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Substance use disorder (SUD), a common comorbidity among people with HIV (PWH), adversely affects HIV clinical outcomes and HIV-related comorbidities. However, less is known about the incidence of different chronic conditions, changes in overall comorbidity burden, and health care utilization by SUD status and patterns among PWH in Florida, an area disproportionately affected by the HIV epidemic. We used electronic health records (EHR) from a large southeastern US consortium, the OneFlorida + clinical research data network. We identified a cohort of PWH with 3 + years of EHRs after the first visit with HIV diagnosis. International Classification of Diseases (ICD) codes were used to identify SUD and comorbidity conditions listed in the Charlson comorbidity index (CCI). A total of 42,271 PWH were included (mean age 44.5, 52% Black, 45% female). The prevalence SUD among PWH was 45.1%. Having a SUD diagnosis among PWH was associated with a higher incidence for most of the conditions listed on the CCI and faster increase in CCI score overtime (rate ratio = 1.45, 95%CI 1.42, 1.49). SUD in PWH was associated with a higher mean number of any care visits (21.7 vs. 14.8) and more frequent emergency department (ED, 3.5 vs. 2.0) and inpatient (8.5 vs. 24.5) visits compared to those without SUD. SUD among PWH was associated with a higher comorbidity burden and more frequent ED and inpatient visits than PWH without a diagnosis of SUD. The high SUD prevalence and comorbidity burden call for improved SUD screening, treatment, and integrated care among PWH. [ABSTRACT FROM AUTHOR]

Women Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma; (C2) moderate SU stigma; (C3) higher HIV and lower SU stigma; (C4) moderate HIV and high SU stigma; and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNE and depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30 years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69 years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed. [ABSTRACT FROM AUTHOR]

Little is known about HIV medication concealment behaviors and the effect of medication concealment on antiretroviral therapy (ART) adherence among people with HIV (PWH). This study aims to (1) to describe medication concealment behaviors and factors associated with these behaviors, and (2) assess the association between medication concealment and suboptimal ART adherence. The Florida Cohort Study enrolled adult PWH from community-based clinics around the state from October 2020 to September 2022 (n = 416, 62% aged 50+, 56% male, 44% non-Hispanic Black, 18% Hispanic). Participants responded to questions about sociodemographics, stigma, ART adherence (≥ 85%), symptoms of depression, social networks and disclosure to their networks, and actions to conceal ART to avoid inadvertent disclosure of their HIV status. Analyses were conducted using multivariable logistic regressions models. The most common concealment behavior was hiding ART while having guests over (32%), followed by removing ART labels (26%), and putting ART into a different bottle (16%). Overall, 43% reported ≥ 1 behavior. In multivariable models, depressive symptoms, incomplete disclosure of HIV to close social networks, and not having a close social network were associated with ART concealment. After adjusting for risk factors for suboptimal ART adherence, endorsing hiding medication while having guests was associated with suboptimal ART adherence (aOR 2.87, 95% CI 1.15–7.55). Taking any action and other individual behaviors were not associated. ART concealment behaviors were common but did not consistently negatively influence adherence when accounting for other factors. PWH may want to receive ART medications in ways that ensure privacy and reduce the risk of inadvertent disclosure. [ABSTRACT FROM AUTHOR]

Persons living with HIV (PLWH) and depression or anxiety in the rural South may have suboptimal HIV outcomes. We sought to examine the proportion of PLWH from rural Florida with symptoms of depression or anxiety, the proportion who received depression or anxiety treatment, and the relationship between untreated and treated symptoms of depression or anxiety and HIV outcomes. Cross-sectional survey data collected between 2014 and 2018 were analyzed. Among 187 PLWH residing in rural Florida (median age 49 years, 61.5%, male 45.5% Black), 127 (67.9%) met criteria for symptoms of depression and/or anxiety. Among these 127 participants, 60 (47.2%) were not on depression or anxiety treatment. Participants with untreated symptoms of depression and anxiety (OR 3.2, 95% CI 1.2–9.2, p = 0.03) and treated depression and anxiety with uncontrolled symptoms (OR 1.4, 95% CI 0.5–4.0, p = 0.52) were more likely to have viral non-suppression compared to those without depression or anxiety in an unadjusted bivariate analysis. Only the association between untreated symptoms of depression and anxiety and viral non-suppression was statistically significant, and when adjusting for social and structural confounders the association was attenuated and was no longer statistically significant. This suggests that social and structural barriers impact both mental health and HIV outcomes. Our findings support the need for increased mental health services and resources that address the social and structural barriers to care for PLWH in the rural South. [ABSTRACT FROM AUTHOR]

Photosynthesis is generally assumed to be initiated by a single photon1–3 from the Sun, which, as a weak light source, delivers at most a few tens of photons per nanometre squared per second within a chlorophyll absorption band1. Yet much experimental and theoretical work over the past 40 years has explored the events during photosynthesis subsequent to absorption of light from intense, ultrashort laser pulses2–15. Here, we use single photons to excite under ambient conditions the light-harvesting 2 (LH2) complex of the purple bacterium Rhodobacter sphaeroides, comprising B800 and B850 rings that contain 9 and 18 bacteriochlorophyll molecules, respectively. Excitation of the B800 ring leads to electronic energy transfer to the B850 ring in approximately 0.7 ps, followed by rapid B850-to-B850 energy transfer on an approximately 100-fs timescale and light emission at 850–875 nm (refs. 16–19). Using a heralded single-photon source20,21 along with coincidence counting, we establish time correlation functions for B800 excitation and B850 fluorescence emission and demonstrate that both events involve single photons. We also find that the probability distribution of the number of heralds per detected fluorescence photon supports the view that a single photon can upon absorption drive the subsequent energy transfer and fluorescence emission and hence, by extension, the primary charge separation of photosynthesis. An analytical stochastic model and a Monte Carlo numerical model capture the data, further confirming that absorption of single photons is correlated with emission of single photons in a natural light-harvesting complex.Using a heralded single-photon source along with coincidence counting, we establish time correlation functions for B800 excitation and B850 fluorescence emission and demonstrate that both events involve single photons. [ABSTRACT FROM AUTHOR]

Optimal adherence to pre-exposure prophylaxis (PrEP) is critical, but challenging. Men who have sex with men and transgender women have high rates of HIV incidence and substance use. Substance use is associated with reduced adherence to other medications, but associations between substance use and adherence to PrEP are less clear. Thus, the current review 1) systematically evaluates the measurement of substance use and PrEP adherence in studies examining both and 2) summarizes reported findings. Peer-reviewed articles published between 2010 - April 2021 examining associations between substance use and PrEP adherence were reviewed. Fifty studies met inclusion criteria. Assessment of substance use (i.e., mostly via self-reports at baseline) and PrEP adherence (i.e., often via tenofovir diphosphate [TFV-DP] concentration levels at follow-up) varied considerably across studies. Many studies used categorical variables (e.g., substance use: yes/no). Studies using TFV-DP levels defined adherence consistently (i.e., TFV-DP ≥ 700 fmol/punch), with slight variations. Qualitative studies (n = 10) indicated that substance use (mainly alcohol) is related to poorer PrEP adherence. While quantitative findings to date are equivocal for alcohol, there is a pattern of findings linking stimulant use with poorer PrEP adherence. This review reveals four methodological gaps, which can be addressed in future research by: 1) use of uniform benchmarks for substance use measures, 2) prospective assessment for substance use, 3) use of continuous outcome variables wherever possible, and 4) more extensive consideration of potential confounders. Addressing these methodological gaps may help us reach more definitive conclusions regarding associations between substance use and PrEP adherence. [ABSTRACT FROM AUTHOR]

HIV-related stigma is recognized as a top barrier to achieve viral suppression in the United States, but data describing who is most affected by HIV stigma is limited. The study sought to (1) identify the relationships between HIV-related stigma and unsuppressed viral load and (2) examine whether the association between HIV stigma subtypes and unsuppressed viral load differ by age group (i.e., 18–34, 35–49, and 50+ years-old) using surveillance data from the Florida Medical Monitoring Project (n = 1195). Most participants were 50+ years-old (55%), male (71%), and Black (51%). Enacted stigma was significantly associated with unsuppressed viral loads among the 18–34-year-old age group (OR 1.68, CI 1.09–2.60). After adjusting for potential confounders, only enacted stigma was independently associated with unsuppressed viral load in the 18–34-year-old age group. Results highlight the need for targeted interventions to reduce enacted stigma among younger persons with HIV to achieve viral suppression. [ABSTRACT FROM AUTHOR]

This study evaluated the association between impulsivity and linkage to HIV care among Russians living with HIV recruited from an inpatient narcology hospital. Linking Infectious and Narcology Care (LINC) study participants who completed the Barratt Impulsiveness Scale (BIS) were included in these analyses. The primary independent variable was impulsivity score which was categorized as high impulsivity (BIS score > 71) vs. low impulsivity (BIS score < = 71). The primary outcome, linkage to care post recruitment, was defined as one or more HIV medical care visits at 12-month follow-up. Multiple logistic regression models were used to evaluate the association between high impulsivity and linkage to HIV care controlling for potential confounders. Participants (N = 227) were adults with a mean age of 34 years (SD = 5), and the majority were male (74%). We did not detect a significant association between impulsivity and linkage to HIV care after adjusting for respondents' age, gender, CD4 cell count, and depression score. We also found that substance use and hazardous drinking did not appear to confound the relationship. Although our study was unable to detect an association between impulsivity and linkage to HIV care, it may provide direction for future research exploring the associations between impulsivity and HIV care. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

HIV care engagement is a dynamic process. We employed group-based trajectory modeling to examine longitudinal patterns in care engagement among people who were newly diagnosed with HIV and enrolled in the Ryan White program in Florida (n = 9,755) between 2010 and 2015. Five trajectories were identified (47.9% "in care" with 1–2 care visit(s) per 6 months, 18.0% "frequent care" with 3 or more care visits per 6 months, 11.0% "re-engage", 11.0% "gradual drop out", 12.6% "early dropout") based on the number of care attendances (including outpatient/case management visits, viral load or CD4 test) for each six-month during the first five years since diagnosis. Relative to "in care", people in the "frequent care" trajectory were more likely to be Hispanic/Latino and older at HIV diagnosis, whereas people in the three suboptimal care retention trajectories were more likely to be younger. Area deprivation index, rurality, and county health rankings were also strongly associated with care trajectories. Individual- and community-level factors associated to the three suboptimal care retention trajectories, if confirmed to be causative and actionable, could be prioritized to improve HIV care engagement. [ABSTRACT FROM AUTHOR]

People with HIV (PWH) are at risk for adverse mental health outcomes, which could be elevated during the COVID-19 pandemic. This study describes reasons for changes in mental health among PWH during the pandemic. Data come from closed- and open-ended questions about mental health changes from a follow-up to a cohort study on PWH in Florida during part of the COVID-19 pandemic (May 2020–March 2021). Qualitative data were analyzed using thematic analysis. Among the total sample of 227 PWH (mean age 50.0, 49.7% men, 69.2% Black/African American, 14.1% Hispanic/Latino), 30.4% reported worsened mental health, 8.4% reported improved mental health, and 61.2% reported no change. The primary reasons for worsened mental health were concerns about COVID-19, social isolation, and anxiety/stress; reasons for improved mental health included increased focus on individual wellness. Nearly one-third of the sample experienced worsened mental health. These results provide support for increased mental health assessments in HIV treatment settings. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV. Median age was 57 years, 80% were African-American; and 17% white. Sixty-eight percent had PEth ≥ 20, 46% reported > 2 average drinks/day on TLFB, 61% reported > 1 average drinks/day on TLFB, and 72% had an AUDIT-C ≥ 4. Relative to PEth, sensitivity for AUDIT-C ≥ 4 was 84% (kappa = 0.36), and for TLFB > 1 average drink/day was 76% (kappa = 0.44). Change in alcohol use appeared greater using TLFB measures than PEth. Strategies to robustly assess alcohol use in PWH may require both self-report and biomarkers. [ABSTRACT FROM AUTHOR]

Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.—particularly in the southern U.S.—despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population's unique risks and needs to inform the development of tailored interventions. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence – termed a syndemic, defined as the synergistic effect of two or more conditions—on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47–2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35–2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p =.38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Little is known about how primary care clinicians (PCCs) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. Objective: To better understand PCCs' approaches to managing patients with chronic pain and explore implications for technological and administrative interventions. Design: We conducted adapted critical decision method interviews with 20 PCCs. Each PCC participated in 1–5 interviews. Participants: PCCs interviewed had a mean of 14 years of experience. They were sampled from 13 different clinics in rural, suburban, and urban health settings across the state of Indiana. Approach: Interviews included discussion of participants' general approach to managing chronic pain, as well as in-depth discussion of specific patients with chronic pain. Interviews were audio recorded. Transcripts were analyzed thematically. Key Results: PCCs reflected on strategies they use to encourage and motivate patients. We identified four associated strategic themes: (1) developing trust, (2) eliciting information from the patient, (3) diverting attention from pain to function, and (4) articulating realistic goals for the patient. In discussion of chronic pain management, PCCs often explained their beliefs about opioid therapy. Three themes emerged: (1) Opioid use tends to reduce function, (2) Opioids are often not effective for long-term pain treatment, and (3) Response to pain and opioids is highly variable. Conclusions: PCC beliefs about opioid therapy generally align with the clinical evidence, but may have some important gaps. These findings suggest the potential value of interventions that include improved access to research findings; organizational changes to support PCCs in spending time with patients to develop rapport and trust, elicit information about pain, and manage patient expectations; and the need for innovative clinical cognitive support. [ABSTRACT FROM AUTHOR]

Background: Little is known about the frequency, patterns, and determinants of readmissions among patients initially hospitalized for an ambulatory care-sensitive condition (ACSC). The degree to which hospitalizations in close temporal proximity cluster has also not been studied. Readmission patterns involving clustering likely reflect different underlying determinants than the same number of readmissions more evenly spaced.Objective: To characterize readmission rates, patterns, and predictors among patients initially hospitalized with an ACSC.Design: Retrospective analysis of the 2010-2014 Nationwide Readmissions Database.Participants: Non-pregnant patients aged 18-64 years old during initial ACSC hospitalization and who were discharged alive (N = 5,007,820).Main Measures: Frequency and pattern of 30-day all-cause readmissions, grouped as 0, 1, 2+ non-clustered, and 2+ clustered readmissions.Key Results: Approximately 14% of patients had 1 readmission, 2.4% had 2+ non-clustered readmissions, and 3.3% patients had 2+ clustered readmissions during the 270-day follow-up. A higher Elixhauser Comorbidity Index was associated with increased risk for all readmission groups, namely with adjusted odds ratios (AORs) ranging from 1.12 to 3.34. Compared to patients aged 80 years and older, those in younger age groups had increased risk of 2+ non-clustered and 2+ clustered readmissions (AOR range 1.27-2.49). Patients with chronic versus acute ACSCs had an increased odds ratio of all readmission groups compared to those with 0 readmissions (AOR range 1.37-2.69).Conclusions: Among patients with 2+ 30-day readmissions, factors were differentially distributed between clustered and non-clustered readmissions. Identifying factors that could predict future readmission patterns can inform primary care in the prevention of readmissions following ACSC-related hospitalizations. [ABSTRACT FROM AUTHOR]

While the national HIV infection rate is decreasing, the highest rates of infections continue among men who have sex with men (MSM), particularly minority MSM. It is important to understand attitudes, knowledge, and behaviors surrounding HIV prevention methods, such as pre-exposure prophylaxis (PrEP). In the present study, we created a snapshot of the PrEP continuum of care and identified participant demographic and sources of PrEP awareness factors that were associated with PrEP initiation. Data were collected using anonymous paper-based surveys employing a venue intercept procedure. A total of 188 HIV-negative men completed the survey at Miami Gay Pride 2018. Participants answered questions regarding demographics, PrEP use, and sources of PrEP awareness. The sample was majority Hispanic (55.4%), gay (83.0%), and single (57.7%). The constructed PrEP continuum revealed that a low proportion of those identified as PrEP naïve (n = 143) for HIV infection had PrEP interest (49/143). Moreover, among those who initiated PrEP (n = 45), a high proportion were retained in a PrEP program (37/45), with approximately half achieving medication adherence (25/45). Age group, PrEP knowledge, and source of PrEP awareness were all significantly associated with PrEP initiation. In areas with high HIV infection rates, studies like these offer crucial insight on how public health practitioners should proceed in the goal of decreasing HIV transmission rates. More research is needed to increase PrEP uptake and adherence. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study examined the association between generalized anxiety disorder (GAD) symptoms and healthcare utilization (HCU) among 801 people living with HIV (PLWH). Participants recruited from community health centers in Florida completed questionnaires assessing demographics, substance use, symptoms of GAD and depression, and HCU. Adjusted binary and multinomial logistic regressions assessed the association between moderate-severe GAD symptoms and past 6-month missed HIV-care appointments, overnight hospitalization, and emergency department (ED)/urgent care visits. Participants reporting moderate-severe GAD symptoms had a greater odds of missing an HIV-care appointment (AOR 2.03, 95% CI 1.28–3.24, p = 0.003), spending 2 (AOR 4.35, 95% CI 2.18–8.69, p < 0.001) or 3+ (AOR 2.79, 95% CI 1.20–6.45, p = 0.016) nights in the hospital, and visiting an ED/urgent care facility 2 (AOR 2.63, 95% CI 1.39–4.96, p = 0.003) or 3+ (AOR 2.59, 95% CI 1.27–5.26 p = 0.008) times compared to participants reporting none-mild anxiety. Depression was associated with fewer ED/urgent care visits and overnight hospitalizations, while no association was found with missed primary care appointments. The role of anxiety in illness management remains understudied among PLWH. Anxiety identification and the development of interventions for anxiety among PLWH may have important consequences for healthcare cost saving, patient retention in care, and HIV-disease management. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of non-AIDS-related malignancies is on the rise among people aging with HIV population, but the evidence on healthy behaviors including cancer screening practices in this population subgroup is extremely limited. Therefore, we investigated the prevalence of healthy behaviors and sex-specific cancer screening among persons living with HIV, by sex and time since HIV diagnosis.Methods: We included 517 persons living with HIV from the Florida Cohort. Data were obtained from the baseline and follow-up questionnaires, electronic medical records, and Enhanced HIV/AIDS Reporting System. The prevalence of self-reported, age-appropriate cancer screening (anal, colorectal, prostate, breast, and cervical), and healthy behaviors (sustaining healthy body weight, refraining from smoking and alcohol and engaging in physical activity) was compared by sex and years since HIV diagnosis (≤ 13 vs. > 13 years).Results: In the analyses by sex, females were more likely to be obese than males (56.5% vs. 22.2%, p < 0.0001). Distribution of healthy behaviors did not differ by time since diagnosis among males and females. In the analysis of age-appropriate screening among males, 64.8% never had an anal Pap-smear, 36.2% never had a colonoscopy, and 38.9% never had prostate cancer screening. In the analysis of age-appropriate screening among females, 50.0% never had an anal Pap-smear, 46.5% never had a colonoscopy, 7.9% never had a cervical Pap-smear, and 12.7% never had a mammogram. The difference in anal Pap-smear by sex was statistically significant (p < 0.0001). Among males, the age-adjusted prevalence of never having a colonoscopy was higher in those who had HIV for ≤ 13 years (50.8% vs. 30.6%, p = 0.03).Conclusion: The prevalence of selected healthy behaviors and cancer screening differed by sex and/or years since HIV diagnosis suggesting a need for tailored cancer prevention efforts among persons living with HIV via long-term sex-specific interventions. [ABSTRACT FROM AUTHOR]

The impact of HIV and its treatment on the effects of alcohol remain unclear. Blood alcohol concentrations have been noted to be higher in HIV infected individuals prior to antiretroviral initiation. Our goal was to compare number of drinks to “feel a buzz or high” among HIV infected and uninfected men, stratified by viral load (VL) suppression. Data includes 1478 HIV infected and 1170 uninfected men in the veterans aging cohort study who endorsed current drinking. Mean (SD) number of drinks to feel a buzz was 3.1 (1.7) overall. In multivariable analyses, HIV infected men reported a lower mean number of drinks to feel a buzz compared to uninfected men (coef = −14 for VL < 500; −34 for VL ≥ 500; p ≤ .05). Men with HIV, especially those with a detectable VL, reported fewer drinks to feel a buzz. Future research on the relationship between alcohol and HIV should consider the role of VL suppression. [ABSTRACT FROM AUTHOR]

Background: Rapid HIV testing could increase routine HIV testing. Most previous studies of rapid testing were conducted in acute care settings, and few described the primary care providers' perspective.Objective: To identify characteristics of general internal medicine physicians with access to rapid HIV testing, and to determine whether such access is associated with differences in HIV-testing practices or perceived HIV-testing barriers.Design: Web-based cross-sectional survey conducted in 2009.Participants: A total of 406 physician members of the Society of General Internal Medicine who supervise residents or provide care in outpatient settings.Main Measures: Surveys assessed provider and practice characteristics, HIV-testing types, HIV-testing behavior, and potential barriers to HIV testing.Results: Among respondents, 15% had access to rapid HIV testing. In multivariable analysis, physicians were more likely to report access to rapid testing if they were non-white (OR 0.45, 95% CI 0.22, 0.91), had more years since completing training (OR 1.06, 95% CI 1.02, 1.10), practiced in the northeastern US (OR 2.35; 95% CI 1.28, 4.32), or their practice included a higher percentage of uninsured patients (OR 1.03; 95% CI 1.01, 1.04). Internists with access to rapid testing reported fewer barriers to HIV testing. More respondents with rapid than standard testing reported at least 25% of their patients received HIV testing (51% versus 35%, p = 0.02). However, access to rapid HIV testing was not significantly associated with the estimated proportion of patients receiving HIV testing within the previous 30 days (7.24% vs. 4.58%, p = 0.06).Conclusion: Relatively few internists have access to rapid HIV testing in outpatient settings, with greater availability of rapid testing in community-based clinics and in the northeastern US. Future research may determine whether access to rapid testing in primary care settings will impact routinizing HIV testing. [ABSTRACT FROM AUTHOR]

Current understanding of the soil organic matter (SOM) transformation pathways and mechanisms in coastal wetland ecosystems is limited. This study was carried out to characterize and compare chemical composition of belowground SOM from a freshwater marsh and a saline marsh in coastal Louisiana. Composite samples at three depths (0-50, 50-100, and 100-150 cm) from each site were collected and characterized by solid state C NMR spectroscopy. The C NMR spectral composition of three soil depths of the freshwater marsh was similar and dominated by contribution from polysaccharide carbon (C), followed by equal contributions from aliphatic C and total aromatic C. A steady and more pronounced drop in polysaccharide C with depth, accompanied by the de-methoxylation of lignin moieties, was observed in the profiles of the saline marsh. The δC signature of these marsh soils suggested that much of the C in the saline profile was likely derived from the mixed debris of previous freshwater and saline marsh vegetation rather than from the current salt-tolerant Spartina species alone. It was concluded that the chemical composition of SOM was determined more by the difference between the freshwater and the saline soil environment than by the C source in the coastal wetland ecosystems. [ABSTRACT FROM AUTHOR]

Background: Health care providers may be concerned that prescribing erectile dysfunction drugs (EDD) will contribute to risky sexual behavior.Objectives: To identify characteristics of men who received EDD prescriptions, determine whether EDD receipt is associated with risky sexual behavior and sexually transmitted diseases (STDs), and determine whether these relationships vary for certain sub-groups.Design: Cross-sectional study.Participants: Two thousand seven hundred and eighty-seven sexually-active, HIV-infected and HIV-uninfected men recruited from eight Veterans Health Affairs outpatient clinics. Data were obtained from participant surveys, electronic medical records, and administrative pharmacy data.Measures: EDD receipt was defined as two or more prescriptions for an EDD, risky sex as having unprotected sex with a partner of serodiscordant or unknown HIV status, and STDs, according to self-report.Results: Overall, 28% of men received EDD in the previous year. Eleven percent of men reported unprotected sex with a serodiscordant/unknown partner in the past year (HIV-infected 15%, HIV-uninfected 6%, P < 0.001). Compared to men who did not receive EDD, men who received EDD were equally likely to report risky sexual behavior (11% vs. 10%, p = 0.9) and STDs (7% vs 7%, p = 0.7). In multivariate analyses, EDD receipt was not significantly associated with risky sexual behavior or STDs in the entire sample or in subgroups of substance users or men who had sex with men.Conclusion: EDD receipt was common but not associated with risky sexual behavior or STDs in this sample of HIV-infected and uninfected men. However, risky sexual behaviors persist in a minority of HIV-infected men, indicating ongoing need for prevention interventions. [ABSTRACT FROM AUTHOR]

Background: The incidence of anal cancer has increased in the past decade, especially among men who have sex with men (MSM) and HIV-infected individuals. There is controversy about whether to routinely screen for anal cancer in MSM.Objectives: To determine whether current anal cancer screening behaviors, intention, and concern differ by HIV serostatus and to identify characteristics of men who intend to seek anal cancer screening.Design and Participants: Cross-sectional analysis of data collected from 901 HIV-infected and 1,016 HIV-uninfected MSM from the Multicenter AIDS Cohort Study (MACS) in 2005-2006.Measurements: Self-reported anal cancer screening history, attitudes, and intentions.Results: A history of anal warts was relatively common in these men (39%), whereas having a recent anal Pap test (5%), intention to seek anal cancer screening in the next 6 months (12%), and concern about anal cancer (8.5%) were less common. Intention to seek anal cancer screening was associated with enabling factors (screening availability, health insurance), need factors (HIV-infection, history of anal warts), concern about anal cancer, and recent sexual risk taking. Among four large US cities, there was significant regional variability in anal cancer screening behaviors, intention, and concern (all p<0.001). Most MSM (76%) indicated they would go to their primary care physician for an anal health problem or question.Conclusions: This study demonstrates a low rate of anal cancer screening and intention to screen among MSM. As more evidence emerges regarding screening, primary care physicians should be prepared to discuss anal cancer screening with their patients. [ABSTRACT FROM AUTHOR]

We examined the influence of attitudes concerning HIV transmission, safe sex, and sexual sensation seeking, as well as negotiated risk reduction with primary partners, on the proportion of unprotected sexual partners (%UASP) among men who have sex with men (MSM). Participants were 263 HIV-seropositive and 238 HIV-seronegative MSM in the Multicenter AIDS Cohort Study between 1999 and 2003 who completed a 20-item attitude survey twice. Behavioral data were collected concurrently and 6–12 months after each survey. Among seropositives, decreased HIV concern and increased safer sex fatigue were associated with higher %UASP at 6 and 12 months. Among seronegatives, increased %UASP at 12 months was associated with safer sex fatigue. At 6 months and 12 months, risk reduction agreements were associated with increased %UASP among seronegatives in seroconcordant monogamous relationships, reflecting their abandonment of condoms in such partnerships. We conclude that HIV prevention efforts should target modifiable attitudes (reduced concern about HIV and safer sex fatigue) and increases in sexual risk-taking of MSM, particularly among HIV+ men having sex with serodiscordant partners. [ABSTRACT FROM AUTHOR]

Quantum mechanics hinders our ability to determine the state of a physical system in two ways: individual measurements provide only partial information about the observed system (because of Heisenberg uncertainty), and measurements are themselves invasive—meaning that little or no refinement is achieved by further observation of an already measured system. Theoretical methods have been developed to maximize the information gained from a quantum measurement while also minimizing disturbance, but laboratory implementation of optimal measurement procedures is often difficult. The standard class of operations considered in quantum information theory tends to rely on superposition-basis and entangled measurements, which require high-fidelity implementation to be effective in the laboratory. Here we demonstrate that real-time quantum feedback can be used in place of a delicate quantum superposition, often called a ‘Schrödinger cat state’, to implement an optimal quantum measurement for discriminating between optical coherent states. Our procedure actively manipulates the target system during the measurement process, and uses quantum feedback to modify the statistics of an otherwise sub-optimal operator to emulate the optimal cat-state measurement. We verify a long-standing theoretical prediction and demonstrate feedback-mediated quantum measurement at its fundamental quantum limit over a non-trivial region of parameter space. [ABSTRACT FROM AUTHOR]

Objective: To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance.Design, Participants, and Setting: Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year.Measurements: Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID).Results: One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT.Conclusions: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences. [ABSTRACT FROM AUTHOR]

This work itemizes and critically assesses several 1D and multi-dimensional nuclear magnetic resonance (NMR) techniques, in both the liquid (solvent suppression, APT, DEPT, INEPT, COSY, TOCSY, HSQC, HMQC, HMBC, NOESY, ROESY and others) and solid states (DP, SACP, RAMP-CP, CP-TOSS, MQ-DEPT, 2D 1H–13C HETCOR and others), which are relevant to the characterization of natural organic matter (NOM). The pros and cons of many of the discussed techniques are compared in an effort to provide guidance to the most beneficial utilization of these NMR instrumental techniques for researchers interested in gaining insight into various aspects of NOM. [ABSTRACT FROM AUTHOR]

This cross-sectional study sought to determine the prevalence of smoking, readiness to quit, and preferences for smoking cessation treatments among a sample of 236 homeless adults attending 9 sites serving homeless persons (mean age 41.8 years; 73% male). Two thirds (69%) were current smokers, of whom 37% reported readiness to quit smoking within the next 6 months. In bivariate analyses, persons were significantly ( P < .05) more likely to be ready to quit if they had tried to quit in the past and if they had social support to quit smoking. Nicotine replacement was the most commonly preferred assistance method (44%), and self-efficacy to quit (10-point scale) was significantly greater if assistance was available (7.3 vs 4.9; P < .001). The findings suggest an urgent need to develop and implement smoking cessation programs for homeless persons. [ABSTRACT FROM AUTHOR]

Objective: To examine the relation between problem drinking and medication adherence among persons with HIV infection.Design: Cross-sectional survey.Setting/participants: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998.Measurements and Main Results: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001).Conclusion: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence. [ABSTRACT FROM AUTHOR]

The article reviews the article "Routine Rapid HIV Screening in Six Community Health Centers Serving Populations at Risk," by Janet J. Myers, Cheryl Modica, Mi-Suk Kang Dufor, Caryn Bernstein, and Kathleen McNamara, which appeared within this issue of the "Journal of General Internal Medicine."

Purpose: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida.We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal’s difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models.The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[− 0.002, 0.004]; p = 0.562).The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.Methods: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida.We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal’s difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models.The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[− 0.002, 0.004]; p = 0.562).The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.Results: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida.We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal’s difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models.The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[− 0.002, 0.004]; p = 0.562).The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.Conclusion: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida.We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal’s difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models.The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[− 0.002, 0.004]; p = 0.562).The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma. [ABSTRACT FROM AUTHOR]