Posts classified under: Substance Use

Rectal Transmission of STIs/HIV among Women

While the prevalence and epidemiology of rectal sexually transmitted infections (STIs) are well characterized among men who have sex with men (MSM), little is known about rectal STIs in women. Evidence demonstrates that women also practice anal intercourse (AI) and are therefore at risk for these infections. The proposed study will investigate contextual factors as well as the prevalence and correlates of rectal STIs among women attending public sexually transmitted disease (STD) clinics in Los Angeles County (LAC) and determine if women who report substance use have differing risks for rectal STIs as compared to women who do not report substance use.

The specific aims of the project are to:
(1) identify contextual factors, which influence AI and the acquisition of rectal C. trachomatis and/or N. gonorrhoeae infection among women, comparing the particular context of substance use;
(2) measure the prevalence and correlates of rectal C. trachomatis and/or N. gonorrhoeae infection among women and determine whether this varies by substance use status.

Unprotected AI is recognized as one of the most efficient modes of HIV sexual transmission and is a commonly practiced behavior with opposite sex partners, with estimates of AI ranging from 7-40% in the United States. It is well established that HIV transmission probabilities are increased in the presence of STIs and there is evidence to suggest that among heterosexuals who report recent AI, about 60-80% report never using condoms suggesting they are likely to also be exposed to other STIs. Although it is clear that AI is a sexual practice with a high probability of transmission of HIV, data on the prevalence and incidence of rectal STIs among women reporting recent anal intercourse is limited. The proposed study will use both qualitative and quantitative methods to examine contextual and individual level factors associated with the acquisition of rectal STIs in women who report AI. Specifically, we will use the Theory of Gender and Power as a framework to examine AI and rectal STI-related exposures and risk factors among women attending the 12 public STD clinics in LAC (Aim 1). We will interview both women who are diagnosed with rectal C. trachomatis or N. gonorrhoeae infection and women who are not diagnosed with these infections, in order to identify key differences, particularly by substance use status. Concurrent to the qualitative assessment we will collect quantitative information available as part of the standard of care within the STD clinics. Currently, all clinics collect demographic and risk behavior information and conduct vaginal screening and rectal screening for C. trachomatis and N. gonorrhoeae among women who report AI. The laboratory testing results, along with medical record information will be used to provide estimates of the prevalence and correlates of rectal STIs and determine the extent to which this varies by substance use status (Aim 2).

The findings from this study will be one of the first to describe the prevalence and factors associated with rectal STIs among a relatively high risk group of women. At the end of the award period, these results will not only help inform overall rectal screening guidelines for women but will be used to develop a proposal designed to test a prevention intervention aimed at reducing the acquisition of rectal STIs/HIV among women.

Healthy Living Project (HLP): Multi-Institutional Collaborative Research Project

The UCLA Healthy Living Project was funded by the National Institute of Mental Health (NIMH) and was designed to promote health-related behavior changes in adults living with HIV. This project aimed to reduce sexual and injection drug use risk behaviors among 1,200 HIV positive men and women in order to decrease the likelihood of secondary HIV transmission. The research study focused on four subgroups: women, heterosexual men, men who have sex with men, and injection drug users. The study was conducted at four sites: Los Angeles, Milwaukee, New York, and San Francisco.

Targeted Risk Group:

Adults living with HIV

Interventions, Training Manuals, etc. : 

Intervention model:

Cognitive behavioral intervention comprised of 15 individually delivered counseling sessions covering three areas: “Stress, Coping, and Adjustment,” “Risk Behaviors,” and “Health Behavior.”

Research Methods: 

In a random assignment study, individuals assigned to take part in the intervention were compared with individuals assigned to a control group, i.e. delayed intervention, on HIV-transmission behaviors, including unprotected sex and substance use. Because participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Local Significance: 

The intervention was demonstrated to reduce risky sexual behavior and substance use.
At the end of the study, the goal was to train service provider staff to deliver the intervention to their clients. By collaborating with service providers early on in the intervention study, it was possible to learn how to tailor the intervention to the specific needs of the agencies involved and the people they serve.

International Significance: 

HLP provided a behavioral intervention that can be adapted for other countries and cultures to reduce HIV-transmission risk behaviors

Project Tech Support

Interventions, Training Manuals, etc: 

[Download not found]

Out-of-treatment, methamphetamine-using men who have sex with men (MSM) are at extreme risk of HIV acquisition and transmission, predominantly through high-risk sexual behaviors that are facilitated by use of the drug. Project Tech Support study enrolls 50 out-of-treatment, methamphetamine-using MSM into an information technology (IT) communication intervention. Field workers conduct outreach in identified venues in the natural settings where out-of-treatment, methamphetamine-using MSM congregate. Over the course of two weeks, participants engage in a text messaging intervention and receive real-time HIV prevention messages, social support and referrals for healthier, prosocial choices regarding drug- and sexual-risk behaviors.

The study aims to:

(1) conduct formative work to assist in the development of an IT communication intervention for reducing methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM;

(2) assess the feasibility and utility of the behavioral intervention on the target population; and

(3) gather indicators of the mechanism of action for this intervention, a dose-response association will be evaluated between the extent of use of IT communication system and the degree of reduction in methamphetamine use and concomitant sexual risk behaviors.

Evaluations, including biological markers for drug use and HIV serostatus are collected at baseline and two months post-intervention.  Cognitive and behavioral outcomes are measured. Findings from this study will inform the field on the feasibility of adapting an IT communication intervention for reducing sexual risk behaviors and HIV acquisition and transmission among out-of-treatment, methamphetamine-using MSM.

 

Voucher-based Incentives in a Prevention Setting (VIPS)

Interventions, Training Manuals, etc. : 

  1. [Download not found]
  2. [Download not found]
  3. [Download not found]

Homelessness is a significant problem plaguing American cities and homeless substance abusers face increased risks. Homeless, gay and bisexual male abusers suffer approximately 80% seroprevalence and often engage in exchange sex and resist treatment for substance abuse. Contingency management interventions, which provide positive incentives for behavior change, may be particularly well suited for this disenfranchised, high-risk cohort. Specifically, voucher-based incentive therapies may be effective since they have established potency for increasing prosocial behaviors that successfully compete with taking drugs and for reducing drug use.

A randomized, controlled trial assigns 131 non-treatment seeking gay, bisexual or MSM substance users to either voucher-based incentive therapy or control groups for 24 weeks, with follow-up evaluations at 7, 9 and 12 months post randomization. The voucher-based group earns vouchers in exchange for completing prosocial and healthy behaviors, and/or submitting drug-negative urine and alcohol-negative breath samples, and/or attendance in a standard HIV prevention program, OAPP-funded The G.U.Y.S. Program. The control group receives feedback regarding behaviors performed and urinalysis and breathe alcohol tests, but does not receive voucher points for these behaviors, but does receive vouchers for attendance in a standard HIV prevention program, The G.U.Y.S. Program. Vouchers are redeemable for goods located in an onsite voucher store or purchased for the participant.

The study will assess the efficacy of the voucher-based intervention for increasing prosocial and healthy behavior and reducing substance abuse among these non-treatment seeking gay, bisexual and MSM substance users receiving standard HIV prevention services. The study will also assess the impact of the voucher-based incentive therapy on other measures of therapeutic change consistent with a harm reduction approach, including reduction of psychiatric symptoms, decreased injection drug use and high-risk sexual behavior, increased participation in The G.U.Y.S. Program, and improvement in different domains of overall functioning (medical/social/vocational).  Additionally, the study will examine whether baseline participant characteristics predict voucher-based outcomes.

Applying voucher-based incentive therapy to non-treatment seeking gay, bisexual and MSM substance users as well as integrating the intervention into a county-funded HIV prevention program with a harm reduction philosophy are both highly innovative. The VIPS study has the potential to have a significant impact on the public health of the Los Angeles homeless, gay and bisexual substance-using community. If voucher-based incentive therapy is efficacious for motivating non-treatment seeking gay, bisexual and MSM substance users in a community-based HIV prevention program to increase prosocial and healthy behaviors and decrease drug/alcohol use, established prevention programs may modify their approaches to include contingency management, and use it to address the staggering public health problems non-treatment seeking homeless substance users face on a daily basis.

 

Philani- Cape Town

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), img_5313and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Furthermore, while clinics are the typical sites for treating each of these health problems, the NIAAA-funded Philani study is examining a home-visiting prevention program delivered by neighborhood Mentor Mothers (MM) as an alternative to clinic-based interventions to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for the next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group:
Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles:

  1. [Download not found]
  2. [Download not found]
  3. [Download not found]
  4. [Download not found]
  5. [Download not found]
  6. [Download not found]
  7. [Download not found]
  8. [Download not found]
  9. [Download not found]
  10. [Download not found]
  11. [Download not found]
  12. [Download not found]
  13. [Download not found]
  14. [Download not found]
  15. [Download not found]
  16. [Download not found]
  17. [Download not found]
  18. [Download not found]
  19. [Download not found]
  20. [Download not found]
  21. [Download not found]
  22. [Download not found]
  23. [Download not found]
  24. [Download not found]
  25. [Download not found]
  26. [Download not found]
  27. [Download not found]

Interventions, Training Manuals, etc: 

  1. [Download not found]
  2. [Download not found]
  3. [Download not found]
  4. [Download not found]
  5. [Download not found]
Surveys/Scales Used: 
  1. Tolerance, Worried, Eye-Opener, Amnesia, Cut Down (TWEAK) - Survey
  2. Social Support - Survey
  3. Romantic Relationships - Survey
  4. Reproductive Health - Survey
  5. [Download not found]
  6. Routines
  7. Relationships and Violence - Survey
  8. Household Characteristics and Composition - Survey
  9. AIDS Knowledge and Attitude for Pregnant Women - Survey
  10. Edinburgh Postnatal Depression Score (EPDS)
  11. Alcohol Use Disorders Identification Test (Audit C) - Scale
  12. Feeding Strategies to Prevent Transmission - Survey
  13. Medication Adherence - Survey
  14. Employment and Labor Experience Assessment - Survey
  15. CDC Sexual Behavior Questions (CSBQ)
  16. [Download not found]
  17. Alcohol and Other Drug Abuse (AOD) - Scale
  18. [Download not found]
  19. HIV Testing Assessment - Survey
  20. General Medical History Assessment
  21. General Health Questionnaire

Intervention model:
Mothers who are thriving in the community are chosen to act as role models, i.e. mentor mothers, for mothers at risk in the same community. This is based on the positive peer deviant model. Mentor mothers conduct home visits during the course of the study.

Research Methods:
Twenty four neighborhoods were randomly assigned to the intervention (12 neighborhoods), i.e. a mentor mother home visiting program, or control condition (12 neighborhoods). There are two levels of nesting in the study. Mothers and their infants are nested within neighborhoods, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance:
The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention. Preliminary results are promising and suggest the mentor mother program may be an efficient mechanism to conduct healthcare-related home visits.

International Significance:
If found to be efficacious, the home-visiting model that relies on paraprofessionals, i.e. trained mentor mothers, offers a viable alternative to clinic-based healthcare and or care that requires professional healthcare providers that may not be practical in poorer countries outside the U.S.

Masihambisane – Pregnant Women: KZN

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Since clinics are the typical sites for treating each of these health problems, the NIMH-funded Masihambisane study is examining a clinic-based prevention program delivered by neighborhood Mentor Mothers (MM) to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group: 

Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles :

  • [Download not found]
  • [Download not found]
  • [Download not found]
  • [Download not found]
  • [Download not found]

Interventions, Training Manuals, etc. :  

Surveys and Scales Used: 

Intervention model:  
In the intervention arm, participants will receive the Department of Health-delivered Prevention of Mother to Child Transmission (PMTCT) program plus the Project Masihambisane mentor mothers support program, delivered by HIV-positive mentor mothers. HIV-positive mentor mothers are women who are thriving in the community and who have been through the PMTCT program. They have been recruited and trained to deliver the intervention to pregnant mothers living with HIV.

Research Methods: 

Eight clinics were randomly assigned to the intervention (4 clinics) or control condition (4 clinics). There are two levels of nesting in the study. Mothers and their infants are nested within clinics, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

International Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

Los Angeles County HIV Needs Assessment

The Los Angeles Commission on HIV (COH), in conjunction with the Department of Public Health Office of AIDS Programs and Policy (OAPP) and the Prevention Planning Committee (PPC), developed the Los Angeles County HIV Needs Assessment (LACHNA). This comprehensive survey combined the PPC’s annual prevention survey with the COH’s assessment of service needs and gaps of persons living with HIV/AIDS. Key survey domains included: demographic information, benefit services, Medicare Part D, living situation, substance, psychological symptoms/complaints, medical care, medication adherence, oral health care, unmet need. The project was to conduct an analysis of the LACHNA data for the purpose of planning of HIV/AIDS care and treatment services in Los Angeles, CA.

Guys Understanding Your Situation (G.U.Y.S. Program)

Interventions, Training Manuals, etc. : 

The G.U.Y.S. Program offers a multi-tier health education/risk reduction (HE/RR) intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among homeless, substance-using gay men and non-gay identified men who have sex with other men, and with women, and with transgender women. Most specifically the intervention targets sexual risk behaviors that are most likely to occur while using methamphetamine, particularly unprotected anal intercourse, as well as exchange sex risks and injection drug risks.

The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach, individual-level interventions (ILI), skills building group-level interventions (GLI) and art support GLIs. Follow-up ILI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where homeless, substance-using men congregate. The program has successfully worked with these populations in highly charged sexual arenas and developed non-invasive outreach and intervention strategies for these venues, which vary based on the safety and atmosphere of each public or commercial sex environment. The skills building GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the art support GLI component of the intervention serves to increase social support and self-esteem. Art is used as a harm reduction strategy by offering an opportunity for participants to closely identify their feelings and work towards understanding many of their high-risk behaviors. The art support GLI provides a space to cultivate their voice and express their experiences through art. Both the skills building GLI and art support GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

 

The TransAction Program

Many male-to-female transgender women are at high-risk of HIV infection as a result of several socio-cultural conditions, such as low income, high unemployment, lower levels of education, and unstable housing. Economic necessity, as a result of severe unemployment and housing discrimination, results in a reliance on sex work to secure food, shelter, and money.

The TransAction Program provides culturally appropriate, evidence based HIV prevention services that address both individual and socio-cultural risk factors. The program offers a multi-tier health education and risk reduction (HE/RR) intervention – utilizing both individual and group-delivered interventions – designed to reduce high-risk sexual and drug behaviors among transgender women. Most specifically the intervention target risk behaviors that are specific to the socio-cultural circumstances of high-risk transgenders, particularly exchange sex, hormone misuse, injection and non-injection drug risks. The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach encounters, individual-delivered interventions (IDI), skills building group-delivered interventions (GDI) and support groups.

Follow-up IDI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood, West Hollywood and downtown Los Angeles and in the natural settings where high-risk transgender women congregate. The skills building GDI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the support GDI component of the intervention serves to increase social support and self-esteem. Both the skills building GDI and support GDI – working concomitantly with the outreach encounters and IDI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

The TransAction Skills Building Groups

Support To Reunite, Involve and Value Each Other (STRIVE)

The STRIVE program aimed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. Family conflict is found to cause runaway episodes for youth. Targeting newly homeless youth, this study developed and implemented a 5-session family-based intervention. STRIVE sessions take place with families while youth are still in shelters and/or being served by community agencies, and as they transition back to the home.

Surveys and Scales Used: 

  1. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  2. AIDS Knowledge and Attitude - Survey
  3. Adult Attachment Scale (AAS)
  4. Educational (Academic) Experience Assessment
  5. Family Interdependence - Scale
  6. Family Functioning - Scale
  7. Family Assessment Measure III - Scale
  8. Employment and Labor Experience Assessment - Survey
  9. University of Rhode Island Change Assessment (URICA)
  10. Teaming African American Parents with Survival Skills (TAAPSS) - Survey
  11. Spiritual Intuition Inventory (Religion) - Survey
  12. Self Harm: Suicide History - Survey
  13. Social Support Microsystem Scale (SOC)
  14. Health Belief Model: Intentions for Safer Sex (HBMI) - Scale
  15. Michigan Alcoholism Screening Test (MAST) - Survey
  16. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Adolescent Version
  17. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Parent Version
  18. Runaway Episodes - Survey
  19. Residential Stability (RS) - Survey
  20. Reasons for Leaving Home (RLH) - Survey
  21. [Download not found]
  22. Proactive Attitude Scale (PAS)
  23. Health Belief Model: Perceived Susceptibility (HMBP) - Scale
  24. Parental Monitoring Assessment (PMA)
  25. Parker Parental Bonding Instrument
  26. Parent Involvement & Supervision - Scale
  27. NSBA Religious Involvement - Survey
  28. Multiple Problem Behavior: Sex Work - Survey
  29. The Mini-Mental State Exam (MMSE) - Scale
  30. McMaster Family Assessment Device (FAD) - Scale
  31. Inventory of Parent and Peer Attachment (IPPA)
  32. House Rules - Scale
  33. Getting Services Assessment - Survey
  34. Difficulties in Emotion Regulation Scale (DERS)
  35. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  36. Conflict Resolution - Conflict Tactics Scale (CTS)
  37. Autonomy Self Report: Adolescent Autonomy - Scale
  38. AIDS Risk Behavior Assessment (ARBA) - Scale
  39. PTSD Index for DSM IV (Adolescent version) - UCLA
  40. Positive Attitudes Toward Living at Home - Survey

Targeted Risk Group: 

Newly homeless youth in Los Angeles

Intervention model: 

A behavioral family-based intervention model was used to address family conflict and promote positive family-child interactions.

Research Methods: 

This study consisted of two phases Phase 1 was focus groups and key informant interviews to develop research design, measures, an intervention activities. Phase 2 implemented family intervention sessions with baseline and 3, 6, 12, 18, 24 month follow ups.

Local Significance: 

Positive outcomes for reducing HIV risk behaviors and improving mental health.

International Significance: 

N/A
 
1 2 3 4
Copyright © 2025 CHIPTS - Center for HIV Identification, Prevention and Treatment Services. All rights reserved. Admin
site by Pendari