Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors among Women in Methadone Treatment in New York City?

BACKGROUND:

Childhood sexual abuse (CSA) is often considered an important distal factor in HIV sexual risk behaviors; however, there are limited and mixed findings regarding this relationship among women experiencing substance use problems. In addition, research with this population of women has yet to examine differences in observed CSA-HIV sexual risk behaviors relationships by CSA type and characteristics.

OBJECTIVES:

This study examines relationships between CSA coding, type, and characteristics and HIV sexual risk behaviors with main intimate partners among a random sample of 390 women in methadone treatment in New York City who completed individual interviews with trained female interviewers.

RESULTS:

Findings from logistic regression analyses indicate that CSA predicts substance use with sexual activity, with variations by CSA coding, type, and characteristics; however, the role of CSA is more limited than expected. Having a main partner with HIV risk mediates some relationships between CSA and drinking four or more drinks prior to sex. Intimate partner violence is the most consistent predictor of sexual risk behaviors. Other salient factors include polysubstance use, depression, social support, recent incarceration, relationship characteristics, and HIV status.

CONCLUSIONS/IMPORTANCE:

This study contributes to understanding of relationships between CSA and HIV sexual risk behaviors and key correlates associated with HIV sexual risk behaviors among women in methadone treatment. It also highlights the complexity of measuring CSA and its association with sexual risk behaviors and the importance of comprehensive approaches to HIV prevention that address psychological, relational, situational, and substance use experiences associated with sexual risk behaviors among this population.

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By:  Engstrom M1, Winham K2, Gilbert L3.

• 1 School of Social Policy & Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA.
• 2 Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA.
• 3 Social Intervention Group, Columbia University , New York , New York , USA. 

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High Rates of Abscesses & Chronic Wounds in Community-Recruited Injection Drug Users & Associated Risk Factors

OBJECTIVES:

Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assessed the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP).

METHODS:

We performed a cross-sectional study of BNEP clients aged 18 years or more who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regressions.

RESULTS:

Of the 152 participants, 63.2% were men, 49.3% were white, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women and those reporting skin-popping. In a multivariate model, risk factors for an abscess included injecting with a family member/partner. In a multivariable analysis of current chronic wounds, cleaning skin with alcohol before injection was protective.

CONCLUSIONS:

Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds seemed linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.

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By:  Smith ME1, Robinowitz N, Chaulk P, Johnson KE.

• 1From the Department of Medicine (MES, KEJ), Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD; and Baltimore City Health Department (NR, PC), Baltimore, MD. 

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Surgical Intervention for Penile Methamphetamine Injections

Methamphetamine is a central nervous system stimulant and is the second most commonly used illicit drug after cannabis. Methamphetamine use for sexual pleasure is well documented. In this case report, we describe two cases presenting to our urban county hospital associated with complications related to penile injection of methamphetamine. Both patients developed penile abscesses and required urgent surgical incision and drainage. Penile abscesses represent a rare complication associated with IV drug administration into the penile corpora. Resultant penile abscesses require broad-spectrum antibiotics and surgical drainage. Further understanding of methamphetamine abuse along with the role it plays in sexual enhancement would be an invaluable addition to understanding of the rationale behind this self-administered stimulant. Drainage of penile abscesses associated with IV drug users may be hazardous to healthcare providers who are at risk from a needle stick injury.

Below:  Contrast CT scan of the pelvis of Case 1. CT scan showed abscesses within or adjacent to the bilateral corpus cavernosa. The largest abscess was located in the left corpus cavernosum, measuring 4.8 × 2.8 × 4.4 cm. The additional left corpus cavernosum and right corpus cavernosum abscesses measured 2.4 cm and 1.6 cm, respectively, in longest diameter on coronal views.

Below:  Contrast CT scan of the pelvis of Case 2. CT scan showed diffuse edematous thickening of the skin of the penis without evidence of focal fluid collection or abscess

Full article at: http://goo.gl/MF9WJK

By: Thomas W. Gaither, * E. Charles Osterberg, Mohannad A. Awad, and Benjamin N. Breyer

Department of Urology, University of California, San Francisco, 1001 Potrero Avenue, Suite 3A20, San Francisco, CA 94117, USA

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