Psychological Distress, Drug Use, Sexual Risks & Medication Adherence among Young HIV-Positive Black Men Who Have Sex with Men: Exposure to Community Violence Matters

In the USA, Black males are disproportionately affected by community violence and HIV. The aim of this study was to assess whether exposures to community violence are related to psychological distress, drug use, sexual risk behaviors, and medication adherence among a sample of HIV-positive young Black men who had sex with men (YBMSM). Data are from 98 YBMSM ages 18-29 years recruited from Chicago who completed measures on demographics, exposures to community violence, psychological distress, drug use, condomless anal intercourse, and medication adherence. 

Rates of exposure to community violence were high and youth reported victimization and witnessing numerous types of violence in their lifetime. In adjusted logistic regression analyses, models indicate that YBMSM reporting higher levels of exposure to community violence had significantly higher rates of condomless anal intercourse in the previous 6 months (AOR: 5.33, 95%CI: 1.38-20.55). 

Additionally, exposure to community violence was positively associated with psychological distress, hard drug use, and use of marijuana as a sex drug. Adherence to HIV antiretroviral medication was negatively associated with community violence (AOR: 0.36, 95%CI: 0.13-0.97). Rates of exposure to community violence are especially high in urban communities. 

Overall findings suggest that treatment, intervention, and programmatic approaches that include initiatives to address exposure to community violence might correlate with better health-related outcomes for HIV-positive YBMSM.

Purchase full article at:   http://goo.gl/GEXEA6

By:  Quinn K1, Voisin DR2,3, Bouris A2,3, Schneider J3,4,5.

• 1 Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine , Medical College of Wisconsin , Milwaukee , WI , USA.
• 2 School of Social Service Administration , University of Chicago , Chicago , IL , USA.
• 3 STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA.
• 4 Department of Medicine , University of Chicago , Chicago , IL , USA.
• 5 Department of Public Health Sciences , University of Chicago , Chicago , IL , USA. 
• AIDS Care. 2016 Feb 26:1-7. 

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Psychological Well-Being among Religious and Spiritual-identified Young Gay and Bisexual Men

Religiosity and spirituality are often integral facets of human development. Young gay and bisexual men (YGBM), however, may find themselves at odds when attempting to reconcile potentially conflicting identities like religion and their sexual orientation. 

We sought to explore how different components of religiosity (participation, commitment, spiritual coping) are linked to different markers of psychological well-being (life purpose, self-esteem, and internalized homophobia). 

Using data collected in Metro Detroit (N = 351 ages 18-29 years; 47 % African American, 29 % Non-Latino White, 8 % Latino, 16 % Other Race), we examined how components of religiosity/spirituality were associated with psychological well-being among religious/spiritual-identified participants. 

An overwhelming majority (79.5 %) identified as religious/spiritual, with most YGBM (91.0 %) reporting spirituality as a coping source. Over three quarters of our religious/spiritual sample (77.7 %) reported attending a religious service in the past year. Religious participation and commitment were negatively associated with psychological well-being. 

Conversely, spiritual coping was positively associated with YGBM’s psychological well-being. Programs assisting YGBM navigate multiple/conflicting identities through sexuality-affirming resources may aid improve of their psychological well-being. 

We discuss the public health potential of increasing sensitivity to the religious/spiritual needs of YGBM across social service organizations.

Purchase full article at:   http://goo.gl/yCrT1Z

By:  

Steven Meanley

, Emily S. Pingel

, José A. Bauermeister 

University of Michigan School of Public Health

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Ethnic Differences in the Links Between Benefit Finding & Psychological Adjustment in People Living with HIV

Experiencing growth after the diagnosis of a life threatening illness is commonly reported among people living with HIV (PLWH). 

The links between benefit finding and better adjustment in PLWH have been identified, but it is less clear whether these links vary by ethnicity. Minority stress theory suggests that individuals from minority populations may have unique stress experiences, which can have negative health implications but may also provide opportunity for growth. 

We hypothesized that the association between benefit finding and psychological adjustment would be stronger for Black (n = 80) than White (n = 87) PLWH. Contrary to predictions, the relationship between benefit finding and better adjustment was significant for White but not Black PLWH. Post-hoc analyses suggested that sexual orientation played role in this relationship. 

The relationship between benefit finding and psychological adjustment may be complex for Black PLWH, or they may achieve adjustment using other resources.

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By:  Fekete EM1, Chatterton M2, Skinta MD3, Williams SL4.

• 1School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN, 46227, USA. feketee@uindy.edu.
• 2School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN, 46227, USA.
• 3Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA.
• 4Department of Psychology, East Tennessee State University, P.O. Box 70649, Johnson City, TN, 37614, USA.
• J Behav Med. 2016 Jan 19. 

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'Two Pains Together': Patient Perspectives on Psychological Aspects of Chronic Pain While Living with HIV

OBJECTIVE:

Chronic pain is common in HIV-infected individuals. Understanding HIV-infected patients' chronic pain experience not just from a biological, but also from a psychological perspective, is a critical first step toward improving care for this population. Our objective was to explore HIV-infected patients' perspectives on psychological aspects of chronic pain using in-depth qualitative interviews.

METHODS:

Investigators engaged in an iterative process of independent and group coding until theme saturation was reached.

RESULTS:

Of the 25 patients with chronic pain interviewed, 20 were male, 15 were younger than age 50, and 15 were African-American. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders.

CONCLUSIONS:

The results suggest that psychological approaches to chronic pain treatment may be well received by HIV-infected patients.

...Use of alcohol/drugs to self-medicate for pain

A minority of participants reported that pain actually led them to use alcohol or drugs, in an attempt to alleviate their suffering. One participant described how in his case alcohol worked to help him manage his pain:

I would just drink [alcohol] it until my mind – it takes your mind differently. After you’ve had a few you get a good buzz going on and you don’t think about the pain no more. 34-year-old African-American male

Another participant explained how pain actually fueled the development of his addiction to illicit drugs:

Well, [pain and drug use] go hand in hand. Because when I hurt I wanna stop hurting so… and I know that… I know what will help me stop hurting…But and that’s the problem now is I use it when I’m not hurting…. It did go hand in hand for me but now it just became a, a problem or addiction.” 45-year-old African-American male

Most participants who discussed the role of illicit substances felt that self-medication in this way is only a temporary fix. After the drug has worn off, the person is left with their original pain:

You know, you know, drugs doesn’t help because uh if you try to alleviate the pain with – with drinkin’ alcohol ‘cause you gonna just – it’s gonna be a hurtin’ drunk. 52-year-old African-American male with severe chronic pain

For the few minutes that I’m using drugs, I don’t hurt…. And I might, uh, it might last, the pain might be gone for thirty minutes, hour…. But that’s only because cocaine done numb the feeling, I guess…But it, it always comes back which caused me to keep going get more cocaine 45-year-old African-American male

One participant felt that after getting off drugs his pain was even worse:

Uh actually … when I was doin’ the drugs [crack cocaine] I – I didn’t notice the pain. But now that I’m not I do feel – feel it a little more intensely. 48-year-old African American male...

Full article at:   http://goo.gl/2uCSXY

By:   Merlin JS¹, Walcott M², Ritchie C³, Herbey I², Kertesz SG⁴, Chamot E⁵, Saag M², Turan JM⁵.

¹Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

²Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

³Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California, United States of America; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, United States of America.

⁴Birmingham VA Medical Center, Birmingham, Alabama, United States of America; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

⁵School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

  

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The Physical & Psychological Effects of HIV Infection & Its Treatment on Perinatally HIV-Infected Children

Introduction

As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment.

Methods

We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities.

Results and discussion

Perinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous definitions, to name a few.

Conclusions

Success in treating perinatally HIV-infected children and better understanding of the physical and psychological implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for perinatally infected children and their transition to adulthood.

Full article at:   http://goo.gl/Qh85Da

By:   Rachel C Vreeman,§,1,2,3 Michael L Scanlon,*,1,2 Megan S McHenry,*,1,2 and Winstone M Nyandiko*,2,3

¹Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

²Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

³Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

^§Corresponding author: Rachel C Vreeman, Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, HITS Suite 1000, Indianapolis, IN 46202, USA. Tel: +1 317 278 0552. Fax: +1 317 278 0456. (Email:ude.ui@nameervr)

 

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Trajectories of Psychological Distress After Prison Release: Implications for Mental Health Service Need in Ex-Prisoners

Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community.

The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage.

We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours.

For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.

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By:  Thomas EG1, Spittal MJ1, Heffernan EB2, Taxman FS3, Alati R4, Kinner SA1.

• 1Melbourne School of Population and Global Health,University of Melbourne,Parkville,VIC,Australia.
• 2School of Medicine,University of Queensland,Herston,QLD,Australia.
• 3Criminology,Law & Society,College of Humanities and Social Sciences,George Mason University,Fairfax,VI,USA.
• 4School of Public Health and Centre of Youth Substance Abuse Research,University of Queensland,Herston,QLD,Australia. 

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Ties That Bind: Community Attachment & The Experience of Discrimination among Black Men Who Have Sex with Men

In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. 

This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. 

Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. 

Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu.

Full article at: http://goo.gl/OmS1w1

By: Laurens Van Sluytman,a,* Pilgrim Spikes,b Vijay Nandi,c Hong Van Tieu,c Victoria Frye,c Jocelyn Patterson,b and Beryl Koblinc

^aSchool of Social Work, Morgan State University, Baltimore, USA

^bDivision of HIV/AIDS Prevention, US Centers for Disease Control, Atlanta, USA

^cNew York Blood Center, New York, USA

^*Corresponding author: Email: ude.nagrom@namtyulsnav.snerual

   

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Garnering an In-Depth Understanding of Men Who Have Sex with Men in Chennai, India: Analysis of Sexual Minority Status & Psychological Distress

Men who have sex with men (MSM) in India are a hidden and largely understudied population, and have an HIV prevalence 17 times higher than that of the general Indian population. Experiences of social marginalization and negative psychosocial conditions occur concurrent to HIV risk among Indian MSM. To better understand the contextual variables driving HIV risk and inform intervention development, five focus groups (n = 46) and nine key informant interviews were conducted with 55 MSM in Chennai in 2010. NVivo software was used to code the transcripts, and data were analyzed using qualitative descriptive analysis methodology. 

Participants described sources of psychological distress and low self-worth related to gender non-conformity and sexual minority status. These included stigma from society, pressure to marry, lack of familial acceptance, childhood sexual abuse, and the imperative to keep sexual minority status a secret. 

Participants' personal evaluations revealed that self-acceptance may be an important resilience factor that can shield these psychosocial and HIV risk factors. In promoting health-seeking behavioral changes for Indian MSM at an individual level, our findings point to the potential strength of strategies that focus on self-acceptance of one's sexual minority identity to foster better psychosocial and overall health.

Via:  http://ht.ly/S0jIY

By: Mimiaga MJ1, Closson EF, Thomas B, Mayer KH, Betancourt T, Menon S, Safren SA.

• 1Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Behavioral Medicine, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.

Psychological Distress among Victimized Women on Probation and Parole: A Latent Class Analysis

Below:  Standardized mean scores of three subgroups of victimized women on probation and parole across nine latent class indicator variables

Latent class analysis was used to identify subgroups of victimized women (N=406) on probation and parole differentiated by levels of general psychological distress. The nine primary symptom dimensions from the Brief Symptom Inventory (BSI) were used individually as latent class indicators (Derogatis, 1993). Results identified three classes of women characterized by increasing levels of psychological distress; classes were further differentiated by posttraumatic stress disorder symptoms, cumulative victimization, substance use and other domains of psychosocial functioning (i.e., sociodemographic characteristics; informal social support and formal service utilization; perceived life stress; and resource loss). The present research was effective in uncovering important heterogeneity in psychological distress using a highly reliable and easily accessible measure of general psychological distress. Differentiating levels of psychological distress and associated patterns of psychosocial risk can be used to develop intervention strategies targeting the needs of different subgroups of women. Implications for treatment and future research are presented.

Women are among the fastest growing segment of the correctional population. At present, over 200,000 women are incarcerated and more than 1 million women are on probation (Ajinkya, 2012). Approximately one out of every 89 women in the U.S. is involved in the criminal justice system and over 85% are sanctioned within the community...

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