HIV Risk-taking Behaviour Research Articles

Racial Differences of Psychosocial Characteristics, HIV Risk-Taking and HIV Prevention Uptake between Men Who Have Sex with Men Only and Men Who Have Sex with Men and Women: A Community-Based Study in Two US Cities

ABSTRACT Bisexual behavior preference plays an important role in shaping HIV risks among men who have sex with men (MSM), yet few studies have examined the racial differences in the patterns of sexual risk and HIV prevention uptake between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). We conducted a community-based study to identify and compare psychosocial characteristics, sexual risks, HIV testing frequency, and pre-exposure prophylaxis (PrEP) engagement between Black and White MSMW and MSMO in two US cities. Findings indicate that White MSMW were most likely to engage in HIV risk-taking behaviors (e.g., alcohol/drug use before sex, condomless/group sex), while Black MSMW were least likely to recently test for HIV or report awareness (aPR: 0.32, 95% CI: 0.17–0.61), willingness (aPR: 0.58, 95% CI: 0.30–0.98), and use (aPR: 0.59, 95% CI: 0.31–0.93) of PrEP. Findings from our study supplement salient information for designing culturally tailored HIV prevention interventions for specific MSM subgroups in the US.

Associations Between Social Capital and HIV Risk-Taking Behaviors Among Men Who Have Sex with Men in Japan.

Social capital has been positively associated with reduced HIV risk. However, few studies have investigated if associations vary between men who have sex with men (MSM) or heterosexual alters (possessors of actual resources embedded within social capital networks) and HIV risk-taking behaviors. In a cross-sectional survey of 1564 MSM in Greater Tokyo, we investigated whether social capital ascertained from MSM or heterosexual alters influenced HIV risk-taking behaviors (i.e., consistent condom use and lifetime HIV testing). Multiple logistic regression revealed that MSM with high levels of social capital from heterosexual networks were twice as likely to report consistent condom use with casual male partners, while MSM who reported high levels of social capital from MSM networks were over twice as likely to have tested for HIV yet were half as likely to use condoms consistently with regular male partners. Associations between MSM, social capital, and HIV testing indicate the potential for integrating social capital enhancement programs into current HIV interventions.

Mobile HIV Testing Through Social Networking Platforms: Comparative Study.

BackgroundImproving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation.ObjectiveThe aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms.MethodsA comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors.ResultsWe recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model.ConclusionsThrough effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes.

Initiation of Low-threshold Buprenorphine in Nontreatment Seeking Patients With Opioid Use Disorder Engaged in Hepatitis C Treatment.

The ANCHOR program offered buprenorphine treatment to people who inject drugs engaged in hepatitis C (HCV) treatment at a Washington, DC harm reduction organization. This analysis describes the program model and outcomes of the opioid care continuum at 1 year. Primary outcomes were initiation of buprenorphine and retention in care, defined by an active buprenorphine prescription at given time points. Secondary outcomes included treatment interruptions, reasons for treatment noninitiation and termination, buprenorphine and opiate use, and HIV risk behaviors. Buprenorphine and opiate use were measured by urine toxicology screens and HIV risk behavior was quantified using a validated survey. Of 67 patients receiving HCV treatment not on opioid agonist therapy at baseline, 96% (n = 64) were interested and 73% (n = 49) initiated buprenorphine. Retention was 82% (n = 40), 65% (n = 32), and 59% (n = 29) at months 1, 6, and 12, respectively. Retention at 12 months was associated with self-reported engagement in routine medical care (P < 0.01), but was not associated with gender, stable housing, past opioid agonist therapy, or past overdose. Among retained patients, urine screens positive for opioids were 73% (n = 29), 56% (n = 18), and 79% (n = 23) at months 1, 6, and 12. There was a significant mean decrease in HIV risk-taking behavior scores over the treatment period, primarily driven by reduced injection frequency. Patients engaged in HCV treatment at a harm reduction organization showed a high rate of initiation of buprenorphine treatment, with retention comparable to other treatment settings. Although most patients continued using opioids on treatment, there was a reduced frequency of injection drug use, a significant driver of OUD-related risk. These data support the use of low-threshold buprenorphine access alongside HCV treatment to reduce morbidity and mortality in people with OUD.

Modeling upstream socioeconomic inequities and syndemic conditions among mothers over time.

Mothers in lower social locations are particularly vulnerable to the syndemic conditions of substance abuse, violence, and HIV/AIDS (SAVA), yet few studies have examined the impact of upstream socioeconomic inequities as salient determinants of syndemic conditions in their lives. The purpose of this study was to investigate the influence of Temporary Assistance for Needy Families (TANF) receipt, TANF sanctions, and economic hardship (EH) on SAVA syndemic conditions that included indicators of substance use, HIV risk-taking behaviors, and intimate partner violence among mothers over time. Using data from the Fragile Families and Child Wellbeing Study (n=4,898), we investigated the longitudinal measurement invariance of a proposed measure of syndemic conditions among mothers over five waves and performed path analysis to investigate the relationships between TANF use, TANF sanctions, and EH with syndemic conditions. Analyses revealed the presence of SAVA syndemic conditions and EH predicted increased SAVA in subsequent waves. Relationships between reported race of the mother and the sanctioning of TANF benefits and increased SAVA were also noted. This study has implications regarding race, welfare policy and sanctioning practices, and the socioeconomic determinants of health that drive syndemic conditions among mothers in the United States.

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean.

Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.

HIV and drug related stigma and risk-taking behaviors among people who inject drugs: a systematic review and meta-analysis

The impact of HIV-related stigma on people living with HIV has been well documented, but there have been few studies examining how drug-related stigma impacts risk-taking in the lives of people who inject drugs (PWID). This meta-analysis aimed to determine HIV and drug-related stigma and the association it has with risk-taking behaviors among PWID. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in March 2019. After reviewing for any study duplicates the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. After a detailed assessment, a total of 14 studies containing 13,689 participants met the eligibility criteria. Among the potential risk factors: employment status, depression and sharing injecting paraphernalia had a significant relationship with HIV and drug stigma among PWIDs respectively (OR = 0.78, 95%CI = 0.62–0.98), (OR = 1.84, 95%CI = 1.45–2.33) and (OR = 2.20, 95%CI = 1.84–1.63). Illicit drug use related stigma was found to be associated with several concurrent effects. The impact of stigma should be considered in the development of drug use prevention strategies. Perceived stigma is correlated with numerous negative consequences in other populations including people living with HIV/AIDS. These data suggest this could also be generalized to people who inject drugs because it seems that individuals with internalized stigma experience drug dependence, reduced comfort in seeking help from services and higher rates of depression.

Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men.

Among HIV-uninfected, social media–using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as “unlikely” and 12% as “impossible.” Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.

Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments.

The need for HIV testing in US emergency departments (EDs) has not been assessed, particularly among Latino immigrants and Blacks. We surveyed Latino immigrant and Black 18 to 64-year-old patients at 4 EDs about demographic characteristics, HIV testing history, and health literacy. A subset of patients was further surveyed on HIV risk-taking behaviors. Of the 2,265 participants, 24% had never been tested for HIV. Latino immigrants were more likely than Blacks never to have been tested for HIV (28% vs. 16%). In multivariable logistic regression, for Latino immigrants, male gender and lower health literacy were associated with no previous HIV testing. Among the 1,141-participant subset providing HIV risk-taking behavior data, 23% reported at least one risk factor and of those with at least one risk factor, 23% had never been tested for HIV. There remains a need for HIV testing among adult Latino immigrant and Black patients in US EDs.

Adverse Childhood Experiences and HIV Risk Behaviors in Young Adult Afghan Immigrants to Eastern Iran

This study aims to examine the association between separate and accumulative ACEs and migration-associated HIV risk behaviors among Afghan immigrants to Iran. A retrospective survey was conducted in three provinces of Iran. Respondent-driven sampling (RDS) technique recruited a sample of 772 young adult Afghan immigrants aged 18 to 37 years. Data were collected through structured interviews between January and March 2019. ACEs and HIV risk behaviors were measured, respectively, by an adapted version of the WHO Adverse Childhood Experiences InternationalQuestionnaire (ACE-IQ) and HIV Risk-taking Behavior Scale (HRBS). A notable proportion of participants with a mean percentage of 78.3 ± 10.49 reported cumulative ACEs. Only a mean percentage of 5.5 ± 3.18 of participants reported HIV risk behaviors. After adjusting for intra-class correlation (ICC), significantly higher odds of drug-related behaviors were found among respondents who were exposed to family dysfunction during childhood (aOR= 2.53, 95% CI 1.32–3.75) and those who experienced cumulative childhood adversities (aOR= 1.96, 95% CI 1.09–2.83). Respondents with no education (aOR= 1.38, 95% CI 0.85–1.92), those who were exposed to childhood family dysfunction (aOR= 2.10, 95% CI 1.39–2.81), and those who experienced cumulative childhood adversities (aOR= 2.31, 95% CI 1.33–3.29) were more likely to report sexual risk behaviors. Prevention of ACEs and support for Afghan immigrants exposed to ACEs to develop resilience are essential to improving the HIV health of young adults in future generations. Cumulative ACEs and, separately, family dysfunction, are overlapping risk factors for HIV risk behaviors in young adult Afghan immigrants

244 HIV Testing History, Testing Interest, and HIV Risk-Taking Behaviors Among Adult Accident and Emergency Department Patients in Belize City

Testing for HIV in emergency departments (EDs) has been advocated for in developed countries to identify those with an undiagnosed HIV infection who might not be tested elsewhere and link them to care. However, the utility of HIV testing in developing country EDs is not yet well established. Belize has the highest HIV prevalence in Central America yet its EDs do not routinely offer HIV testing. At the Karl Heusner Memorial Hospital Authority (KHMHA) Accident and Emergency Department (A&E) in Belize City, we assessed HIV testing need among the adult population based on prevalence of lack of prior HIV testing, reported risk of HIV infection, and interest in being tested in the ED. Between June and August of 2018, we recruited a random sample of KHMHA A&E patients and surveyed them using an audio computer-assisted self-interviewer. Participants were English-speaking, 18-64 years old, not critically ill or injured, not a prison inmate/under arrest, and were able to provide informed consent. HIV positivity, prior testing prevalence, and reasons for no prior HIV testing were summarized. Reported HIV risk behaviors and HIV testing interest in the A&E were compared by prior HIV testing status. Multivariable logistic regression was used to identify factors associated with lack of previous HIV testing. Of 301 KHMHA A&E patients screened for study eligibility, patient-reported HIV prevalence was 6%. Of the 264 HIV-uninfected participants, 26% never had been tested for HIV. Of the 69 not previously HIV tested, 28% reported never having been offered testing. Of the 264 HIV-uninfected participants, 6.1% reported injection drug use and 49.2% report having condomless sex in the past 10 years. Prevalence of condomless sex with casual and exchange partners was similar for those never HIV tested vs. tested previously (casual: 25% vs. 27%, p<0.87; exchange: 7.4% vs. 9.7%, p<0.81). Belief in the importance of HIV testing for all A&E patients was similar for never HIV tested vs. tested previously (90% vs. 90%; p<0.30). Participants with fewer years of formal education (primary school or less as compared to tertiary education) (aOR: 4.75 [95% CI: 1.8, 12.4]) and males (aOR: 2.81 [95% CI: 1.5, 5.3]) were less likely to have been HIV tested (Table). Absence of prior HIV testing, lack of being offered an HIV test previously, and the high prevalence of reported HIV risk behaviors indicate that that patients in this developing country could benefit from an A&E-based HIV testing program. Furthermore, the overwhelming majority of patients are supportive of being tested for HIV in the A&E.

Violence Exposure, Drug Use and HIV/AIDS Risk Taking Behaviors: The Role of Gender

ObjectiveTo examine gender differences among African American young adults in their exposure to violence (ETV) before age 18 and community violence as an adult, and the relationship of these exposures to drug use and HIV risk taking behaviors (HIVRTB). MethodWe detail these experiences in 440 self-identified African Americans, ages 18 to 25, from socio-economically disadvantaged wards in Washington, DC. Factor analysis was used to identify the types of violence experienced before age 18 and as adults. Regression was used to identify which types of violence had the greatest impact on subsequent drug use and HIVRTB. ResultsWe found gender differences in the types of violence experienced and their effects on drug use and HIVRTB. For women, the strongest ETV factors were direct personal violence, and exposure to drug sales or physical violence as adults. For men, the strongest factors were feeling unsafe in different situations as adults and exposure to violence among adults before age 18. ConclusionsWe identified the specific kinds of violence that are most likely to impact drug use and risky sexual behaviors that can leave one vulnerable to HIV and how these differ between women and men exposed to both childhood violence and community violence as an adult. Our findings point toward the need for trauma-informed programs that are tailored to gender.

Factors influencing HIV risk-taking behaviours amongst textile factory workers living with HIV in Lesotho.

With its number of employees ranging from 45,310 to 46,000, the textile and apparel industry is the main private sector employer of labour in Lesotho. It has been reported that a third (an estimated 34%) of these workers are living with HIV. There is perception that textile factory workers living with HIV (TFWLWH) in Lesotho indulge in HIV risk-taking behaviours. However, no study has yet investigated or documented factors that influence risk-taking behaviours amongst these workers. Transmitting the disease to others, treatment complications and death consequent to HIV reinfection are complications associated with HIV risk-taking behaviours by seropositive individuals. Using an in-depth, face-to-face, semi-structured interview, this study obtained the perspectives of ten factory workers from three randomly selected textile factories in Maseru, Lesotho on factors that influence HIV-risk taking behaviour amongst TFWLWH in Lesotho. Analysis of the comments given by workers revealed four core themes, namely, peer pressure, communication, cultural norms and societal norms. Determining the predictors of HIV risk-taking behaviours amongst these workers will inform both present and future interventions aimed at supporting textile factory workers living with HIV in Lesotho. This supports the need for continued research to identify HIV risk-taking behaviours by people living with HIV countrywide, to decrease the incidence of new infections and complications arising from reinfection.

Correlates and Treatment Outcome of Risky Sexual Behaviour in Young Males with ADHD and Comorbid Alcohol Use Disorder: A Prospective Study

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with risky sexual behavior (RSB). Alcohol use and high perceived stress in young adulthood contributes to this association. Previous studies have not found methylphenidate to reduce RSB in ADHD, as the population had comorbidities such as mood disorders and antisocial personality disorder. We aimed to study (a) the association of RSB with ADHD and severity of alcohol use among adolescents and young adult males with ADHD who had comorbid alcohol use disorder and (b) the effect of treatment of ADHD using methylphenidate on RSB in this population at 3- and 6-month follow-ups. Methodology: The study had 31 participants who were selected by screening for RSBs using the sexual behavior section of the HIV Risk-taking Behavior Scale (HRBS) manual among a cohort of individuals with ADHD and early onset alcohol use. These individuals were also administered WHO ADHD self-report scale (ASRS), alcohol-use disorders identification test (AUDIT), perceived stress scale (PSS), and HRBS-sexual behavior section. They were then treated with methylphenidate and these assessments were repeated at 3 and 6 months. Results: Those having ADHD with RSB had higher total ADHD score ( P = .007) and inattention score ( p = .0001) than those without RSB. There was a significant correlation between the ADHD total score with alcohol-use severity ( r = 0.47), with RSB ( r = 0.34), and ADHD hyperactivity scores with alcohol-use severity ( r = 0.49) and with RSB ( r = 0.34). There was also a significant reduction of ADHD total, inattention and hyperactivity scores, alcohol-use severity scores, RSB and perceived stress scores with use of methylphenidate at 3- and 6-month follow-ups. Multiple logistic regression predicted reduction in ADHD total scores to reduce RSB (odds ratio [OR] = 1.26, P = .01). Conclusion: RSB was associated with severity of ADHD and alcohol use. Methylphenidate not only reduced ADHD severity but also alcohol-use severity and RSB, whose reduction was predicted by reduction in ADHD severity.

Prevalence of HIV risk behavior among male substance abusing offenders of intimate partner violence

PurposeThe purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The current study also aims to determine whether HIV risk-taking behaviors (e.g. trading sex for money or drugs, having unprotected sex with multiple partners) differ among substance using IPV offenders with and without a history of sexual aggression.Design/methodology/approachSecondary analyses were conducted from Easton et al.’s (2017) randomized controlled trial of substance use domestic violence treatment among substance using IPV offenders. Correlational analyses were conducted to assess the relationship between pre-treatment sexual aggression, HIV risk-taking behaviors, substance use and aggression. Analyses of covariance were conducted in order to determine differences in participants’ HIV risk-taking behaviors based on their history of sexual aggression while controlling for hours of contact with the female partners.FindingsIn a sample of 63 participants, males with higher rates of sexual aggression were more likely to engage in sexual risk-taking behaviors. This study encountered a correlation between pre-treatment risk-taking behavior and verbal and physical aggression, as well as a correlation between pre-treatment risk-taking behaviors and cocaine use. Results neither suggest a relationship between sexual aggression and alcohol use nor HIV risk-taking behaviors and alcohol use at pre-treatment.Research limitations/implicationsThe present study is limited by sample size and power.Originality/valueThis study is among the first of its kind to investigate HIV risk-taking behaviors among substance using offenders of IPV. This study provides support for the inclusion of treatment targeting HIV risk-taking behaviors among IPV offenders.

Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients

People who inject drugs (PWID) are at increased risk of HIV infection. Although methadone maintenance therapy can help lower this risk, many methadone patients continue to engage in HIV risk behaviors, especially patients who use cocaine and alcohol. The purpose of the current study was to investigate relations between alcohol use disorders and HIV risk behavior in 239 cocaine-dependent methadone patients participating in a randomized controlled trial of a behavioral intervention to promote cocaine abstinence. Past 3-month HIV Risk-taking Behavior Scale (HRBS) scores were compared between cocaine-dependent methadone patients who met DSM-IV-TR diagnostic criteria for alcohol abuse or dependence and those who did not meet these criteria. No significant differences in HRBS drug subscale scores were observed between participants with and without alcohol use disorders, indicating risky drug use was similar between groups. However, alcohol use disorder was significantly associated with HRBS sex subscale scores (t=2.59, p=0.01), indicating participants with alcohol use disorders were more likely to engage in risky sexual behavior. Item-level analyses of the sex-related HRBS questions showed participants with alcohol use disorders were significantly more likely than participants without alcohol use disorders to have unprotected sex, engage in transactional (paid) sex, and have anal sex. Interventions are needed to reduce risky sexual behavior and attenuate the spread of HIV in this high-risk population.

Developing a program for enhancing youth HIV treatment adherence and risk reduction.

Youth living with HIV face difficult and challenging situations that decrease their adherence to antiretroviral medications. In this study, we developed a pilot program to enhance HIV treatment adherence and risk reduction among youth living with HIV based on collaboration with a community hospital involving a multi-disciplinary healthcare team. Participants were 25 youth living with HIV/AIDS, 18 caregivers, and 12 healthcare providers. The action research process comprised a preliminary stage and four phases of assessment, planning, implementation, and evaluation. This program used "edutainment", participatory learning, and multi-disciplinary collaboration to improve HIV treatment adherence and HIV risk behavior knowledge, motivation, and behavior. Education aimed to improve knowledge of antiretroviral drugs and HIV risk-taking behaviors. Motivation was directed at reframing beliefs and increasing positive attitudes of youth toward treatment adherence and raising awareness about safer sex behaviors. The behavioral skills focused on medication management in daily life activities, problem-solving, refusal and negotiation, and condom use. Findings provided preliminary evidence that the program was practical in a clinical context in a community hospital.

Correlates of HIV Risk-taking Behaviors among African-American College Students: HIV Knowledge and Ethnic Identity.

We examined ethnic identity in relation to hazardous alcohol use, illicit drug use, and risky sexual behavior in 266 college students recruited on the campus of a historically Black college/university (HBCU). Participants were primarily African American students participating in HIV education and prevention outreach efforts. Data regarding prevalence of substance use, binge drinking, and sexual risk behaviors are reported. Results found no relationship among the risk variables and ethnic identity. HIV knowledge score results demonstrated a need to continue HIV education to include the less publicized facts about HIV transmission. Results are discussed in terms of implications for prevention efforts with African American college students.

Pre-incarceration police harassment, drug addiction and HIV risk behaviours among prisoners in Kyrgyzstan and Azerbaijan: results from a nationally representative cross-sectional study.

IntroductionThe expanding HIV epidemic in Azerbaijan and Kyrgyzstan is concentrated among people who inject drugs (PWID), who comprise a third of prisoners there. Detention of PWID is common but its impact on health has not been previously studied in the region. We aimed to understand the relationship between official and unofficial (police harassment) detention of PWID and HIV risk behaviours.MethodsIn a nationally representative cross-sectional study, soon-to-be released prisoners in Kyrgyzstan (N=368) and Azerbaijan (N=510) completed standardized health assessment surveys. After identifying correlated variables through bivariate testing, we built multi-group path models with pre-incarceration official and unofficial detention as exogenous variables and pre-incarceration composite HIV risk as an endogenous variable, controlling for potential confounders and estimating indirect effects.ResultsOverall, 463 (51%) prisoners reported at least one detention in the year before incarceration with an average of 1.3 detentions in that period. Unofficial detentions (13%) were less common than official detentions (41%). Optimal model fit was achieved (X2=5.83, p=0.44; Goodness of Fit Index (GFI) GFI=0.99; Comparative Fit Index (CFI) CFI=1.00; Root Mean Square Error of Approximation (RMSEA) RMSEA=0.00; PCLOSE=0.98) when unofficial detention had an indirect effect on HIV risk, mediated by drug addiction severity, with more detentions associated with higher addiction severity, which in turn correlated with increased HIV risk. The final model explained 35% of the variance in the outcome. The effect was maintained for both countries, but stronger for Kyrgyzstan. The model also holds for Kyrgyzstan using unique data on within-prison drug injection as the outcome, which was frequent in prisoners there.ConclusionsDetention by police is a strong correlate of addiction severity, which mediates its effect on HIV risk behaviour. This pattern suggests that police may target drug users and that such harassment may result in an increase in HIV risk-taking behaviours, primarily because of the continued drug use within prisons. These findings highlight the important negative role that police play in the HIV epidemic response and point to the urgent need for interventions to reduce police harassment, in parallel with interventions to reduce HIV transmission within and outside of prison.

Serotonin-Related Gene Polymorphisms and Asymptomatic Neurocognitive Impairment in HIV-Infected Alcohol Abusers.

HIV-infected individuals continue to experience neurocognitive deterioration despite virologically successful treatments. While the cause remains unclear, evidence suggests that HIV-associated neurocognitive disorders (HAND) may be associated with neurobehavioral dysfunction. Genetic variants have been explored to identify risk markers to determine neuropathogenesis of neurocognitive deterioration. Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life and HIV risk-taking behaviors. Single nucleotide polymorphisms in the SLC6A4, TPH2, and GALM genes may affect the activity of serotonin and increase the risk of HAND. The present study explored the relationship between SLC6A4, TPH2, and GALM genes and neurocognitive impairment in HIV-infected alcohol abusers. A total of 267 individuals were genotyped for polymorphisms in SLC6A4 5-HTTLPR, TPH2 rs4570625, and GALM rs6741892. To assess neurocognitive functions, the Short Category and the Auditory Verbal Learning Tests were used. TPH2 SNP rs4570625 showed a significant association with executive function in African American males (odds ratio 4.8, 95% CI, 1.5–14.8; P = 0.005). Similarly, GALM SNP rs6741892 showed an increased risk with African American males (odds ratio 2.4, 95% CI, 1.2–4.9; P = 0.02). This study suggests that TPH2 rs4570625 and GALM rs6741892 polymorphisms may be risk factors for HAND.