Peer-Reviewed Journal Articles

2016

Contingent vs. Non-Contingent Rewards: Time-based Intervention Response Patterns among Stimulant-using Men who have Sex with Men.


Fletcher, J. B., Landovitz, R. J., Shoptaw, S., & Reback, C. J. (2016). Contingent vs. Non-Contingent Rewards: Time-based Intervention Response Patterns among Stimulant-using Men who have Sex with Men. Journal of Substance Abuse Treatment.

Abstract/Summary: Stimulant use rates are higher among men who have sex with men (MSM) than the general population. Contingency management (CM) may be an effective intervention for reducing stimulant use in this population. To specify both the mechanism and temporal effects of contingent reward on behavior change, logistic growth trajectory modeling (LGTM) was used to contrast a non-contingent matched rewards condition (i.e., non-contingent yoked controls; NCYC) to a voucher-based CM intervention (maximum = $430) to reduce stimulant use among MSM. Stimulant-using MSM were randomized to either a CM intervention (n = 70) or a NCYC condition (n = 70). Results from a LGTM (analytical sample n = 119; nCM = 61; nNCYC = 58) indicated four distinct intervention response patterns: responders (i.e., predicted >90% stimulant metabolite-free urinalyses; 64.7% of sample); worsening intervention response (14.3%); non-responders (12.6%); and, single-positive (8.4%); all estimated trajectory coefficients were significant at p < 0.03 (2-tailed). Participants receiving CM were significantly overrepresented in the responder (64%) and single-positive (80%) categories (χ2(3) = 29.04; p < 0.001); all non-responders and 76.5% of the worsening intervention response category were in the NCYC condition. Results demonstrate the utility of trajectory modeling and further support the contingent application of reward as the operative mechanism associated with patterns of stimulant abstinence with CM applied to a sample of stimulant-using MSM outside the context of formal drug treatment.

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Prevalence and correlates of marijuana use among HIV-seropositive and seronegative men in the Multicenter AIDS Cohort Study (MACS), 1984-2013


Okafor, C. N., Cook, R. L., Chen, X., Surkan, P. J., Becker, J. T., Shoptaw, S., … & Plankey, M. W. (2016). Prevalence and correlates of marijuana use among HIV-seropositive and seronegative men in the Multicenter AIDS Cohort Study (MACS), 1984-2013. The American Journal of Drug and Alcohol Abuse, 1-11.

Abstract/Summary:

BACKGROUND:
Marijuana use is common among HIV+ individuals, but few studies have examined long-term trends in prevalence and correlates of use.

METHODS:
We evaluated trends (1984-2013) in the annual prevalence of current (past 6-month use) and daily (among current users) marijuana use and determined correlates of use among 2742 HIV-seropositive (HIV+) and 3172 HIV-seronegative (HIV-) men who have sex with men in the Multicenter AIDS Cohort Study (MACS). Poisson regression models were used to estimate prevalence ratios of marijuana use separately for the men who were enrolled before 2001 (early-cohort) and after 2001 (late-cohort).

RESULTS:
Over the 29 years of the study, the prevalence of current marijuana use declined significantly, whereas daily use among users increased among all men in the early and late-cohorts. A HIV+ status was associated with higher prevalence of marijuana use among the men in the early-cohort (adjusted prevalence ratio [aPR] = 1.53, 95% confidence interval [CI]:1.42, 1.64, p = <0.0001), but not in the men in the late-cohort (aPR = 0.90, 95% CI: 0.79, 1.03, p = 0.1424). Alcohol use and cigarette smoking were being positively associated with marijuana use.

CONCLUSIONS:
Although the annual prevalence of current marijuana use decreased significantly over time in the MACS, daily use among users increased significantly. Further, among the HIV+ men, our study did not show clinically significant adverse effects of marijuana use on highly active antiretroviral therapy use, CD4+ count, or HIV viral load.

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CXCR4-using HIV variants in a cohort of Black men who have sex with men: HIV Prevention Trials Network 061


Chen ,I., Huang, W., Connor, M.B., Frantzell, A., Cummings, V., Beauchamp, G.G., Griffith, S., Fields, S.D., Scott, H.M., Shoptaw, S., del Rio C. CXCR4-using HIV variants in a cohort of Black men who have sex with men: HIV Prevention Trials Network 061. HIV clinical trials. 2016 Jul 3;17(4):158-64.

Abstract/Summary:

OBJECTIVE:
To evaluate factors associated with HIV tropism among Black men who have sex with men (MSM) in the United States enrolled in a clinical study (HIV Prevention Trials Network 061).


METHODS:
HIV tropism was analyzed using a phenotypic assay (Trofile assay, Monogram Biosciences). Samples were analyzed from 43 men who were HIV infected at enrollment and reported either exclusive insertive intercourse or exclusive receptive intercourse; samples were also analyzed from 20 men who were HIV uninfected at enrollment and seroconverted during the study. Clonal analysis of individual viral variants was performed for seroconverters who had dual/mixed (DM) viruses.


RESULTS:
DM viruses were detected in samples from 11 (26%) of the 43 HIV-infected men analyzed at the enrollment visit; HIV tropism did not differ between those reporting exclusive insertive vs receptive intercourse. DM viruses were also detected in five (25%) of the 20 seroconverters. DM viruses were associated with lower CD4 cell counts. Seroconverters with DM viruses had dual-tropic viruses only or mixed populations of CCR5- and dual-tropic viruses.


CONCLUSIONS:
DM viruses were frequently detected among Black MSM in this study, including seroconverters. Further studies are needed to understand factors driving transmission and selection of CXCR4- and dual-tropic viruses among Black MSM.


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Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study


Friedman, M. R., Coulter, R. W., Silvestre, A. J., Stall, R., Teplin, L., Shoptaw, S., … & Plankey, M. W. (2016). Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study. AIDS care, 1-12.

Abstract/Summary: Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients  = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.


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A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men


Carrico, A. W., Jain, J., Discepola, M. V., Olem, D., Andrews, R., Woods, W. J., … & Moskowitz, J. T. (2016). A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. BMC Public Health, 16(1), 673.

Abstract/Summary:

BACKGROUND:
Contingency management (CM) is an evidence-based intervention providing tangible rewards as positive reinforcement for abstinence from stimulants such as methamphetamine. Integrative approaches targeting affect regulation could boost the effectiveness of CM in community-based settings and optimize HIV/AIDS prevention efforts.


METHODS/DESIGN:
This randomized controlled trial with HIV-positive, methamphetamine-using men who have sex with men (MSM) is examining the efficacy of a 5-session, individually delivered positive affect regulation intervention – Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). ARTEMIS is designed to sensitize individuals to non-drug-related sources of reward as well as assist with managing depression and other symptoms of stimulant withdrawal during CM. HIV-positive, methamphetamine-using MSM who are enrolled in a community-based, 12-week CM program are randomized to receive ARTEMIS or an attention-matched control condition. Follow-up assessments are conducted at 3, 6, 12, and 15 months after enrollment in CM. Four peripheral venous blood samples are collected over the 15-month follow-up with specimen banking for planned biomarker sub-studies. The primary outcome is mean HIV viral load. Secondary outcomes include: sustained HIV viral suppression, T-helper cell count, psychological adjustment, stimulant use, and potentially amplified transmission risk behavior.


DISCUSSION:
Implementation of this randomized controlled trial highlights the importance of delineating boundaries between research activities and community-based service provision. It also provides insights into best practices for integrating the distinct agendas of academic and community partners in clinical research. This trial is currently enrolling and data collection is anticipated to be completed in September of 2018.

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Determining Survey Satisficing of Online Longitudinal Survey Data in the Multicenter AIDS Cohort Study: A Group-Based Trajectory Analysis


Di, J., Li, Y., Friedman, M. R., Reddy, S., Surkan, P. J., Shoptaw, S., & Plankey, M. (2016). Determining Survey Satisficing of Online Longitudinal Survey Data in the Multicenter AIDS Cohort Study: A Group-Based Trajectory Analysis. JMIR Public Health and Surveillance, 2(2).

Abstract/Summary:

BACKGROUND:
Survey satisficing occurs when participants respond to survey questions rapidly without carefully reading or comprehending them. Studies have demonstrated the occurrence of survey satisficing, which can degrade survey quality, particularly in longitudinal studies.

OBJECTIVE:
The aim of this study is to use a group-based trajectory analysis method to identify satisficers when similar survey questions were asked periodically in a long-standing cohort, and to examine factors associated with satisficing in the surveys having sensitive human immunodeficiency virus (HIV)-related behavioral questions.

METHODS:
Behavioral data were collected semiannually online at all four sites of the Multicenter AIDS Cohort Study (MACS) from October 2008 through March 2013. Based on the start and end times, and the word counts per variable, response speed (word counts per second) for each participant visit was calculated. Two-step group-based trajectory analyses of the response speed across 9 study visits were performed to identify potential survey satisficing. Generalized linear models with repeated measures were used to investigate the factors associated with satisficing on HIV-related behavioral surveys.

RESULTS:
Among the total 2138 male participants, the median baseline age was 51 years (interquartile range, 45-58); most of the participants were non-Hispanic white (62.72%, 1341/2138) and college graduates (46.59%, 996/2138), and half were HIV seropositive (50.00%, 1069/2138). A total of 543 men (25.40%, 543/2138) were considered potential satisficers with respect to their increased trajectory tendency of response speed. In the multivariate analysis, being 10 years older at the baseline visit increased the odds of satisficing by 44% (OR 1.44, 95% CI 1.27-1.62, P<.001). Compared with the non-Hispanic white participants, non-Hispanic black participants were 122% more likely to satisfice the HIV-related behavioral survey (OR 2.22, 95% CI 1.69-2.91, P<.001), and 99% more likely to do so for the other race/ethnicity group (OR 1.99, 95% CI 1.39-2.83, P<.001). Participants with a high school degree or less were 67% more likely to satisfice the survey (OR 1.67, 95% CI 1.26-2.21, P<.001) compared with those with a college degree. Having more than one sex partner and using more than one recreational drug reduced the odds of satisficing by 24% (OR 0.76, 95% CI 0.61-0.94, P=.013) and 28% (OR 0.72, 95% CI 0.55-0.93, P=.013), respectively. No statistically significant association of HIV serostatus with satisficing was observed.

CONCLUSIONS:
Using a group-based trajectory analysis method, we could identify consistent satisficing on HIV-related behavioral surveys among participants in the MACS, which was associated with being older, being non-white, and having a lower education level; however, there was no significant difference by HIV serostatus. Methods to minimize satisficing using longitudinal survey data are warranted.

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Safety of Intravenous Methamphetamine Administration During Ibudilast Treatment


DeYoung, D. Z., Heinzerling, K. G., Swanson, A. N., Tsuang, J., Furst, B. A., Yi, Y., … & Shoptaw, S. J. (2016). Safety of Intravenous Methamphetamine Administration During Ibudilast Treatment. Journal of clinical psychopharmacology.

Abstract/Summary:

BACKGROUND:
Methamphetamine dependence is a significant public health concern without any approved medications for treatment. We evaluated ibudilast, a nonselective phosphodiesterase inhibitor, to assess the safety and tolerability during intravenous methamphetamine administration. We conducted a randomized, double-blind, placebo-controlled, within-subjects crossover clinical trial.

METHODS:
Participants received ibudilast (20 mg twice daily followed by 50 mg twice daily) and placebo, with order determined by randomization, and then underwent intravenous methamphetamine challenges (15 and 30 mg). We monitored cardiovascular effects, methamphetamine pharmacokinetics, and reported adverse events.

RESULTS:
Ibudilast treatment had similar rates of adverse events compared with placebo, and there was no significant augmentation of cardiovascular effects of methamphetamine. Pharmacokinetic analysis revealed no clinically significant change in maximum concentration or half-life of methamphetamine with ibudilast.

CONCLUSIONS:
Methamphetamine administration during ibudilast treatment was well tolerated without additive cardiovascular effects or serious adverse events, providing initial safety data to pursue ibudilast’s effectiveness for the treatment of methamphetamine dependence.

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Stability of Bisexual Behavior and Extent of Viral Bridging Behavior Among Men Who Have Sex with Men and Women


Friedman MR, Stall R, Plankey M, Shoptaw S, Herrick AL, Surkan PJ, Teplin L, Silvestre AJ. Stability of Bisexual Behavior and Extent of Viral Bridging Behavior Among Men Who Have Sex with Men and Women. Archives of Sexual Behavior. 2016 Nov 21:1-0.

Abstract/Summary: Bisexual men experience significant health disparities likely related to biphobia. Biphobia presents via several preconceptions, including that bisexuality is transitory, and that bisexual men act as viral bridges between men who have sex with men and heterosexual populations. We analyzed data from a prospective cohort of gay and bisexual men, the Multicenter AIDS Cohort Study, to test these preconceptions. Men reporting both male and female sexual partners (MSMW) between 2002 and 2009 (n = 111) were classified as behaviorally bisexual. We assessed five hypotheses over two domains (transience of bisexual behavior and viral bridging). No evidence was found supporting the transitory nature of bisexuality. Trajectories of bisexual behavior were not transient over time. We found little evidence to support substantial viral bridging behavior. Notably, HIV-positive MSMW reported lower proportions of female partners than HIV-negative MSMW. Our results provide no empirical support for bisexual transience and scant support for viral bridging hypotheses. Our results provide key data showing that male bisexual behavior may be stable over long time periods and that behaviorally bisexual men’s risk to female sexual partners may be lower than expected.

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Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013


Okafor, C. N., Cook, R. L., Chen, X., Surkan, P. J., Becker, J. T., Shoptaw, S., … & Plankey, M. W. (2016). Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013. AIDS and behavior, 1-14.

Abstract/Summary: To construct longitudinal trajectories of marijuana use in a sample of men who have sex with men living with or at-risk for HIV infection. We determined factors associated with distinct trajectories of use as well as those that serve to modify the course of the trajectory. Data were from 3658 [1439 HIV-seropositive (HIV+) and 2219 HIV-seronegative (HIV-)] participants of the Multicenter AIDS Cohort Study. Frequency of marijuana use was obtained semiannually over a 29-year period (1984-2013). Group-based trajectory models were used to identify the trajectories and to determine predictors and modifiers of the trajectories over time. Four distinct trajectories of marijuana use were identified: abstainer/infrequent (65 %), decreaser (13 %), increaser (12 %) and chronic high (10 %) use groups. HIV+ status was significantly associated with increased odds of membership in the decreaser, increaser and chronic high use groups. Alcohol, smoking, stimulant and other recreational drug use were associated with increasing marijuana use across all four trajectory groups. Antiretroviral therapy use over time was associated with decreasing marijuana use in the abstainer/infrequent and increaser trajectory groups. Having a detectable HIV viral load was associated with increasing marijuana use in the increaser group only. Future investigations are needed to determine whether long-term patterns of use are associated with adverse consequences especially among HIV+ persons.

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Effect of adolescent substance use and antisocial behavior on the development of early adulthood depression


Choi, T. K., Worley, M. J., Trim, R. S., Howard, D., Brown, S. A., Hopfer, C. J., … & Wall, T. L. (2016). Effect of adolescent substance use and antisocial behavior on the development of early adulthood depression. Psychiatry research, 238, 143-149

Abstract/Summary: Major depressive disorder (MDD) is a prevalent and frequently comorbid psychiatric disorder. This study evaluates the development of depressive symptoms, MDD diagnosis, and suicidal ideation in a high-risk sample (N=524) diagnosed with conduct disorder (CD) and substance use disorder (SUD) symptoms as youth and re-assessed approximately 6.5 years later. Dual trajectory classes of both alcohol and other drug use (AOD) and antisocial behavior (ASB), previously identified using latent class growth analyses (LCGA), were used to predict depression outcomes. The Dual Chronic, Increasing AOD/Persistent ASB, and Decreasing Drugs/Persistent ASB classes had higher past-week depression scores, more past-year MDD symptoms, and were more likely to have past-year MDD than the Resolved class. The Dual Chronic and Decreasing Drugs/Persistent ASB classes also had more past-year MDD symptoms than the Persistent AOD/Adolescent ASB class. Youth at highest risk for developing or maintaining depression in adulthood had the common characteristic of persistent antisocial behavior. This suggests young adulthood depression is associated more with persistent antisocial behavior than with persistent substance use in comorbid youth. As such, interventions targeting high-risk youth, particularly those with persistent antisocial behavior, are needed to help reduce the risk of severe psychosocial consequences (including risk for suicide) in adulthood.

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The Association Between Age and Ethics-Related Issues in Using Social Media for HIV Prevention in Peru


Chiu, C. J., Menacho, L., & Young, S. D. (2016). The Association Between Age and Ethics-Related Issues in Using Social Media for HIV Prevention in Peru. Ethics & behavior, 26(2), 99-109.

Abstract/Summary: Little research has focused on the ethical issues around using social media for HIV prevention in low- and middle-income countries (LMICs), such as Peru. This study surveyed participants from the HOPE social media HIV intervention HIV intervention in Peru to assess their experiences and perceptions of ethical issues in the study and the impact of age on their experiences and perceptions. This study found that, compared to younger participants, older participants were more likely to express higher levels of understanding of the consent form and trust that other participants were real. Older participants also reported being less likely to benefit in learning about their HIV status. Findings suggest that age plays a role in participants’ experiences in a social media-based HIV intervention.

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HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users


Garett, R., Smith, J., Chiu, J., & Young, S. D. (2016). HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users. AIDS care, 28(6), 731-735.

Abstract/Summary: The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD = 5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.

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A review of social media technologies across the global HIV care continuum

Garett, R., Smith, J., & Young, S. D. (2016). A review of social media technologies across the global HIV care continuum. Current opinion in psychology, 9, 56-66.

Abstract/Summary: HIV remains one of the main health global threats of the 21st century. There is a great need to reach HIV at-risk and HIV+ populations across the HIV care continuum to improve HIV prevention, testing, and treatment. New technologies, such as Social Media (SM) and Social Networking Sites (SNS) have shown early promise in HIV research studies. To assess the state of research on the use of SM/SNSs across the HIV continuum, we conducted a systematic literature review on HIV-related research using SM during the last 10 years. A total of 44 papers were identified, of which 17 (38.6%) were classified as intervention studies and 19 (61.3%) as observational. The focus areas of the studies was evenly distributed between outreach outreach/recruitment (n=15, 34.1%), surveillance/observation (n=13, 29.5%) and prevention/treatment (n=16, 36.4%). Researchers engaged the community through Facebook (n=26, 59.1%), multiple-platforms (n=13, 29.5%), or one of several geo-social networking sites (n=10, 22.7%). Studies primarily targeted MSM (n=24, 54.5%) and youth (n=13, 29.5%) with little research focused on HIV+ populations (n=5, 11.4%). The current state of the field, trends, and limitations of this work are discussed.

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HIV testing among social media-using Peruvian men who have sex with men: correlates and social context

Krueger, E. A., Chiu, C. J., Menacho, L. A., & Young, S. D. (2016). HIV testing among social media-using Peruvian men who have sex with men: correlates and social context. AIDS care, 1-5.

Abstract/Summary: HIV remains concentrated among men who have sex with men (MSM) in Peru, and homophobia and AIDS-related stigmas have kept the epidemic difficult to address. Gay self-identity has been associated with increased HIV testing, though this relationship has not been examined extensively. Social media use has been rapidly increasing in Peru, yet little is known about MSM social media users in Peru. This study sought to investigate the demographic, behavioral, and stigma-related factors associated with HIV testing among social media-using Peruvian MSM. Five hundred and fifty-six MSM from Lima and surrounding areas were recruited from social networking websites to complete a survey on their sexual risk behaviors. We examined the demographic and social correlates of HIV testing behavior among this sample. Younger age and non-gay identity were significantly associated with lower likelihood of getting tested in univariate analysis. After controlling for key behaviors and AIDS-related stigma, younger age remained significantly associated with decreased testing. Participants who engaged in discussions online about HIV testing were more likely to get tested, while AIDS-related stigma presented a significant barrier to testing. Stigma severity also varied significantly by sexual identity. Youth appear to be significantly less likely than older individuals to test for HIV. Among Peruvian MSM, AIDS-related stigma remains a strong predictor of willingness to get tested. Social media-based intervention work targeting Peruvian youth should encourage discussion around HIV testing, and must also address AIDS-related stigma.

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Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men

Chiu, C.J., Young, S.D. (2016). Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men. AIDS Care. 2016;28(3):289-93.

Abstract/Summary: High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07-6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2-3.12), uncertain HIV status (4.29, 1.37-14.4), and having sex under the influence of alcohol (2.46, 1.06-5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02-6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56-0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions.

Read the full commentary here.

Substanse Use Disorder Patient Privacy and Comprehensive Care in Integrated Health Care Settings

Schaper, E., Padwa, H., Urada, D., & Shoptaw, S. (2016). Substance use disorder patient privacy and comprehensive care in integrated health care settings. Psychological Services, 13(1), 105.
Abstract/Summary: The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations—Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular—will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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Substance use and sexual risk behaviors among Peruvian MSM social media users

Young, S. D., Nianogo, R. A., Chiu, C. J., Menacho, L., & Galea, J. (2016). Substance use and sexual risk behaviors among Peruvian MSM social media users. AIDS care, 28(1), 112-118.

Abstract/Summary: Peru is experiencing a concentrated HIV epidemic among men who have sex with men (MSM). Substance use (alcohol and drug use) has been found to be associated with HIV-related sexual risk behaviors. A recent surge in the number of social media users in Peru has enabled these technologies to be potential tools for reaching HIV at-risk individuals. This study sought to assess the relationship between substance use and sexual risk behaviors among Peruvian MSM who use social media. A total of 556 Peruvian MSM Facebook users (ages 18-59) were recruited to complete a 92-item survey on demographics, sexual risk behaviors, and substance use. We performed a logistic regression of various sexual risk behaviors (e.g., unprotected sex, casual sex) on substance abuse, including alcohol, adjusting for potential covariates. Drinking more than five alcoholic drinks a day in the past three months was associated with an increased odds of having unprotected sex (vaginal and anal) (aOR: 1.52; 95% CL: 1.01, 2.28), casual sex (1.75; 1.17, 2.62), and sex with unknown persons (1.82; 1.23, 2.71). Drug use was not significantly associated with sexual risk behaviors. Among Peruvian MSM social media users, findings suggest that alcohol use was associated with increased HIV-related sexual risk behaviors.

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Childhood Exposure to Religions With High Prevalence of Members Who Discourage Homosexuality Is Associated With Adult HIV Risk Behaviors and HIV Infection in Black Men Who Have Sex With Men

Nelson, L. E., Wilton, L., Zhang, N., Regan, R., Thach, C. T., Dyer, T. V., . . . HPTN 061 Study Team. (2016). Childhood Exposure to Religions With High Prevalence of Members Who Discourage Homosexuality Is Associated With Adult HIV Risk Behaviors and HIV Infection in Black Men Who Have Sex With Men. American Journal of Men’s Health. Epub ahead of print. PMID: PMCID in process.

Abstract/Summary: Exposure to childhood religious affiliations where the majority of members discourage homosexuality may have negative psychological impacts for Black men who have sex with men. This study tested the hypothesis that exposures to these environments during childhood were associated with adulthood human immunodeficiency virus (HIV)/sexually transmitted infection (STI) behavioral risk and HIV infection, because these exposures influenced HIV/STI risk by undermining race/ sexual identity congruence and increasing internalized homophobia and interpersonal anxiety. Structural equation modeling as well as logistic and Poisson regressions were performed using baseline data from HIV Prevention Trials Network 061 (N = 1,553). Childhood religion affiliations that were more discouraging of homosexuality were associated with increased likelihood of HIV infection; however, the association was no longer significant after adjusting for age, income, and education. Having a childhood religion affiliation with high prevalence of beliefs discouraging homosexuality was associated with increased numbers of sexual partners (adjusted odds ratio = 4.31; 95% confidence interval [3.76, 4.94], p < .01). The hypothesized path model was largely supported and accounted for 37% of the variance in HIV infection; however, interpersonal anxiety was not associated with HIV/STI risk behaviors. Structural interventions are needed that focus on developing affirming theologies in religious institutions with Black men who have sex with men congregants. Read the full commentary here.

A few words on ‘Which medications are suitable for agonist drug maintenance’


Shoptaw S. (2016). A few words on ‘Which medications are suitable for agonist drug maintenance’. Addiction, 111(5):778-9. Epub 2016 Feb 23. PMID: 26913986.
Abstract/Summary: Identifying factors that correspond with treatment outcomes may be critical to developing and implementing successful agonist maintenance strategies for substance use disorders other than opioid and nicotine. Completing the research portfolio necessary to promote agonist maintenance therapies for cannabis use disorder has a high impact on public health.

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Ibudilast attenuates subjective effects of methamphetamine in a placebo-controlled inpatient study

Worley MJ, Heinzerling KG, Roche DJ, Shoptaw S. (2016). Ibudilast attenuates subjective effects of methamphetamine in a placebo-controlled inpatient study. Drug Alcohol Depend, 1;162:245-50. Epub 2016 Mar 3. PMID: 26993372.

 

Abstract/Summary:

Background
Despite numerous clinical trials no efficacious medications for methamphetamine (MA) have been identified. Neuroinflammation, which has a role in MA-related reward and neurodegeneration, is a novel MA pharmacotherapy target. Ibudilast inhibits activation of microglia and pro-inflammatory cytokines and has reduced MA self-administration in preclinical research. This study examined whether ibudilast would reduce subjective effects of MA in humans.

Methods
Adult, non-treatment seeking, MA-dependent volunteers (N = 11) received oral placebo, moderate ibudilast (40 mg), and high-dose ibudilast (100 mg) via twice-daily dosing for 7 days each in an inpatient setting. Following infusions of saline, MA 15 mg, and MA 30 mg participants rated 12 subjective drug effects on a visual analog scale (VAS).

Results
As demonstrated by statistically-significant ibudilast × MA condition interactions (p < .05), ibudilast reduced several MA-related subjective effects including High, Effect (i.e., any drug effect), Good, Stimulated and Like. The ibudilast-related reductions were most pronounced in the MA 30 mg infusions, with ibudilast 100 mg significantly reducing Effect (97.5% CI [−12.54, −2.27]), High (97.5% CI [−12.01, −1.65]), and Good (97.5% CI [−11.20, −0.21]), compared to placebo.

Conclusions
Ibudilast appeared to reduce reward-related subjective effects of MA in this early-stage study, possibly due to altering the processes of neuroinflammation involved in MA reward. Given this novel mechanism of action and the absence of an efficacious medication for MA dependence, ibudilast warrants further study to evaluate its clinical efficacy.

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Long-Term Cigarette Smoking Trajectories Among HIV-Seropositive and Seronegative MSM in the Multicenter AIDS Cohort Study


Akhtar-Khaleel WZ, Cook RL, Shoptaw S, Surkan PJ, Teplin LA, Stall R, Beyth RJ, Manini TM, Plankey M. (2016). Long-Term Cigarette Smoking Trajectories Among HIV-Seropositive and Seronegative MSM in the Multicenter AIDS Cohort Study. AIDS Behav. [Epub ahead of print]. PMID: 26922718
Abstract/Summary: To examine the association between demographic characteristics and long-term smoking trajectory group membership among HIV-seropositive and HIV-seronegative men who have sex with men (MSM). A cohort of 6552 MSM from the Multicenter AIDS Cohort Study were asked detailed information about their smoking history since their last follow-up. Group-based trajectory modeling was used to examine smoking behavior and identify trajectory group membership. Because participants enrolled after 2001 were more likely to be younger, HIV-seronegative, non-Hispanic black, and have a high school diploma or less, we also assessed time of enrollment in our analysis. Participants were grouped into 4 distinct smoking trajectory groups: persistent nonsmoker (n = 3737 [55.9 %]), persistent light smoker (n = 663 [11.0 %]), heavy smoker to nonsmoker (n = 531 [10.0 %]), and persistent heavy smoker (n = 1604 [23.1 %]). Compared with persistent nonsmokers, persistent heavy smokers were associated with being enrolled in 2001 and later (adjusted odds ratio [aOR] 2.35; 95 % CI 2.12-2.58), having a high school diploma or less (aOR 3.22; 95 % CI 3.05-3.39), and being HIV-seropositive (aOR 1.17; 95 % CI 1.01-1.34). These associations were statistically significant across all trajectory groups for time of enrollment and education but not for HIV serostatus. The overall decrease of smoking as shown by our trajectory groups is consistent with the national trend. Characteristics associated with smoking group trajectory membership should be considered in the development of targeted smoking cessation interventions among MSM and people living with HIV.
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Single nucleotide polymorphism near CREB1, rs7591784, is associated with pretreatment methamphetamine use frequency and outcome of outpatient treatment for methamphetamine use disorder.


Heinzerling, K. G., Demirdjian, L., Wu, Y., & Shoptaw, S. (2016). Single nucleotide polymorphism near CREB1, rs7591784, is associated with pretreatment methamphetamine use frequency and outcome of outpatient treatment for methamphetamine use disorder. Journal of Psychiatric Research, 74, 22-29.


Abstract/Summary: Although stimulant dependence is highly heritable, few studies have examined genetic influences on methamphetamine dependence. We performed a candidate gene study of 52 SNPs and pretreatment methamphetamine use frequency among 263 methamphetamine dependent Hispanic and Non-Hispanic White participants of several methamphetamine outpatient clinical trials in Los Angeles. One SNP, rs7591784 was significantly associated with pretreatment methamphetamine use frequency following Bonferroni correction (p < 0.001) in males but not females. We then examined rs7591784 and methamphetamine urine drug screen results during 12 weeks of outpatient treatment among males with treatment outcome data available (N = 94) and found rs7591784 was significantly associated with methamphetamine use during treatment controlling for pretreatment methamphetamine use. rs7591784 is near CREB1 and in a linkage disequilibrium block with rs2952768, previously shown to influence CREB1 expression. The CREB signaling pathway is involved in gene expression changes related to chronic use of multiple drugs of abuse including methamphetamine and these results suggest that variability in CREB signaling may influence pretreatment frequency of methamphetamine use as well as outcomes of outpatient treatment. Medications targeting the CREB pathway, including phosphodiesterase inhibitors, warrant investigation as pharmacotherapies for methamphetamine use disorders.


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2015


Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review


Young, S.D., Swendeman, D., Holloway, I.W., Reback, C.J., Kao, U. (2015) Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review. Current HIV/AIDS Report, 12(4):462-71.
Abstract/Summary: Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.

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Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain


Worley, M.J., Heinzerling, K.G., Shoptaw, S., Ling, W. (2015). Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain. Exp Clin Psychopharmacology, 2015 Dec;23(6):428-35.

Abstract/Summary: The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.

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Methods for measuring diffusion of a social media-based health intervention.


Young, S. D., Belin, T. R., Klausner, J., & Valente, T. W. (2015). Methods for Measuring Diffusion of a Social Media-Based Health Intervention. Social Networking, 4 (02), 41.

 

Abstract/Summary: This study evaluated the feasibility of measuring diffusion from a social networking community-level intervention. One year after completion of a randomized controlled HIV prevention trial on Facebook, 112 minority men who have sex with men (MSM) were asked to refer African-American and/or Latino sex partners to complete a survey. Results suggest that, compared to non-referrers, referrers spent more time online, controlling for age, race, education, and condition. Over 60% of referrals reported hearing about the intervention, and over half reported that the referrer talked to them about changing health behaviors. Results provide support and initial feasibility of using social networking for diffusing community-based HIV interventions.
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Unmet physical and mental healthcare needs among stimulant-using gay and bisexual homeless men.


Salem, B. E., Nyamathi, ANP, A., Reback, C., Shoptaw, S., Zhang, S., & Nudelman, O. (2015). Unmet Physical and Mental Healthcare Needs Among Stimulant-using Gay and Bisexual Homeless Men. Issues in mental health nursing, 36(9), 685-692.

 

Abstract/Summary: The aim of this study was to gain a greater understanding of predictors of the unmet physical and mental healthcare needs of homeless, stimulant-using, gay and bisexual (G/B) men. This study correlated baseline self-reported unmet physical and mental healthcare needs among stimulant-using homeless G/B men (n = 422, 18-46 years of age). A structured questionnaire was administered at baseline and data were collected from October 2009 to January 2013. The study was approved by the University of California Human Subjects’ Protection committee and the Friends Research Institute Human Research Protection Committee. Logistic regression revealed that those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain, were more likely to experience unmet needs for physical health care. In terms of unmet mental health needs, those who self-reported moderate-to-very severe pain and/or those reporting having sex while high, were more likely to report unmet needs for mental health care. In contrast, those reporting receiving social support from others were less likely to have an unmet mental healthcare need. Research implications are discussed as they relate to access to healthcare needs among this vulnerable population.
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Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities.


Williams, J. K., Wilton, L., Magnus, M., Wang, L., Wang, J., Dyer, T. P., … & Stephenson, R. (2015). Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. American journal of public health, 105(12), 2473-2481. p/>
Abstract/Summary: Objectives. We assessed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM).

Methods. Participants were 1522 Black MSM recruited from 6 US cities between July 2009 and December 2011. Univariate and multivariable logistic regression models were used.

Results. Participants reported sex before age 12 years with someone at least 5 years older (31.1%), unwanted sex when aged 12 to 16 years (30%), IPV (51.8%), and depression (43.8%). Experiencing CSA when aged 12 to 16 years was inversely associated with any receptive condomless anal sex with a male partner (adjusted odds ratio [AOR]=0.50; 95% confidence interval [CI]=0.29, 0.86). Pressured or forced sex was positively associated with any receptive anal sex (AOR=2.24; 95% CI=1.57, 3.20). Experiencing CSA when younger than 12 years, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were positively associated with having more than 3 male partners in the past 6 months. Among HIV-positive MSM (n=337), CSA between ages 12 and 16 years was positively associated with having more than 3 male partners in the past 6 months.

Conclusions. Rates of CSA, IPV, and depression were high, but associations with HIV sexual risk outcomes were modest.

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Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care‐based multi‐component brief intervention to reduce risky drug use.


Gelberg, L., Andersen, R. M., Afifi, A. A., Leake, B. D., Arangua, L., Vahidi, M., … & Baumeister, S. E. (2015). Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care‐based multi‐component brief intervention to reduce risky drug use. Addiction, 110(11), 1777-1790.

 

Abstract/Summary:
Aims
To assess the effect of a multi-component primary care delivered brief intervention for reducing risky psychoactive drug use (RDU) among patients identified by screening.

Design
Multicenter single-blind two-arm randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3-month follow-up. Randomization and allocation to trial group were computer-generated.

Setting
Primary care waiting rooms of five federally qualified health centers in Los Angeles County (LAC), USA.

Participants
A total of 334 adult primary care patients (171 intervention; 163 control) with RDU scores (4-26) on the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) self-administered on tablet computers. 261 (78%) completed follow-up. Mean age was 41.7 years; 62.9% were male; 37.7% were Caucasian.

Intervention(s) and Measurement
Intervention patients received brief (typically 3-4 minutes) clinician advice to quit/reduce their drug use reinforced by a video doctor message, health education booklet and up to two 20-30-minute follow-up telephone drug use coaching sessions. Controls received usual care and cancer screening information. Primary outcome was patient self-reported use of highest scoring drug (HSD) at follow-up.

Findings
Intervention and control patients reported equivalent baseline HSD use at 3-month follow-up. After adjustment for covariates, in the complete sample linear regression model, intervention patients used their HSD on 3.5 fewer days in the previous month relative to controls (P<0.001), and in the completed sample model, intervention patients used their HSD 2.2 fewer days than controls (P<0.005). No compensatory increases in use of other measured substances were found.

Conclusions
A primary-care based, clinician-delivered brief intervention with follow-up coaching calls may decrease risky psychoactive drug use.
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Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men.


Nyamathi, A., Reback, C. J., Shoptaw, S., Salem, B. E., Zhang, S., & Yadav, K. (2015). Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men. American journal of men’s health. Epub ahead of print. PMID – 26130725.

 

Abstract/Summary: A randomized controlled trial was conducted with homeless gay and bisexual men to assess the impact of two culturally sensitive intervention programs on reduction of drug use and risky sexual behavior. In this study, gay and bisexual men between 18 and 46 years of age were randomly assigned to one of two culturally sensitive behavioral intervention programs: a Nurse Case Management Plus Contingency Management (NCM + CM; n = 204) or a Standard Education Plus Contingency Management (SE + CM; n = 210) program. Regardless of group assignment, significant and clinically relevant reductions were observed in stimulant use over time. Multivariable predictors of stimulant use at 4- and 8-month follow-up evaluations were recent injection drug use, tested positive for HIV, or for use of amphetamine. Data revealed a significant linear decline over time for those who had sex with multiple partners. Furthermore, being HIV positive was associated with reporting multiple partners, while higher homophobia scores and having children were inversely related to reports of having sex with multiple partners at follow-up. Culturally sensitive approaches are needed to successfully reduce drug use and risky sexual activities among gay and bisexual populations.
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Impact of community-based programs on incarceration outcomes among gay and bisexual stimulant-using homeless adults.


Nyamathi, A. M., Reback, C. J., Shoptaw, S., Salem, B. E., Zhang, S., Farabee, D., & Khalilifard, F. (2015). Impact of community-based programs on incarceration outcomes among gay and bisexual stimulant-using homeless adults. Community mental health journal, 1-6.

 

Abstract/Summary: This study was part of a randomized controlled trial designed to improve hepatitis knowledge and health promoting behaviors and subsequently decrease stimulant use and incarceration with 422 (G/B) homeless men between 18 and 46 years of age. Findings revealed that no significant program differences on incarceration in the 4 months following the intervention. However, younger participants (p = .010), and those with prior incarceration (p = .001) were at greater risk for incarceration at 4 months. An additional factor associated with incarceration at 4 months included living on the street for at least 1 week (p = .049).
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Using behavioral economics to predict opioid use during prescription opioid dependence treatment.


Worley, M. J., Shoptaw, S. J., Bickel, W. K., & Ling, W. (2015). Using behavioral economics to predict opioid use during prescription opioid dependence treatment. Drug and alcohol dependence, 148, 62-68.

Epub ahead of print.

Abstract/Summary:
Abstract
Background

Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction.

Methods

Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine–naloxone and counseling in a multi-site clinical trial (N = 353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use.

Results

Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR = 1.30, p < .001) and a greater proportion of their income on drugs (OR = 1.31, p < .001) were more likely to use opioids during treatment.

Conclusions

Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.

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Ethics Issues in Social Media-Based HIV Prevention in Low- and Middle-Income Countries.


Chiu, C. J., Menacho, L., Fisher, C., & Young, S. D. (2015). Ethics Issues in Social Media–Based HIV Prevention in Low-and Middle-Income Countries. Cambridge Quarterly of Healthcare Ethics, 24(03), 303-310. PMID: 26059956

Abstract/Summary: Questions have been raised regarding participants’ safety and comfort when participating in e-health education programs. Although researchers have begun to explore this issue in the United States, little research has been conducted in low- and middle-income countries, where Internet and social media use is rapidly growing. This article reports on a quantitative study with Peruvian men who have sex with men who had previously participated in the Harnessing Online Peer Education (HOPE) program, a Facebook-based HIV education program. The survey assessed participants’ ethics-relevant perspectives during recruitment, consent, intervention, and follow-up.
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Clinical Management of Substance Use and Substance Use Disorders Among LGBT Individuals.


Hall, Timothy M.; Cathy Reback; & Steven Shoptaw. “Clinical Management of Substance Use and Substance Use Disorders Among LGBT Individuals.” In: Kenneth Mayer, Hilary Goldhammer & Harvey J. Makadon, eds. (2015) Fenway Guide to LGBT Health, 2nd Edition. Philadelphia: American College of Physicians.

Abstract/Summary: This chapter addresses: 1) the history and social context of substance use in relation to LGBT health; 2) distinguishing substance use from substance use disorder (SUD) or addiction; 3) current epidemiology of substance use and addiction in LGBT populations; 4) links between substance use or SUD and high-risk sexual behaviors; and 5) evidence-based treatments for SUD.
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Contingency management facilitates the use of postexposure prophylaxis among stimulant-using men who have sex with men.


Landovitz, R. J., Fletcher, J. B., Shoptaw, S., & Reback, C. J. (2014, December). Contingency Management Facilitates the Use of Post-Exposure Prophylaxis among Stimulant-using Men Who Have Sex with Men. In Open forum infectious diseases (p. ofu114). Oxford University Press. PMID: 25884003

Abstract/Summary: Background.  Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence. Methods.  We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent “yoked” control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors. Results.  At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1-47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9-21.9). Conclusions.  CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters.
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Exposure to Theory-Driven Text Messages is Associated with HIV Risk Reduction Among Methamphetamine-Using Men Who have Sex with Men.


Reback, C. J., Fletcher, J. B., Shoptaw, S., & Mansergh, G. (2015). Exposure to Theory-Driven Text Messages is Associated with HIV Risk Reduction Among Methamphetamine-Using Men Who have Sex with Men. AIDS and Behavior, 1-12. [Epub ahead of print] PMID: 25563501

Abstract/Summary: Fifty-two non-treatment-seeking methamphetamine-using men who have sex with men were enrolled in Project Tech Support, an open-label pilot study to evaluate whether exposure to theory-based [social support theory (SST), social cognitive theory (SCT), and health belief model (HBM)] text messages could promote reductions in HIV sexual risk behaviors and/or methamphetamine use. Multivariable analyses revealed that increased relative exposure to HBM or SCT (vs. SST) text messages was associated with significant reductions in the number of HIV serodiscordant unprotected (i.e., without a condom) anal sex partners, engagement in sex for money and/or drugs, and frequency of recent methamphetamine use; additionally, increased relative exposure to HBM (vs. SCT or SST) messages was uniquely associated with reductions in the overall number of non-primary anal sex partners (all p ≤ 0.05, two-tailed). Pilot data demonstrated that text messages based on the principles of HBM and SCT reduced sentinel HIV risk and drug use behaviors in active methamphetamine users.
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Impact of Community-Based Programs on Incarceration Outcomes Among Gay and Bisexual Stimulant-Using Homeless Adults.


Nyamathi AM, Reback CJ, Shoptaw S, Salem BE, Zhang S, Farabee D, Khalilifard F. Impact of Community-Based Programs on Incarceration Outcomes Among Gay and Bisexual Stimulant-Using Homeless Adults. Community Ment Health J. 2015 Jan 1. [Epub ahead of print] PMID: 25549923

Abstract/Summary: This study was part of a randomized controlled trial designed to improve hepatitis knowledge and health promoting behaviors and subsequently decrease stimulant use and incarceration with 422 (G/B) homeless men between 18 and 46 years of age. Findings revealed that no significant program differences on incarceration in the 4 months following the intervention. However, younger participants (p = .010), and those with prior incarceration (p = .001) were at greater risk for incarceration at 4 months. An additional factor associated with incarceration at 4 months included living on the street for at least 1 week (p = .049).
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Conversation with Walter Ling.


Ling, W. (2015). Conversation with Walter Ling. ADDICTION, 110(1), 14-18. PMID: 25322681 [PMCID- in process]

Abstract/Summary: In this occasional series, we record the views and personal experiences of people who have especially contributed to the evolution of ideas in the journal’s field of interest. Dr Walter Ling is a neurologist and psychiatrist, and is Director of the Integrated Substance Abuse Programs (ISAP) at the University of California, Los Angeles (UCLA), one of the foremost substance abuse research groups in the world. Dr Ling led pivotal clinical trials in the United States for all three of the only US Food and Drug Administration-approved opiate pharmacotherapies, levo-acetylmethadol (LAAM), buprenorphine and naltrexone, and is leading ongoing efforts for approval for sustained-release buprenorphine.
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Social Network Moderators of Naltrexone and Behavioral Treatment Effects on Heavy Drinking in the COMBINE Study.


Worley MJ, Witkiewitz K, Brown SA, Kivlahan DR, Longabaugh R. Social Network Moderators of Naltrexone and Behavioral Treatment Effects on Heavy Drinking in the COMBINE Study. Alcoholism: Clinical & Experimental Research. 2015 Jan. Vol. 39, No. 1.

Abstract/Summary:: Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study.
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The Effects of Naltrexone on Subjective Response to Methamphetamine in a Clinical Sample: a Double-Blind, Placebo-Controlled Laboratory Study.


Ray LA, Bujarski S, Courtney KE, Moallem NR, Lunny K, Roche D, Leventhal A, Shoptaw S, Heinzerling K, London ED, Miotto K. The Effects of Naltrexone on Subjective Response to Methamphetamine in a Clinical Sample: A Double-Blind, Placebo-Controlled Laboratory Study. Neuropsychopharmacology. 2015 Mar 24. doi: 10.1038/npp.2015.83. [Epub ahead of print] PMCID: PMC in process.

Abstract/Summary: Methamphetamine (MA) use disorder is a serious psychiatric condition for which there are no FDA-approved medications. Naltrexone (NTX) is an opioid receptor antagonist with demonstrated efficacy, albeit moderate, for the treatment of alcoholism and opioid dependence. Preclinical and clinical studies suggest that NTX may be useful for the treatment of MA use disorder. To inform treatment development, we conducted a double-blind, randomized, crossover, placebo-controlled human laboratory study of NTX. Non-treatment-seeking individuals meeting DSM-IV criteria for MA abuse or dependence (n=30) completed two separate 5-day inpatient stays. During each admission, participants completed testing sessions comprised of MA cue-reactivity and intravenous MA administration (30 mg) after receiving oral NTX (50 mg) or placebo for 4 days. This study tested the hypotheses that NTX would (a) attenuate cue-induced MA craving, and (b) reduce subjective responses to MA administration. Results largely supported the study hypotheses such that (a) NTX significantly blunted cue-induced craving for MA and (b) attenuated several of the hedonic subjective effects of MA, including craving, during controlled MA administration and as compared with placebo. NTX decreased overall subjective ratings of ‘crave drug,’ ‘stimulated,’ and ‘would like drug access,’ decreased the the post-MA administration time course of ‘anxious’ and increased ratings of ‘bad drug effects,’ as compared with placebo. These findings support a potential mechanism of action by showing that NTX reduced cue-induced craving and subjective responses to MA. This is consistent with positive treatment studies of NTX for amphetamine dependence, as well as ongoing clinical trials for MA.
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A comparison of self-reported sexual risk behaviours between US civilian and active duty military women.


Stahlman S, Javanbakht M, Cochran S, Shoptaw S, Hamilton AB, Gorbach PM. A comparison of self-reported sexual risk behaviours between US civilian and active duty military women. Sex Health. 2015 Apr 7. doi: 10.1071/SH14211. [Epub ahead of print] PMCID: PMC in process.

Abstract/Summary: Women in the US military report a high prevalence of sexual risk behaviours, such as binge drinking and new or multiple sexual partnerships. However, demographical differences pose challenges to making comparisons with civilians. Two public-use datasets were used to compare prevalence of sexual risk behaviours between sexually active military and civilian women, after adjusting for demographic factors. It was found that women in the military reported a higher prevalence of binge drinking and new/multiple sexual partners as compared with civilians, which suggests that military women are a high-risk group and the military environment may at least partially facilitate these risk behaviours.
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The Relationship Between Online Social Network Use, Sexual Risk Behaviors, and HIV Sero-Status Among a Sample of Predominately African American and Latino Men Who have Sex with Men (MSM) Social Media Users.


Chiu CJ, Young SD. The Relationship Between Online Social Network Use, Sexual Risk Behaviors, and HIV Sero-Status Among a Sample of Predominately African American and Latino Men Who have Sex with Men (MSM) Social Media Users. AIDS Behav. 2015 Jan 9. [Epub ahead of print]PMCID: PMC in process.

Abstract/Summary: Social networking technologies have emerged as potential platforms to reach HIV(+) MSM in HIV interventions. This study sought to compare use of online social networking sites (SNSs) and sexual risk behaviors between HIV(+) and HIV(−) individuals among a sample of predominately African American and Latino SNS-using MSM. A total of 112 MSM Facebook users were recruited online and offline and completed an online survey. We performed regression models to assess the association between HIV status, SNS use, and sexual risk behaviors. After adjusting for age, race, and employment status, being HIV positive was significantly associated with a greater number of sexual partners (ARR = 2.84, p = 0.0017) and lower comfort levels of discussing HIV/STI status on SNSs (AOR: 0.23, p = 0.011). Findings suggest that HIV status is associated with sexual risk behaviors and SNS use among SNS-using MSM. We discuss the implications for online HIV prevention.
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Feasibility of Recruiting Peer Educators to Promote HIV Testing Using Facebook Among Men Who have Sex with Men in Peru.


Menacho LA, Galea JT, Young SD. Feasibility of Recruiting Peer Educators to Promote HIV Testing Using Facebook Among Men Who have Sex with Men in Peru. AIDS Behav. 2015 Jan 25. [Epub ahead of print] PMCID: PMC in process.

Abstract/Summary: A peer leader-based intervention using social media can be an effective means to encourage Peruvian gay men to test for HIV. The objective was to explore the feasibility of recruiting and training leaders to deliver a peer intervention via Facebook to promote HIV testing. Training consisted of three sessions focused on HIV epidemiology, consequences of stigma associated with HIV, and ways to use Facebook. We performed pre- and post-training evaluations to assess HIV knowledge and comfort using Facebook. We trained 34 peer leaders. At baseline, the majority of peer leaders were already qualified and knowledgeable about HIV prevention and use of social media. We found a significant increase in proportion of peer leaders who were comfortable using social media to discuss about sexual partners and about STIs. It is feasible to recruit peer leaders who are qualified to conduct a social media based HIV prevention intervention in Peru.
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Antiretroviral drug use and HIV drug resistance among HIV-infected Black men who have sex with men: HIV Prevention Trials Network 061.


Chen I, Connor MB, Clarke W, Marzinke MA, Cummings V, Breaud A, Fogel JM, Laeyendecker O, Fields SD, Donnell D, Griffith S, Scott HM, Shoptaw S, Rio CD, Magnus M, Mannheimer S, Wheeler DP, Mayer KH, Koblin BA, Eshleman SH. Antiretroviral drug use and HIV drug resistance among HIV-infected Black men who have sex with men: HIV Prevention Trials Network 061. J Acquir Immune Defic Syndr. 2015 Apr 8. [Epub ahead of print] PMCID: PMC in process.

Abstract/Summary: HPTN 061 enrolled Black men who have sex with men in the United States. Some men with low/undetectable HIV RNA had unusual patterns of antiretroviral (ARV) drug use or had drugs detected in the absence of viral suppression. This report includes a comprehensive analysis of ARV drug use and drug resistance among men in HPTN 061 who were not virally suppressed.
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Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study.


Friedman MR, Stall R, Plankey M, Wei C, Shoptaw S, Herrick A, Surkan PJ, Teplin L, Silvestre AJ. Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS. 2015 Apr 13. [Epub ahead of print] PMID: 25870981

Abstract/Summary: The objective of this study is to determine associations between intertwining epidemics (syndemics) and HIV medication adherence and viral load levels among HIV-positive MSM and to test whether adherence mediates the relationship between syndemics and viral load.
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Twitter: A Novel Tool for Studying the Health and Social Needs of Transgender Communities.


Krueger EA, Young SD. Twitter: A Novel Tool for Studying the Health and Social Needs of Transgender Communities. JMIR Ment Health. 2015 Apr-Jun;2(2). pii: e16. PMID: 26082941

Abstract/Summary: Limited research has examined the health and social needs of transgender and gender nonconforming populations. Due to high levels of stigma, transgender individuals may avoid disclosing their identities to researchers, hindering this type of work. Further, researchers have traditionally relied on clinic-based sampling methods, which may mask the true heterogeneity of transgender and gender nonconforming communities. Online social networking websites present a novel platform for studying this diverse, difficult-to-reach population. Read the full text here.


Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among US Active Duty Service Women.


Stahlman S, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM. Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among US Active Duty Service Women. J Trauma Stress. 2015 May 14. doi: 10.1002/jts.22009. [Epub ahead of print] PMID: 25976935

Abstract/Summary: Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, screening positive for mental disorders, or substance use, among active duty service women. The sample included 7,415 female military personnel, of whom 13.4% reported unwanted sexual contact (including any touching of genitals) since entering the military. After adjusting for potentially confounding variables, factors independently associated with unwanted sexual contact included military-related stress (adjusted odds ratio [AOR] = 2.44), family/personal life-related stress (AOR = 1.78), and gender-related stress (AOR = 1.98) in the past 12 months. In addition, screening positive for depression, anxiety, posttraumatic stress disorder, or psychological distress, and suicidal ideation or attempt were associated with unwanted sexual contact (AOR = 1.57-2.11). For drug/alcohol use, only misuse of tranquilizers/muscle relaxers (past 12 months) was associated with report of unwanted sexual contact (AOR = 1.35). Given the prevalence of unwanted sexual contact and corresponding adverse health outcomes in this sample of active duty women, strategies to create military structural/cultural changes and reduce gender-related stress and sexism are needed.
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Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective: Progress, Gaps, and Future Directions.


Springer SA, Larney S, Alam-Mehrjerdi Z, Altice FL, Metzger D, Shoptaw S. Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective: Progress, Gaps, and Future Directions. J Acquir Immune Defic Syndr. 2015 Jun 1;69 Suppl 1:S155-61. doi: 10.1097/QAI.0000000000000637. PMID: 25978482

Abstract/Summary: Although there have been significant reductions in the number of new HIV infections globally from 2009 to 2013, incidence remains unacceptably high for persons who use drugs. In many settings, women and girls who inject drugs (WWID) with HIV/AIDS experience poor treatment access, including evidence-based practices like antiretroviral therapy and drug treatment. Medication-assisted therapies (MAT) for substance use disorders are especially inaccessible, which in their absence, increases HIV transmission risk. Irrespective of setting or culture, drug treatment using MAT is not only effective but also cost-effective at reducing opioid use and linked injection and sexual risks. Data presented here for WWID address their access to MAT for opioid addiction and to treatments being developed that address the relationship, family, and vocational needs of this group. The most glaring finding is that globally, WWID frequently are excluded in surveys or studies with an impressive lack of disaggregated data by gender when surveying access to MAT—even in wealthy countries. Despite this, there have been some striking improvements in implementing drug treatment as prevention, notably in Iran and China. Still, real barriers remain for women and girls to accessing drug treatment, other harm reduction services, and antiretroviral therapy. Development and/or implementation of interventions that facilitate women and girls engaging in drug treatment that address their roles within society, work, and family/relationships, and outcome evaluation of these interventions are crucial.
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Trends and Predictors of Cigarette Smoking Among HIV Seropositive and Seronegative Men: The Multicenter Aids Cohort Study.


Akhtar-Khaleel WZ, Cook RL, Shoptaw S, Surkan P, Stall R, Beyth RJ, Teplin LA, Plankey M. Trends and Predictors of Cigarette Smoking Among HIV Seropositive and Seronegative Men: The Multicenter Aids Cohort Study. AIDS Behav. 2015 Jun 21. [Epub ahead of print] PMID: 26093780

Abstract/Summary: We measured the trend of cigarette smoking among HIV-seropositive and seronegative men over time from 1984 to 2012. Additionally, we examined the demographic correlates of smoking and smoking consumption. Six thousand and five hundred and seventy seven men who have sex with men (MSM) from the Multicenter AIDS Cohort Study (MACS) were asked detailed information about their smoking history since their visit. Prevalence of smoking and quantity smoked was calculated yearly from 1984 to 2012. Poisson regression with robust error variance was used to estimate prevalence ratios of smoking in univariate and multivariate models. In 2012, 11.8 and 36.9 % of men who were enrolled in the MACS before 2001 or during or after 2001 smoked cigarettes, respectively. In the multivariate analysis, black, non-Hispanic, lower education, enrollment wave, alcohol use, and marijuana use were positively associated with current smoking in MSM. HIV serostatus was not significant in the multivariate analysis. However, HIV variables, such as detectable viral load, were positively associated. Though cigarette smoking has declined over time, the prevalence still remains high among subgroups. There is still a need for tailored smoking cessation programs to decrease the risk of smoking in HIV-seropositive MSM.
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Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles.


Brooks RA, Landovitz RJ, Regan R, Lee SJ, Allen VC Jr. Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2015 Jan 30. [Epub ahead of print] PMCID: PMC4520772.

Abstract/Summary: This study assessed perceptions of pre-exposure prophylaxis (PrEP) and their association with PrEP adoption intention among a convenience sample of 224 low socioeconomic status black men who have sex with men (BMSM) residing in Los Angeles. Participants received educational information about PrEP and completed an in-person interview. More than half (60%) of the participants indicated a high intention to adopt PrEP. Younger BMSM (18-29 years) were twice as likely to report a high intention to adopt PrEP compared to older BMSM (30+ years). Only 33% of participants were aware of PrEP and no participant had ever used PrEP. Negative perceptions were associated with a lower PrEP adoption intention and included being uncomfortable taking an HIV medicine when HIV-negative and not knowing if there are long-term side effects of taking an HIV medication. These findings suggest that BMSM may adopt PrEP but that negative perceptions may limit its uptake among this population. In order to facilitate PrEP adoption among BMSM targeted educational and community awareness programmes are needed to provide accurate information on the benefits of PrEP and to address the negative perceptions of PrEP held by local BMSM populations.
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2014


Nondisclosure of HIV Status in a Clinical Trial Setting: Antiretroviral Drug Screening Can Help Distinguish Between Newly Diagnosed and Previously Diagnosed HIV Infection. 2014


Marzinke MA, Clarke W, Wang L, Cummings V, Liu TY, Piwowar-Manning E, Breaud A, Griffith S, Buchbinder S, Shoptaw S, Del Rio C, Magnus M, Mannheimer S, Fields SD, Mayer KH, Wheeler DP, Koblin BA, Eshleman SH, Fogel JM. Nondisclosure of HIV Status in a Clinical Trial Setting: Antiretroviral Drug Screening Can Help Distinguish Between Newly Diagnosed and Previously Diagnosed HIV Infection. Clin Infect Dis. 2014 Jan; 58(1):117-20. Epub 2013 Oct 2. PMCID: PMC3864502.

Abstract/Summary: In The HIV Prevention Trials Network 061 study, 155 human immunodeficiency virus (HIV)–infected men reported no prior HIV diagnosis; 83 of those men had HIV RNA levels of

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Commentary on Gowin et. al (2014): Brain is behavior—methamphetamine dependence and recovery.


Shoptaw, S. Commentary on Gowin et. al (2014): Brain is behavior—methamphetamine dependence and recovery. Addiction. Jan 2014. 109:248-249. PMC not applicable.

Abstract/Summary: No abstract available.

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Types of Female Partners Reported by Black Men Who Have Sex with Men and Women (MSMW) and Associations with Intercourse Frequency, Unprotected Sex and HIV and STI Prevalence. 2014


Harawa N, Wilton L, Wang L, Mao C, Kuo I, Penniman T, Shoptaw S, Griffith S, Williams JK, Cummings V, Mayer K, Koblin B; HPTN 061. Types of Female Partners Reported by Black Men Who Have Sex with Men and Women (MSMW) and Associations with Intercourse Frequency, Unprotected Sex and HIV and STI Prevalence. AIDS Behav. 2014 Feb 13 (Epub ahead of print). PMCID: PMC in process.

Abstract/Summary: We used baseline data from a study of Black MSM/MSMW in 6 US cities to examine the association of female partnership types with disease prevalence and sexual behaviors among the 555 MSMW participants. MSMW reported more than three times as many total and unprotected sex acts with each primary as they did with each non-primary female partner. We compared MSMW whose recent female partners were: (1) all primary (“PF only”, n = 156), (2) both primary and non-primary (“PF & NPF”, n = 186), and (3) all non-primary (“NPF only”, n = 213). HIV/STI prevalence did not differ significantly across groups but sexual behaviors did. The PF only group had the fewest male partners and was the most likely to have only primary male partners; the PF & NPF group was the most likely to have transgender partners. PF & NPF men reported the most sex acts (total and unprotected) with females; NPF only men reported the fewest. Implications for HIV risk and prevention are discussed.

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The Influence of Social Networking Technologies on Female Religious Veil-Wearing Behavior in Iran. 2014


Young S, Shakiba A, Kwok J, Montazeri SM. The Influence of Social Networking Technologies on Female Religious Veil-Wearing Behavior in Iran. Cyberpsychology, Behavior, and Social Networking. 2014 Mar 10 (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Social networking technologies can influence attitudes, behaviors, and social norms. Research on this topic has been conducted primarily among early adopters of technology and within the United States. However, it is important to evaluate how social media might affect people’s behaviors in international settings, especially among countries with longstanding, government recommended, cultural and religious traditions and behaviors, such as Iran. This study seeks to assess whether Iranian women who have been using social networking technologies for a longer time (compared to those who have recently joined) would be less likely to cover themselves with a veil and be more comfortable publicly displaying pictures of this behavior on Facebook. Iranian females (N=253) were selected through snowball sampling from nongovernmental organizations in November 2011 and asked to complete a survey assessing their use of Facebook, concerns about not wearing a veil in Facebook pictures, and their actual likelihood of wearing a veil. Items were combined to measure lack of interest in wearing a veil. Length of time as a Facebook user was significantly associated with not wearing a veil (b=0.16, p<0.01), controlling for age, education, and frequency of using Facebook. Results also revealed a significant relationship such that older people were more likely to adhere to the religious behavior of wearing a veil (b=-0.45, p<0.01). Social networking technologies can affect attitudes and behaviors internationally. We discuss methods of using social media for self-presentation and expression, as well as the difficulties (and importance) of studying use of technologies, such as social media, internationally.

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Associations Between Obesity and History of Abuse among American Indians in Rural California. 2014


Hodge F, Stemmler MS, Nandy K. Associations between Obesity and History of Abuse among American Indians in Rural California. J. Obes Weight Loss Ther. 2014, 4:1 http://dx.doi.org/10.4172/2165-7904.1000208

Abstract/Summary: This paper explores factors associated with obesity among American Indians. A cross-sectional survey of American Indian adults (N=459) was conducted at 13 rural reservation sites in California. Participants responded to a survey about their health and wellness perceptions. The Body Mass Index (BMI) was used to assess obesity. A predictive model for BMI was built using a generalized regression model. Having high blood pressure and having a history of verbal abuse in childhood were significant predictors of higher BMI. Participants with high blood pressure were more likely to have 3.2 units of BMI higher on average than those who do not have high blood pressure (p-value <0.0001). Similarly, those with a history of childhood verbal abuse were likely to have 1.9 units higher BMI on average compared to those with no such history. Having a history of diabetes or sexual abuse in childhood trend towards increased BMI, although not statistically significant. Identifying childhood trauma and its impact on adult obesity rates among American Indians provides new avenues for intervention. Efforts to reduce overweight and obesity should include culturally sensitive interventions to ameliorate what is lost through personal violations of stigma, abuse or neglect.

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Depression and Health Risk Behaviors: Towards Optimizing Primary Care Service Strategies for Addressing Risk. 2014


Asarnow JR, Zeledon LR, D’Amico E, LaBorde A, Anderson M, Avina C, Arslanian T, Do M, Harwood J, Shoptaw S. Depression and Health Risk Behaviors: Towards Optimizing Primary Care Service Strategies for Addressing Risk. Primary Health Care. 2014 (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: PURPOSE: Depression and health risk behaviors in adolescents are leading causes of preventable morbidity and mortality. Primary care visits provide prime opportunities to screen and provide preventive services addressing risk behaviors/conditions. This study evaluated the co-occurrence of depression and health risk behaviors (focusing on smoking, drug and alcohol misuse, risky sexual behavior, and obesity-risk) with the goal of informing preventive service strategies. METHODS: Consecutive primary care patients (n=217), ages 13 to 18 years, selected to over-sample for depression, completed a Health Risk Behavior Survey and the Diagnostic Interview Schedule for Children and Adolescents (DISC) depression module. RESULTS: Youths with DISC-defined past-year depression were significantly more likely to report risk across multiple risk-areas, Wald X2(1)=14.39, p<.001, and to have significantly higher rates of past-month smoking, X2(1)=5.86, p=.02, substance misuse, X2(1)=15.12, p<.001, risky sex,X2 (1) =5.04, p=.03, but not obesity-risk, X2 (1) =0.19,p=.66. Cross-sectional predictors of risk behaviors across risk areas were similar. Statistically significant predictors across all risk domains included: youths’ expectancies about future risk behavior; attitudes regarding the risk behavior; and risk behaviors in peers/others in their environments. CONCLUSIONS: Depression in adolescents is associated with a cluster of health risk behaviors that likely contribute to the high morbidity and mortality associated with both depression and health risk behaviors. Consistent with the United States National Prevention Strategy (2011) and the focus on integrated behavioral and medical health care, results suggest the value of screening and preventive services using combination strategies that target depression and multiple areas of associated health risk.

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Correlates of Self-Reported Incarceration Among Homeless Gay and Bisexual Stimulant-Using Young Adults. 2014


Nyamathi A, Reback CJ, Salem BE, Zhang S, Shoptaw S, Branson CM, Leake B. Correlates of Self-Reported Incarceration Among Homeless Gay and Bisexual Stimulant-Using Young Adults. West J Nurs Res. 2014 Apr 14 (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Gay and bisexual (G/B) homeless adults face multiple challenges in life which may place them at high risk for incarceration. Yet, little is known about this understudied population in terms of risk for incarceration. Baseline data collected from a longitudinal study between October 2009 and March 2012 in Hollywood, California, explored correlates of self-reported incarceration among G/B homeless stimulant-using adults (N = 353). Findings revealed older age, less education, having children, as well as a history of injection drug use and being born in the United States were positively associated with incarceration. Moreover, having poor social support and having received hepatitis information were also correlated with a history of incarceration. Our findings help us gain a greater awareness of homeless G/B adults who may be at greater risk for incarceration, which may be used by health care providers to design targeted interventions for this underserved population.

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Sexual Risk Trajectories Among MSM in the United States: Implications for Pre-exposure Prophylaxis Delivery. 2014


Pines HA, Gorbach PM, Weiss RE, Shoptaw S, Landovitz RJ, Javanbakht M, Ostrow DG, Stall RD, Plankey M. Sexual Risk Trajectories Among MSM in the United States: Implications for Pre-exposure Prophylaxis Delivery. J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):579-86. PMCID: PMC in progress.

Abstract/Summary: BACKGROUND: Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, sexual risk trajectories among HIV-negative MSM were characterized.
METHODS: At semiannual visits from 2003 to 2011, HIV-negative MSM (N = 419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors (SRBs) since their last visit. Based on their reported behaviors, participants were assigned a SRB score at each visit as follows: 0 = no insertive or receptive anal intercourse, 1 = no unprotected insertive or receptive anal intercourse, 2 = only unprotected insertive anal intercourse, 3 = unprotected receptive anal intercourse with 1 HIV-negative partner, 4 = condom serosorting, 5 = condom seropositioning, and 6 = no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores.

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Self-Reported Sexually Transmitted Infections and Sexual Risk Behaviors in the US Military: How Sex Influences Risk. 2014


Stahlman S, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM. Self-Reported Sexually Transmitted Infections and Sexual Risk Behaviors in the US Military: How Sex Influences Risk. Sex Transm Dis. 2014 Jun;41(6):359-64. PMCID: PMC in progress.

Abstract/Summary: BACKGROUND: Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes.
METHODS: We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members. RESULTS:
There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners). CONCLUSIONS: Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.

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Stuck in the Middle: Longitudinal HIV-Related Health Disparities Among Men Who Have Sex With Men and Women. 2014


Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the Middle: Longitudinal HIV-Related Health Disparities Among Men Who Have Sex With Men and Women. J Acquir Immune Defic Syndr. 2014 Jun 1;66(2):213-20. PMCID: PMC in progress.

Abstract/Summary: INTRODUCTION: Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. METHODS: Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. RESULTS: MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). DISCUSSION: Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.

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Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. 2014


Reback, C.J., Shoptaw, S. Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. Addictive Behaviors. 2014 Aug;39(8):1286-91. Epub 2011 Nov 26. PMCID: PMC3326187.

Abstract/Summary: This study compared outcomes in methamphetamine use and sexual risk behaviors from a modified gay-specific, cognitive behavioral therapy (GCBT) combined with a low-cost contingency management (CM; [GCBT+CM]) intervention to prior findings from clinical trials of the original GCBT. Effect sizes for primary outcomes were compared using meta analysis. Comparisons of effect sizes at end of treatment showed the modified GCBT+CM produced significantly fewer consecutive weeks of methamphetamine abstinence (-0.44, CI: -0.79, -0.09) and fewer male sexual partners (-0.36, CI: -0.71, -0.02) than the first trial of GCBT, and more days of methamphetamine use (0.35, CI: 0.02, 0.68) than the second trial of GCBT. At 26-week follow-up, the modified GCBT+CM produced greater effects in reducing the number of male sexual partners (-0.54, CI: -0.89, -0.19; -0.51, CI: -0.84, -0.18). The original GCBT produced more and mostly short-term beneficial drug use outcomes, though sexual behavior changes consistently favored the modified GCBT+CM. On balance, most benefits are retained with the modified GCBT+CM intervention.

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Methods of using real-time social media technologies for detection and remote monitoring of HIV outcomes. 2014


Young SD, Rivers C, Lewis B. Methods of using real-time social media technologies for detection and remote monitoring of HIV outcomes. Prev Med. 2014 Feb 8. [Epub ahead of print] PMCID: PMC in progress.

Abstract/Summary: OBJECTIVE: Recent availability of “big data” might be used to study whether and how sexual risk behaviors are communicated on real-time social networking sites and how data might inform HIV prevention and detection. This study seeks to establish methods of using real-time social networking data for HIV prevention by assessing 1) whether geolocated conversations about HIV risk behaviors can be extracted from social networking data, 2) the prevalence and content of these conversations, and 3) the feasibility of using HIV risk-related real-time social media conversations as a method to detect HIV outcomes. METHODS: In 2012, tweets (N=553,186,061) were collected online and filtered to include those with HIV risk-related keywords (e.g., sexual behaviors and drug use). Data were merged with AIDSVU data on HIV cases. Negative binomial regressions assessed the relationship between HIV risk tweeting and prevalence by county, controlling for socioeconomic status measures. RESULTS: Over 9800 geolocated tweets were extracted and used to create a map displaying the geographical location of HIV-related tweets. There was a significant positive relationship (p<.01) between HIV-related tweets and HIV cases. CONCLUSION: Results suggest the feasibility of using social networking data as a method for evaluating and detecting Human immunodeficiency virus (HIV) risk behaviors and outcomes.

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Electronic vending machines for dispensing rapid HIV self-testing kits: a case study. 2014


Young SD, Klausner J, Fynn R, Bolan R. Electronic vending machines for dispensing rapid HIV self-testing kits: a case study. AIDS Care. 2014 Feb;26(2):267-9. PMCID: PMC3917319.

Abstract/Summary: This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: (1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, (2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and (3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits.

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Randomized, placebo-controlled trial of bupropion in methamphetamine-dependent participants with less than daily methamphetamine use. 2014


Heinzerling KG, Swanson AN, Hall TM, Ba YY, Wu Y, Shoptaw SJ. Randomized, placebo-controlled trial of bupropion in methamphetamine-dependent participants with less than daily methamphetamine use. Addiction. 2014 Jun 4. doi: 10.1111/add.12636. [Epub ahead of print] PMID: 24894963

Abstract/Summary: AIMS: Two previous randomized trials found an effect for bupropion in reducing methamphetamine use in the subgroup with lower frequency of methamphetamine use at baseline. This study aimed to replicate these results by comparing bupropion versus placebo in methamphetamine dependent participants with less than daily methamphetamine use at baseline. METHODS: Methamphetamine dependent volunteers reporting methamphetamine use on ≤ 29 of past 30 days were randomized to bupropion 150mg twice daily (N=41) or placebo (N=43) and outpatient counseling for 12 weeks. The primary outcome was the proportion achieving end of treatment (EOT) methamphetamine abstinence (weeks 11 and 12) for bupropion versus placebo. A post hoc analysis compared EOT abstinence by medication adherence assessed via plasma bupropion/hydroxybupropion level. RESULTS: There was no significant difference in EOT abstinence between bupropion (29%, 12/41) and placebo (14%, 6/43; p = 0.087). Among participants receiving bupropion, EOT abstinence was significantly higher in participants assessed as medication adherent by plasma bupropion/hydroxybupropion levels (54%, 7/13) compared to non-adherent participants (18%, 5/28; p = 0.018). Medication adherence by plasma levels was low (32%). CONCLUSIONS: Bupropion may be efficacious for reducing methamphetamine in people with less than daily baseline methamphetamine use but the evidence remains inconclusive.

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Getting Off: Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. 2014


Reback, C.J., Shoptaw, S. Getting Off: Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. Addictive Behaviors. 2014 Aug;39(8):1286-91. Epub 2011 Nov 26. PMCID: PMC3326187

Abstract/Summary: This study compared outcomes in methamphetamine use and sexual risk behaviors from a modified gay-specific, cognitive behavioral therapy (GCBT) combined with a low-cost contingency management (CM; [GCBT+CM]) intervention to prior findings from clinical trials of the original GCBT. Effect sizes for primary outcomes were compared using meta analysis. Comparisons of effect sizes at end of treatment showed the modified GCBT+CM produced significantly fewer consecutive weeks of methamphetamine abstinence (-0.44, CI: -0.79, -0.09) and fewer male sexual partners (-0.36, CI: -0.71, -0.02) than the first trial of GCBT, and more days of methamphetamine use (0.35, CI: 0.02, 0.68) than the second trial of GCBT. At 26-week follow-up, the modified GCBT+CM produced greater effects in reducing the number of male sexual partners (-0.54, CI: -0.89, -0.19; -0.51, CI: -0.84, -0.18). The original GCBT produced more and mostly short-term beneficial drug use outcomes, though sexual behavior changes consistently favored the modified GCBT+CM. On balance, most benefits are retained with the modified GCBT+CM intervention.

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HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel.

Marrazzo, J. M., del Rio, C., Holtgrave, D. R., Cohen, M. S., Kalichman, S. C., Mayer, K. H., … & Kumarasamy, N. (2014). HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society–USA Panel. JAMA, 312(4), 390-409. PMID: 25038358

Abstract/Summary: IMPORTANCE: Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings.

OBJECTIVE: To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings.

DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society—USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus.

RESULTS: Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible.

CONCLUSIONS AND RELEVANCE: Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.

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Incorporating guidelines for use of mobile technologies in health research and practice.

Young SD, Holloway IW, Swendeman D. Incorporating guidelines for use of mobile technologies in health research and practice. Int Health. 2014 Apr 8. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: This report aims to create initial recommendations to guide researchers’ decisions on the development and use of mobile technologies for public health research. We recommend that mobile technologies for public health research should be: scalable and sustainable; draw on social, psychological and/or behavioral theoretical models; be able to be integrated with multiple communication devices; incorporate social network and/or geographic metrics and take a community-based participatory approach to development and implementation. All of these approaches are discussed.

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Project HOPE: Online Social Network Changes in an HIV Prevention Randomized Controlled Trial for African American and Latino Men Who Have Sex With Men. 2014


Young SD, Holloway I, Jaganath D, Rice E, Westmoreland D, Coates T. Project HOPE: Online Social Network Changes in an HIV Prevention Randomized Controlled Trial for African American and Latino Men Who Have Sex With Men. Am J Public Health. 2014 Jul 17:e1-e6. [Epub ahead of print] PMID: 25033137

Abstract/Summary:Objectives: We examined whether and how an HIV prevention diffusion-based intervention spread throughout participants’ online social networks and whether changes in social network ties were associated with increased HIV prevention and testing behaviors. Methods: We randomly assigned 112 primarily racial/ethnic minority men who have sex with men (MSM) to receive peer-delivered HIV (intervention) or general health (control) information over 12 weeks through closed Facebook groups. We recorded participants’ public Facebook friend networks at baseline (September 2010) and follow-up (February 2011), and assessed whether changes in network growth were associated with changes in health engagement and HIV testing. Results: Within-group ties increased in both conditions from baseline to follow-up. Among the intervention group, we found a significant positive relation between increased network ties and using social media to discuss sexual behaviors. We found a positive trending relationship between increased network ties and likelihood of HIV testing, follow-up for test results, and participation in online community discussions. No significant differences were seen within control groups. Conclusions: Among high-risk MSM, peer-led social media HIV prevention interventions can increase community cohesion. These changes appear to be associated with increased HIV prevention and testing behaviors.

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Acceptability of Using Electronic Vending Machines to Deliver Oral Rapid HIV Self-Testing Kits: A Qualitative Study. 2014


Young SD, Daniels J, Chiu CJ, Bolan RK, Flynn RP, Kwok J, Klausner JD. Acceptability of Using Electronic Vending Machines to Deliver Oral Rapid HIV Self-Testing Kits: A Qualitative Study. PLoS One. 2014 Jul 30;9(7):e103790. doi: 10.1371/journal.pone.0103790. eCollection 2014. PMID: 25076208

Abstract/Summary: INTRODUCTION: Rates of unrecognized HIV infection are significantly higher among Latino and Black men who have sex with men (MSM). Policy makers have proposed that HIV self-testing kits and new methods for delivering self-testing could improve testing uptake among minority MSM. This study sought to conduct qualitative assessments with MSM of color to determine the acceptability of using electronic vending machines to dispense HIV self-testing kits. MATERIALS AND METHODS: African American and Latino MSM were recruited using a participant pool from an existing HIV prevention trial on Facebook. If participants expressed interest in using a vending machine to receive an HIV self-testing kit, they were emailed a 4-digit personal identification number (PIN) code to retrieve the test from the machine. We followed up with those who had tested to assess their willingness to participate in an interview about their experience. RESULTS: Twelve kits were dispensed and 8 interviews were conducted. In general, participants expressed that the vending machine was an acceptable HIV test delivery method due to its novelty and convenience. DISCUSSION: Acceptability of this delivery model for HIV testing kits was closely associated with three main factors: credibility, confidentiality, and convenience. Future research is needed to address issues, such as user-induced errors and costs, before scaling up the dispensing method.

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Low-level Viremia Early in HIV Infection. 2014


Chen I, Cummings V, Fogel JM, Marzinke MA, Clarke W, Connor MB, Griffith S, Buchbinder S, Shoptaw S, Rio CD, Magnus M, Mannheimer S, Wheeler DP, Mayer KH, Koblin BA, Eshleman SH. Low-level Viremia Early in HIV Infection. J Acquir Immune Defic Syndr. 2014 Aug 19. [Epub ahead of print] PMCID: PMC4213245

Abstract/Summary: HIV RNA levels are usually high early in HIV infection. In the HPTN 061 study, men were tested for HIV infection every 6 months; 6 (21.4%) of 28 men who acquired HIV infection during the study had low or undetectable HIV RNA at the time of HIV diagnosis. Antiretroviral drugs were not detected at the time of HIV diagnosis. False-negative HIV test results were obtained for 2 men using multiple assays. Antiretroviral drug resistance mutations were detected in HIV from 1 man. Additional studies are needed to identify factors associated with low HIV RNA levels during early HIV infection.

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Stimulant Use and Progression to AIDS or Mortality After The Initiation of Highly Active Anti-Retroviral Therapy. 2014


Carrico AW, Shoptaw S, Cox C, Stall R, Li X, Ostrow DG, Vlahov D, Plankey MW. Stimulant Use and Progression to AIDS or Mortality After The Initiation of Highly Active Anti-Retroviral Therapy. J Acquir Immune Defic Syndr. 2014 Sep 30. [Epub ahead of print] PMID: 25271387

Abstract/Summary: BACKGROUND:
HIV-positive persons who use stimulants (eg, methamphetamine) experience profound health disparities, but it remains unclear whether these persist after highly active antiretroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined whether stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART.
METHODS:
Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (ie, 0%, 1%-49%, 50%-99%, and 100%) was examined as a time-varying predictor of (1) all-cause mortality and (2) AIDS or all-cause mortality.
RESULTS:
Among the 1313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risk analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (adjusted odds ratio = 1.54; 95% confidence interval: 1.02 to 2.33; P < 0.05).
CONCLUSIONS:
HIV-positive stimulant-using MSM receiving HAART seem to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared with nonusers. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.

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Intimate partner violence and reproductive health among methamphetamine-using women in Los Angeles: a qualitative pilot study. 2014


Abdul-Khabir W, Hall T, Swanson AN, Shoptaw S. Intimate partner violence and reproductive health among methamphetamine-using women in Los Angeles: a qualitative pilot study. J Psychoactive Drugs. 2014 Sep-Oct;46(4):310-6. doi: 10.1080/02791072.2014.934978. PMCID: PMC4188630.

Abstract/Summary: Among women, methamphetamine (meth) use has been associated with intimate partner violence (IPV); however, few studies have looked at the context of IPV. This qualitative pilot study explored the experiences of meth-using women in Los Angeles County regarding: (1) IPV in their most recent primary relationship; (2) use of contraception and reproductive health services; and (3) meth use during pregnancy. Participants (n=30) were recruited through community advertising and at three addiction treatment centers to participate in 15-20 minute, semi-structured interviews recorded with handwritten transcripts. The team analyzed transcripts for key themes. Participants reported IPV (n=19, 63%) as recipients (50%), perpetrators (40%), and/or both (27%), occurring mainly during active meth use or withdrawal. While most (n=25) continued meth use during at least one pregnancy, some (n=5, 17%) identified pregnancy as a motivation to quit or reduce use, suggesting an opportunity for intervention. Though most women knew about free and low-cost reproductive health services, few accessed them, with 33% citing aspects of meth use itself as a barrier. One-third (45/133) of reported pregnancies were terminated by abortion. Most women (67%) began using before age 18, suggesting need for screening and intervention among adolescents.

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Behavioral insights on big data: using social media for predicting biomedical outcomes. 2014

Young SD. Behavioral insights on big data: using social media for predicting biomedical outcomes. Trends Microbiol. 2014 Nov;22(11):601-2. doi: 10.1016/j.tim.2014.08.004. Epub 2014 Oct 29. PMCID: PMC in progress.

Abstract/Summary: Among women, methamphetamine (meth) use has been associated with intimate partner violence (IPV); however, few studies have looked at the context of IPV. This qualitative pilot study explored the experiences of meth-using women in Los Angeles County regarding: (1) IPV in their most recent primary relationship; (2) use of contraception and reproductive health services; and (3) meth use during pregnancy. Participants (n=30) were recruited through community advertising and at three addiction treatment centers to participate in 15-20 minute, semi-structured interviews recorded with handwritten transcripts. The team analyzed transcripts for key themes. Participants reported IPV (n=19, 63%) as recipients (50%), perpetrators (40%), and/or both (27%), occurring mainly during active meth use or withdrawal. While most (n=25) continued meth use during at least one pregnancy, some (n=5, 17%) identified pregnancy as a motivation to quit or reduce use, suggesting an opportunity for intervention. Though most women knew about free and low-cost reproductive health services, few accessed them, with 33% citing aspects of meth use itself as a barrier. One-third (45/133) of reported pregnancies were terminated by abortion. Most women (67%) began using before age 18, suggesting need for screening and intervention among adolescents.

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A “big data” approach to HIV epidemiology and prevention. 2014

Young SD. A “big data” approach to HIV epidemiology and prevention. Prev Med. 2014 Nov 8;70C:17-18. doi: 10.1016/j.ypmed.2014.11.002. [Epub ahead of print] PMCID: PMC in progress.

Abstract/Summary: The recent availability of “big data” from social media and mobile technologies provides promise for development of new tools and methods to address the HIV epidemic. This manuscript presents recent work in this growing area of bioinformatics, digital epidemiology, and disease modeling, describes how it can be applied to address HIV prevention, and presents issues that need to be addressed prior to implementing a mobile technology big-data approach to HIV prevention.

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Piloting an HIV self-test kit voucher program to raise serostatus awareness of high-risk African Americans, Los Angeles. 2014

Marlin RW, Young SD, Bristow CC, Wilson G, Rodriguez J, Ortiz J, Mathew R, Klausner JD. Piloting an HIV self-test kit voucher program to raise serostatus awareness of high-risk African Americans, Los Angeles. BMC Public Health. 2014 Nov 26;14(1):1226. [Epub ahead of print] PMCID: PMC in progress.

Abstract/Summary: Background: Up to half of all new HIV cases in Los Angeles may be caused by the 20-30% of men who have sex with men (MSM) with unrecognized HIV infection. Racial/ethnic minority MSM are at particularly high risk for being sero-unaware and due to stigma and poor healthcare access might benefit from novel private, self-testing methods, such as the recently FDA-approved OraQuick(R) In-Home HIV Test. Methods: From July-November 2013, we undertook a pilot study to examine the feasibility of a voucher program for free OraQuick(R) tests targeting African American MSM in Los Angeles. We determined feasibility based on: (1) the establishment of a voucher redemption and third-party payment system, (2) the willingness of community-based organizations (CBOs) to disseminate vouchers, and (3) the collection of user demographics, test and linkage-to-care results with an anonymous telephone survey. Results: We partnered with Walgreens(R) to create a voucher and third-party reimbursement system for free OraQuick(R) tests. Voucher distribution was divided into two periods. In total, 641 vouchers were supplied to CBOs: 274 (42.7%) went to clients and of those 53 (19.3%) were redeemed. Fifty (18.2%) of the 274 clients were surveyed: 44 (88%) were African American, 39 (78%) reported being likely to repeat voucher use, 44 (88%) reported reviewing pre-test information, and 37 (74%) the post-test information. Three (6%) of 50 survey respondents reported newly testing HIV-positive of whom all (100%) reported seeking medical care. Two withheld their results, both of whom also sought medical care. Conclusions: Developing and partnering with a commercial pharmacy to institute a voucher system to facilitate HIV self-testing with linkage-to-care was feasible. Our findings suggest the voucher program was associated with increasing the identification of new cases of HIV infection with high rates of linkage to care. Expanded research and evaluation of voucher programs for HIV self-test kits among high-risk groups is warranted.

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Association between Obesity and History of Abuse among American Indians in Rural California. 2014


Hodge F, Stemmler MS, Nandy K. ] Association between Obesity and History of Abuse among American Indians in Rural California. J Obes Weight Loss Ther. 2014;4. pii: 1000208. PMCID: PMC4236913

Abstract/Summary: OBJECTIVES: To explore factors associated with obesity among American Indians. METHODS: A cross-sectional survey of American Indian adults (N=459) was conducted at 13 rural reservation sites in California. Participants responded to a survey about their health and wellness perceptions. The Body Mass Index (BMI) was used to assess obesity. A predictive model for BMI was built using a generalized regression model. RESULTS: Having high blood pressure and having a history of verbal abuse in childhood were significant predictors of higher BMI. Participants with high blood pressure were likely to have 3.2 units of BMI higher on average than those who do not have high blood pressure (p-value <0.0001). Similarly, those with a history of childhood verbal abuse were likely to have 1.9 units higher BMI on average compared to those with no such history. Having a history of diabetes or sexual abuse in childhood trend towards increased BMI, although not statistically significant. CONCLUSION: Identifying childhood trauma and its impact on adult obesity rates among American Indians provides new avenues for intervention. Efforts to reduce over weight and obesity should include culturally sensitive interventions to ameliorate and repair what is lost through personal violations of stigma, abuse or neglect.
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Sometimes Poppers Are Not Poppers: Huffing as an Emergent Health Concern Among MSM Substance Users. 2014


Hall TM, Shoptaw S, Reback CJ. Sometimes Poppers Are Not Poppers: Huffing as an Emergent Health Concern Among MSM Substance Users. J Gay & Lesbian Health. 14 Oct 2014 DOI:10.1080/19359705.2014.973180

Abstract/Summary: While men who have sex with men (MSM) in North America have commonly used alkyl nitrite “poppers,” related to the vasodilator amyl nitrite, in sexual contexts since at least the 1970s, they do not have a significant history of using solvent or propellant inhalants, known as “huffing.” This may be changing, with some solvents being marketed as a “new form of poppers.” Huffing solvents carries considerably more health risk than using alkyl nitrite poppers, but this may not be recognized by clinicians, who usually have little knowledge of either, or MSM, who do not have a cultural history of huffing. We discuss this potential recent trend and health risks.
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2013


Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. 2013


Herrick AL, Lim SH, Plankey MW, Chmiel JS, Guadamuz TE, Kao U, Shoptaw S, Carrico A, Ostrow D, Stall R. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health. 2013 Jan;103(1):79-85 PMCID: 3518355

Abstract/Summary: We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland–Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ2 = 247.94; P < .001; df = 22). We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

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It gets better: Resolution of internalized homophobia over time and associations with positive health outcomes among MSM. 2013

Herrick, A.L., Lim, S.H., Plankey, M.W., Chmiel, J.S., Guadamuz, T.E., Kao, U., Shoptaw, S., Ostrow, D., Plankey, M.W. It gets better: Resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behavior. 2013 Jan 3. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.

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Pilot randomized trial of Bupropion for adolescent methamphetamine abuse/dependence. 2013


Heinzerling, K.G., Gadzhyan J., van Oudheusden H., Rodgriguez, F., McCracken, J., Shoptaw, S. Pilot randomized trial of Bupropion for adolescent methamphetamine abuse/dependence. Journal of Adolescent Health. 2013 Jan 16. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Nineteen adolescents with methamphetamine abuse (n ¼ 2) or dependence (n ¼ 17) were randomly assigned to bupropion SR (Sustained Release Formula) 150 mg twice daily or placebo for 8 weeks with regular outpatient substance abuse counseling. Bupropion was well-tolerated except for one female in the bupropion group who was hospitalized for suicidal ideation during a methamphetamine relapse. Adolescents receiving bupropion and females provided significantly fewer methamphetamine-free urine tests compared to participants receiving placebo and males respectively. Results do not support the feasibility of additional trials of bupropion for adolescent methamphetamine abuse/dependence. Future studies should investigate the influence of gender on adolescent methamphetamine abuse and treatment outcomes.

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Stimulant use among African American and Latino MSM social networking users. 2013


Young, S.D., Shoptaw, S. Stimulant use among African American and Latino MSM social networking users. Journal of Addiction Disorders. 2013 Jan; 32(1): 39-45. PMCID: PMC in progress.

Abstract/Summary: High stimulant-using and at-risk HIV populations, such as African American and Latino men who have sex with men (MSM), are increasingly using social networking technologies. However, no known research has explored associations between stimulant use, sexual risk behaviors, and social networking among these populations. Participants of this research study were recruited using the Facebook Connect software application, which narrowed the sample to 118 (primarily African American and Latino MSM) active Facebook users. Participants completed demographic, Internet and social media use, and drug use survey items. Participants reported high rates of cocaine and methamphetamine use (both more than 15% within the past 12 months). More than 70% of participants reported using social networking technologies to meet people, and more than 30% used them to find sexual partners. A multivariate logistic regression showed that (1) participants using social networks to find sexual partners were more likely to have used methamphetamines within the past 12 months and (2) those who were more comfortable talking online compared to face-to-face had over 4 times the odds of methamphetamine use and over 6 times the odds of cocaine use within the past 12 months. Minority MSM who used social networks to meet men and find sexual partners had high risk for stimulant use. Understanding drug use among minority social networking users will provide insights to incorporate these technologies into drug prevention interventions.

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Correlates of Hepatitis B Virus and HIV knowledge among gay and bisexual homeless young adults in Hollywood. 2013


Nyamathi, A., Salem, B., Reback, C.J., Shoptaw, S., Branson, C.M., Idemundia, F.E., Kennedy, B., Khalilifard, F., Marfisee, M., Liu, Y. Correlates of Hepatitis B Virus and HIV knowledge among gay and bisexual homeless young adults in Hollywood. American Journal of Men’s Health. 2013 Jan; 7(1):18-26. PMCID: PMC3724810

Abstract/Summary: Homeless gay and bisexual (G/B) young men have multiple risk factors that increase their risk of contracting hepatitis B virus (HBV) and human immunodeficiency virus (HIV). This study used baseline information from structured instruments to assess correlates of knowledge to HIV and HBV infection from 267 young (18-39 year old) G/B active methamphetamine, cocaine, and crack-using homeless men enrolled in a longitudinal trial. The study was designed to reduce drug use and improve knowledge of hepatitis and HIV/AIDS in a community center in Hollywood, California. Regression modeling revealed that previous hepatitis education delivered to G/B men was associated with higher levels of HIV/AIDS and hepatitis knowledge. Moreover, higher HIV/AIDS knowledge was associated with combining sex and drinking alcohol. Associations with hepatitis B knowledge was found among G/B men who were engaging in sex while under the influence of marijuana, who were receiving support from non–drug users, and who had been homeless in the last 4 months. Although being informed about HIV/AIDS and hepatitis did not preclude risky sexual and drug use behavior, knowledge about the dangers of concurrent sex with substance use is important. As higher levels of knowledge of hepatitis was associated with more moderate drug use, early access to testing and teaching harm reduction strategies remain critical to reduce exposure and infection of HBV and HIV in this population.

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The influence of social networking photos on social norms and sexual health behaviors. 2013


Young, S.D., Jordan, A.H. The influence of social networking photos on social norms and sexual health behaviors. Cyberpsychology, Behavior and Social Networking. 2013 Feb 25. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Two studies tested whether online social networking technologies influence health behavioral social norms, and in turn, personal health behavioral intentions. In Study 1, experimental participants browsed peers’ Facebook photos on a college network with a low prevalence of sexually suggestive content. Participants estimated the percentage of their peers who have sex without condoms, and rated their own future intentions to use condoms. Experimental participants, compared to controls who did not view photos, estimated that a larger percentage of their peers use condoms, and indicated a greater intention to use condoms themselves in the future. In Study 2, participants were randomly assigned to view sexually suggestive or nonsexually suggestive Facebook photos, and responded to sexual risk behavioral questions. Compared to participants viewing nonsuggestive photos, those who viewed sexually suggestive Facebook photos estimated that a larger percentage of their peers have unprotected sexual intercourse and sex with strangers and were more likely to report that they themselves would engage in these behaviors. Thus, online social networks can influence perceptions of the peer prevalence of sexual risk behaviors, and can influence users’ own intentions with regard to such behaviors. These studies suggest the potential power of social networks to affect health behaviors by altering perceptions of peer norms.

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Feasibility of using social networking technologies for health research among men who have sex with men: A mixed methods study. 2013


Young, S.D., Jaganath, D. Feasibility of using social networking technologies for health research among men who have sex with men: A mixed methods study. American Journal of Men’s Health. 2013 Feb 12. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: This study aims to assess the feasibility and acceptability of using social networking as a health research platform among men who have sex with men (MSM). Fifty-five MSM (primarily African American and Latino) were invited to join a “secret” group on the social networking website, Facebook. Peer leaders, trained in health education, posted health-related content to groups. The study and analysis used mixed (qualitative and quantitative) methods. Facebook conversations were thematically analyzed. Latino and African American participants voluntarily used social networking to discuss health-related knowledge and personal topics (exercise, nutrition, mental health, disease prevention, and substance abuse) with other group participants (N = 564 excerpts). Although Latinos comprised 60% of the sample and African Americans 25.5%, Latinos contributed 82% of conversations and African Americans contributed only 15% of all conversations. Twenty-four percent of posts from Latinos and 7% of posts from African Americans were related to health topics. Results suggest that Facebook is an acceptable and engaging platform for facilitating and documenting health discussions for mixed methods research among MSM. An understanding of population differences is needed for crafting effective online social health interventions.

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Online social networking for HIV education and prevention: a mixed-methods analysis. 2013


Young, S.D., Jaganath, D. Online social networking for HIV education and prevention: a mixed-methods analysis. Sexually Transmitted Diseases. 2013 Feb; 40(2):162-7. PMCID: PMC in progress.

Abstract/Summary: The purpose of this study is to use mixed (qualitative/ quantitative) methods to determine (1) the feasibility and acceptability of using online social networking to facilitate HIV-related discussions and (2) the relationship between HIV-related online discussions and requests for a home-based HIV testing kit among men who have sex with men. Participants, primarily African American and Latino, were invited to join a ‘‘secret’’ group on the social networking Web site, Facebook. Peer leaders, trained in HIV prevention, posted HIV-related content. Participants were not obligated to respond to discussions or remain within the group. Participant public group conversations were qualitatively and thematically analyzed. Quantitative methods tested associations between qualitative data, participants’ demographic information, and likelihood of requesting a home-based HIV testing kit. Latino and African American participants (n = 57) voluntarily used Facebook to discuss the following HIV-related topics (n = 485 conversations): prevention and testing, knowledge, stigma, and advocacy. Older participants more frequently discussed prevention and testing, stigma, and advocacy, although younger participants more frequently discussed HIV knowledge-related conversations. As the study progressed, the proportion of messages related to prevention and testing and HIV stigma increased. Multivariate analysis showed that participants posting about HIV prevention and testing (compared with those who did not) were significantly more likely to request an HIV testing kit (odds ratio, 11.14; P = 0.001). Facebook can serve as an innovative forum to increase both HIV prevention discussions and HIV testing requests among at-risk groups.

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Interventions for Addiction: Comprehensive Addictive Behaviors and Disorders. 2013


Brensilver, M., Shoptaw, S. (2013). Pharmacotherapy of Cocaine Dependence. In P. Miller (Ed.), Interventions for Addiction: Comprehensive Addictive Behaviors and Disorders. (439–448). San Diego, CA: Elsevier, Inc.

Abstract/Summary: This chapter describes the rationale and targets for cocaine pharmacotherapies, reviews the evidence for select agents, discusses emerging pharmacogenetic data, and proposes directions for future work.


Not just the needle: the state of HIV-prevention science among substance users and future directions. 2013


Shoptaw, S., Montgomery, B., Williams, C.T., El-Bassel, N., Aramrattana, A., Metsch, L., Metsch, L., Metzger, D.S., Kuo, I., Bastos, F.I., Strathde, S.A. Not just the needle: the state of HIV-prevention science among substance users and future directions. J Acquir Immune Defic Syndr 2013; 63:S174-S178. PMCID: PMC in progress.

Abstract/Summary: Efforts to prevent HIV transmission among substance using populations have focused primarily on injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by noninjectable means, and there is a dearth of HIV prevention interventions that target noninjecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine, in addition to new and emerging substances (eg, synthetic cannabinoids, cathinones, and other amphetamine analogs) are needed to develop and scale up effective and robust interventions for populations at risk for HIV transmission via sexual behaviors related to noninjection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV infected and those who are HIV uninfected and are at high risk. We propose a research agenda that prioritizes (1) combination HIV prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in nontreatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence.

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Severity of drug dependence and perceived need for treatment among a sample of adult club users in Shanghai, China. 2013


Ding, Y., He, N., Shoptaw, S., Gao, M., Detels, R. Severity of drug dependence and perceived need for treatment among a sample of adult club users in Shanghai, China. Soc Psychiatr Epidemiol. 2013 May 29. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: Two hundred and seventy-six club drug users were recruited using respondent-driven sampling (RDS). Severity of dependence on club drugs was measured using the Severity of Dependence Scale (SDS). 69.9 % reported dependence on club drugs (i.e., SDS C 4) and 36.6 % reported severe dependence (i.e., SDS C 6). One-eighth (12.7 %) perceived need for drug treatment. Severe dependence on club drugs was more likely among those who reported recent use of ecstasy and those who had more depressive symptoms, but less likely among those reporting recent use of methamphetamine. Perceived need for treatment was more likely among those who lived with a spouse or boy/girlfriend, but less likely among those had prior drug treatment experience and more severe club drug dependence. Our findings suggest that educational activities should be implemented to raise public awareness about the powerful addictive properties of club drugs, along with efforts to reduce stigma towards drug abuse and psychiatric disorders. Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.

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Up in smoke? A preliminary open-label trial of nicotine replacement therapy and cognitive behavioral motivational enhancement for smoking cessation among youth in Los Angeles. 2013


Swanson AN, Shoptaw S, Heinzerling KG, Wade AC, Worley M, McCracken J, Wilson SA, Asarnow J, London ED. Up in smoke? A preliminary open-label trial of nicotine replacement therapy and cognitive behavioral motivational enhancement for smoking cessation among youth in Los Angeles. Subst Use Misuse. 2013 Jul 3. (Epub ahead of print). PMCID: PMC in progress.

Abstract/Summary: In 2008–2009, we conducted a 6-week, open-label trial of transdermal nicotine replacement therapy and practical counseling for 34 adolescents seeking smoking cessation in Los Angeles. Dependent outcomes were study retention, use of the patch, and 7-day quit status at the end-of-study and at follow-up visits. Predictors of outcomes included cigarette dependence, withdrawal symptoms, demographic and psychiatric measures, and other substance use. Variables significant in bivariate analysis (p < .10) were retained in a multivariate model. Subjects had significant pre-to-post reductions in quit rates, dependence, and withdrawal symptoms. Subjects also reported a high number of comorbidities. Implications for clinicians are discussed.

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Correlates of HIV acquisition in a cohort of black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. 2013


Koblin, B., Mayer K., Eshleman, S., Wang, L., Mannheimer, S., del Rio, C., Shoptaw, S., Magnus, M., Buchbinder, S., Wilton, L., Ting-Yuan, L., Cummings, V., Piwowar-Manning, E., Fields, S., Griffith, S., Elharrar, V., Wheeler, D., for the HPTN 061 Protocol Team. Correlates of HIV acquisition in a cohort of black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. PLoS ONE 8(7): e70413. doi:10.1371/journal.pone.0070413

Abstract/Summary: Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other races/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts. From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional hazards modeling with time-dependent covariates was used to identify correlates of HIV acquisition.

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Differences in substance use, psychosocial characteristics and HIV-related sexual risk behavior between black men who have sex with men only (BMSMO) and black men who have sex with men and women (BMSMW) in six US cities. 2013


Dyer, T.P., Regan, R., Wilton, L., Harawa, N.T., Ou, S.S., Wang, L., Shoptaw, S. Differences in substance use, psychosocial characteristics and HIV-related sexual risk behavior between black men who have sex with men only (BMSMO) and black men who have sex with men and women (BMSMW) in six US cities. Journal of Urban Health. 2013 Jul 30 (Epub ahead of print) PMCID: PMC in progress.

Abstract/Summary: We assessed associations in substance use, psychosocial characteristics, and HIV related sexual risk behaviors, comparing characteristics of Black men who only have sex with other men only (BMSMO; n=839) to Black men who have sex with men and women (BMSMW; n=590). The study analyzed baseline data from the HIV Prevention Trials Network Brothers Study (HPTN 061), a feasibility study of a multi-component intervention for Black MSM in six US cities. Bivariate analyses compared BMSMO to BMSMW along demographics, substance use, psychosocial characteristics, and HIV-related sexual risk behaviors. Logistic regression models then assessed multivariable associations between being BMSMW and the odds of engaging in HIV-related sexual risk behaviors. Adjusted analyses revealed that BMSMW remained more likely to have unprotected anal intercourse while under the influence of alcohol (AOR: 1.45; 95 % CI:1.11–1.90) and were more likely to receive money/drugs for sex (AOR: 2.11; 95 % CI:1.48–3.03), compared to BMSMO. Substance use is an important factor to be considered when developing risk-reduction interventions for BMSMW. Structural interventions that address factors that may contribute to exchange sex among these men are also warranted.

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Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. 2013


Reback, C.J., Fletcher, J.B., Shoptaw, S., Grella, C.E. Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. Drug & Alcohol Dependence. 2013 Jul 23 (Epub ahead of print) PMCID: PMC in progress.

Abstract/Summary: It is particularly important to survey substance use trends in populations most impacted by the consequences of substance use. Men who have sex with men (MSM) exhibit rates of methamphetamine and other substance use that exceeds those observed among other populations in the United States. Such substance use has been associated with numerous negative health sequelae. An outreach program performed street encounters with 5599 unique substance-using MSM from January 1, 2008 through December 31, 2011 to collect data on self-reported sociodemographics and recent substance use. Data were aggregated into six-month cohorts for comparisons of recent substance use patterns across time. Participants averaged 33 years of age (SD = 8), most were Caucasian/white (47%) or Hispanic/ Latino (32%), and the self-reported HIV seroprevalence rate was 13.4%. Across cohorts, reported use of alcohol (range = 91–93%), marijuana (range = 36–46%), and/or methamphetamine (range = 23–27%) was common; prevalence of amyl nitrite (max = 14%), ecstasy (max = 12%), powder cocaine (max = 8%) and/or crack cocaine (max = 4%) use, although less common, were still elevated relative to the United States general population. Methamphetamine and other substance use remained common among substance-using MSM, demonstrating the need for continued substance use interventions geared toward this high-risk population.

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Pharmacotherapy of amphetamine-type stimulant dependence: An update. 2013


Brensilver, M., Heinzerling, K.G., Shoptaw, S. Pharmacotherapy of amphetamine-type stimulant dependence: An update. Drug Alcohol Rev. 2013 Apr 25 (Epub ahead of print) PMCID: PMC in progress.

Abstract/Summary: Methamphetamine or amphetamine-type stimulants are the second most frequently used illicit drug worldwide, second only to cannabis. Behavioural treatments are efficacious, but their impact is limited, underscoring the need for other treatment options, notably, pharmacotherapy. A review of randomized controlled trials of pharmacotherapies for methamphetamine or amphetamine-type stimulants was performed using PubMed and Google Scholar databases. Evidence for efficacy of medications is reported. Clinical trials have yielded no broadly effective pharmacotherapy. Promising signals have been observed for methylphenidate, naltrexone, bupropion and mirtazapine in subgroups of patients in reducing stimulant use (e.g., patients with less severe dependence at baseline, men who have sex with men), though none has produced an unambiguous, replicable signal of efficacy. Problems in Phase II trials, including high drop-out rates, missing data problems, and a lack of agreement on outcomes complicate efforts to find a broadly effective pharmacotherapy for ATS disorders. Efforts to address these problems include calls for better validation of pharmacological target exposure, receptor binding, and functional modulation. As well, there is a need for agreement in using findings from preclinical and early phases of the medication development process for selecting better pharmacotherapy candidates. After over 20 years of efforts worldwide to develop a broadly effective medication for dependence on methamphetamine or amphetamine-type stimulants, no candidate has emerged. This highlights the need for new compounds, consistent and stringent research methods, better integration between preclinical and clinical stages of medication development, and improved collaboration between government, industry and researchers.

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Development of a Model Program for Gay and Bisexual Male Methamphetamine Users. 2013


Reback CJ, Veniegas R, Shoptaw S. Getting Off: Development of a Model Program for Gay and Bisexual Male Methamphetamine Users. J Homosex. 2013 Nov 18. PMID: 24245506 [Epub ahead of print]

Abstract/Summary: An evidence-based gay-specific cognitive behavioral therapy (GCBT) intervention for methamphetamine-using gay and bisexual men was adapted for use in a community-based setting, thereby moving research into practice. The 48-session, 16-week GCBT intervention was revised to 24 sessions requiring 8 weeks and renamed Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users. GCBT was modified for implementation within the limited resources and capacity of community-based organizations while also retaining drug use and HIV risk reduction outcomes. Since 2007, Getting Off has been sustained with public health funding at the community site and has been adopted by multiple community-based sites.

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Spend today, clean tomorrow: Predicting methamphetamine abstinence in a randomized controlled trial. 2013


Ling Murtaugh K, Krishnamurti T, Davis AL, Reback CJ, Shoptaw S. Spend today, clean tomorrow: Predicting methamphetamine abstinence in a randomized controlled trial. Health Psychol. 2013 Sep; 32(9):958-66. PMCID: PMC in progress.

Abstract/Summary: This secondary analysis of data from a randomized controlled trial tested two behavioral economics mechanisms (substitutability and delay discounting) to explain outcomes using contingency management (CM) for methamphetamine dependence. Frequency and purchase type (hedonic/ utilitarian and consumable/durable) of CM payments were also examined. Methods: A total of 82 methamphetamine-dependent gay/bisexual men randomly assigned to conditions delivering CM received monetary vouchers in exchange for stimulant-negative urine samples in a 16-week trial requiring thrice weekly visits (Shoptaw et al., 2005). At any visit participants could redeem vouchers for goods. A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined aspects of the frequency and type of these CM purchases. Results: After controlling for severity of baseline methamphetamine use and accumulated CM wealth, as measured by cumulative successful earning days, participants who redeemed CM earnings at any visit (“spenders”) were significantly more likely to produce stimulant-negative urine samples in the subsequent visit, compared with those who did not redeem (“savers”) 1.011 [1.005, 1.017], Z 3.43,p .001. Conclusions: Findings support the economic concept of substitutability of CM purchases and explain trial outcomes as a function of frequency of CM purchases rather than frequency or accumulated total CM earnings. Promotion of frequent purchases in incentive-based programs should facilitate substitution for the perceived value of methamphetamine and improve abstinence outcomes.

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Nondisclosure of HIV Status in a Clinical Trial Setting: Antiretroviral Drug Screening Can Help Distinguish Between Newly Diagnosed and Previously Diagnosed HIV Infection. 2013


Marzinke MA, Clarke W, Wang L, Cummings V, Liu TY, Piwowar-Manning E, Breaud A, Griffith S, Buchbinder S, Shoptaw S, Del Rio C, Magnus M, Mannheimer S, Fields SD, Mayer KH, Wheeler DP, Koblin BA, Eshleman SH, Fogel JM. Nondisclosure of HIV Status in a Clinical Trial Setting: Antiretroviral Drug Screening Can Help Distinguish Between Newly Diagnosed and Previously Diagnosed HIV Infection. Clin Infect Dis. 2013 Nov 5. PMID: 24092804 [Epub ahead of print]

Abstract/Summary: In The HIV Prevention Trials Network 061 study, 155 human immunodeficiency virus (HIV)-infected men reported no prior HIV diagnosis; 83 of those men had HIV RNA levels of

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Commentary on: HIV antiretroviral prophylaxis for injecting drug users. 2013


Miller WC, Hoffman IF, Latkin CA, Strathdee SA, Shoptaw S. Commentary on: HIV antiretroviral prophylaxis for injecting drug users. Lancet. 2013 Sep 7;382(9895):853. PMID: 24012262

Abstract/Summary: Comment on
Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.

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Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California. 2013


Landovitz RJ, Tseng CH, Weissman M, Haymer M, Mendenhall B, Rogers K, Veniegas R, Gorbach PM, Reback CJ, Shoptaw S. Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California. J Urban Health. 2013 Aug;90(4):729-39. PMCID: PMC3732683

Abstract/Summary: Young men who have sex with men (YMSM) are at alarming risk for HIV acquisition, demonstrating the highest rates of incident infection of any age-risk group. GRINDR is a global positioning service-based social networking application popular with YMSM for sexual partnering. To assess the characteristics of YMSM who use GRINDR, we conducted a computer-assisted self-interview-based survey of 375 YMSM using GRINDR in metropolitan Los Angeles, recruited using the GRINDR platform. The median age was 25 (interquartile range, 22-27) years old, 42.4 % caucasian, 6.4 % African American, 33.6 % Latino, and 14.1 % Asian/Pacific Islander. Participants reported high rates of sexual partnering and unprotected anal intercourse (UAI). The majority (70 %) of those reporting unprotected anal intercourse reported low perception of HIV-acquisition risk. Of the participants, 83.1 % reported HIV testing within the past 12 months; 4.3 % had never been HIV tested. Of the participants, 4.5 % reported HIV-positive serostatus; 51.7 % indicated that they would be interested in participating in a future HIV prevention trial. Latinos were more likely than either caucasians or African Americans to endorse trial participation interest (odds ratio, 1.9; 95 % confidence interval [1.1-3.3]). HIV-positive test results were associated with increased number of anal sex partners in the past 3 months (adjusted odds ratio (AOR), 1.53 [0.97-2.40]), inconsistent inquiry about partners’ serostatus (AOR, 3.63 [1.37-9.64]), reporting the purpose for GRINDR use including “friendship” (AOR, 0.17 [0.03-1.06), and meeting a sexual partner in a bookstore in the past 3 months (AOR, 33.84 [0.99-1152]). Men recruited via GRINDR were high risk for HIV acquisition or transmission and interested in clinical trial participation, suggesting potential for this method to be used for recruitment of YMSM to HIV prevention trials.

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Social Media Technologies for HIV Prevention Study Retention Among Minority Men Who Have Sex with Men (MSM)2013


Young SD.Social Media Technologies for HIV Prevention Study Retention Among Minority Men Who Have Sex with Men (MSM). AIDS Behav. 2013 Sep 6. [Epub ahead of print] PMID: 24062015

Abstract/Summary: This brief report describes results on study retention among minority men who have sex with men (MSM) from a 12-week, social networking-based, HIV prevention trial with 1-year follow-up. Participants, primarily minority MSM, were recruited using online and offline methods and randomly assigned to a Facebook (intervention or control) group. Participants completed a baseline survey and were asked to complete two follow-up surveys (12-week follow-up and 1-year post-intervention). 94 % of participants completed the first two surveys and over 82 % completed the baseline and both post-intervention surveys. Participants who spent a greater frequency of time online had almost twice the odds of completing all surveys. HIV negative participants, compared to those who were HIV positive, had over 25 times the odds of completing all surveys. HIV prevention studies on social networking sites can yield high participant retention rates.

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Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. 2013


Young SD, Cumberland WG, Lee SJ, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013 Sep 3;159(5):318-24. PMID: 24026317

Abstract/Summary: Sixteen peer leaders were randomly assigned to deliver information about HIV or general health to participants via Facebook groups over 12 weeks. After participants accepted a request to join the group, participation was voluntary. Group participation and engagement were monitored. Participants could request a free, home-based HIV testing kit and completed questionnaires at baseline and 12-week follow-up. Participant acceptance of and engagement in the intervention and social network participation, rates of home-based HIV testing, and sexual risk behaviors. Almost 95% of intervention participants and 73% of control participants voluntarily communicated using the social platform. Twenty-five of 57 intervention participants (44%) requested home-based HIV testing kits compared with 11 of 55 control participants (20%) (difference, 24 percentage points [95% CI, 8 to 41 percentage points]). Nine of the 25 intervention participants (36%) who requested the test took it and mailed it back compared with 2 of the 11 control participants (18%) who requested the test. Retention at study follow-up was more than 93%.

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Sexual risk and HIV prevention behaviours among African-American and Latino MSM social networking users. 2013


Young SD, Szekeres G, Coates T. Sexual risk and HIV prevention behaviours among African-American and Latino MSM social networking users. Int J STD AIDS. 2013 Aug;24(8):643-9. PMCID: PMC3855428

Abstract/Summary: This study explores the feasibility of recruiting minority men who have sex with men Facebook users for human immunodeficiency virus (HIV) prevention studies and notes demographic and sexual risk behaviours. Facebook-registered men who have sex with men (MSM; N = 118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (coefficient = −0.48, p < 0.05) of unprotected receptive anal intercourse compared to Latino MSM. Results suggest that minority social media users can be recruited for HIV studies and that sexual risk behavioural differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.

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The relationship between online social networking and sexual risk behaviors among men who have sex with men (MSM). 2013


Young SD, Szekeres G, Coates T. The relationship between online social networking and sexual risk behaviors among men who have sex with men (MSM). PLoS One. 2013 May 1;8(5):e62271. PMCID: PMC3642936

Abstract/Summary: Online social networking usage is growing rapidly, especially among at-risk populations, such as men who have sex with men (MSM). However, little research has studied the relationship between online social networking usage and sexual risk behaviors among at-risk populations. One hundred and eighteen Facebook-registered MSM (60.1% Latino, 28% African American; 11.9% other) were recruited from online (social networking websites and banner advertisements) and offline (local clinics, restaurants and organizations) venues frequented by minority MSM. Inclusion criteria required participants to be men who were 18 years of age or older, had had sex with a man in the past 12 months, were living in Los Angeles, and had a Facebook account. Participants completed an online survey on their social media usage and sexual risk behaviors. Results from a multivariable regression suggest that number of sexual partners met from online social networking technologies is associated with increased: 1) likelihood of having exchanged sex for food, drugs, or a place to stay within the past 3 months; 2) number of new partners within the past 3 months; 3) number of male sex partners within the past 3 months; and 4) frequency of engaging in oral sex within the past 3 months, controlling for age, race, education, and total number of sexual partners. Understanding the relationship between social media sex-seeking and sexual risk behaviors among at-risk populations will help inform population-focused HIV prevention and treatment interventions.

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Electronic vending machines for dispensing rapid HIV self-testing kits: A case study. 2013


Young SD, Klausner J, Fynn R, Bolan R. Electronic vending machines for dispensing rapid HIV self-testing kits: A case study. AIDS Care. 2013 Jun 18. PMID: 23777528 [Epub ahead of print]

Abstract/Summary: This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: (1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, (2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and (3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits.

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Online Technologies for Health Information and Education: A literature review. 2013


Gill HK, Gill N, Young SD. Online Technologies for Health Information and Education: A literature review. J Consum Health Internet. 2013 Apr 1;17(2): 139-150. PMCID: PMC3899793.

Abstract/Summary: There is a growing body of research focused on the use of social media and Internet technologies for health education and information sharing. The authors reviewed literature on this topic, with a specific focus on the benefits and concerns associated with using online social technologies as health education and communication tools. Studies suggest that social media technologies have the potential to safely and effectively deliver health education, if privacy concerns are addressed. Utility of social media-based health education and communication will improve as technology developers and public health officials determine ways to improve information accuracy and address privacy concerns.

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2012


Optimizing pain management through collaborations with behavioral and addiction medicine in primary care. 2012


Brensilver M, Tariq S, Shoptaw S. Optimizing pain management through collaborations with behavioral and addiction medicine in primary care. Primary Care. 2012 Dec;39(4):661-9. PMCID: PMC in progress.

Abstract/Summary: Chronic noncancer pain (CNCP) affects many primary care patients, and carries a large human and economic burden. In response to the widespread perception that pain is underdiagnosed and undertreated, regulatory bodies have encouraged more comprehensive services to address pain syndromes. Significant hurdles exist in treating CNCP in primary care settings, and interventional therapies and pharmacotherapy often do not provide complete symptomatic relief. This article describes a multidimensional and interdisciplinary approach to the treatment of CNCP. The utility of collaborations with behavioral and addiction medicine specialists optimizes care and advances models of patient treatment within a primary care patient-centered medical home.

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Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study. 2012


Shoptaw S, Stall R, Bordon J, Kao U, Cox C, Li X, Ostrow DG, Plankey MW. Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study. International Journal of STD & AIDS. 2012 Aug;23(8):576-80. PMCID: PMC in process.

Abstract/Summary: We examined associations between stimulant use (methamphetamine and cocaine) and other substances (nicotine, marijuana, alcohol and inhaled nitrites) with immune function biomarkers among HIV-seropositive (HIV +) men taking highly active antiretroviral therapy (ART) and HIV-seronegative (HIV-) men in the Multicenter AIDS Cohort Study. Among HIV + men, cumulative adherence to ART (4.07, 95% confidence interval [CI]: 3.52, 4.71, per 10 years of adherent ART use), and recent cohort enrolment (1.38; 95% CI: 1.24, 1.55) were multiplicatively associated with increase in CD4+/CD8+ ratios. Cumulative use of methamphetamine (0.93; 95% CI: 0.88, 0.98, per 10 use-years), cocaine (0.93; 95% CI: 0.89, 0.96, per 10 use-years) and cumulative medical visits (0.99; 95% CI: 0.98, 0.99, per 10 visit-years), each showed small negative associations with CD4+/CD8+ ratios. Among HIV- men, cumulative medical visits (0.996; 95% CI: 0.993, 0.999), cumulative number of male sexual partners (0.999; 95% CI: 0.998, 0.9998, per 10 partner-years) and cigarette pack-years (1.10; 95% CI: 1.02, 1.18, per 10 pack-years) were associated with CD4+/CD8+ ratios over the same period. ART adherence is associated with a positive immune function independent of stimulant use, underscoring the influence of ART on immune health for HIV+ men who engage in stimulant use.

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Integration of behavioral medicine in primary care. 2012


Bholat MA, Ray L, Brensilver M, Ling K, Shoptaw S. Integration of behavioral medicine in primary care. Primary Care. 2012 Dec;39(4)605-14. PMCID: PMC in progress.

Abstract/Summary: The health care system in the United States is inefficient and there are many incentives for sustainable changes in the delivery of care. Incorporating behavioral medicine offers a wide range of opportunities. Within primary care settings, pain disorders, addiction, depression, and anxiety disorders are highly prevalent. Numerous chronic health conditions also require behavioral support for lifestyle change. These disorders are optimally managed through interdisciplinary collaborations that include a behavioral medicine component. This article discusses the effective integration of behavioral medicine within a primary care patient-centered medical home and describes the organizational planning and structure required for success.

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Cigarette smoking as a target for potentiating outcomes for methamphetamine abuse treatment. 2012


Brensilver M, Heinzerling KG, Swanson AN, Telesca D, Furst BA, Shoptaw SJ. Cigarette smoking as a target for potentiating outcomes for methamphetamine abuse treatment. Drug Alcohol Rev. 2012 Mar 4. doi: 10.1111/j.1465-3362.2012.00423.x. [Epub ahead of print]. PMCID: PMC3371287.

Abstract/Summary: Introduction and Aims. Cigarette smoking occurs frequently among individuals with methamphetamine (MA) dependence. Preclinical and clinical evidence has suggested that the common co-abuse of MA and cigarettes represents a pharmacologically meaningful pattern. Methods. The present study is a secondary analysis of a randomised, placebo-controlled 36; placebo = trial of bupropion treatment for MA dependence (bupropion n 37). A hierarchical logistic modelling approach assessed the efficacy of = n bupropion for reducing MA use separately among smokers and non-smokers. Among smokers, relations between cigarettes smoked and MA use were assessed. Results. Smoking status did not affect treatment responsiveness in either the bupropion condition or the placebo condition. In the placebo condition, increased cigarette use was associated with an increased probability of MA use during the same time period. This effect was not observed in the bupropion condition. Discussion and Conclusions. Initial smoking status did not impact treatment outcomes. Among smokers, results suggest that bupropion may dissociate cigarette and MA use. The effect was modest and a precise pharmacological mechanism remains elusive. Cholinergic systems may be relevant for MA use outcomes. Future studies should continue to assess the role of smoking in MA treatment outcomes.

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A retrospective analysis of two randomized trials of bupropion for methamphetamine dependence: Suggested guidelines for treatment discontinuation/augmentation. 2012


Brensilver M, Heinzerling KG, Swanson AN, Shoptaw SJ. A retrospective analysis of two randomized trials of bupropion for methamphetamine dependence: Suggested guidelines for treatment discontinuation/ augmentation. Drug Alcohol Depend. 2012 Apr 23. [Epub ahead of print]

Abstract/Summary:

BACKGROUND: Two clinical trials have shown efficacy for bupropion in treating methamphetamine (MA) dependence among those with moderate baseline MA use. However, treatment response is highly variable and it is unclear what duration of treatment is necessary to determine if maintaining the treatment course is indicated or if discontinuation or augmentation is appropriate. The present study assessed the relationship among early bupropion treatment response for moderate MA users and end-of-treatment (EOT) abstinence. These data provide estimates of the duration of treatment and the degree of responsiveness required to persist in bupropion treatment.

METHODS: Participants with moderate baseline MA use in the bupropion condition of two randomized double-blind placebo controlled trials were included. The relationship between early treatment response and EOT outcomes was assessed with Receiver Operating Characteristic (ROC) curves.

RESULTS: With thrice weekly urine drug testing, excellent predictive power was established in the first two weeks of treatment. The inability to achieve at least three MA negative samples in the first two weeks is associated with greater than 90% likelihood of treatment failure. More closely approximating clinical settings, once-weekly testing featured reliable predictive power within three weeks, suggesting that the failure to produce at least two clean samples in the first three weekly visits confers high risk of treatment failure.

DISCUSSION: The findings provide preliminary evidence to guide clinical decisions for moderate MA users receiving bupropion. The results are consistent with data from the smoking cessation literature and may highlight the importance of early response in addiction treatment.

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Where are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Have Sex with Men in Los Angeles County. 2012


Holloway IW, Cederbaum JA, Ajayi A, Shoptaw S. Where are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Have Sex with Men in Los Angeles County. Journal of Primary Prevention. 2012 Nov 7. Epub ahead of print. PMCID: PMC in progress.

Abstract/Summary: Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M (age) = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0 % of all participants had previously attended an HIV prevention program, and that 21.3 % of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p < .05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0 %), not perceiving themselves to be at risk for HIV infection (14.0 %), and believing that they already knew everything they needed to know about HIV transmission (23.0 %). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.

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Gender, Brain-Derived Neurotrophic Factor Val66Met, and Frequency of Methamphetamine Use. 2012


Heinzerling KG, Shoptaw S. Gender, Brain-Derived Neurotrophic Factor Val66Met, and Frequency of Methamphetamine Use. Gend Med. 2012 Apr;9 (2):112-20. Epub 2012 Mar 23. PMCID: PMC3322259

Abstract/Summary:

BACKGROUND: Frequency of pretreatment methamphetamine (MA) use is an important predictor of outcomes of treatment for MA dependence. Preclinical studies suggest females self-administer more MA than males, but few clinical studies have examined potential sex differences in the frequency of MA use. Estrogen increases expression of brain-derived neurotrophic factor (BDNF), which has effects on MA-induced striatal dopamine release and protects against MA-induced neurotoxicity.

OBJECTIVE: We examined potential effects of sex, the Val66Met polymorphism in BDNF, and their interaction on frequency of MA use among 60 Caucasian MA-dependent volunteers screening for a clinical trial.

METHODS: Data was taken from 60 Caucasian MA-dependent volunteers screening for a clinical trial.

RESULTS: Females reported significantly more pretreatment days with MA use in the past 30 days than males. There was a significant interaction between sex and BDNF Val66Met, with the highest frequency of MA use among females with Val/Val genotype.

CONCLUSIONS: These results, although preliminary, add to the literature documenting sexual dimorphism in response to stimulants, including MA, and suggest a potential biological mechanism involving BDNF that might contribute to these differences. Additional research characterizing the biological basis of altered response to MA among females is warranted.

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Analysis of online social networking peer health educators. 2012


Young SD. (2012). Analysis of online social networking peer health educators. Studies in Health Technology and Informatics, 181, 253-9. PMCID: PMC in process.

Abstract/Summary: This study seeks to determine whether peer leaders can be recruited to deliver a community-based health intervention using social media. African American and Latino men who have sex with men (MSM) were recruited as peer leaders for either an HIV prevention or general health intervention using social networking technologies. Peer leaders attended 3 training sessions on how to use social media for health behaviour change. Baseline and post-training questionnaires were given to ensure that peer leaders were qualified in using social media to communicate health information. Repeated measures ANOVA models and ÷2 tests assessed differences in peer leader knowledge and comfort using social networking technologies pre- and post-training. Post-training, peer leaders were significantly more comfortable using social media to discuss sexual positions. Almost all peer leaders reported being comfortable using social media. There were no significant pre- and post-training differences on other knowledge or comfort measures. Results suggest that peer leaders can be recruited to conduct health interventions using social networking technologies. The discussed training plan can be adapted to health domains to ensure that peer leaders are qualified to conduct health interventions using social media.

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Prevention case management improves socioeconomic standing and reduces symptoms of psychological and emotional distress among transgender women. 2012


Reback CJ, Shoptaw S, Downing MJ. Prevention case management improves socioeconomic standing and reduces symptoms of psychological and emotional distress among transgender women. AIDS Care. 2012 Sep;24(9):1136-44. PMCID: PMC in process.

Abstract/Summary: Urban transgender women often experience several sociocultural co-factors which contribute to their risk of HIV infection. A transgender-specific HIV Prevention Case Management (PCM) intervention was implemented in a community HIV prevention setting and targeted reducing sex work and homelessness, increasing legal employment and income, and reducing psychological and emotional distress symptoms. Sixty high-risk transgender women were enrolled in the ten-session PCM intervention. Participants completed approximately nine out of the ten sessions (M = 8.7; SD = 2.6) and six-month follow-up evaluations were completed with 97% of the participants. Findings from baseline to follow-up evaluations demonstrated a decrease in homelessness (31.0% vs. 10.3%, p<0.01), less reliance on exchange sex as a primary source of income (41.4% vs. 22.4%, p < 0.05), and significant decreases in symptom complaints across multiple Brief Symptom Inventory sub-scales, including depression, hostility, phobic anxiety, and psychoticism (all significant at p<0.05). Further, socioeconomic improvements following the intervention were significantly associated with psychological and emotional gains. The study suggests that adding a culturally appropriate PCM intervention in a community setting is beneficial in addressing co-factors for HIV infection as well as psychological and emotional distress symptoms among this extremely high-risk population.

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Sexual Risk Behaviors and Acceptability of HIV Pre-Exposure Prophylaxis Among HIV-Negative Gay and Bisexual Men in Serodiscordant Relationships: A Mixed Methods Study. 2012


Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee SJ,Barkley TW. Sexual Risk Behaviors and Acceptability of HIV Pre-Exposure Prophylaxis Among HIV-Negative Gay and Bisexual Men in Serodiscordant Relationships: A Mixed Methods Study. AIDS Patient Care and STDs. Volume 26, Number 2, 2012.

Abstract/Summary: The objective of this mixed methods study was to examine current sexual risk behaviors, acceptability and potential adoption of pre-exposure prophylaxis (PrEP) for HIV prevention, and sexual behavior intentions with PrEP adoption among HIV-negative gay and bisexual men (GBM) in HIV serodiscordant relationships. A multiracial/ethnic sample of 25 HIV-negative GBM in serodiscordant relationships completed a qualitative interview and a brief interviewer-administered survey. A modified grounded theory approach was used to identify key themes relating to acceptability and future adoption of PrEP. Participants reported engaging in sexual risk behaviors that place them at risk for HIV infection. Participants also reported a high level of acceptability for PrEP and willingness to adopt PrEP for HIV prevention. Qualitative themes explaining future PrEP adoption included: (1) the opportunity to engage in sex using a noncondom HIV prevention method, (2) protection from HIV infection, and (3) less anxiety when engaging in sex with an HIV-positive partner. Associated with the future adoption of PrEP, a majority (64%) of participants indicated the likelihood for an increase in sexual risk behaviors and a majority (60%) of participants also indicated the likelihood for a decrease or abandonment of condom use, both of which are in contrast to the findings from the large iPrEx study. These findings suggest that the use of PrEP by HIV-negative GBM in serodiscordant relationships carries with it the potential for risk compensation. The findings suggest that PrEP only be offered as part of a comprehensive HIV prevention strategy that includes ongoing risk reduction counseling in the delivery of PrEP to help moderate risk compensation.

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Placebo-group responders in methamphetamine pharmacotherapy trials: the role of immediate establishment of abstinence. 2012


Brensilver M, Heinzerling KG, Swanson AN, Shoptaw SJ. Placebo-group responders in methamphetamine pharmacotherapy trials: the role of immediate establishment of abstinence. Exp Clin Psychopharmacol. 2012 Oct;20(5):430-5. PMCID: PMC in progress.

Abstract/Summary: Treatment responses of placebo groups in addiction medicine trials have important implications for research methodology and clinical practice, however studies examining placebo group responses in addiction medicine are scarce. Extant data suggest the importance of early treatment responsiveness for long-term outcomes. Among methamphetamine-(MA) dependent individuals randomized to placebo pill plus behavioral support conditions in pharmacotherapy development trials, we hypothesized that immediate abstinence would be a necessary but insufficient predictor for end-of-trial (EOT) abstinence. The study is a secondary analysis of participants (n = 184; 36% female) in the placebo condition of three randomized, placebo-controlled methamphetamine dependence pharmacotherapy trials. Receiver operating characteristic (ROC) curve analyses assessed the predictive power of initial abstinence, assessed by thrice weekly urine samples, for EOT abstinence. Sixty percent of individuals with complete abstinence in the first two weeks of treatment were abstinent at EOT, while 18% of people who failed to meet this standard were abstinent at EOT. Early response was related to retention at EOT and 12-month follow-up. Findings suggest that the inability to achieve at least three MA negative screenings in the first two weeks is associated with greater than 90% likelihood of treatment failure. A third week of screening added minimally to the prediction of EOT outcomes. The prediction of treatment failure was more precise than the prediction of treatment success. The absence of a clinical response in the first two weeks of treatment among participants in the placebo group signals high risk of treatment failure. The majority of information regarding response in the placebo group from a 12-week trial is obtained early in the trial.

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. Epidemiology, Sexual Risk Behavior, and HIV Prevention Practices of Men who Have Sex with Men Using GRINDR in Los Angeles, California. 2012


Landovitz RJ, Tseng CH, Weissman M, Haymer M, Mendenhall B, Rogers K, Veniegas R, Gorbach PM, Reback CJ, Shoptaw S. Epidemiology, Sexual Risk Behavior, and HIV Prevention Practices of Men who Have Sex with Men Using GRINDR in Los Angeles, California. J Urban Health. 2012 Sep 14 [Epub ahead of print]

Abstract/Summary: Young men who have sex with men (YMSM) are at alarming risk for HIV acquisition, demonstrating the highest rates of incident infection of any age-risk group. GRINDR is a global positioning service-based social networking application popular with YMSM for sexual partnering. To assess the characteristics of YMSM who use GRINDR, we conducted a computer-assisted self-interview-based survey of 375 YMSM using GRINDR in metropolitan Los Angeles, recruited using the GRINDR platform. The median age was 25 (interquartile range, 22-27) years old, 42.4 % caucasian, 6.4 % African American, 33.6 % Latino, and 14.1 % Asian/Pacific Islander. Participants reported high rates of sexual partnering and unprotected anal intercourse (UAI). The majority (70 %) of those reporting unprotected anal intercourse reported low perception of HIV-acquisition risk. Of the participants, 83.1 % reported HIV testing within the past 12 months; 4.3 % had never been HIV tested. Of the participants, 4.5 % reported HIV-positive serostatus; 51.7 % indicated that they would be interested in participating in a future HIV prevention trial. Latinos were more likely than either caucasians or African Americans to endorse trial participation interest (odds ratio, 1.9; 95 % confidence interval [1.1-3.3]). HIV-positive test results were associated with increased number of anal sex partners in the past 3 months (adjusted odds ratio (AOR), 1.53 [0.97-2.40]), inconsistent inquiry about partners’ serostatus (AOR, 3.63 [1.37-9.64]), reporting the purpose for GRINDR use including “friendship” (AOR, 0.17 [0.03-1.06), and meeting a sexual partner in a bookstore in the past 3 months (AOR, 33.84 [0.99-1152]). Men recruited via GRINDR were high risk for HIV acquisition or transmission and interested in clinical trial participation, suggesting potential for this method to be used for recruitment of YMSM to HIV prevention trials.

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Behavioral Evidence of HIV Testing Stigma. 2012


Young SD, Zhu Y. (2012). Behavioral Evidence of HIV Testing Stigma. AIDS and Behavior, 16(3), 736-40. PMCID: PMC 3240738

Abstract/Summary: To avoid HIV testing stigma, people may engage in non-stigmatized behaviors to conceal their interest in HIV testing. We examined 165,828 outpatient visits in a 2002-2007 national survey to explore whether people receiving an HIV diagnostic test, compared to people receiving non-stigmatized, diagnostics tests (mammography and blood pressure testing), listed their interest in testing more frequently as a non-primary reason for visit, listed a greater number of reasons for visiting the clinic, and listed more reasons for visit unrelated to the testing performed. Among people who reported HIV testing as a reason for visit, 42.39% requested HIV testing as a non-primary reason for visit (mammography: 13.77%; blood pressure: 18.01%), and on average listed more reasons for visiting the clinic. The odds of requesting additional unrelated services for HIV testing patients was almost 5 times that of patients requesting blood pressure tests and over 20 times the odds of mammography patients. Together, we interpret these results as initial behavioral evidence of people’s avoidance of HIV stigma in health care settings. We hope that this manuscript serves as a call to action for future research exploring causal relationships between health service usage and HIV stigma.

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Harnessing Online Peer Education (HOPE): Integrating C-POL and social media to train peer leaders in HIV prevention. 2012


Jaganath D, Gil H, Cohen A, Young SD. (2012). Harnessing Online Peer Education (HOPE): Integrating C-POL and social media to train peer leaders in HIV prevention. AIDS Care, 24(5), 593-6. PMCID: PMC3342451

Abstract/Summary: Novel methods, such as Internet-based interventions, are needed to combat the spread of HIV. While past initiatives have used the Internet to promote HIV prevention, the growing popularity, decreasing digital divide, and multi-functionality of social networking sites, such as Facebook, make this an ideal time to develop innovative ways to use online social networking sites to scale HIV prevention interventions among high-risk groups. The UCLA Harnessing Online Peer Education study is a longitudinal experimental study to evaluate the feasibility, acceptability, and preliminary effectiveness of using social media for peer-led HIV prevention, specifically among African American and Latino Men who have Sex with Men (MSM). No curriculum currently exists to train peer leaders in delivering culturally aware HIV prevention messages using social media. Training was created that adapted the Community Popular Opinion Leader (C-POL) model, for use on social networking sites. Peer leaders are recruited who represent the target population and have experience with both social media and community outreach. The curriculum contains the following elements: discussion and role playing exercises to integrate basic knowledge of HIV/AIDS, awareness of sociocultural HIV/AIDS issues in the age of technology, and communication methods for training peer leaders in effective, interactive social media-based HIV prevention. Ethical issues related to Facebook and health interventions are integrated throughout the sessions. Training outcomes have been developed for long-term assessment of retention and efficacy. This is the first C-POL curriculum that has been adapted for use on social networking websites. Although this curriculum has been used to target African-American and Latino MSM, it has been created to allow generalization to other high-risk groups.

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COMT Val158Met, BDNF Val66Met, and OPRM1 Asn40Asp and Methamphetamine Dependence Treatment Response: Preliminary Investigation. 2012


Heinzerling K, McCracken JT, Swanson AN, Ray L, Shoptaw S. COMT Val158Met, BDNF Val66Met, and OPRM1 Asn40Asp and Methamphetamine Dependence Treatment Response: Preliminary Investigation. Journal of Clinical Psychopharmacology.2012 Feb:32 (1):135-7. [PMCID: PMC in process]

Abstract/Summary: The interaction between modafinil and COMT Val158Met observed in our study of MA dependence is similar to findings from a study of cognitive effects of modafinil in healthy sleep-deprived adults, which also found response to modafinil only among Val/Val participants.8 The Val allele is associated with lower prefrontal dopaminergic and cognitive function relative to the Met allele.4,5 Response to modafinil, a medication with dopaminergic and cognitive enhancing effects, may be limited to Val/Val participants who experience a deficit in dopaminergic and cognitive functioning relative to Met carriers that is ameliorated by treatment with modafinil. Additional studies examining COMT Val158Met as a potential marker of response to modafinil, as well as other dopaminergic and cognitive enhancing medications, in stimulant dependence are warranted. Although results of this exploratory study are preliminary, they provide the first data on potential genetic moderators of MA dependence treatment response and may guide the design of future prospective pharmacogenetic studies in MA dependence.

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Double-blind placebo-controlled evaluation of the PROMETA™ Protocol for methamphetamine dependence. 2012


Ling W, Shoptaw S, Hillhouse, Bholat MA, Charuvastra C, Heinzerling K, Chim D, Annon J, and Doraimani G. Double-blind placebo-controlled evaluation of the PROMETA™ Protocol for methamphetamine dependence. Addiction. 106: doi:10.1111/j.1360-0443.2011.03619.x Epub Ahead of Print. PMCID: PMC in progress.

Abstract/Summary:

AIMS: To evaluate the efficacy and safety of the PROMETA™ Protocol for treating methamphetamine dependence.

DESIGN: A double-blind, placebo-controlled 108-day study with random assignment to one of two study conditions: active medication with flumazenil (2 mg infusions on days 1, 2, 3, 22, 23), gabapentin (1200 mg to day 40) and hydroxazine (50 mg to day 10) versus placebo medication (with active hydroxazine only).

SETTING: Three substance abuse treatment clinics: two in-patient, one out-patient.

PARTICIPANTS: Treatment-seeking, methamphetamine-dependent adults (n = 120).

MEASUREMENTS: Primary outcome was percentage of urine samples testing negative for methamphetamine during the trial.

FINDINGS: No statistically significant between-group differences were detected in urine drug test results, craving, treatment retention or adverse events.

CONCLUSIONS: The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving.

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A Novel Combination HIV Prevention Strategy: Post-Exposure Prophylaxis with Contingency Management for Substance Abuse Treatment Among Methamphetamine-Using Men Who Have Sex With Men. 2012


Landovitz RJ, Fletcher JB, Inzhakova G., Lake JE, Shoptaw S, Reback CJ. A Novel Combination HIV Prevention Strategy: Post-Exposure Prophylaxis with Contingency Management for Substance Abuse Treatment Among Methamphetamine-Using Men Who Have Sex With Men. AIDS Patient Care and STDs. 2012 Jun;26(6):320-8. PMCID:PMC3366332

Abstract/Summary: Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.

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Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men who have Sex with Men. 2012


Reback CJ, Grant DL, Fletcher JB, Branson CM, Shoptaw S, Bowers JR, Charania M, Mansergh G. Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men Who Have Sex with Men. AIDS Behav. 2012 Oct;16(7):1993-2002. PMCID: PMC in process.

Abstract/Summary: Text-messaging interventions present a novel approach for targeting high-risk men who have sex with men (MSM) who may not respond to or may be difficult to reach for face-to-face or site-based interventions. Project Tech Support (N = 52) was an open label pilot study testing the feasibility and utility of a text-messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM. Participants in the two-week intervention received social support and health education text messages transmitted in real-time. At follow-up, there were significant decreases in frequency of methamphetamine use and unprotected sex while on methamphetamine (both p < 0.01), and a significant increase in self-reported abstinence from methamphetamine use (13.3 % vs. 48.9 %; p < 0.001). Additionally, participants reported reductions of unprotected anal intercourse with HIV-positive partners (p < 0.01); with HIV-negative partners, participants reported fewer insertive and receptive episodes (both p < 0.05). Findings demonstrate that text messaging is a promising intervention for reaching and potentially changing HIV high-risk behaviors among out-of-treatment, methamphetamine-using MSM.

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Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study. 2012


Penniman-Dyer T, Shoptaw S, Guadamuz T, Plankey M, Kao U, Ostrow D, Chmiel J, Herrick A, Stall R. Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study. Journal of Urban Health. 2012 Aug;89(4):697-708. PMCID: PMC in process.

Abstract/Summary: This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI-1.1, 3.3) and stress (OR: 2.67, 95% CI=1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI=1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95%, CI=1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI=1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI=1.2, 3.5) and IPV (OR: 2.84, 95% CI=1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI=1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.

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Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men. 2012


Murphy RD, Gorbach PM, Weiss RE, Hucks-Ortiz C, Shoptaw SJ. Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men. AIDS Behav. 2012 May 27. [Epub ahead of print] PMCID: PMC347932

Abstract/Summary: Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.

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Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. 2012


Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A. Substance Use Scientific Committee of the HIV Prevention Trials Network. Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. Current Opinion on HIV/AIDS. 2012 Jul;7(4):320-5.PMCID: PMC in process

Abstract/Summary:

PURPOSE OF REVIEW: Recent breakthroughs in HIV-prevention science led us to evaluate the current state of combination HIV prevention for injection drug users (IDUs). We review the recent literature focusing on possible reasons why coverage of prevention interventions for HIV, hepatitis C virus (HCV) and tuberculosis among IDUs remains dismal. We make recommendations for future HIV research and policy.

RECENT FINDINGS: IDUs disproportionately under-utilize voluntary HIV counseling and testing (VCT), primary care and antiretroviral therapy (ART), especially in countries that have the largest burden of HIV among IDUs. IDUs present later in the course of HIV infection and experience greater morbidity and mortality. Why are IDUs under-represented in HIV-prevention research, access to treatment for both HIV and addiction, and access to HIV combination prevention? Possible explanations include addictophobia, apathy, and inattention, which we describe in the context of recent literature and events.

SUMMARY: This commentary discusses the current state of HIV-prevention interventions for IDUs including VCT, needle and syringe program (NSP), opioid substitution therapy (OST), ART and pre-exposure chemoprophylaxis (PrEP), and discusses ways to work towards true combination HIV prevention for IDU populations. Communities need to overcome tacit assumptions that IDUs can navigate through systems that are maintained as separate silos, and begin to take a rights-based approach to HIV prevention to ensure that IDUs have equitable access to life-saving prevention and treatments.

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Anal human papillomavirus infection in a street-based sample of drug using HIV positive men. 2012


Cranston RD, Murphy R, Weiss RE, Da Costa M, Palefsky J, Shoptaw S, Gorbach PM. Anal human papillomavirus infection in a street-based sample of drug using HIV positive men. Int J STD AIDS. 2012 Mar;23(3):195-200. PMCID: PMC in process.

Abstract/Summary: HIV facilitates an increase in human papillomavirus (HPV)-associated conditions. HIV-positive men living in a substance use context in Los Angeles, USA, were recruited using respondent-driven sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. A total of 316 evaluable men were enrolled in the study. The prevalence of any HPV, high-risk (HR) infection and multiple-type infection was highest for men who have sex with men (MSM) (93.9%, 64.6% and 29.7%, respectively). When any HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence, respectively, with similarly high rates maintained up to age 49 years. The individual’s use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV detection. In this marginalized population, high prevalence rates of anal HPV and HR-HPV occurring over a wide age range may increase the individual’s risk for anal dysplasia and anal cancer.

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Recommended guidelines on using social networking technology for HIV prevention research. 2012


Young SD. Recommended guidelines on using social networking technologies for HIV prevention research. AIDS Behav. 2012 Oct;16(7):1743-5. PMCID: PMC3459230.

Abstract/Summary: This manuscript presents the field of social networking for HIV prevention by highlighting (a) the purpose of social networking technologies, (b) methods of using the technologies for HIV prevention research, and (c) recommended guidelines to improve data quality and study efficacy.

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Changes in Stimulant Drug Use Over time in the MACS. 2012


Lim SH, Ostrow D, Stall R, Chmiel J, Herrick A., Shopatw S., Kao U, Carrico A., Plankey M. Changes in Stimulant Drug Use Over time in the MACS: Evidence for Resilience Against Stimulant Drug Use Among Men Who Have Sex with Men. AIDS Behavior. 2012 Jan;16(1):151-8. PMCID: PMC3133874

Abstract/Summary: Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)-an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.

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Adversity & Syndemic Production Among Men Participating in the MACS. 2012


Herrick AL, Lim SH, Plankey MW, Chmiel JS, Guadamuz TT, Kao U, Shoptaw S, Ostrow D, Stall R. Adversity and Syndemic Production Among Men Participating in the Multicenter AIDS Cohort Study: A Life-Course Approach. American Journal of Public Health. 2013 Jan; 103(1):79-85. Epub 2012 Nov 15. PMCID: PMC in progress

Abstract/Summary: Objectives. We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Methods. Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. Results. Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (÷(2) = 247.94; P < .001; df = 22). Conclusions. We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

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Correlates of depressed mood among young stimulant-using homeless gay and bisexual men. 2012


Nyamathi A. Branson C, Idemundia F, Reback C, Shoptaw S, Marfisee M, Keenan C, Khalilifard F, Liu Y, Yadav K. Correlates of depressed mood among young stimulant-using homeless gay and bisexual men. Issues Ment Health Nurs. 2012 Ocg;33(10):641-9. PMCID: PMC in process.

Abstract/Summary: Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services.

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2011


Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. 2011


Zorick T, Sugar CA, Hellemann G, Shoptaw S, London, ED. Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. Drug & Alcohol Dependence. 2011 Nov 1; 118(2-3):500-3. PMCID: PMC3181284

Abstract/Summary: Using a dataset from a 12-week randomized, placebo-controlled trial of sertraline (100mg daily) for MA addiction, we identified participants who had completed at least 8 weeks of the trial (n=61sertraline, n=68 placebo). We compared the proportions of MA-positive urine tests for weeks 8-12 of the trial for these subjects to their pre-randomization baseline, and identified those subjects who increased MA use during treatment. Using classification trees, we then assessed all data collected during the study to identify factors associated with increasing MA use during treatment with sertraline, compared to placebo.

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The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. 2011


Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. AIDS & Behavior. 2011 Oct; 15(7):1347-58 PMCID: PMC3180610

Abstract/Summary: We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners’: (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.

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A quasi F test functional linear models with functional covariates and its application to longitudinal data. 2011


Xu H, Shen Q, Yang Z, Shoptaw S. A quasi F test functional linear models with functional covariates and its application to longitudinal data. Statistics In Medicine. 2011 Oct 15; 30(23):2842-53. PMCID: PMC21786285

Abstract/Summary: Functional linear models are useful in analyzing data from designed experiments and observational studies with functional responses, as well as longitudinal data with a large number of repeated measures on each subject. We propose a quasi F-test for functional linear models with functional covariates and outcomes. We develop a numerical procedure and an efficient approximation for computing p-values, and present a simple way to test individual predictors. For illustration, we apply the proposed procedure to a longitudinal depression data set with repeatedly measured methamphetamine use as a predictor. We conduct a simulation study to assess the size and the power of the test.

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Clinical Correlates of Health-Related Quality of Life Among Opioid-Dependent Patients. 2011


Heslin KC, Stein JA, Heinzerling KG, Pan D, Magladry C, Hays RD. Clinical Correlates of Health-Related Quality of Life Among Opioid-Dependent Patients. Quality Life Res. 2011 October; 20(8): 1205-1213. PMCID: PMC3178032

Abstract/Summary: Previous work suggests that opioid users have lower health-related quality of life (HRQOL) than patients with more prevalent chronic illnesses such as hypertension or diabetes. Although comparisons with population norms are informative, studies of the correlates of HRQOL for opioid users are needed to plan clinical services. We tested a conceptual model of the pathways between physiologic factors and symptoms in relation to HRQOL among 344 opioid users in a clinical trial. Physical and mental HRQOL were measured by the Short-Form (SF)-36; withdrawal signs, symptoms, and functioning were also measured with validated instruments. Using structural equation modeling, we tested hypotheses that medical history directly predicts withdrawal signs and symptoms, and that medical history, withdrawal signs and symptoms, and functioning predict the physical and mental HRQOL latent variables of the SF-36.

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NIDA’s Clinical Trials Network: An opportunity for HIV research in community substance abuse treatment programs. 2011


Tross S, Campbell AN, Calsyn DA, Metsch LR, Sorensen JL, Shoptaw S, Haynes L, Woody GE, Malow RM, Brown LS, Feaster DJ, Booth RE, Mandler RN, Masson C, Holmes BW, Colfax G, Brooks AJ, Hien DA, Schackman BR, Korthuis PT, Miele GM. Clinical Trials Network HIV Special Interest Group. NIDA’s Clinical Trials Network: An opportunity for HIV research in community substance abuse treatment programs. American Journal of Drug & Alcohol Abuse. 2011 Sep; 37(5):283-93. PMCID: PMC3361073.

Abstract/Summary: HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.

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Recommendations for Using Online Social Networking Technologies to Reduce Inaccurate Online Health Information. 2011


Young SD. Recommendations for Using Online Social Networking Technologies to Reduce Inaccurate Online Health Information. Online J Health Allied Sci. 2011 July 30; 10(2):2. PMCID: PMC3196338

Abstract/Summary: This short report highlights the increasing use of the Internet and online social networking technologies for health information and health decision making, and the consequences of seeking information from sites with biased or inaccurate health information. As the number of disreputable health information sites continues to grow rapidly, this paper provides practical advice for health providers on how they can help prevent health information consumers from seeking inaccurate information online. Reflecting on the utility of online social networking technologies for reaching large audiences, we recommend that health providers use online social networking technologies to communicate with patients and consumers of health information and direct them to reputable sources with accurate health information. We outline the steps to this approach.

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Impact of prison status on HIV-related risk behaviors. 2011


Hudson A, Nyamathi A, Bhattacharya D, Marlow E, Shoptaw S, Marfisee M, Leake B. Impact of prison status on HIV-related risk behaviors. AIDS Behavior. 2011 February; 15(2): 340–346. PMCID: PMC2945614

Abstract/Summary: Baseline data were collected to evaluate the effectiveness of interventions on completion of the hepatitis A and B vaccine series among 664 sheltered and street-based homeless adults who were: (a) homeless; (b) recently (<1 year) discharged from prison; (c) discharged 1 year or more; and (d) never incarcerated. Group differences at baseline were assessed for socio-demographic characteristics, drug and alcohol use, sexual activity, mental health and public assistance. More than one-third of homeless persons (38%) reported prison time and 16% of the sample had been recently discharged from prison. Almost half of persons who were discharged from prison at least 1 year ago reported daily use of drugs and alcohol over the past 6 months compared to about 1 in 5 among those who were recently released from prison. As risk for HCV and HIV co-infection continues among homeless ex-offenders, HIV/HCV prevention efforts are needed for this population.

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Online Social Networking Technologies, HIV Knowledge, and Sexual Risk and Testing Behaviors Among Homeless Youth. 2011


Hudson A, Nyamathi A, Bhattacharya D, Marlow E, Shoptaw S, Marfisee M, Leake B. Impact of prison status on HIV-related risk behaviors. AIDS Behavior. 2011 February; 15(2): 340–346. PMCID: PMC2945614

Abstract/Summary: This study evaluates associations between online social networking and sexual health behaviors among homeless youth in Los Angeles. We analyzed survey data from 201 homeless youth accessing services at a Los Angeles agency. Multivariate (regression and logistic) models assessed whether use of (and topics discussed on) online social networking technologies affect HIV knowledge, sexual risk behaviors, and testing for sexually transmitted infections (STIs). One set of results suggests that using online social networks for partner seeking (compared to not using the networks for seeking partners) is associated with increased sexual risk behaviors. Supporting data suggest that (1) using online social networks to talk about safe sex is associated with an increased likelihood of having met a recent sex partner online, and (2) having online sex partners and talking to friends on online social networks about drugs and partying is associated with increased exchange sex. However, results also suggest that online social network usage is associated with increased knowledge and HIV/STI prevention among homeless youth: (1) using online social networks to talk about love and safe sex is associated with increased knowledge about HIV, (2) using the networks to talk about love is associated with decreased exchange sex, and (3) merely being a member of an online social network is associated with increased likelihood of having previously tested for STIs. Taken together, this study suggests that online social networking and the topics discussed on these networks can potentially increase and decrease sexual risk behaviors depending on how the networks are used. Developing sexual health services and interventions on online social networks could reduce sexual risk behaviors.

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2010


Effects of treatment for tobacco dependence on resting cerebral glucose metabolism. 2010


Costello MR, Mandelkern MA, Shoptaw S, Shulenberger S, Baker SK, Abrams AL, Xia C, London ED, Brody AL. Effects of treatment for tobacco dependence on resting cerebral glucose metabolism. Neuropsychopharmacology. 2010 Feb; 35(3):605-12. PMC2813904

Abstract/Summary: While bupropion HCl and practical group counseling (PGC) are commonly used treatments for tobacco dependence, the effects of these treatments on brainfunction are not well established. For this study, 54 tobacco-dependent cigarette smokers underwent resting (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning before and after 8 weeks of treatment with bupropion HCl, PGC, or pill placebo. Using Statistical Parametric Mapping (SPM 2), changes in cerebral glucose metabolism from before to after treatment were compared between treatment groups and correlations were determined between amount of daily cigarette usage and cerebral glucose metabolism. Compared with placebo, the two active treatments (bupropion HCl and PGC) had reductions in glucose metabolism in the posterior cingulate gyrus. Further analysis suggested that PGC had a greater effect than bupropion HCl on glucose metabolism in this region. We also found positive correlations between daily cigarette use and glucose metabolism in the left occipital gyrus and parietal-temporal junction. There were no significant negative correlations between daily cigarette use and glucose metabolism. Our findings suggest that bupropion HCl and PGC reduce neural activity much as the performance of a goal-oriented task does in the default mode network of the brain, including the posterior cingulate gyrus. Thus, this study supports the theory that active treatments for tobacco dependence move the brain into a more goal-oriented state.

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Staff strategies for improving HIV detection using mobile HIV rapid testing. 2010


Grusky O, Roberts KJ, Swanson AN, Rhoades H, Lam M. Staff strategies for improving HIV detection using mobile HIV rapid testing. Behav Med. 8 Jul 2010; 35(4):101-11.

Abstract/Summary: This paper examines the performance of 13 mobile testing units (MTUs) and rapid HIV testing technology in Los Angeles County as reflected in the relationship between the cognitive strategies used by MTU staff regarding instructions to clients about picking up their test results and returning for test results, and following up with those clients who did not return, and the spatial distribution of MTUs and AIDS rates in 2003. Maps were created using geographic information systems (GIS) data on 93 MTU testing locations and 2003 AIDS cases data. MTU staff (N = 45) were interviewed and several themes were identified. MTU testing locations were clustered near high AIDS rate areas. Staff reports were obtained on 24 clients in the past 6 months who received HIV-negative test results and 24 clients during the same time period who received HIV-positive test results. Staff strategies that were used included keeping clients with them while rapid test results were being processed and adjusting to clients’ schedules when arranging for picking up test results. Some staff used tangible incentives such as vouchers for area businesses to encourage preliminary HIV-positive clients to return for confirmatory test results. Staff also sought to convince clients who preliminarily tested HIV-positive to convert from anonymous to confidential testing in order to facilitate clients’ linkage to treatment. The GIS findings and client risk data support the Centers for Disease Control and Prevention policy of implementing MTUs and rapid testing in large urban communities with high AIDS rates.

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Challenges in providing services in methadone maintenance therapy clinics in China: service providers’ perceptions. 2010


Lin C, Wu Z, Rou K, Pang L, Cao X, Shoptaw S, Detels R. Challenges in providing services in methadone maintenance therapy clinics in China: service providers’ perceptions. Int J Drug Policy. 2010 May; 21(3):173-8. Epub 2009 Oct 8.PMCID: PMC2847064

Abstract/Summary: The Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics. One service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1–2 hours to describe their perceptions of working in MMT clinics. Qualitative data were analyzed using ATLAS.ti. The grounded theory was used to guide the data analysis. Participants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers.

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Feasibility and acceptability of a phase II randomized pharmacologic intervention for methamphetamine dependence in high-risk men who have sex with men. 2010


Das M, Santos D, Matheson T, Santos GM, Chu P, Vittinghoff E, Shoptaw S, Colfax GN. Feasibility and acceptability of a phase II randomized pharmacologic intervention for methamphetamine dependence in high-risk men who have sex with men. AIDS. 2010 Apr 24;24(7):991-1000. PMCID: PMC3619723

Abstract/Summary: The objective of this study was to determine whether actively using, methamphetamine (meth)-dependent men who have sex with men (MSM) could be enrolled and retained in a pharmacologic intervention trial, and the degree to which participants would adhere to study procedures, including medication adherence. Thirty meth-dependent, sexually active MSM were randomized to receive daily bupropion XL 300 mg or placebo for 12 weeks. Participants received weekly substance use counseling, provided weekly urine specimens, and completed monthly audio-computer assisted self-interview (ACASI) behavioral risk assessments. Adherence was measured by medication event monitoring systems (MEMS) caps (the number of distinct MEMS cap openings divided by the number of expected doses) and self-report.

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Behavioral Treatment Approaches for Methamphetamine Dependence and HIV-related Sexual Risk Behaviors Among Urban Gay and Bisexual Men. 2010


Shoptaw S, Reback CJ, Peck JA, Yang X, Rotheram-Fuller E, Larkins S, Veniegas R. Behavioral Treatment Approaches for Methamphetamine Dependence and HIV-related Sexual Risk Behaviors Among Urban Gay and Bisexual Men. Drug Abuse: Prevention and Treatment. 2010 March.

Abstract/Summary: Methamphetamine-dependent gay and bisexual men (GBM) are at high risk for HIV transmission, largely due to drug-associated sexual risk behaviors. This project evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors among this population. In this randomized controlled trial, 162 methamphetamine-dependent (SCID-verified) GBM in Los Angeles County were randomly assigned to one of four treatment conditions for 16 weeks: standard cognitive behavioral therapy (CBT, n=40), contingency management (CM, n=42), combined cognitive behavioral therapy and contingency management (CBT+CM, n=40), and a culturally tailored cognitive behavioral therapy (GCBT, n=40). Stimulant use was assessed thrice-weekly during treatment using urine drug screens (48 measures). Sexual risk behaviors were monitored monthly (four measures). Follow-up assessments were conducted at 6 (80.0%) and 12 months (79.9%).

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Structural-level factors affecting implementation of the methadone maintenance therapy program in China. 2010


Lin C, Wu Z, Rou K, Yin W, Wang C, Shoptaw S, Detels R. Structural-level factors affecting implementation of the methadone maintenance therapy program in China. Journal of Substance Abuse Treatment. 2010 Mar; 38(2):119-27. PMC2814942

Abstract/Summary: This study identifies structural -level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.

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Effect of motivational interviewing on reduction of alcohol use. 2010


Nyamathi A, Shoptaw S, Cohen A, Greengold B, Nyamathi K, Marfisee M, de Castro V, Khalilifard F, George D, Leake B. Effect of motivational interviewing on reduction of alcohol use. Drug Alcohol Depend. 2010 Feb 1;107(1):23-30.PMID: 19836904 [PubMed – indexed for MEDLINE]

Abstract/Summary: Methadone-Maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and Hepatitis B virus (HBV) infection. Nurse-led Hepatitis Health Promotion (HHP) may be one strategy to decrease alcohol use in this population. The objective of this study was to evaluate the impact of nurse-led HHP, delivered by nurses compared to Motivational Interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use. A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: 1) nurse-led hepatitis health promotion group sessions (n=87); 2) MI delivered in group sessions (MI-group; n=90), or 3) MI delivered one-on-one sessions (MI-single, n=79).

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Smoking-induced change in intrasynaptic dopamine concentration: effect of treatment for Tobacco Dependence. 2010


Brody AL, London ED, Olmstead RE, Allen-Martinez Z, Shulenberger S, Costello MR, Abrams AL, Scheibal D, Farahi J, Shoptaw S, Mandelkern MA. Smoking-induced change in intrasynaptic dopamine concentration: effect of treatment for Tobacco Dependence. Psychiatry Res. 2010 Dep 30: 183(3): 218-24. Epub 2010 Aug 3. PMCID: PMC2947623.

Abstract/Summary: The aim of this study was to determine whether standard treatments for Tobacco Dependence affect smoking-induced changes in intrasynaptic dopamine (DA) concentration. Forty-three otherwise healthy adult cigarette smokers (10 to 40 cigarettes per day) were treated with either practical group counseling (PGC) psychotherapy (n=14), bupropion HCl (n=14), or matching pill placebo (n=15) (random assignment) for 8 weeks. Before and after treatment, each subject underwent a bolus-plus-continuous-infusion (11)C-raclopride positron emission tomography (PET) scanning session, during which he or she smoked a regular cigarette. The PET scanning outcome measure of interest was percent change in smoking-induced (11)C-raclopride binding potential (BP(ND)) in the ventral caudate/nucleus accumbens (VCD/NAc), as an indirect measure of DA release. Although the entire study sample had a smaller mean smoking-induced reduction in VCD/NAc BP(ND) after treatment (compared to before treatment), this change was highly correlated with smaller total cigarette puff volumes (and not other treatment variables). These data indicate that smoking-induced DA release is dose-dependent, and is not significantly affected by reductions in daily smoking levels or treatment type.

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Developing a Text Messaging Risk Reduction Intervention for Methamphetamine-Using MSM: Research Note. 2010


Reback CJ, Ling D, Shoptaw S, Rohde J. Developing a Text Messaging Risk Reduction Intervention for Methamphetamine-Using MSM: Research Note. Open AIDS J. 2010 May 14; 4:116-22. PMCID: PMC2905770.

Abstract/Summary: Men who have sex with men (MSM) who use methamphetamine experience high risks for HIV infection due to sexual transmission behaviors often engaged in when under the influence of methamphetamine. Methamphetamine-using MSM use various forms of information technology (IT) communication such as instant messaging, social networking sites, and websites to facilitate a sexual and/or drug “hook up.” Given the acceptability of IT communication in their daily lives, an IT intervention represents an appropriate strategy to reach and intervene with out-of-treatment, methamphetamine-using MSM. The aim of this study was to conduct formative work to develop a text messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM, which involved conducting focus groups, community partners’ meetings, and a pre-test intervention.

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Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence. 2010


Heinzerling KG, Swanson AN, Kim S, Cederblom L, Moe A, Ling W, Shoptaw S. Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence. Drug Alcohol Depend. 2010 Jun 1; 109(1-3):20-9. Epub 2010 Jan 25. PMCID: PMC2875545.

Abstract/Summary: The objective of this study was to compare modafinil to placebo for reducing methamphetamine (MA) use, improving retention, and reducing depressive symptoms and MA cravings. Rates of adverse events and cigarette smoking with modafinil versus placebo were also compared. Following a 2-week, non-medication lead-in period, 71 treatment-seeking MA-dependent participants were randomly assigned to modafinil (400mg once daily; N=34) or placebo (once daily; N=37) for 12 weeks under double-blind conditions. Participants attended clinic thrice-weekly to provide urine samples analyzed for MA-metabolite, to complete research assessments, and to receive contingency management and weekly cognitive behavioral therapy (CBT) sessions.

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Changes in Stimulant Drug Use Over time in the MACS: Evidence for Resilience Against Stimulant Drug Use Among Men Who Have Sex with Men. 2010


Lim SH, Ostrow D, Stall R, Chmiel J, Herrick A., Shopatw S., Kao U, Carrico A., Plankey M. Changes in Stimulant Drug Use Over time in the MACS: Evidence for Resilience Against Stimulant Drug Use Among Men Who Have Sex with Men. AIDS Behavior. 2010 Dec 30 [Epub ahead of print]. PMCID: PMC in process.

Abstract/Summary: Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)-an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.

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Contingency Management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. 2010


Menza TW, Jameson DR, Hughes JP, Colfax GN, Shoptaw S, Golden MR. Contingency Management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. BMC Public Health. 2010;10: 774. PMCID: PMC3016390.

Abstract/Summary: Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM’s effectiveness. We randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57).

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2009


The cardiovascular and subjective effects of methamphetamine combined with gamma-vinyl-gamma-aminobutyric acid (GVG) in non-treatment seeking methamphetamine-dependent volunteers. 2009

De La Garza R, Zorick T, Heinzerling K, Nusinowitz S, London E, Shoptaw S, Moody D, Newton T. The cardiovascular and subjective effects of methamphetamine combined with gamma-vinyl-gamma-aminobutyric acid (GVG) in non-treatment seeking methamphetamine-dependent volunteers. Pharmacology, Biochemistry & Behavior. 2009; 94(1):186-193.

Abstract/Summary: Gamma-vinyl-gamma-aminobutyric acid (GVG) elevates central nervous system gamma-aminobutyric acid (GABA) levels by irreversibly inhibiting GABA transaminase. An open-label clinical trial in humans suggested that GVG may reduce cocaine and methamphetamine use. To test safety and to obtain preliminary data on efficacy of GVG for treating methamphetamine dependence, we conducted a double-blind, placebo-controlled, parallel group study of GVG interaction with the cardiovascular and subjective effects produced by methamphetamine. Non-treatment seeking methamphetamine-dependent volunteers received either GVG (N=8) or placebo (N=9) by random assignment. GVG treatment was initiated at 1 g/day and increased to 5 g/day. After reaching the target dose of 5 g/day, participants received methamphetamine (15+30 mg, IV), and cardiovascular and subjective effects were assessed. No serious adverse events were noted, and the total number of adverse events was similar between the treatment groups. Considering the full time course and peak effects independently, no significant differences were detected between the groups for systolic or diastolic blood pressures, or heart rate, following methamphetamine exposure. Some methamphetamine-induced cardiovascular changes approached significance (p<0.10) and may warrant attention in future trials. Methamphetamine-induced subjective effects (“any drug effect”, “high”, “crave methamphetamine”) were statistically similar between GVG and placebo treatment groups. Pharmacokinetic data indicate that GVG treatment did not alter methamphetamine or amphetamine plasma levels, and there was no association between methamphetamine or amphetamine plasma levels and peak cardiovascular effects. Taken together, the data indicate that GVG treatment is generally well tolerated but not efficacious in attenuating the positive subjective effects of methamphetamine in the laboratory.

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Predicting adherence to treatment for methamphetamine dependence from neuropsychological and drug use variables. 2009

Dean A, London E, Sugar C, Kitchen C, Swanson A-N, Heinzerling K, Kalechstein A, Shoptaw S. Predicting adherence to treatment for methamphetamine dependence from neuropsychological and drug use variables. Drug and Alcohol Dependence. 2009;105(1-2): 48-55.

Abstract/Summary: Although some individuals who abuse methamphetamine have considerable cognitive deficits, no prior studies have examined whether neurocognitive functioning is associated with outcome of treatment for methamphetamine dependence. In an outpatient clinical trial of bupropion combined with cognitive behavioral therapy and contingency management (Shoptaw, S., Heinzerling, K.G., Rotheram-Fuller, E., Steward, T., Wang, J., Swanson, A.N., De La Garza, R., Newton, T., Ling, W., 2008. Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence. Drug Alcohol Depend 96, 222-232.), 60 methamphetamine-dependent adults completed three tests of reaction time and working memory at baseline. Other variables that were collected at baseline included measures of drug use, mood/psychiatric functioning, employment, social context, legal status, and medical status. We evaluated the relative predictive value of all baseline measures for treatment outcome using Classification and Regression Trees (CART; Breiman, L., Friedman, J.H., Olshen, R.A., Stone, C.J., 1984. Classification and Regression Trees. Wadsworth, Belmont, CA.), a nonparametric statistical technique that produces easily interpretable decision rules for classifying subjects that are particularly useful in clinical settings. Outcome measures were whether or not a participant completed the trial and whether or not most urine tests showed abstinence from methamphetamine abuse. Urine-verified methamphetamine abuse at the beginning of the study was the strongest predictor of treatment outcome; two psychosocial measures (e.g., nicotine dependence and Global Assessment of Functioning) also offered some predictive value. A few reaction time and working memory variables were related to treatment outcome, but these cognitive measures did not significantly aid prediction after adjusting for methamphetamine usage at the beginning of the study. On the basis of these findings, we recommend that research groups seeking to identify new predictors of treatment outcome compare the predictors to methamphetamine usage variables to assure that unique predictive power is attained.

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Increasing the reach of HIV testing to young Latino MSM: results of a pilot study. 2009

Erausquin J, Duan N, Grusky O, Swanson A, Kerrone D, Rudy E. Increasing the reach of HIV testing to young Latino MSM: results of a pilot study. Journal of Health Care for the Poor and Underserved. 2009; 20(3):756-765.

Abstract/Summary: In the U.S., HIV infections are increasing among men who have sex with men (MSM), particularly young, racial/ethnic minority MSM. To examine the feasibility of increasing HIV testing among young Latino MSM by integrating tailored outreach strategies with testing, counseling, and HIV medical services, we designed a descriptive study comparing demographic characteristics, behaviors, and HIV test results of clients from the intervention period with clients who tested during other time periods. Clients in the intervention period were younger and more likely to be Latino than those in other time periods. In addition, clients who received outreach were more likely than those who did not receive outreach to report methamphetamine use, sex with an HIV-positive person, and sex with a sex worker. Venue-based and selective media outreach, in combination with linking rapid testing to HIV care, may help overcome some of the barriers to testing among high-risk young Latino MSM.

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Impact of prison status on HIV-related risk behaviors. 2009

Hudson AL, Nyamathi A, Bhattacharya D, Marlow E, Shoptaw S, Marfisee M, Leake B. Impact of prison status on HIV-related risk behaviors. AIDS Behavior. 2009. Epub ahead of print.

Abstract/Summary: Baseline data were collected to evaluate the effectiveness of interventions on completion of the hepatitis A and B vaccine series among 664 sheltered and street-based homeless adults who were: (a) homeless; (b) recently (<1 year) discharged from prison; (c) discharged 1 year or more; and (d) never incarcerated. Group differences at baseline were assessed for socio–demographic characteristics, drug and alcohol use, sexual activity, mental health and public assistance. More than one-third of homeless persons (38%) reported prison time and 16% of the sample had been recently discharged from prison. Almost half of persons who were discharged from prison at least 1 year ago reported daily use of drugs and alcohol over the past 6 months compared to about 1 in 5 among those who were recently released from prison. As risk for HCV and HIV co-infection continues among homeless ex-offenders, HIV/HCV prevention efforts are needed for this population.

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Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: sampling methods and implications. 2009

Iguchi MY, Ober AJ, Berry SH, Fain T, Heckathorn DD, Gorbach PM, Heimer R, Kozlov A, Ouellet LJ, Shoptaw S, Zule WA. Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: sampling methods and implications. Journal of Urban Health. 2009;86 Suppl 1:5-3. PMC2705484.

Abstract/Summary: The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (DU), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and DU. The goal of the sampling approach was to recruit an RDS sample of MSM, DU, and individuals who were both MSM and DU (MSM/DU), as well as a sample of sex partners of MSM, DU, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites—Los Angeles, Chicago, and Raleigh–Durham—the sample consisted of older (mean age=41 years), primarily black MSM and DU (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age=28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site).

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Multi-center trial of baclofen for abstinence initiation in severe cocaine-dependent individuals.2009

Kahn R, Biswas K, Childress AR, Shoptaw S, Fudala PJ, Gorgon L, Montoya I, Collins J, McSherry F, Li SH, Chiang N, Alathari H, Watson D, Liberto J, Beresford T, Stock C, Wallace C, Gruber V, Elkashef A. Multi-center trial of baclofen for abstinence initiation in severe cocaine-dependent individuals. Drug and Alcohol Dependence. 2009;103(1-2):59-64.

Abstract/Summary: Cocaine dependence is a major public health problem for which there is no FDA-approved pharmacological treatment. Baclofen is a GABAB receptor agonist that in preclinical and early pilot clinical trials has shown promise for the treatment of cocaine dependence. The purpose of this multi-site, double-blind study, was to compare the safety and efficacy of baclofen (60 mg/day) vs placebo in an 8-week treatment of individuals with severe cocaine dependence. The primary outcome measure was subjects’ self-reported cocaine use substantiated by urine benzoylecgonine (BE). Analysis of the data did not show a significant difference between the groups treated with baclofen and placebo. The current results do not support a role for 60 mg baclofen in treating cocaine dependence in the population studied. The contrast of this result to earlier, preclinical and human pilot data with baclofen may reflect the trial’s focus on severe cocaine-dependent users, and/or the need for a higher baclofen dose. Baclofen’s potential as a relapse prevention agent was not tested by the current design, but may be a useful target for future studies.

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Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (LA VOICES).2009

Newman PA, Lee SJ, Duan N, Rudy E, Nakazono TK, Boscardin J, Kakinami L, Shoptaw S, Diamant A, Cunningham WE. Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (LA VOICES). Health Service Research. 2009, Sept 24.

Abstract/Summary:

Objective: To assess HIV vaccine acceptability among high-risk adults in Los Angeles.

Study Setting: Sexually transmitted disease clinics, needle/syringe exchange programs, Latino community health/HIV prevention programs.

Study Design: Cross-sectional survey using conjoint analysis. Participants were randomly selected using three-stage probability sampling.

Data Collection: Sixty-minute structured interviews. Participants rated acceptability of eight hypothetical vaccines, each with seven dichotomous attributes, and reported post-vaccination risk behavior intentions.

Principal Findings: Participants (n=1164; 55.7 percent male, 82.4 percent ethnic minority, mean age=37.4 years) rated HIV vaccine acceptability from 28.4 to 88.6; mean=54.5 (SD=18.8; 100-point scale). Efficacy had the greatest impact on acceptability, followed by side effects and out-of-pocket cost. Ten percent would decrease condom use after vaccination.

Conclusions: Findings support development of social marketing interventions to increase acceptability of “partial efficacy” vaccines, behavioral interventions to mitigate risk compensation, and targeted cost subsidies.

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Correlates of hospitalization for alcohol-using methadone-maintained persons with physical health problems. 2009

Nyamathi A, Compton P, Cohen A, Marfisee M, Shoptaw S, Greengold B, Castro VD, Reaves M, Hasson A, George D, Leake B. Correlates of hospitalization for alcohol-using methadone-maintained persons with physical health problems. Western Journal of Nursing Research. 2009; 31(4): 525-543.

Abstract/Summary: This cross-sectional study (n = 190) examined correlates of hospitalization for physical health problems among methadone maintenance therapy (MMT) clients with a history of alcohol abuse. The study was derived from baseline data collected for a longitudinal trial assessing the effect of motivational interviewing among alcohol-abusing adults undergoing MMT. The sample included clients who were 18–55 years of age, abusing alcohol, and receiving MMT from five large methadone maintenance clinics in the Los Angeles area. A structured questionnaire was used to collect the data. Correlates of hospitalization in logistic regression analysis included lack of social support, recent victimization, age of first alcohol use, chronic severe pain in the previous six months, not having children, and ethnicity. Identification of hospitalization risk factors among alcohol-abusing MMT clients is a first step to developing risk-reducing interventions designed to lower hospitalization rates in this population.

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Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults. 2009

Nyamathi A, Liu Y, Marfisee M, Shoptaw S, Gregerson P, Saab S, Leake B, Tyler D, Gelberg L. Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults. Nursing Research. 2009; 58(1):13-22.

Abstract/Summary: Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI).

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Effect of motivational interviewing on reduction of alcohol use. 2009

Nyamathi A, Shoptaw S, Cohen A, Greengold B, Nyamathi K, Marfisee M, de Castro V, Khalilifard F, George D, Leake B. Effect of motivational interviewing on reduction of alcohol use. Drug and Alcohol Dependence. 2009, Feb 1: 107(1):23-30.

BACKGROUND: Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population.

OBJECTIVE: To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use.

METHODS: A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions (n=87); (2) MI delivered in group sessions (MI-group; n=79), or (3) MI delivered one-on-one sessions (MI-single, n=90).

RESULTS: Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p<.05). In multiple logistic regression analysis controlling for alcohol consumption at baseline and other covariates, no differences by condition were found.

DISCUSSION: As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.

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Factors associated with eventlevel stimulant use during sex in a sample of older, low-income men who have sex with men. 2009

Ober A, Shoptaw S, Wand PC, Gorbach P, Weiss RE. Factors associated with eventlevel stimulant use during sex in a sample of older, low-income men who have sex with men. Drug and Alcohol Dependence. 2009;102 (1):123-129. PMC2649661

Abstract/Summary: Prior research shows that stimulant use is consistently associated with high-risk sexual behavior in samples of men who have sex with men (MSM), but few studies have explored factors associated with use of crack or methamphetamine during sex during specific sexual events among older, very low-income MSM. This study examined stimulant use during the most recent sexual episodes in a sample of primarily older, very low-income MSM (n=779). Although crack use was more prevalent than methamphetamine use (33% vs. 22%), findings suggest that methamphetamine users may be at greater risk for HIV transmission. HIV prevalence was higher among methamphetamine users (49%) than among crack users (24%). Having unprotected sex (OR 2.77, 95% CI 1.46-5.26), having sex in a public sex venue (OR 3.63, 95% CI 1.52-8.64), having sex with an HIV positive rather than with an HIV negative partner (OR 6.15, 95% CI 2.14-17.62), having exchanged sex for money or drugs (OR 4.16, 95% CI 1.78-9.72), and having a higher number of sexual partners (OR 1.67, 95% CI 1.17-2.38) all were associated with increased odds of methamphetamine use during sex. Fewer high-risk behaviors were associated with increased odds of using crack during sex. Having unprotected sex was associated with increased odds of crack use during sex only when sex partners were perceived to be HIV negative rather than to be HIV positive or of unknown status. Findings provide observations on associations between stimulant use during sex and risk behaviors that may be important to HIV prevention and drug treatment approaches for urban, older, very poor MSM.

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Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. 2009

Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, Stall RC. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. Journal of Acquired Immune Deficiency Syndromes. 2009; 51(3):349-355.

BACKGROUND: New HIV infections are being observed among men who have sex with men (MSM). Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention.

METHODS: During the follow-up period (1998-2008), we identified 57 HIV seroconverters among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex drugs (inhaled nitrites or “poppers”, stimulants, and erectile dysfunction drugs) used at the current or previous semiannual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated.

RESULTS: The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the Multicenter AIDS Cohort Study. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex drug use.

CONCLUSIONS: Use of poppers, stimulants, and erectile dysfunction drugs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies.

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Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men. 2009

Rudy ET, Shoptaw S, Lazzar M, Bolan RK, Tilekar SD, Kerndt PR. Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men. Sexually Transmitted Disease. 2009; 36(11): 693-695.

Abstract/Summary: This study compared associations between methamphetamine use, drug use other than methamphetamine, and HIV transmission factors among men who have sex with men, attending an sexually transmitted disease clinic. Of 6435 participants, newly recognized HIV status (OR: 3.02 95% CI: 2.30, 3.99) was associated with methamphetamine use compared with nondrug users, an association not found among other club drug users.

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Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. 2009

Shoptaw S, Weiss RE, Munjas B, Hucks-Ortiz C, Young SD, Larkins S, Victorianne GD, Gorbach PM. Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health. 2009;86 Suppl 1:77-92. PMC2705491

Abstract/Summary: This study evaluates associations between internalized homonegativity and demographic factors, drug use behaviors, sexual risk behaviors, and HIV status among men who have sex with men (MSM) and with men and women (MSM/W). Participants were recruited in Los Angeles County using respondent-driven sampling (RDS) and completed the Internalized Homonegativity Inventory (IHNI) and questionnaires on demographic and behavioral factors. Biological samples were tested for HIV and for recent cocaine, methamphetamine, and heroin use. The 722 MSM and MSM/W participants were predominantly African American (44%) and Hispanic (28%), unemployed (82%), homeless (50%), and HIV positive (48%) who used drugs in the past 6 months (79.5%). Total and Personal Homonegativity, Gay Affirmation, and Morality of Homosexuality IHNI scores were significantly higher for African American men than for other ethnicities, for MSM/W than for MSM, for recent cocaine users than for recent methamphetamine users, and for HIV-seronegative men than for HIV-seropositive men. Linear regression showed the Gay Affirmation scale significantly and inversely correlated with the number of sexual partners when controlling for effects of ethnicity/race and sexual identification, particularly for men who self-identified as straight. Highest IHNI scores were observed in a small group of MSM/W (n=62) who never tested for HIV. Of these, 26% tested HIV positive. Findings describe ways in which internalized homophobia is a barrier to HIV testing and associated HIV infection and signal distinctions among participants in this sample that can inform targeted HIV prevention efforts aimed at increasing HIV testing.

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Treatment for amphetamine withdrawal. Cochrane Database Systematic Review. 2009

Shoptaw SJ, Kao U, Heinzerling K, Ling W. Treatment for amphetamine withdrawal. Cochrane Database Systematic Review. 2009;(2):CD003021.

BACKGROUND: Few studies examined treatments for amphetamine withdrawal, although it is a common problem among amphetamine users. Its symptoms, in particular intense craving, may be a critical factor leading to relapse to amphetamine use. In clinical practice, medications for cocaine withdrawal are commonly used to manage amphetamine withdrawal although the pharmacodynamic and pharmacokinetic properties of these two illicit substances are different.

OBJECTIVES: To assess the effectiveness of pharmacological alone or in combination with psychosocial treatment for amphetamine withdrawals on discontinuation rates, global state, withdrawal symptoms, craving, and other outcomes.

SELECTION CRITERIA: All randomised controlled and clinical trials evaluating pharmacological and or psychosocial treatments (alone or combined) for people with amphetamine withdrawal symptoms.

DATA COLLECTION AND ANALYSIS: Two authors evaluated and extracted data independently. The data were extracted from intention-to-treat analyses. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess dichotomous outcomes. The Weighted Mean Difference (WMD) with 95% CI was used to assess continuous outcomes.

MAIN RESULTS: Four randomised controlled trials (involving 125 participants) met the inclusion criteria for the review. Two studies found that amineptine significantly reduced discontinuation rates and improved overall clinical presentation, but did not reduce withdrawal symptoms or craving compared to placebo. The benefits of mirtazapine over placebo for reducing amphetamine withdrawal symptoms were not as clear. One study suggested that mirtazapine may reduce hyperarousal and anxiety symptoms associated with amphetamine withdrawal. A more recent study failed to find any benefit of mirtazapine over placebo on retention or on amphetamine withdrawal symptoms.

AUTHORS’ CONCLUSIONS: No medication is effective for treatment of amphetamine withdrawal. Amineptine showed reduction in discontinuation rates and improvement in clinical presentation compared to placebo, but had no effect on reducing withdrawal symptoms or craving. In spite of these limited benefits, amineptine is not available for use due to concerns over abuse liability when using the drug. The benefits of mirtazapine as a withdrawal agent are less clear based on findings from two randomised controlled trials: one report showed improvements in amphetamine withdrawal symptoms over placebo; a second report showed no differences in withdrawal symptoms compared to placebo. Further potential treatment studies should examine medications that increase central nervous system activity involving dopamine, norepinephrine and/or serotonin neurotransmitters, including mirtazapine

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Treatment for amphetamine psychosis. 2009

Shoptaw SJ, Kao U, Ling W. Treatment for amphetamine psychosis. Cochrane Database Systematic Review. 2009;(1):CD003026.

BACKGROUND: Chronic amphetamine users may have experience of paranoia and hallucination. It has long been believed that dopamine antagonists, such as chlorpromazine, haloperidol, and thioridazine, are effective for the treatment of amphetamine psychosis.

OBJECTIVES: To evaluate risks, benefits, costs of treatments for amphetamine psychosis.

SELECTION CRITERIA: All randomised controlled and clinical trials (RCTs, CCTs) evaluating treatments (alone or combined) for people with amphetamine psychosis

DATA COLLECTION AND ANALYSIS: Two authors evaluated and extracted the data independently. Dichotomous data were extracted on an intention-to-treat basis in which the dropouts were assigned as participants with the worst outcomes. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess the dichotomous data. The Weighted Mean Difference (WMD) with 95% CI was used to assess the continuous data.

MAIN RESULTS: The comprehensive searches found one randomised controlled trial of treatment for amphetamine psychosis meeting the criteria for considering studies. The study involved 58 participants and compared the efficacy and tolerability of two antipsychotic drugs, olanzapine (a newer antipsychotic) and haloperidol (a commonly used antipsychotic medication used as a control condition), in treating amphetamine-induced psychosis. The results show that both olanzapine and haloperidol at clinically relevant doses were efficacious in resolving psychotic symptoms, with the olanzapine condition showing significantly greater safety and tolerability than the haloperidol control as measured by frequency and severity of extrapyramidal symptoms.

AUTHORS’ CONCLUSIONS: Only one RCT of treatment for amphetamine psychosis has been published. Outcomes from this trial indicate that antipsychotic medications effectively reduce symptoms of amphetamine psychosis, the newer generation and more expensive antipsychotic medication, olanzapine, demonstrates significantly better tolerability than the more affordable and commonly used medication, haloperidol.There are other two studies that did not meet the inclusion criteria for this review. The results of these two studies show that agitation and some psychotic symptoms may be abated within an hour after antipsychotic injection.Whether this limited evidence can be applied for amphetamine psychotic patients is not yet known.The medications that should be further investigate are conventional antipsychotics, newer antipsychotics and benzodiazepines. However, naturalistic studies of amphetamine psychotic symptoms and the prevalence of relapse to psychosis in the presence of amphetamine, are also crucial for advising the development of study designs appropriate for further treatment studies of amphetamine psychosis.

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HIV partner notification: predictors of discussion and agreements from provider reports. 2009

Swendeman D, Grusky O, Swanson A. HIV partner notification: predictors of discussion and agreements from provider reports. AIDS Behavior. 2009; 13(3):573-81.

Abstract/Summary: This study examines organizational, provider, client, and test-event level predictors of HIV partner notification (PN) discussion and agreements based on providers’ most recent HIV-positive post-test counseling session. Staff (n = 621) were sampled from for-profit, nonprofit, and county government HIV testing organizations (N = 159) in Los Angeles County from 2003 to 2007. Among providers who conducted an HIV-positive post-test counseling session (n = 204), 65% discussed PN but only 10% had confirmed agreement to provider-involved PN (PIPN). In multi-level regression analyses PN discussion was predicted by provider HIV-test training and knowledge, and patients requesting a test while presenting HIV/AIDS symptoms. The strongest predictor of PIPN agreement was public health HIV testing settings followed by counseling by program managers or infectious disease specialists across settings. None of the injecting drug users or patients presenting with AIDS, but not requesting a test, agreed to PIPN. Organizational and provider-level interventions on PN will be needed to realize cost-effective benefits of expanded HIV testing and counseling.

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Adapting HIV prevention evidence-based interventions in practice settings: an interview study. 2009

Veniegas RC, Kao UH, Rosales R. Adapting HIV prevention evidence-based interventions in practice settings: an interview study. Implementation Science. 2009 Nov 23; 4:76. PMC2788516.

Abstract/Summary: Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations — modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements. Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention.

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Pilot safety evaluation of varenicline for the treatment of methamphetamine dependence.

Zorick T, Sevak R, Miotto K, Shoptaw S, Swanson AN, Clement C, De La Garza R, Newton T, London E. Pilot safety evaluation of varenicline for the treatment of methamphetamine dependence. Journal of Experimental Pharmacology. 2009 Dec24.

Despite the worldwide extent of methamphetamine dependence, no medication has been shown to effectively treat afflicted individuals. One relatively unexplored approach is modulation of cholinergic system function. Animal research suggests that enhancement of central cholinergic activity, possibly at nicotinic acetylcholine receptors (nAChRs), can reduce methamphetamine-related behaviors. Further, preliminary findings indicate that rivastigmine, a cholinesterase inhibitor, may reduce craving for methamphetamine after administration of the drug in human subjects. We therefore performed a double-blind, placebo-controlled, crossover pilot study of the safety and tolerability of varenicline in eight methamphetamine-dependent research subjects. Varenicline is used clinically to aid smoking cessation, and acts as a partial agonist at α4β2 nAChRs with full agonist properties at α7 nAChRs. Oral varenicline dose was titrated over 1 week to reach 1 mg bid, and then was co-administered with 30 mg methamphetamine, delivered in ten intravenous infusions of 3 mg each. Varenicline was found to be safe in combination with IV methamphetamine, producing no cardiac rhythm disturbances or alterations in vital sign parameters. No adverse neuropsychiatric sequelae were detected either during varenicline titration or following administration of methamphetamine. The results suggest that varenicline warrants further investigation as a potential treatment for methamphetamine dependence.

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