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OBJECTIVE: This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV. DESIGN: We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. METHODS: We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. RESULTS: Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effecton set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. CONCLUSION: Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.

Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM (

Men who have sex with men (MSM) over 45 years of age are more likely to report loneliness and bear a disproportionate percentage of the Human Immunodeficiency Virus (HIV) disease burden than their heterosexual peers. Social support is a buffer against loneliness and is also associated with improved HIV health. To investigate the perceived social support of older MSM and the methods they used to communicate with people in their support networks, we surveyed 1,066 middle age and aging men in the Multicenter AIDS Cohort Study. We found that 24.6% of participants reported primarily communicating electronically with people in their support networks, and that these participants were more likely to be HIV-positive, to have lower social support scores, and lower support satisfaction. The findings of this study suggest that one in four older HIV-positive MSM may face barriers to obtaining social support in person, and that interventions to increase in-person support may be warranted.

BACKGROUND: Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive-adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV−). METHODS: Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH, 557 HIV−) Women’s Interagency HIV Study (WIHS) participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS: The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51 % vs 41%; p

Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22–84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452–S462. https://doi.org/10.2105/AJPH.2022.306735 )

This study's objective was determining whether gap detection deficits are present in a longstanding cohort of people living with HIV (PLWH) compared to those living without HIV (PLWOH) using a new gap detection modelling technique (i.e. fitting gap responses using the Hill equation and analysing the individual gap detection resulting curves with non-linear statistics). This approach provides a measure of both gap threshold and the steepness of the gap length/correct detection relationship.The relationship between the correct identification rate at each gap length was modelled using the Hill equation. Results were analysed using a nonlinear mixed-effect regression model.45 PLWH (age range 41-78) and 39 PLWOH (age range 38-79) were enrolled and completed gap detection testing.The likelihood ratio statistic comparing the full regression model with the HIV effects to the null model, assuming one population curve for both groups, was highly significant (PLWH showed degraded gap detection ability compared to PLWOH, likely due to central nervous system effects of HIV infection or treatment. The Hill equation provided a new approach for modelling gap detection ability.

Introduction Increased resilience has been consistently linked to improved mental and physical health outcomes. Because individuals with HIV have a longer life expectancy than ever before, it is imperative to identify mechanisms to promote resilience in this population. Physical activity has significant potential to strengthen resilience and improve overall well-being in individuals with HIV. The goal of this study was to investigate whether increased physical activity is positively associated with increased individual-level psychosocial resilience, and whether this association varied by HIV status. Methods Data for this analysis were obtained from the Multicenter AIDS Cohort Study (MACS), a longitudinal observational cohort study following men living with and without HIV in the United States. Specifically, cross-sectional data collected between October 2016 and March 2017 from 1118 MACS participants enrolled in the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men sub-study were used. Odds ratios were determined using logistic regression to examine the association of physical activity with psychosocial resilience (measured using the 14-item Resilience Scale). Results Among all MACS participants enrolled in the sub-study, both sufficient physical activity and health-enhancing physical activity were positively associated with high resiliency (odds ratio, 2.20 [95% CI, 1.36-3.56] and odds ratio, 3.72 [95% CI, 2.30-6.03], respectively). Among the participants with HIV, only health-enhancing physical activity was positively associated with high resiliency (odds ratio, 3.07 [95% CI, 1.54-6.14]). Conclusions At the level of individual patient care, physical activity has significant potential to improve health outcomes and strengthen resilience in individuals living with HIV.

Introduction Negative aging perceptions have been shown to influence one’s health care–seeking behaviors; this relationship has not been studied among middle-aged and aging adults living with HIV. The current study uses data from the Multicenter AIDS Cohort Study (MACS) to investigate the association between subjective age and health care avoidance. Objective To examine the hypothesis that adults living with HIV who perceive themselves as older, after adjustment for covariates, would be more likely to avoid care than their HIV-negative counterparts who perceive themselves as older. Methods The MACS is a prospective study of more than 7000 sexual minority men living with and without HIV from 4 metropolitan US areas. The Understanding Patterns of Healthy Aging in Men Who Have Sex With Men sub-study of the MACS was conducted from April 2016 to March 2019. Current analyses use cross-sectional data on 1118 participants from this sub-study from October 2016 to March 2017. Logistic regression was used to produce odds ratios and 95% CIs examining the association between subjective age and health care avoidance. Covariates included age, HIV status, race and ethnicity, education, and comorbid conditions. Further analyses were conducted among persons living with HIV, which included CD4 counts and viral load detection as covariates. Results In the full sample and sample of people living with HIV, after adjustment for covariates, there was a positive association between older subjective age and health care avoidance and a negative association between younger subjective age and health care avoidance, albeit both not statistically significant. Living with HIV was positively associated with health care avoidance, but not statistically significant. Conclusions Future studies with larger sample sizes are needed to elucidate the significance of subjective age and health care avoidance. Aside from the pivotal role of health care avoidance, the field of HIV and aging may benefit from identifying other psychological, physiological, and behavioral mechanisms by which perceptions of aging influence health.

Despite the Philippines facing the fastest growing HIV epidemic among men who have sex with men (MSM) in the Asia/Pacific region, the Philippines reports slow uptake of HIV testing. We reviewed the epidemiology of the HIV epidemic and the current state of HIV testing and other public health interventions in the Philippines to identify possible reasons behind the reported low rates of testing uptake among MSM. Social factors such as HIV-related stigma, misconceptions of the virus, fear of testing HIV-positive, and financial instability contribute to testing hesitancy among MSM. Further investigation is needed to confirm whether recent responses by the Philippine government has increased HIV testing uptake to mitigate the current epidemic.

Introduction Older subjective age, or felt age, has been positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. To our knowledge, there is no literature exploring the association between subjective aging and depression among people living with HIV. Data from the Multicenter AIDS Cohort Study (MACS) was used to understand the role that subjective aging plays on depression among people who are living with and without HIV. We hypothesized that feeling older will be negatively associated with presenting symptoms of depression among men living with HIV compared to men living without HIV following an adjustment to the model to control for covariates. Methods The MACS is an observational cohort study that follows sexual minority men living with and without HIV in four sites within the United States: Baltimore, Maryland/Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania/Columbus, Ohio. MACS participants attend semiannual visits that collect social, behavioral, medical history, and specimens using an Audio Computer-Assisted Self-Interview and standardized clinical examinations. The study design of the MACS has been described elsewhere. From 1984 to 2018, 7,352 men have been enrolled the MACS. 1,118 of these men were included in this study from the MACS substudy, ‘Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men’, which was administered in six waves between March 2016 and September 2019. We used cross-sectional data from October 2016 to April 2017. Odds ratios (including 95% CIs) were generated using logistic regression models to test the association of subjective age with the presence of depressive symptoms (defined as a score >=16 using the Center for Epidemiological Study Depression scale). Odds ratios were adjusted for age, race/ethnicity, educational attainment, smoking status, history of hypertension, renal disease, dyslipidemia, liver disease, diabetes and HIV status. Results After adjusting for covariates, older age discrepancy was associated with higher odds of depressive symptoms (vs younger discrepancy; OR: 4.00; 95% CI: 2.39-6.69). Increasing age (5-year increase; OR: 0.81; 95% CI: 0.72-0.91) was associated with lower odds of depressive symptoms. Lower educational attainment was associated with higher odds of depressive symptoms (less than high school degree vs graduate school; OR: 5.33; 95% CI: 1.96-14.53) (high school vs graduate school: OR: 1.93; 95% CI: 1.10-3.37). There was no statistically significant association of HIV status or other covariates with risk of depressive symptoms. Conclusion Our findings demonstrated a statistically significant positive association between older subjective age (independent of increasing chronological age) and greater risk of depressive symptoms. We also found that having a high school or less than a high school education also increased this risk. Statistical significance was not present based on HIV status or other covariates in the adjusted model. Health care professionals should be aware of their patient’s perception of aging in order to address depressive symptoms related to feeling older. Counteracting a person feeling older can be achieved through exercising regularly, prioritizing preventive care, maintaining a vibrant social life, and having an optimistic attitude on the years ahead of them.

Background Infection with human immunodeficiency virus (HIV) is associated with higher risk for myocardial disease despite modern combination antiretroviral therapy (cART). Factors contributing to this excess risk, however, remain poorly characterized. We aimed to assess cross-sectional relationships between elevations of left atrial volume index (LAVI) and myocardial extracellular volume (ECV) fraction that have been reported in persons living with HIV and levels of circulating biomarkers of inflammation, fibrosis, and myocyte stretch among persons living with and without HIV (PLWH, PLWOH). Methods Participants from three cohorts of PLWH and PLWOH underwent cardiovascular magnetic resonance imaging for measurement of LAVI and ECV. Levels of circulating proteins (IL-6, sCD14, galectin-3, NT-proBNP, GDF-15, TIMP-2, MMP-2, and hsTnI) were measured using immunoassays. Associations were assessed using logistic and linear regression, adjusting for demographics, substance use, and clinical characteristics. Results Among 381 participants with and without HIV, median age (IQR) was 55.1 (51.2, 58.4) years, 28% were female, 69% were Black, and 46% were current smokers. Sixty-two percent were PLWH (n = 235), of whom 88% were receiving cART and 72% were virally suppressed. PLWH had higher levels of sCD14 (p = p = p = 0.03) compared to PLWOH, while levels of other biomarkers did not differ by HIV serostatus, including IL-6 (p = 0.84). Among PLWH, higher sCD14, GDF-15, and NT-proBNP were also associated with lower CD4 + cell count, and higher NT-proBNP was associated with detectable HIV viral load. NT-proBNP was associated with elevated LAVI (OR: 1.79 [95% CI: 1.31, 2.44]; p Conclusions Our findings suggest that elevated levels of sCD14, GDF-15, and NT-proBNP among PLWH compared to PLWOH observed in the current cART era may only minimally reflect HIV-associated elevations in LAVI and ECV. Future studies of excess risk of myocardial disease among contemporary cohorts of PLWH should investigate mechanisms other than those connoted by the studied biomarkers.

Background and Objective Overweight and obesity influence cognitive health, and measured during midlife, may be associated with declining neuropsychological performance (NP) and late-onset dementia in older adults. Few studies have considered these associations in women living with HIV (WLWH). We examined associations cross-sectionally and up to 10 years longitudinally between body mass index (BMI) and waist circumference (WC) and NP in middle-aged WLWH and women without HIV (HIV-).Methods.BMI and WC were measured in 432 virologically-suppressed WLWH and 367 HIV- women, >40 years, who participated in the Women’s Interagency HIV Study (WIHS) and with NP assessments every two years from 2009-2019. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV serostatus were used to examine cross-sectional associations of BMI and WC with each NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Results were outputted as beta-coefficients (b) and 95% Confidence Intervals (95%CI). Covariates included sociodemographic, behavioral, and HIV-related characteristics.ResultsAt baseline, obese WLWH (BMI>30.0 kg/m2) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07], p=0.043) compared to normal (BMI 18.5–24.9 kg/m2). Longitudinally over ~8 years follow-up, obese versus overweight WLWH improved on learning (β=1.88, 95%CI [0.24, 3.51], p=0.025).Among HIV- women, an overweight versus normal BMI was associated with declining memory (β=-3.13, 95%CI [-5.75, -0.51], p=0.019); however, obese versus overweight HIV- women improved on memory (β=2.47, 95%CI [0.47, 4.46], p=0.015). Among HIV- women, increasing WC was associated with decreasing executive (β=-0.07, 95%CI [-0.11, -0.02], p=0.058), processing speed (β=-0.05, 95%CI [-0.10, -0.01], p=0.044), and motor (β=-0.05, 95%CI [-0.10, -0.01], p=0.033) performance during follow-up.ConclusionsCross-sectional and longitudinal associations of BMI and central adiposity and NP were mixed among WLWH and HIV- women during midlife. However, HIV- women may experience greater NP decline in association with higher adiposity compared to WLWH.

BackgroundAt the start of the COVID-19 pandemic, HIV experts suggested that an increase in mental health diagnoses and substance use among people living with HIV (PLHIV) may be an unintended consequence of COVID-19 mitigation efforts (e.g., limiting social contact). We evaluated short-term trajectories in binge drinking, marijuana, and recreational drug use in a prospective cohort of PLHIV.MethodsData (N=2121 PLHIV) consist of survey responses on substance use behaviors from two pre-COVID-19 (October 2018-September 2019) and one COVID-19-era (April 2020-September 2020) timepoints within the MACS/WIHS Combined Cohort Study (MWCCS). We conducted group-based trajectory models, triangulated with generalized linear mixed models, to assess changes in binge drinking, daily marijuana use, and recreational drug use at the start of the pandemic. Controlling for age and race/ethnicity, we tested whether trajectories differed by sex and early-pandemic depressive symptoms, loneliness, and social support.ResultsGroup-based trajectory models yielded two trajectory groups for binge drinking (none vs. any), marijuana (none/infrequent vs. daily), and recreational drug use (none vs. any). Binge drinking and recreational drug use decreased at the beginning of the pandemic. Generalized linear mixed model supported these trends. Consistent with prior research, male sex and having depressive symptoms early pandemic were positively associated with each substance use outcomes. Social support was inversely associated with recreational drug use.ConclusionsContrary to hypotheses, problematic substance use behaviors decreased from pre-pandemic to the post-pandemic follow-up in our sample of PLHIV. Ongoing surveillance is needed to assess whether this pattern persists as the pandemic continues.

BACKGROUND With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. OBJECTIVE This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. METHODS This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. RESULTS Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. CONCLUSIONS Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. INTERNATIONAL REGISTERED REPORT RR1-10.2196/25750

Background: Medical students have been shown to have knowledge deficiencies and stigmatizing attitudes that may compromise their care of patients with human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Many medical schools now offer early exposure to patient care and encourage students to volunteer in free clinics where sexual health care is a common patient concern. In light of increased student involvement in patient care, we sought to characterize knowledge gaps and stigmatizing attitudes in first-year medical students in a major United States city.Methods: We developed a survey instrument by integrating previously validated HIV and STI knowledge questionnaires. These multiple-choice questions tested concepts such as disease transmission, clinical testing modalities, and sexual health care practice standards. In addition, we created a 4-item Likert-type scale to determine student attitudes toward patients with HIV and STIs.Results: A total of 459 medical students completed the questionnaire. The students were predominantly female (254; 55.3%), white (294; 64.1%), and Christian (241; 52.5%), with a mean age of 23.7 (standard deviation 2.45) years. The survey instrument demonstrated significant knowledge gaps in certain areas of HIV/STI testing and counseling, as well as a consistent minority of students who expressed discomfort examining or treating patients with HIV. Overall, 57.8% of the knowledge questions were answered correctly, and 14.3% of students (n=65) were not comfortable touching a patient with HIV.Conclusions: These findings suggest that medical students possess knowledge gaps and stigmatizing attitudes, which could potentially impact patient care in the practice settings in which medical students provide sexual health care. Future research should focus on 3 approaches to overcoming deficiencies in knowledge and attitudes: (1) cultural sensitivity training, (2) targeted education modules, and (3) practical testing training.

Recent research suggests that cocaine may directly affect the pathobiology of HIV by causing immune alterations in different lymphocytes such as helper T cells (CD4), suppressor/cytotoxic T cells (CD8), and natural killer (NK) cells.1 Studies show that cocaine interferes with the body’s ability to defend against infection by inhibiting the effector functions of neutrophils and macrophages, and by suppressing cytokine production, decreasing operation of important immune responses.2 Cocaine also enhances the replication of HIV in vitro.3 Cells from chronic cocaine users more readily support HIV replication and development of AIDS-defining opportunistic infections than cells from nonusers, suggesting a direct role for cocaine in the acquisition and progression of AIDS.2 Recently, cocaine has been shown to cause membrane permeability facilitating endothelial transmigration of infected dendritic cells across the blood brain barrier to the central nervous system.4 There is also evidence of cocaine-mediated alteration of immune responses and host resistance due to disturbances in the balance of Th1 pro-inflammatory versus Th2 anti-inflammatory cytokines and lipid bioeffectors.3 Epidemiologic research confirms that crack users are at high risk for HIV infection and progression.5-6 In a prospective study of HIV-seropositive drug users, crack use was significantly associated with progression to AIDS.7 A study of HIV-positive current and former drug users found that active cocaine use was the strongest predictor of failure to maintain viral suppression; 13% of active users maintained suppression vs. 46% of non-users.8 In a prospective cohort study, compared with nonusers and former users, active cocaine and heroin users experienced smaller median reductions in HIV-1 RNA and smaller median increases in CD4 from baseline, controlling for antiretroviral exposure, adherence, and socio-demographic factors.9 Compared to nonusers, the risk of AIDS-related opportunistic conditions was greater for persistent users and intermittent users during periods of active use, with no difference during periods of abstinence.10 Mixed results characterize studies of drug users in exclusively female U.S. cohorts. In a multi-center cohort of HIV-positive women, injection drug use was not associated with progression to AIDS.11 Another large multi-site cohort study found that hard drug use (i.e., cocaine, heroin, methadone, or injecting drugs) was significantly associated with AIDS-defining illnesses, but not with change in CD4, HIV-RNA, or mortality.12 In a third multi-site cohort of HIV+ women, non-injection drug use was associated with time to AIDS-defining event but not with AIDS-related mortality.13 While suggestive, these studies and others focusing on injection drug use do not uniformly demonstrate a link between illicit drug use and HIV-1 disease progression.14-17 Possible reasons include: diverse definitions of illness progression; failure to differentiate between active and nonactive users; and lack of distinction between mortality due to AIDS versus non-AIDS causes.17 Other reasons include lack of controls for highly active antiretroviral therapy (HAART) use and adherence, and inadequate follow-up periods. We addressed all of these issues by examining patterns of crack use and their association with four distinct measures of HIV/AIDS disease progression in a multi-center cohort over an eight-and-one-half-year period during the HAART era.

To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors.Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 seropositive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004.HIV-1 infection was independently associated with MetSynd [33% vs 22%, P0.0001 in HIV-seropositive compared with HIV-seronegative women; adjusted odds ratio (OR) 1.79 (95% confidence interval 1.48, 2.16)]. HIV-infected women had higher mean triglyceride (154 vs 101 mg/dL, P0.0001) and lower mean high-density lipoprotein cholesterol levels (46 vs 55 mg/dL, P0.0001). Most notable factors associated with higher prevalence of MetSynd among HIV-infected women included older age (OR=1.38 per 5 year increase, P0.0001); higher body mass index; current smoking; HIV-1 RNA (OR=1.36, P=0.019, for50,000 vs80 copies/mL); and use of stavudine (OR=1.28, P=0.009). Nevirapine use was protective (OR=0.75, P=0.016). There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR=1.15, P=0.134).MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women. This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.

Gender-based violence (GBV) threatens women's health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization (intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up.HIV-infected and uninfected participants (n=2,838) in the Women's Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015-2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex.Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio [AIRR]Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women's safety.

Background: Delta-9-tetrahydrocannabinol (THC), the active constituent of marijuana, is an effective agent in the prevention of chemotherapy-induced nausea and vomiting. Aim: To determine the effect of THC on gastric emptying of a radiolabelled solid food in humans. Methods: Thirteen healthy volunteers underwent gastric emptying studies after receiving THC and placebo in a randomized double-blind fashion on 2 separate days. THC, at a dose of 10 mg/m2 of body surface area, or placebo were administered. Results: Gastric emptying after THC was slower than placebo in all subjects. Mean percentage of isotope remaining in the stomach was significantly greater than after placebo from 30 min (85.5 ± 4.3% vs. 94.2 ± 1.4% placebo and THC, respectively, P

Pain is a common problem among persons living with HIV. In this population, pain often co-occurs with psychological symptoms, as well as illicit drug abuse. Recently, the misuse of prescription drugs, including the misuse of opioid medications for pain relief, has emerged as a significant public health problem. The purpose of this article is to review the literature on the associations among pain, illicit drug use, and symptoms of depression and anxiety in the misuse of prescription medications in HIV disease.Although relatively little attention has centered on the management of pain, psychological symptoms and other distressing, yet treatable symptoms in HIV, the fact that drug abuse behaviors now constitute a primary risk factor for HIV infection requires a shift in focus for clinicians and researchers alike. There is currently little agreement regarding the medical provision of opioids to persons with a history of illicit drug use. Thus, additional research is required to ensure adequate treatment of pain and psychological symptoms in persons living with HIV while minimizing the risk of prescription drug misuse.

Recent studies have demonstrated a high prevalence of pharyngeal (P) and rectal (R) Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections among men who have sex with men (MSM). Guidelines by the Centers for Disease Control and Prevention recommend testing at least annually. But surveys of medical providers suggest that adherence to these guidelines is minimal as a result of limited time and staff. Because of these concerns, we evaluated the feasibility and accuracy of patient self-testing.Three-hundred seventy-four patients at a Washington, DC clinic who identified themselves as MSM and requested testing for sexually transmitted infections (STIs) participated in the study. Patients performed self-screening using the Gen-Probe APTIMA Combo 2 (AC2) kit after viewing written and pictorial instructions. Trained providers also screened patients. We randomized the order in which patients or providers performed testing.Among those receiving specific tests, 8% of patients tested positive for R-GC, 9.3% for P-GC, 12.7% for R-CT, and 1.3% for P-CT. We performed McNemar tests, stratified by infection type and anatomic site to evaluate concordance. Self-administered testing was significantly better at identifying P-GC (discordant: 3%) and R-GC (discordant: 2.9%) (P ≤.01), and had results similar to provider- administered testing for P-CT (discordant: 0.5%) and R-CT (discordant: 1.1%) detection.The equivalent or better detection rates for rectal and oral gonorrhea and chlamydia among patients suggest that patients are capable of performing their own screening for STIs, which may increase infection detection and treatment.

Objectives. We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Methods. Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland–Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. Results. Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ2 = 247.94; P Conclusions. We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

Since the introduction of highly active antiretroviral therapy (HAART) and the subsequent increased life expectancy in HIV-infected persons, non-HIV-related diseases have become an important cause of morbidity and mortality. This cross-sectional study reports the prevalence of overweight and obesity, and sociodemographic, psychological, and substance use-related risk factors for elevated body mass index (BMI) among 2157 HIV-seropositive (HIV+) in comparison to 730 HIV-seronegative (HIV-) participants in the Women's Interagency HIV Study (WIHS). Separate univariable and multivariate linear regression analyses were completed for HIV+ and HIV- women. Our study revealed a similar proportion of obesity (body mass index [BMI] >or=30) among HIV+ (33%) and HIV- women (29%) (p = 0.12), as well as comparable median BMI (HIV+: 26.1 versus HIV-: 26.7, p = 0.16). HIV+ compared to HIV- women, respectively, were significantly (p < 0.01) older (median = 35.6 versus. 32.5), but similar (p = 0.97) by race/ethnicity (57% African American, 28% Hispanic, and 15% white for both). In multivariate models for both HIV+ and HIV- women, African American race/ethnicity was significantly (p < 0.05) associated with higher BMI, while higher quality of life score and illicit hard drug use were associated with lower BMI. Additionally, smoking, alcohol use, markers of advanced HIV infection (AIDS diagnosis, elevated HIV viral load, low CD4 count), and a history of antiretroviral therapy use (ART) were also associated with lower BMI among HIV+ women. In conclusion, risk factors for elevated BMI were similar for HIV+ and HIV- women in the WIHS. For HIV+ women, all markers of advanced HIV infection and ART use were additionally associated with lower BMI.

New HIV infections are being observed among men who have sex with men (MSM). Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention.During the follow-up period (1998-2008), we identified 57 HIV seroconverters among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex drugs (inhaled nitrites or "poppers", stimulants, and erectile dysfunction drugs) used at the current or previous semiannual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated.The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the Multicenter AIDS Cohort Study. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex drug use.Use of poppers, stimulants, and erectile dysfunction drugs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies.

Objective: To examine the association of body mass index to all-cause and cardiovascular disease (CVD) mortality in white and African American women. Research methods and procedures: Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate). Results: There was a significant interaction between ethnicity and BMI for both all-cause (p

PLANKEY MICHAEL W, JUNE STEVENS, KATHERINE M FLEGAL, PHILIP F RUST. Prediction equations do not eliminate systematic error in self-reported body mass index. Epidemiological studies of the risks of obesity often use body mass index (BMI) calculated from self-reported height and weight. The purpose of this study was to examine the pattern of reporting error associated with self-reported values of BMI and to evaluate the extent to which linear regression models predict measured BMI from self-reported data and whether these models could compensate for this reporting error. We examined measured and self-reported weight and height on 5079 adults aged 30 years to 64 years from the second National Health and Nutrition Examination Survey. Measured and self-reported BMI (kg/m2) was calculated, and multiple linear regression techniques were used to predict measured BMI from self-reported BMI. The error in self-reported BMI (self-reported BMI minus measured BMI) was not constant but varied systematically with BMI. The correlation between measured BMI and the error in self-reported BMI was −0.37 for men and −0.38 for women. The pattern of reporting error was only weakly associated with self-reported BMI, with the correlation being 0.05 for men and −0.001 for women. Error in predicted BMI (predicted BMI minus measured BMI) also varied systematically with measured BMI, but less consistently with self-reported BMI. More complex models only slightly improved the ability to predict measured BMI compared with self-reported BMI alone. None of the equations were able to eliminate the systematic reporting error in determining measured BMI values from self-reported data. The characteristic pattern of error associated with self-reported BMI is difficult or impossible to correct by the use of linear regression models.

Rationale and Objectives. We assessed the follow-up behavior of women who had abnormal results of screening mammograms taken on a mobile van. Methods. A retrospective cohort study was conducted between 1988 and 1991 of all women served by a mobile mammography van in rural North Carolina. Compliance with radiologist recommendations for followup was assessed through review of patient records and mail surveys of patients with incomplete records. Results. Compliance was 44% for negative or benign mammograms, 57% for indeterminate mammograms, and 62% for probably malignant or malignant mammograms. Women who had a previous mammogram or had a malignant finding were more likely to comply with follow-up recommendations (p < .0001) than women with normal or benign results and no history of mammography. Compilers and noncompliers did not differ with respect to family history of breast cancer or personal history of breast discomfort. Conclusion. Compliance with recommendations in this setting was lower than expected. This may be because rural women using mobile van mammography have limited access to the resources needed for appropriate follow-up. Further research is needed to examine explanations for poor compliance in this setting.

Anthropometric measurements were compared in 312 white and 242 black women (mean age 54) who were participants in the Charleston Heart Study. Body mass index (BMI) was greater in black women (27.8 kg/m2) than in white women (24.7 kg/m2) as were body circumferences. However, when the girth measurements were adjusted for BMI, some racial differences were reversed. Age, smoking and BMI-adjusted abdominal girth was smaller in the black women than in the white women (88.9 cm vs 92.2 cm). The ratio of abdomen to midarm circumference was larger in white women than black women (3.24 vs 3.09), and could be interpreted to indicate a less central fat pattern in the black women. This conclusion should be viewed with caution since circumference measurements, though often used in epidemiologic research, do not differentiate between subcutaneous fat and visceral fat.

Radionuclide measurement of esophageal transit has been proposed as a screening test for esophageal motor dysfunction. In this study we evaluated the radionuclide esophageal transit test in 49 consecutive patients undergoing esophageal manometry for esophageal motor disorders. Esophageal transit was assessed using a 10-ml water bolus labeled with 250 microCi technetium-99m sulfur colloid. In preliminary studies in 14 healthy controls, mean transit time was 9.6 +/- 2.1 (SD) sec. Prolonged transit (greater than 15 sec) was observed in two of 28 swallow sequences in the control subjects. Transit times were prolonged in all patients with achalasia or diffuse esophageal spasm, and in five of seven patients with nonspecific abnormalities of peristaltic progression. The test was abnormal in only three of seven patients with high-amplitude peristalsis (nutcracker esophagus) and in none of three patients with hypertensive lower esophageal sphincter. Additionally, prolonged transit was seen in two of 18 patients with normal manometry. We conclude that the radionuclide transit test using a liquid bolus successfully identifies motor disorders characterized by defective peristaltic progression but not disorders in which peristalsis is intact. A major limiting factor appears to be the small number of swallow sequences tested. The test may not, therefore, be accurate enough to consider adopting as a sensitive and noninvasive screening test in the evaluation of patients with suspected esophageal motor disorders.

Sequential first pass radionuclide angiocardiography can be performed in rapid succession using gold-195m because of its low radiation dose and short half-life (30.5 seconds). In 25 patients with known or suspected coronary artery disease, first pass studies with gold-195m were obtained using a computerized multicrystal gamma camera at rest (n = 29), at the end of each 3 minute stage of exercise (n = 25) and immediately after exercise (n = 23). In 13 patients, assessment of left ventricular function during exercise with gold-195m was combined with thallium-201 stress scintigraphy. Left ventricular ejection fraction at rest assessed with technetium-99m and gold-195m correlated well (r = 0.93). In addition, repeat left ventricular ejection fractions at rest with gold-195m correlated closely (r = 0.96). Comparing peak exercise left ventricular ejection fraction with ejection fraction at rest, abnormal left ventricular reserve was found in 20 of 25 patients. Various abnormal patterns of left ventricular ejection fraction response were noted, showing the diagnostic potential of serial exercise angiocardiography. Thallium-201 myocardial images, obtained on a single crystal gamma camera after multiple gold-195m injections, were all of good diagnostic quality and were abnormal in 10 of 13 patients. Thus, multiple high count rate first pass studies can be obtained with gold- 195m during and after exercise, allowing serial study Of physiologic changes in left ventricular function during exercise. Thallium-201 myocardial imaging can be performed using the same exercise test, providing direct comparison of myocardial function and perfusion.