Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV

Youth living with HIV (YLH) experience multiple disease-related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual- and neighborhood-level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood-specific data were compiled from the 2010 U.S. Census Bureau and matched with individual-level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non-Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross-level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.

Depression and stigma in high-risk youth living with HIV: a multi-site study

INTRODUCTION

This study explored the relationship between depression, stigma, and risk behaviors in a multi-site study of high-risk youth living with HIV (YLH) in the United States.

METHODS

All youth met screening criteria for either problem level substance use, current sexual risk, and/or suboptimal HIV medication adherence. Problem level substance use behavior was assessed with the CRAFFT, a six-item adolescent screener. A single item was used to screen for current sexual risk and for an HIV medication adherence problem. Stigma and depression were measured via standard self-report measures.

RESULTS

Multiple regression analysis revealed that behavioral infection, older age, more problem behaviors, and greater stigma each contributed to the prediction of higher depression scores in YLH. Associations between depression, stigma, and problem behaviors are discussed. More than half of the youth in this study scored at or above the clinical cut-off for depression. Results highlight the need for depression-focused risk reduction interventions that address stigma in YLH.

DISCUSSION

Study outcomes suggest that interventions are needed to address stigma and depression, not only among youth living with HIV, but in the communities in which they live.

Multiple risk behaviors among youth living with human immunodeficiency virus in five U.S. cities

PURPOSE

To describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites.

METHODS

Youth (N=352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior.

RESULTS

Of the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem.

CONCLUSIONS

Results suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.

One-stop shopping: description of a model program to provide primary care to substance-abusing women and their children

Primary care services were developed to provide comprehensive women's health and pediatric care to substance-abusing women and their children in a substance abuse treatment program. A pediatric nurse practitioner and a certified nurse mid-wife functioned in collaborative roles with the objective of providing women and their children better access to health services. Data were collected on intake on general health maintenance, birth variables, and parenting education. Findings that were consistent with current research literature included better outcomes at birth for women who received prenatal care, up-to-date health maintenance visits, and improved immunization rates. An increase in relapse was noted for women during the postpartum period. Through a structured parenting education program women were found to have improved parenting skills. Women in drug treatment respond positively to a collaborative comprehensive model of practice. Many women who left the program continued to bring their children to the pediatric nurse practitioner for health care.