Posts classified under: Substance Use

HIV/STD Risk Behaviors in Methamphetamine User Networks

SATH-CAP stands for the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The overall goal of SATH-CAP is to better understand how patterns of sexual and drug use behaviors along with other social and environmental factors, such as other sexually transmitted diseases, places where people gather for sex and drug activities, and types of partnerships, influence the spread of HIV/AIDS from people currently at high risk for HIV/AIDS, like drug users and men who have sex with men (MSM), to those at a lower risk.

Specifically, the study seeks to answer these primary questions:

  • To what extent do HIV infections among drug-using populations spread to uninfected drug users and non-drug users through drug-related and/or sexual transmission behaviors?
  • What individual (behavioral, biological), network, and structural characteristics influence the speed, extent and path of the spread?

The SATH-CAP includes five research centers, a scientific and logistical coordinating center at RAND, and the funder, the National Institute on Drug Abuse (NIDA). The research centers are:

  • Research Triangle Institute (RTI)
  • University of California, Los Angeles (UCLA)
  • University of Illinois, Chicago (UIC)
  • Yale University
  • The Biomedical Center (BMC), St. Petersburg, Russia, Andrei Kozlov

Los Angeles County Methamphetamine Prevention Initiative

There is a significant unmet need in Los Angeles County for methamphetamine-specific training, and community service agencies and outreach workers need education and training on effective approaches to engage and serve persons in the community at risk. Training and technical assistance is also needed for service providers on the latest evidence-based methamphetamine treatment approaches.

More specifically, trainings are needed that cover methamphetamine-specific issues crucial for the development of skills by medical providers, clinicians and outreach workers serving clients who use methamphetamine and address specific concerns around providing culturally appropriate care for specific populations. These trainings address issues such as: mental health considerations, psychological complications, sexual and cybersex addiction and current evidence based treatments.

This training project included the following activities:

  • Providing consultation and technical assistance to the Los Angeles County Alcohol and Drug Program Administration (ADPA) and the Office of AIDS Programs and Policy (OAPP)
  • Developing training curricula and module for ADPA or OAPP-funded substance abuse or HIV/AIDS treatment providers
  • Developing and disseminating web-based training module
  • Providing in-service trainings for Los Angeles County Methamphetamine Task Forces
  • Providing in-service trainings for ADPA and OAPP-funded Drug Abuse and HIV prevention agencies serving young women
  • Providing tailored technical assistance

Recruiting and Engaging Adolescents in Creating Hope (Project REACH)

Project REACH aims to create an effective recruitment and retention method for family interventions for substance abuse and adapt culturally-appropriate substance abuse programs targeting African American adolescents who are enrolled in Los Angeles County Office of Education (LACOE) schools and their parents (parents includes an adult guardian).
Targeted Risk Group: 
Probation youth and their families in Los Angeles
Research Methods: 
The project has two phases. The first phase is to develop an effective way to recruit families into a family intervention for substance abuse and determine how to make the intervention culturally appropriate. The family intervention that will be adapted for this project is Families that Care: Guiding Good Choices ((aka “Preparing for the Drug Free Years”) (GGC). GGC has been proven to reduce substance abuse, address family conflict through problem solving and communication techniques, and finally increase family connectedness. These activities will be done in collaboration with school administrators, probation officials, teachers, students and parents through key informant interviews and focus groups. The second phase will pilot test the adaptation of GGC in a sample of 60 African American from LACOE schools and their parents.
Local Significance: 
Expect to improve recruitment and retention in GGC, and GGC will improve family functioning and mental health, and decrease problem behaviors (HIV risk behaviors, school performance and recidivism).

Safety Counts

Drug users have a high risk of HIV infection. Because certain neighborhoods have higher levels of substance abuse, HIV risk becomes related to geography as well. Thus, there is need for local street outreach programs such as Safety Counts.

Research Methods:

In a quasi experimental, cross-over design, two Los Angeles neighborhoods were randomly assigned to receive either (1) Voluntary HIV Counseling and Testing (VCT) or (2) Safety Counts. In Phase 1, injection drug users and crack users in these neighborhoods attended the respective intervention. In Phase 2, each neighborhood and therefore its participants received the alternative intervention. Participants were reassessed at 5–9 months. Data collected included demographics, sexual risk behavior, and substance abuse.The Safety Counts intervention differed from the VCT intervention in that Safety Counts offered skill-building and goal-setting workshops, one-on-one counseling sessions to implement goals, street contacts to support other participants, and social events.

Local Significance: 

Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for injection drug users and crack users.

Nsindikanjake Vocational Training Project

Socio-economic status plays an important role in HIV risk and prevention. Specifically, poverty can lead to survival sex and unprotected sex. The Nsindikanjake Vocational Training Project, a collaboration between UCLA and the Uganda Youth Development League (UYDEL), aims to reduce HIV risk among urban Ugandan youth through vocational education and training.

From February 2005 to January 2006, 100 13- to 23-year-old participants were recruited from two different youth centers in the slums of Kampala, Uganda. Youth were randomized by site to an immediate vocational training intervention (N=50 youth) or a 4-month delayed vocational training (N=50 youth). Participants were assessed at baseline, 4, and 24 months later. Youth were asked about employment, sexual risk behaviors, delinquent behavior, quality of life, mental health symptoms, and drug use.Vocational education consisted of apprenticeships with local artisans for 4 to 8 hours, 5 days a week. Artisans received training in having conversations with youth about HIV and how to cope with unprofessional behavior (e.g., tardiness, hygiene problems). Youth in the delayed training condition received vocational training after a 4-month follow-up assessment was completed. The final assessment was administered 24 months after enrollment, by which time all youth had received training.
Vocational training may be highly useful in supporting the impact of HIV prevention. The participants receiving vocational training showed reduced delinquent behaviors and greater improvements in employment, life satisfaction, and social support compared to control participants. Both conditions demonstrated such improvements at two years, especially ongoing employment which remained strong.

Vietnam – Development of a Family Intervention to Address Drug Use and HIV in Vietnam

This two-year study will be conducted in Phu Tho Province, Vietnam in collaboration with the Vietnam National Institute of Hygiene & Epidemiology (NIHE). This study will develop and pilot an intervention aimed at increasing family support for IDU’s behavior change and family capacities to effectively cope with the impact of IDUs and HIV.

Targeted Risk Group: 

IDUs, family members

Intervention model: 

Planned behavior change, Stages of change, and Psych-education

Research Methods: 

• Focus group to develop the content, format and delivery plan for the intervention
• Intervention will be delivered to 40 IDUs and 40 their family members
• Assessments will be conducted with 80 IDUs and 80 Family members at baseline, 3-month and 6-month follow-ups.

Local Significance: 

The findings from the study will inform the design of the full-scale intervention trial for families coping with IDU and/or HIV in Vietnam. By addressing HIV and IDUs, this intervention could potentially reduce the psychological, physical and emotional demands of living with chronic HIV, coping with drug use, and improve the safety of society. A dissemination of the intervention design to district hospitals in Vietnam can improve the lives of families in dealing HIV and IDUs.

International Significance: 

This study demonstrates a model to combine traditional drug use treatment with psychosocial and behavioral intervention. This can be applied to other countries with different cultures.

Interventions for Substance-Using Youth Living with HIV

Project Name: 
Interventions for Substance Using Youth Living with HIV
Project Type: 
Living with HIV
Substance Abuse
Interventions for Substance Using Youth Living with HIV
Project Description:
Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, improving their quality of life. Over the last 4 years, an intensive 31-session, 3-module intervention was designed, implemented, and evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: 1) only 30% of YLH continue their substance use and sex risk after learning they are seropositive 2) 30% of YLH never attended any group session, and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medical regimens.Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (Changing Lifestyles: Effort And Rewards) will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami and LA. In addition, we will examine I) how YLH’s substance use influences seeking and adhering to combination antiretroviral therapies,and youth’s reinitiation of transmission acts based on their viral loads, beliefs regarding transmissivity of undetectableviral loads, as well as beliefs in post-exposureprophylaxis and life expectancies; 2) how well the components of the Social Action Model predict reductions insubstance use, sexual behaviors, relapse, improvements in health adherence,acquisition of knowledge of the program, and quality of life (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical, nonmedical services, and differential benefits of telephone groups, individual sessions, and small groups (from previous study).
Scope:
The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions)that is delivered in either a)anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will 1) in Module 1, reduce substance use sexual behaviors that may transmit or enhance transmission of the HIV virus. 2) in Module 2, reduce the negative impacts of substance use on seeking and utilizing healthcare, and increase assertiveness and adherence to health regimens. 3) In Module 3, enhance quality of life and self-actualization in order to maintain behavior changes over time.

National Institute on Drug Abuse, Grant 5R01DA07903-08

Methamphetamine Abuse Treatment in HIV Prevention

Gay and bisexual males who use methamphetamine are at extremely high risk for HIV infection. Methamphetamine use in this population is highly associated with risky sexual behavior, with users of the drug reporting an increased number of sexual partners, decreased use of condoms, and an increased likelihood of being HIV-infected or having a sexually transmitted disease.

This study (1) adopted, tailored and transferred an evidenced-based, gay-specific cognitive behavioral therapy (GCBT) intervention for methamphetamine-abusing gay and bisexual males from a research setting for use in a community-based HIV prevention setting; (2) optimized the GCBT intervention by coupling it with a contingency management (CM) intervention to create one behavioral intervention for producing sustained HIV sexual and drug risk reductions; and (3) developed a continuing care intervention to support and maintain longer-term behavior changes.

171 gay or bisexual males who meet criteria for methamphetamine abuse were enrolled into the 16-week behavioral intervention consisting of GCBT+CM during weeks 1 through 8, and Continuing Care+CM during weeks 9 through 16. Assessments were conducted at baseline, 8-week, 16-week, and 26-week post admission. Findings from this study will inform the field on best practices for providing HIV prevention interventions specifically designed for methamphetamine-abusing gay and bisexual males.

Optimizing Access to nPEP for HIV Using Contingency Management in Stimulant-Using MSM

The majority of new HIV infections across Los Angeles County continue to be found among men who have sex with other men (MSM). Within MSM, stimulant abuse, particularly methamphetamine abuse, is the major factor in driving new infections, primarily via behavioral disinhibition contributing MSM methamphetamine users to engage in extremely high-risk sexual transmission behaviors. Friends Care combines the biomedical intervention of Post-exposure Prophylaxis (PEP) for HIV prevention with the behavioral intervention Contingency Management (CM), which targets reduction of methamphetamine use as a way of reducing concomitant high-risk sexual behaviors for HIV-negative, methamphetamine-using MSM.

Friends Care will enroll 49 HIV-negative, methamphetamine-using MSM into the CM component of the dual intervention. Participants receive a baseline assessment including urine analysis for the presence of methamphetamine metabolites, a rapid oral HIV antibody test, a physical examination including a comprehensive metabolic panel and complete blood count, HIV/STI prevention information, and medication adherence information. Following baseline assessments, participants begin an 8-week, 3x/week, CM intervention and are given a 4-day starter pack of tenofivir with emtricitabine (i.e., Truvada). Participants earn vouchers for methamphetamine metabolite-free urine samples, which are redeemable for goods and services.

In the event of an unexpected high-risk sexual exposure to HIV, i.e., unprotected anal intercourse with an HIV-positive or status unknown partner, participants are instructed to immediately call the clinic and begin the 4-dose starter pack of Truvada. An appointment with the physician is scheduled within 96 hours of the participant’s first dose of Truvada; participants then receive a second rapid oral HIV antibody test and are given the additional 24-day pack of Truvada.

Participants return to the clinic at 3-months post baseline for a follow-up evaluation and a third rapid oral HIV antibody test. In combining these two interventions in this unique program, Friends Care aims to reduce methamphetamine use and concomitant high-risk sexual behaviors, while reducing potential seroconversions.

Oral and Dental Consequences of Methamphetamine Use

Burgeoning clinical reports and media coverage link methamphetamine (MA) use with accelerated and extensive dental deterioration, leading to the common moniker “meth mouth”. The oral effects may be exacerbated in immune-compromised individuals who are at increased risk for caries and periodontal disease. Despite the emergent personal and societal impact, actual occurrence of the condition is unclear, clinical descriptions remain anecdotal, underlying mechanisms poorly understood, and diagnosis overlooked or belated until the damage is manifestly overt.
We propose to carry out the first systematic study of the oral health ramifications of MA use, combining detailed dental examinations with extensive sociobehavioral assessments including a comprehensive drug-use history. We hypothesize that MA users will have a substantially greater occurrence of oral consequences, particularly dental caries and periodontal disease, and a lower oral health related quality of life than a demographically similar group of propensity-score matched individuals from the National Health and Nutrition Examination Survey (NHANES).

Using a cross-sectional survey of 500 adult MA users, we will :

  1. Validate that the rates and patterns of dental caries experience and oral disease are substantially different in methamphetamine (MA) users than non-MA users.We hypothesize that the patterns of dental caries and other indicators of adverse oral health (e.g., periodontal disease, dry mouth) will be more common in MA users than in demographically comparable samples from the NHANES general population surveys.
  2. Characterize the relationship between dental consequences, patterns of MA-use and other individual characteristics. We hypothesize that greater dental consequences will be associated with the frequency, amount, mode of MA use as well as individual variables such as HIV infection.
  3. Develop a composite index of dental disease, based on a detailed pattern of dental caries experience, that can help dentists reliably distinguish MA users from non-users. We hypothesize that the specificity of the tooth surfaces involved and the oral health effects will help dentists distinguish MA-users from non-users.
  4. To investigate the extent to which negative self-image among MA-users is associated with a willingness to seek treatment. We hypothesize that MA-users with a low dental self-image will be more willing to engage in substance abuse treatment.

A key goal is to summarize and disseminate our research findings through a web based, centralized repository of high-quality, indexed digital images documenting the range of oral manifestations and their association with the levels of MA use. Understanding the oral consequences of MA use and the contextual sociobehavioral determinants will help dental professionals distinguish the condition at an early stage, develop best practices for managing the consequences, and set the stage for targeted prevention and intervention
strategies that meaningfully involve the dental community in the healthcare of MA users.

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