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Behavioral Medicine Service, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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16
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Jemison D, Jackson S, Oni O, Cats-Baril D, Thomas-Smith S, Batchelder A, Rodriguez A, Dilworth SE, Metsch LR, Jones D, Feaster DJ, O’Cleirigh C, Ironson G, Carrico AW. Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women. AIDS Behav 2019; 23:2467-2476. [PMID: 31407212 DOI: 10.1007/s10461-019-02625-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log10 HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.
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Everitt-Penhale B, Kagee A, Magidson JF, Joska J, Safren SA, O’Cleirigh C, Witten J, Lee JS, Andersen LS. 'I went back to being myself': acceptability of a culturally adapted task-shifted cognitive-behavioural therapy (CBT) treatment for depression (Ziphamandla) for South African HIV care settings. PSYCHOL HEALTH MED 2019; 24:680-690. [PMID: 30652921 PMCID: PMC6484450 DOI: 10.1080/13548506.2019.1566624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/25/2018] [Indexed: 12/22/2022]
Abstract
There is a need for a culturally adapted, evidence-based, psychotherapy treatment that is effective, acceptable, and feasible for integration into primary care in South Africa. This qualitative study used exit interviews to examine participants' experiences of an adapted cognitive-behavioural therapy treatment for adherence and depression, task-shifted and delivered by nurses in two peri-urban HIV clinics near Cape Town. Nine semi-structured exit interviews were conducted with isiXhosa-speaking females and analysed using thematic analysis. Overall, participants responded positively to the treatment, viewing it as acceptable and beneficial and as a catalyst to returning to normalcy. Results indicated that participants viewed the treatment as being effective in ameliorating their depressive symptoms and improving their adherence to ART . Additional benefits described included improvements in subjective wellbeing and social and occupational functioning. Several began or resumed employment, an important behavioural indicator of the treatment's capacity to facilitate positive change and cost saving. Recommendations to improve the treatment included using video material and educating others about depression. These findings have positive implications regarding the acceptability and cultural applicability of the treatment for use in South Africa.
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Affiliation(s)
- B. Everitt-Penhale
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - A. Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - J. F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - J. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S. A. Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C. O’Cleirigh
- Behavioral Medicine, Massachusetts General Hospital/Department of Psychiatry, Harvard University, Boston, MA, USA
| | - J. Witten
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J. S. Lee
- Department of Psychology, University of Miami, Miami, FL, USA
| | - L. S. Andersen
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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18
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Boroughs MS, Ehlinger PP, Batchelder AW, Safren SA, O’Cleirigh C. Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse. J Trauma Stress 2018; 31:665-675. [PMID: 30338584 PMCID: PMC6557140 DOI: 10.1002/jts.22335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
Emerging adulthood (EA) is a developmental period marked by unique challenges that affect health including burgeoning occupational, relational, and financial stability; and increased risk taking in terms of sexual behavior(s) and substance use. Data were collected from 296 HIV-uninfected sexual minority men with childhood sexual abuse (CSA) histories. We analyzed baseline assessment data from a multisite randomized controlled trial that tested the efficaciousness of an experimental psychosocial treatment and examined vulnerabilities known to be linked with CSA. Our analyses compared EA sexual minority men, aged 18-29, with older sexual minority men (OSMM) on posttraumatic stress disorder (PTSD) and other mental health and substance use outcomes. We found higher odds of PTSD, odds ratio (OR) = 0.57, 95% CI [0.33, 0.96]; panic disorder or panic disorder with agoraphobia, OR = 0.36, 95% CI [0.16, 0.85]; and cocaine use, OR = 0.50, 95% CI [0.25, 0.97], among OSMM and higher odds of alcohol intoxication, OR = 5.60, 95% CI [3.20, 9.82]; cannabis use, OR = 3.09, 95% CI [1.83, 5.21]; and non-HIV sexually transmitted infections, OR = 3.03, 95% CI [1.29, 7.13], among the EA men. These results present a complex picture of health risks among sexual minority men in general and EA sexual minority men in particular. HIV seroconversion linked health risk behaviors, among sexual minority men, may be better addressed via increased attention to treating trauma and comorbid mental health and substance use problems using evidence-based psychosocial assessments and integrated treatment platforms that are tailored to this population.
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Affiliation(s)
- Michael S. Boroughs
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Peter P. Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon, USA
| | - Abigail W. Batchelder
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven A. Safren
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Department of Psychology, University of Miami, Miami, Florida, USA
| | - Conall O’Cleirigh
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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19
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Banerjee N, Ironson G, Fitch C, Boroughs MS, Safren SA, Powell A, O’Cleirigh C. The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men. J Trauma Stress 2018; 31:602-612. [PMID: 30028033 PMCID: PMC6286675 DOI: 10.1002/jts.22304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/06/2022]
Abstract
Self-medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self-blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals' self-perceptions and appraisals of the world as dangerous may play a role in self-medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV-infection risk.
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Affiliation(s)
- Nikhil Banerjee
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Calvin Fitch
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | | | - Steven A. Safren
- Department of Psychology, University of Miami, Coral
Gables, Florida, USA
| | - Alexis Powell
- Miller School of Medicine, University of Miami, Miami,
Florida, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Harvard Medical
School/Massachusetts General Hospital, Boston, Massachusetts, USA
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20
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Mimiaga MJ, Thomas B, Mayer KH, Regenauer KS, Dange A, Andres Bedoya C, Rawat S, Balu V, O’Cleirigh C, Biello KB, Anand V, Swaminathan S, Safren SA. A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol. BMC Public Health 2018; 18:890. [PMID: 30021566 PMCID: PMC6052541 DOI: 10.1186/s12889-018-5838-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India. METHODS Funded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months. DISCUSSION HIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.
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Affiliation(s)
- Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
- Center for Health Equity Research, Brown University, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI USA
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconness Medical Center, Boston, MA USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Kristen S. Regenauer
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - C. Andres Bedoya
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - Vinoth Balu
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Katie B. Biello
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
| | | | | | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Miami, Coral Gables, FL USA
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21
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Pence BW, Mills JC, Bengtson AM, Gaynes BN, Breger TL, Cook RL, Moore RD, Grelotti DJ, O’Cleirigh C, Mugavero MJ. Association of Increased Chronicity of Depression With HIV Appointment Attendance, Treatment Failure, and Mortality Among HIV-Infected Adults in the United States. JAMA Psychiatry 2018; 75:379-385. [PMID: 29466531 PMCID: PMC5875308 DOI: 10.1001/jamapsychiatry.2017.4726] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Depression commonly affects adults with HIV and complicates the management of HIV. Depression among individuals with HIV tends to be chronic and cyclical, but the association of this chronicity with HIV outcomes (and the related potential for screening and intervention to shorten depressive episodes) has received little attention. OBJECTIVE To examine the association between increased chronicity of depression and multiple HIV care continuum indicators (HIV appointment attendance, treatment failure, and mortality). DESIGN, SETTING, AND PARTICIPANTS The study comprised an observational clinical cohort of 5927 patients with 2 or more assessments of depressive severity who were receiving HIV primary care at 6 geographically dispersed US academic medical centers from September 22, 2005, to August 6, 2015. MAIN OUTCOMES AND MEASURES Missing a scheduled HIV primary care visit, detectable HIV RNA viral load (≥75 copies/mL), and all-cause mortality. Consecutive depressive severity measures were converted into a time-updated measure: percentage of days with depression (PDD), following established methods for determining depression-free days. RESULTS During 10 767 person-years of follow-up, the 5927 participants (5000 men, 926 women, and 1 intersex individual; median age, 44 years [range, 35-50 years]) had a median PDD of 14% (interquartile range, 0%-48%). During follow-up, 10 361 of 55 040 scheduled visits (18.8%) were missed, 6191 of 28 455 viral loads (21.8%) were detectable, and the mortality rate was 1.5 deaths per 100 person-years. Percentage of days with depression showed a dose-response relationship with each outcome. Each 25% increase in PDD led to an 8% increase in the risk of missing a scheduled appointment (risk ratio, 1.08; 95% CI, 1.05-1.11), a 5% increase in the risk of a detectable viral load (risk ratio, 1.05; 95% CI, 1.01-1.09), and a 19% increase in the mortality hazard (hazard ratio, 1.19; 95% CI, 1.05-1.36). These estimates imply that, compared with patients who spent no follow-up time with depression (PDD, 0%), those who spent the entire follow-up time with depression (PDD, 100%) faced a 37% increased risk of missing appointments (risk ratio, 1.37; 95% CI, 1.22-1.53), a 23% increased risk of a detectable viral load (risk ratio, 1.23; 95% CI, 1.06-1.43), and a doubled mortality rate (hazard ratio, 2.02; 95% CI, 1.20-3.42). CONCLUSIONS AND RELEVANCE Greater chronicity of depression increased the likelihood of failure at multiple points along the HIV care continuum. Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes. Clinic-level trials of protocols to promptly identify and appropriately treat depression among adults living with HIV should be conducted to understand the effect of such protocols on shortening the course and preventing the recurrence of depressive illness and improving clinical outcomes.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | - Jon C. Mills
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | | | - Bradley N. Gaynes
- Department of Psychiatry, School of Medicine, the University of North Carolina at Chapel Hill
| | - Tiffany L. Breger
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville,Department of Medicine, University of Florida, Gainesville
| | - Richard D. Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David J. Grelotti
- Department of Psychiatry, School of Medicine, University of California, San Diego
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Community Health, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Michael J. Mugavero
- Department of Medicine, University of Alabama at Birmingham,UAB Center for AIDS Research, University of Alabama at Birmingham
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22
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Dale SK, Pierre-Louis C, Bogart LM, O’Cleirigh C, Safren SA. Still I rise: The need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cultur Divers Ethnic Minor Psychol 2018; 24:15-25. [PMID: 28604021 PMCID: PMC5726949 DOI: 10.1037/cdp0000165] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Psychosocial factors of trauma and abuse, racial discrimination, HIV stigma, and gender-related stressors (e.g., prioritizing others' needs) have been associated with antiretroviral treatment (ART) nonadherence and poor viral suppression among Black women living with HIV (BWLWH). To inform the development of an intervention addressing these psychosocial factors to improve ART adherence, the authors sought the insight of BWLWH. METHOD Qualitative semistructured interviews were conducted with 30 BWLWH to gather information on their experiences with trauma, racism, HIV stigma, gender-related stressors, ART adherence, and coping strategies, and their insights on the proposed intervention. Participants' interviews were audio-recorded, transcribed, and coded using thematic content analysis and grounded theory. RESULTS Participants shared (a) their experiences with trauma/abuse, racism, HIV-stigma, gender-related stress, and medication adherence; (b) coping strategies they use (e.g., social support, awareness [acknowledging systemic racism], assertiveness, selective disclosure of HIV status, and prioritizing the self); (c) how each of these adversities relate to their medication adherence and how they found ways to self-validate and practice self-primacy and self-care, including medication adherence in spite of adversities; and (d) enthusiasm for the proposed intervention. CONCLUSIONS Culturally adapted interventions are needed to improve the health of BWLWH by enhancing coping strategies for the multiple adversities they face and promoting self-validation, self-primacy, and self-care in spite of adversities. (PsycINFO Database Record
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Affiliation(s)
- Sannisha K. Dale
- Massachusetts General Hospital
- Harvard Medical School
- University of Miami, Department of Psychology
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23
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Bere T, Nyamayaro P, Magidson JF, Chibanda D, Chingono A, Munjoma R, Macpherson K, Ndhlovu CE, O’Cleirigh C, Kidia K, Safren SA, Abas M. Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva. J Health Psychol 2017; 22:1265-1276. [PMID: 26893295 PMCID: PMC4990503 DOI: 10.1177/1359105315626783] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n=4) and patients (n=15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6months.
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Affiliation(s)
- Tarisai Bere
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | | | | | - Dixon Chibanda
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Alfred Chingono
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Ronald Munjoma
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Kirsty Macpherson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
| | | | | | | | | | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
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24
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Wang K, White Hughto JM, Biello KB, O’Cleirigh C, Mayer KH, Rosenberger JG, Novak DS, Mimiaga MJ. The role of distress intolerance in the relationship between childhood sexual abuse and problematic alcohol use among Latin American MSM. Drug Alcohol Depend 2017; 175:151-156. [PMID: 28432938 PMCID: PMC5487024 DOI: 10.1016/j.drugalcdep.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/07/2017] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) and its well-documented association with substance use in adulthood, little research has examined the psychological mechanisms underlying this association. The current study utilized a large, multinational sample of MSM in Latin America to examine the role of distress intolerance (i.e., decreased capacity to withstand negative psychological states) in the relationship between childhood sexual abuse history and problematic alcohol use. METHODS As part of an online survey conducted among members of the largest social/sexual networking website for MSM in Latin America, participants (n=19,451) completed measures of childhood sexual abuse history, distress intolerance, and problematic alcohol use (CAGE score>=2). RESULTS Participants who reported a history of childhood sexual abuse indicated higher levels of distress intolerance, which was in turn associated with greater odds of engaging in problematic alcohol use. A mediation analysis further showed that distress intolerance partially accounted for the significant association between childhood sexual abuse history and problematic alcohol use. CONCLUSION These findings provide initial evidence for the role of distress intolerance as a process through which early trauma shapes MSM health later in life. These findings also underscore the potential utility of addressing distress intolerance in alcohol use prevention and intervention efforts that target MSM with a history of childhood sexual abuse.
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Affiliation(s)
- Katie Wang
- Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA.
| | - Jaclyn M. White Hughto
- Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Departments of Epidemiology and Behavioral and Social Health Sciences, Brown University, School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Department of Psychology, Harvard Medical School/Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA, 02114, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Division of Infectious Disease, Department of Medicine, Harvard Medical School/Beth Israel, Deaconess Medical Center, 110 Francis Street, Boston, MA, 02215, USA
| | - Joshua G. Rosenberger
- Department of Biobehavioral Health, Penn State University, 114 Biobehavioral Health Building University Park, PA, 16802, USA
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., 215 First Street, Cambridge, MA, 02142, USA
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Departments of Epidemiology and Behavioral and Social Health Sciences, Brown University, School of Public Health, 121 South Main Street, Providence, RI, 02912, USA,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, Providence, RI, 02912, USA
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25
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Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health 2017; 14:59-71. [PMID: 28055823 PMCID: PMC5953431 DOI: 10.1071/sh16083] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Steven Safren
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Avery D. Mitchell
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
- Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, Chapel Hill, NC 27599, USA
| | - Ivan Ivardic
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
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26
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Perry NS, Wade Taylor S, Elsesser S, Safren SA, O’Cleirigh C. The Predominant Relationship Between Sexual Environment Characteristics and HIV-Serodiscordant Condomless Anal Sex Among HIV-Positive Men Who Have Sex with Men (MSM). AIDS Behav 2016; 20:1228-35. [PMID: 26395194 DOI: 10.1007/s10461-015-1202-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In some studies, situational factors have been shown to be stronger predictors of condomless sex than individual risk factors. Cross-sectional relationships between condomless anal sex (CAS) with HIV-serodiscordant partners and risk factors across ecological levels (individual, sexual environment) were examined using a sample (N = 60) of HIV-positive men who have sex with men (MSM) who reported multiple recent episodes of CAS. Negative binomial regressions were used to evaluate the association of contextual risk factors (e.g., substance use during sex, transactional sex, public sex, sex at a sex party) with recent condomless sex, controlling for demographics and mental health. Results demonstrated that sexual environment factors, particularly sex under the influence of drugs or alcohol (B = .019, p < .05), transactional sex (B = .035, p < .01), and public sex (B = .039, p < .01) explained a large proportion of the variance in CAS. Only sex at a sex party was not related to CAS (p = .39). For each additional sexual environment in which men engaged, their rates of CAS increased (B = .39, p < .01). Secondary prevention interventions that are tailored to the proximal sexual environment could be maximally effective, particularly if they address substance use and other challenging sexual situations.
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27
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Hart TA, Tulloch TG, O’Cleirigh C. Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men. Cognitive and Behavioral Practice 2014. [DOI: 10.1016/j.cbpra.2013.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Markowitz SM, O’Cleirigh C, Hendriksen ES, Bullis JR, Stein M, Safren SA. Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use. AIDS Behav 2011; 15:1554-60. [PMID: 21161362 DOI: 10.1007/s10461-010-9857-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Childhood sexual abuse (CSA) is related to poorer health outcomes, associated with increased risk for HIV acquisition, and prevalent among HIV risk groups. Links between CSA and health behavior are an important health concern. We examined the relationship between CSA and transmission risk behavior and medication adherence in 119 HIV-infected individuals with an injection drug use history. 47% reported CSA, with no gender difference. Individuals who experienced CSA were more likely to report sexual HIV transmission risk behavior in the past 6 months, more sexual partners, use of heroin in the past 30 days, and worse adherence to HIV medication than those who did not. These findings confirm that rates of CSA are high in this population, and suggest that a history of CSA may place people managing both HIV and opioid dependence at increased risk for HIV transmission, poor adherence to medication, and vulnerability to substance use relapse.
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McCrae RR, Costa PT, Martin TA, Oryol VE, Senin IG, O’Cleirigh C. Personality correlates of HIV stigmatization in Russia and the United States. Journal of Research in Personality 2007. [DOI: 10.1016/j.jrp.2005.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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