Prevalence & Correlates of Transactional Sex among an Urban Emergency Department Sample: Exploring Substance Use & HIV Risk

Men and women involved in transactional sex (TS) report increased rates of HIV risk behaviors and substance use problems as compared with the general population. When people engaged in TS seek health care, they may be more likely to utilize the emergency department (ED) rather than primary care services. 

Our goal was to examine the prevalence and correlates of TS involvement among an ED sample of men and women. Adults ages 18-60 were recruited from an urban ED, as part of a larger randomized control trial. Participants (n = 4,575; 3,045 women, 1,530 men) self-administered a screening survey that assessed past 3-month substance use (including alcohol, marijuana, illicit drugs, and prescription drugs) and HIV risk behaviors, including TS (i.e., being paid in exchange of a sexual behavior), inconsistent condom use, multiple partners, and anal sex. 

Of the sample, 13.3% (n = 610) reported TS within the past 3 months (64.4% were female). Bivariate analysis showed TS was significantly positively associated with alcohol use severity, marijuana use, and both illicit and prescription drug use, and multiple HIV risk behaviors. These variables (except marijuana) remained significantly positively associated with TS in a binary logistic regression analysis. 

The prevalence of recent TS involvement among both male and female ED patients is substantial. These individuals were more likely to report higher levels of alcohol/drug use and HIV risk behaviors. 

The ED may be a prime location to engage both men and women who are involved in TS in behavioral interventions for substance use and sexual risk reduction.

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By:  Patton R1, Blow FC2, Bohnert AS2, Bonar EE2, Barry KL2, Walton MA2.

• 1The Substance Abuse Research Center, University of Michigan.
• 2Department of Psychiatry, University of Michigan. 
• Psychol Addict Behav. 2014 Jun;28(2):625-30. doi: 10.1037/a0035417.

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Gender Comparisons among Asian American and Pacific Islander Patients in Drug Dependency Treatment

BACKGROUND:

Few studies have focused on Asian Americans and Pacific Islanders (AAPIs), despite indications of increasing substance abuse among AAPIs in recent years.

OBJECTIVES:

This prospective longitudinal study examined gender differences among AAPIs in treatment.

METHODS:

The study included 567 (177 women, 390 men) AAPI patients drawn from two prior studies, one with 32 community treatment programs in 13 California counties (CalTOP, 3, 9 months), and another project including 36 treatment sites in 5 California counties (TSI, 3, 12 months). Baseline and follow-up assessments utilized the Addiction Severity Index (ASI). A subset of patients was assessed at 3 and 9/12 months (n = 106).

RESULTS:

  Significant gender-related differences were observed at baseline: fewer women than men were employed or never married. More women were living with someone having alcohol and drug problems. Methamphetamine was the primary drug for women and men, followed by alcohol and heroin. Compared to AAPI men, AAPI women reported greater problem severity in family/social relationships (0.18 vs. 0.11, p <.001), employment (0.68 vs. 0.56, p <.001), and mental health (0.19 vs. 0.14, p <.01). Relative to women, AAPI men reported greater treatment satisfaction at the 3-month follow-up. Significant improvements at follow-up were observed in family, alcohol, drug, and legal domains for both genders, and in mental health for men only. Compared to AAPI men, AAPI women demonstrated significantly greater improvements in drug problems (ΔASI = 0.07, p <.05).

CONCLUSIONS:

Gender differences revealed in this study suggest a need for a greater treatment focus on psychiatric problems for AAPI women and drug use problems for AAPI men.

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By:  Han Y1, Lin V2, Wu F3, Hser YI2.

• 1 Department of Clinical , Social and Administrative Sciences, University of Michigan , Ann Arbor , Michigan , USA.
• 2 Integrated Substance Abuse Treatment, University of California, Los Angeles , Los Angeles , California , USA.
• 3 Research and Evaluation Services Unit, Los Angeles County , Los Angeles , California , USA.
• Subst Use Misuse. 2016 Apr 12:1-11.  

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The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia

HIGHLIGHTS

• Almost half the women engaged in sex work reported violence in the past 12 months.
• Prior physical violence exposure associated with subsequent sexual risk taking.
• Physical violence was associated with amphetamine type stimulant (ATS) use.
• Sexual violence was associated lower levels of condom use with non-paying partners.

BACKGROUND:

Violence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear.

METHODS:

We examined data from an observational cohort of FESW age 15-29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue.

RESULTS:

Of 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04-1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10-5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29-5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38-5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10-0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13-2.93).

CONCLUSIONS:

Physical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.

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By:  Draughon Moret JE1, Carrico AW2, Evans JL3, Stein ES4, Couture MC5, Maher L6, Page K7; Young Women’s Health Study Collaborative.

• 1The Betty Irene Moore School of Nursing at UC Davis, 4610 X Street, #4202 Sacramento, CA 95817, United States. Electronic address: jdmoret@ucdavis.edu.
• 2University of California San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, United States. Electronic address: adam.carrico@ucsf.edu.
• 3UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: jennifer.evans@ucsf.edu.
• 4UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: ellen.stein@ucsf.edu.
• 5University of San Francisco, School of Nursing and Health Professions, Department of Population Sciences, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.
• 6The Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: lmaher@kirby.unsw.edu.au.
• 7Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: pagek@salud.unm.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:171-7. doi: 10.1016/j.drugalcdep.2016.01.028. Epub 2016 Feb 6. 

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John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. 

The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. 

The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. 

Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. 

Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

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By:  Stevens-Watkins D1, Knighton JS2, Allen K3, Fisher S2, Crowell C2, Mahaffey C2, Leukefeld C2, Oser C2.

• 1University of Kentucky. Electronic address: d.stevenswatkins@uky.edu.
• 2University of Kentucky.
• 3Florida State University. 
• J Subst Abuse Treat. 2016 Apr;63:54-60. doi: 10.1016/j.jsat.2016.01.004. Epub 2016 Jan 15.

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Knowledge, Awareness and Behavior: HIV/AIDS and Disasters

African Americans are the most affected by HIV/AIDS. Both males and females continue to be disproportionately affected by HIV/AIDS. They are often drug users or participate in street/drug subculture. Recent weather disasters have required identification of knowledge, beliefs, conduct norms and behavior patterns that are HIV/AIDS risk factors for disaster survivors. This paper examines patterns of behavior and common practices related to HIV among disaster survivors.

Study background

Data for this paper come from a three year renewal project which focused upon the processes by which illicit drug markets were reformulated after disasters and practices of risk behaviors for HIV/AIDS. Hurricanes Katrina, Gustav and Ike presented the opportunity to examine the impact of disasters upon risky behavior among illicit drug users and sellers.

Methods

From 2010-2013 ethnographic study was conducted in New Orleans, Louisiana, Houston and Galveston, Texas. Staff completed in-depth interviews with 132 focal respondents of drug users and sellers. There were 57 focus groups with 243 focus group participants; 350 drug using/selling respondents completed a survey protocol (CAPI), organized around their experiences during the hurricanes.

Results

In both cities respondents displayed knowledge about HIV, modes of transmission and knew that HIV infection can lead to AIDS. Knowledge about time between exposure and infection was mostly imprecise. Most respondents reported they had been tested for HIV multiple times. A large number of participants reported learning about HIV in school, older respondents (mid-40s to 60) reported their knowledge came from television or the streets. Participants expressed fatalistic attitudes toward HIV, believing the virus was fatal even with medication.

Conclusion

With the increase of disasters, more attention needs to be placed upon programs focused on drug consumers. Schools, clinics, public information sources, i.e., TV and radio can make understanding HIV/AIDS a priority through taking into consideration specific populations and making sure literature and other forms of information is adjusted to their understanding.

Full article at:   http://goo.gl/02sruz

By:  Eloise Dunlap

Eloise Dunlap, Director, National Development and Research Institutes, New York, USA;

^*Corresponding author: Eloise Dunlap, Director, National Development and Research Institutes, Institute for Special Population Research, 71 West 23rd Street, 4th floor, New York, United States, Tel: 6466427358; Fax: 9174380894

J Alcohol Drug Depend. 2016 Feb; 4(1): 230.

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Drug-Resistance Strategies of Early Adolescents in Mexico: Gender Differences in the Influence of Drug Offers and Relationship to the Offeror

To address increases in substance use among Mexican adolescents, particularly females, US prevention programs are being adapted to the Mexican cultural context. Understanding how responses to substance offers by Mexican adolescents are shaped by gender and relationships to those making offers is an important step in the adaptation process. 

Using data from Guadalajara, Mexico middle schools (N = 431), this pilot study tested for gender differences in the use of several drug resistance strategies commonly taught in US substance abuse prevention interventions. 

Results indicated that the drug-resistance strategies of Mexican early adolescents differ by gender, type of substance offered, and the youth's relationship to the offeror. Contrary to previous research on older Mexican adolescents, in this sample, females received more substance offers from age peers than males did, and employed a wider repertoire of drug-resistance strategies, including active strategies such as direct refusals. Gender differences in use of the strategies persisted after controlling for number of offers received. There were gender differences in the conditional effects of greater exposure to offers. A larger volume of alcohol and cigarette offers predicted females' use of direct strategies more strongly than for males, but less strongly than males for marijuana offers. 

Females' use of drug resistance strategies was more strongly associated with offers from family adults, siblings, and cousins, while males' use of strategies was predicted more strongly by offers from nonfamily adults. Interpretations and prevention implications are discussed in light of changing gender norms in Mexico and gendered patterns of substance use.

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By:  Kulis S1, Booth JM2, Becerra D3.

• 1 Southwest Interdisciplinary Research Center, Arizona State University , Phoenix , Arizona , USA.
• 2 School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
• 3 School of Social Work, Arizona State University , Phoenix , Arizona , USA.
• Subst Use Misuse. 2016 Feb 23;51(3):370-82. doi: 10.3109/10826084.2015.1110171. Epub 2016 Feb 17. 

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Association of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey-Adolescent Supplement

OBJECTIVE:

To estimate the association of prior lifetime mental disorders with transitions across stages of substance use in a cross-sectional, nationally representative sample of US adolescents.

METHOD:

The sample includes 10,123 adolescents aged 13 to 18 years who participated in the National Comorbidity Survey-Adolescent Supplement (NCS-A), and who were directly interviewed with the Composite International Diagnostic Interview (CIDI) Version 3.0 that generates criteria for DSM-IV disorders.

RESULTS:

Adolescents with prior lifetime mental disorders had high rates of both alcohol (10.3%) and illicit drug (14.9%) abuse, with or without dependence. Alcohol and drug abuse were highest among adolescents with prior anxiety disorders (17.3% and 20%, respectively) and behavior disorders (15.6% and 24%, respectively). Any prior disorder significantly increased the risk of transition from nonuse to first use, and from use to problematic use of either alcohol or illicit drugs. Multivariate models attenuated the magnitude of the risk of transition associated with each disorder, although prior weekly smoking and illicit drug use demonstrated significant risks of transitions across the 3 stages of alcohol or drug use, as did behavior disorders.

CONCLUSION:

The findings provide the first evidence from a nationally representative sample that prior mental disorders represent risk factors for the transition from nonuse to use, and the progression to drug- and alcohol-related problems. Treatment of primary mental disorders is likely to be an important target for the prevention of secondary substance use disorders in youth.

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By:  Conway KP1, Swendsen J2, Husky MM3, He JP4, Merikangas KR5.

• 1Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA), Rockville, MD.
• 2École Pratique des Hautes Études (EPHE), Paris, the National Center for Scientific Research (CNRS), Paris, and University of Bordeaux, France.
• 3University of Paris Descartes, Paris.
• 4Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD.
• 5Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD. Electronic address: merikank@mail.nih.gov. 
• J Am Acad Child Adolesc Psychiatry. 2016 Apr;55(4):280-8. doi: 10.1016/j.jaac.2016.01.006. Epub 2016 Feb 2.

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Mental Health among Men Who Have Sex with Men in Cambodia: Implications for Integration of Mental Health Services within HIV Programs

BACKGROUND:

Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services.

METHODS:

A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress.

RESULTS:

In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress, which indicates poor mental health. Higher levels of psychological distress were independently associated with older age, alcohol use, illicit drug use, poor self-reported quality of life, and reduced condom use at last sex. MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them, a parent or guardian had been physically abused, and a family member had been mentally ill when they were growing up.

CONCLUSIONS:

In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.

Comparisons of sexual behaviors and HIV/STI testing among MSM with a lower and higher level of psychological distress

Sexual behaviors in the past 3 months	Total	Total GHQ-12 score
	(n = 394)	≤3 (n = 241)	>3 (n = 153)	p-value*
Mean number of sex partners	3.9 ± 5.4	3.8 ± 5.7	4.0 ± 5.0	0.68
Used a condom in the last sex	313 (82.8)	202 (87.4)	211 (75.5)	0.003
Had sex with girlfriends	118 (29.9)	79 (32.7)	39 (15.4)	0.03
Mean number of girlfriends you had sex with	1.7 ± 1.1	1.7 ± 1.0	1.9 ± 1.2	0.26
Used a condom in last sex with girlfriends	97 (82.2)	68 (86.1)	29 (74.4)	0.12
Had sex with boyfriends	206 (86.9)	126 (85.7)	80 (88.9)	0.48
Mean number of boyfriends you had sex with	2.4 ± 3.8	2.3 ± 3.5	2.6 ± 4.3	0.53
Used a condom in last sex with boyfriends	192 (92.8)	117 (92.9)	75 (92.6)	0.94
Had anal sex with boyfriends	196 (94.2)	116 (91.3)	80 (98.8)	0.03
Used condom in last anal sex with boyfriend	187 (92.1)	114 (94.2)	73 (89.0)	0.18
Sold sex to men	67 (17.0)	42 (17.4)	25 916.3)	0.78
Used condom when selling sex last time	63 (94.0)	40 (95.2)	23 (92.0)	0.59
Tested for HIV in the past 6 months	252 (64.0)	160 (66.4)	92 (60.1)	0.21
Been diagnosed with an STI	28 (7.1)	16 (6.6)	12 (7.9)	0.63

GHQ general health questionnaire, MSM men who have sex with men, STI sexually transmitted infection

Values are number (%) for categorical variables and mean ± SD for continuous variables

*Chi-square test or Fisher’s exact test was used as appropriate for categorical variables and Student’s t-test was used for continuous variables

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

By:  Yi S1, Tuot S1, Chhoun P2, Pal K2, Choub SC2, Mburu G3,4.

• 1Research Department, KHANA, Phnom Penh, Cambodia.
• 2Programs Department, KHANA, Phnom Penh, Cambodia.
• 3Program Impact Unit, International HIV/AIDS Alliance, Brighton, UK. gmburu@aidsalliance.org.
• 4Department of Health Research, Lancaster University, Lancaster, UK. gmburu@aidsalliance.org. 

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Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods

BACKGROUND:

The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use.

OBJECTIVE:

We examined the concordance of ecological momentary assessment (EMA) of drug use to previously validated biological and audio-computer assisted self-interview (ACASI) methods.

METHODS:

The Exposure Assessment in Current Time (EXACT) study utilized EMA methods to assess drug use in real-time in participants' natural environments. Utilizing mobile devices, participants self-reported each time they used heroin or cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected for measurement of heroin and cocaine and participants answered an ACASI-based questionnaire to report behaviors and drug using events during the prior week. Reports of cocaine and heroin use captured through EMA were compared to weekly biological or self-report measures through percent agreement and concordance correlation coefficients to account for repeated measures. Correlates of discordance were obtained from logistic regression models.

RESULTS:

A total of 109 participants were a median of 48.5 years old, 90% African American, and 52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The percent agreement between EMA and sweat patch methods was 70% for cocaine use and 72% for heroin use, while the percent agreement between EMA and ACASI methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug use by EMA compared to sweat patch and ACASI methods were different by illicit drug type.

CONCLUSIONS:

Our work demonstrates moderate to good agreement of EMA to biological and standard self-report methods in capturing illicit drug use. Limitations occur with each method and accuracy may differ by type of illicit drugs used.

Below:   Reported drug use as assessed by sweat patch (green bars), EMA (orange bars) or ACASI (blue bars) methods

Below:  Figure 2. Percent agreement by drug type and week comparing EMA, sweat patch, and ACASI methods. Panel A: Percent agreement between EMA/Sweat Patch methods (blue bars) and EMA/ACASI methods (green bars) by week for cocaine use. Panel B: Percent agreement between EMA/Sweat Patch methods (orange bars) and EMA/ACASI methods (yellow bars) by week for heroin use.

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By:  Linas BS1, Genz A, Westergaard RP, Chang LW, Bollinger RC, Latkin C, Kirk GD.

• 1Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA. Blinas@jhu.edu.
• JMIR Mhealth Uhealth. 2016 Mar 15;4(1):e27. doi: 10.2196/mhealth.4470. 

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