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DRUG ABUSE AND HIV/AIDS: WOMEN AND YOUTH
Do Sex and Drug Behavior Patterns Account for HIV/STD Racial Disparities?
Denise D. Hallfors, Ph.D.
This paper examines the relationship between race and sexually transmitted disease (STD)/HIV prevalence, after stratifying by sex and drug behavior and controlling for gender, marriage, age at first sex, and socioeconomic status. Data are from Wave III of the National Longitudinal Study of Adolescent Health. Participants were 18 to 26 years old; the analyses were limited to non-Hispanic blacks and whites. Theory and cluster analysis yielded 16 unique behavior patterns. Bivariate analyses examined each behavior pattern by race, gender, and race by gender interaction and then compared biological STD/HIV prevalence by pattern and race. Logistical regressions examined race effects within patterns before and after controlling for the covariates. The unadjusted odds of STD/HIV infection were significantly greater in black young adults than in white young adults for 11 of the risk behavior patterns. Across the behavior patterns, covariates had little effect on reducing the odds ratios for race. White young adults in the United States are at elevated STD/HIV risk only when their behavior is high risk. Black young adults, however, are at high risk even when their behavior is normative. Factors other than individual risk behaviors and covariates appear to account for the racial disparities, arguing for population-level interventions.
Influences of Marijuana Use on HIV/STI Acquisition and Care
Jonathan M. Ellen, M.D.
Marijuana use is not rare among adolescents and young adults, including those most at risk for HIV or those infected with HIV. Evidence of the deleterious effects of marijuana use on adolescent brain functioning are just beginning to emerge. However, there are scant data about the impact of marijuana use on adolescents’ and young adults’ risks for HIV infection and the effect of marijuana on their ability to receive medical care once they have been infected. The objectives of this presentation are to highlight the recent findings from two completed studies funded by the National Institute of Allergy and Infectious Diseases (Bayview Networks Study), National Institute on Drug Abuse and the National Institute of Child Health and Human Development (Adolescent HIV Prevention Trials Network [ATN] Protocol 009) that demonstrate (1) that marijuana use is associated with HIV/STI risk-related sex network structures and (2) that marijuana use is associated with poor medical appointment-keeping among infected women. Additionally, the presentation describes on-going trials within ATN to address the HIV risks associated with marijuana use.
How Does Trauma Contribute to Substance Abuse and HIV Infection Among Ethnic Women?
Gail E. Wyatt, Ph.D.
There are seven factors that are overlooked with regard to African-descended women’s risks for sexually transmitted diseases and HIV that are described. Historical and empirical documentation highlight the need for interventions that are beyond what is currently available.
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Women’s Interagency HIV Study: Association of Substance Use With HIV Clinical Outcomes, Metabolic Conditions, and Psychiatric Comorbidity
Kathryn Anastos, M.D.
The Women’s Interagency HIV Study (WIHS) is a longitudinal observational cohort study of HIV infection in women, with 2,807 HIV-positive women and 959 HIV-negative women enrolled in two waves: 1994–1995 (69.6 percent of the cohort) and 2001–2002. Every 6 months participants are interviewed, receive a physical examination, and provide blood and gynecologic specimens for real-time testing and for the WIHS repository. WIHS resources available to investigators will be discussed, with a focus on those most relevant to the investigations of substance use and related illnesses (e.g., hepatitis B and C infections). There are now nearly 2 million aliquots in the WIHS repository, including serum, plasma, cervicovaginal lavage, urine, and cells, both dry pellets and viable PBMCs, which are available to both WIHS and non-WIHS investigators. WIHS investigations have included the association of substance use with HIV-related clinical and laboratory outcomes (e.g., participants with a history of injection drug use having significantly lower viral loads) both on and off highly active antiretroviral therapy, with risk-taking behaviors and adherence and with non-HIV clinical outcomes, for example, sequelae of HPV infection and the viral hepatitides. Recent WIHS investigations have demonstrated a stronger association of insulin resistance with opiate use than with hepatitis C infection. Unpublished translational and epidemiologic data are shared, and the mechanisms for increasing collaboration from outside researchers explored.
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