We determined whether methamphetamine use is associated with the increased prevalence of primary HIV drug resistance among a cohort of men who have sex with men recently infected with HIV. In multivariate analysis, we found that frequent methamphetamine use was strongly associated with primary non-nucleoside reverse transcriptase inhibitor resistance, but not with protease inhibitor or nucleoside reverse transcriptase inhibitor resistance. We postulate that this association may be caused by methamphetamine-associated treatment interruptions among source partners.
"It is also well-established that HIV-positive stimulant users are more likely to experience difficulties with HIV disease management which lead to elevated HIV viral load and potentially faster mortality.4–7 These difficulties with HIV disease management often co-occur with HIV transmission risk behavior, 8,9 which could contribute to the onward transmission of medication-resistant strains of HIV.10,11 "
[Show abstract][Hide abstract] ABSTRACT: Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.
Journal of Urban Health 04/2014; 91(3). DOI:10.1007/s11524-014-9870-y · 1.90 Impact Factor
"One plausible explanation is that recent research showing reduced transmission risk among HIV-positive individuals on antiretroviral therapy (Cohen et al., 2011; Donnell et al., 2010; Grant et al., 2010) could affect risk perceptions and resulting behaviors . Although one of many possible explanations, this could be particularly important to examine in settings where substance use is high (see Kalichman et al., 2011), because substance use has been shown to negatively affect HIV treatment adherence and viral load counts (Arnsten et al., 2002; Baum et al., 2009, 2010; Fairbairn et al., 2011; Hahn and Samet, 2010; King et al., 2009; Shacham et al., 2011; Toussi et al., 2009) as well as resistance to antiretroviral medications (Cachay et al., 2007; Colfax et al., 2007). Our fi ndings should be considered in light of the study's limitations. "
[Show abstract][Hide abstract] ABSTRACT: Objective:
This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened.
A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI).
HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status.
HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men.
Journal of studies on alcohol and drugs 01/2013; 74(1):158-67. DOI:10.15288/jsad.2013.74.158 · 2.76 Impact Factor
"Stimulant use is associated with increased rates of HIV transmission risk behavior, acquisition of strains of HIV that are resistant to some classes of antiretroviral medications, impaired adherence to anti-retroviral therapy (ART), and elevated HIV viral load (Carrico et al. 2007; Colfax et al. 2007; Gorbach et al. 2008; Hinkin et al. 2007; Johnson et al. 2008; Morin et al. 2007). Consequently, stimulant users have been identified as an important group to target for HIV prevention efforts. "
[Show abstract][Hide abstract] ABSTRACT: The use of stimulants has important implications for HIV prevention and care. However, few investigations have examined psychological
correlates of substance use and adherence to anti-retroviral therapy (ART) among HIV-positive stimulant users. This cross-sectional
investigation examined affective correlates of stimulant use and ART adherence among HIV-positive methamphetamine users. In
total, 122 HIV-positive men who have sex with men or transgendered individuals on ART who reported using methamphetamine in
the past 30days were recruited from the community. HIV-specific traumatic stress was consistently and independently associated
with more frequent cocaine/crack use (but not with methamphetamine use). Positive affect was independently associated with
a decreased likelihood of reporting any injection drug use and an increased likelihood of reporting perfect ART adherence.
HIV-specific traumatic stress may be an important determinant of increased cocaine/crack use in this population. Positive
affect may increase the likelihood that individuals will refrain from injection drug use and achieve high levels of ART adherence.
KeywordsCocaine-HIV/AIDS-Methamphetamine-Positive affect-Trauma-Self medication hypothesis
AIDS and Behavior 08/2010; 14(4):769-777. DOI:10.1007/s10461-008-9513-y · 3.49 Impact Factor
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