Substance Use Among Older People Living With HIV: Challenges for Health Care Providers.

Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol, and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes.

Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles.

Links between HIV and substance use were identified early in the U.S. HIV epidemic.

Barriers and facilitators to successful transition from long-term residential substance abuse treatment.

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment.

Brief Report: The Relationship Between Injection Drug Use Risk Behaviors and Markers of Immune Activation.

High levels of immune activation are reported for people who inject drugs. Studies of the relationship between injection behaviors and immune activation have yielded mixed results, in part due to lack of control for hepatitis C virus in analyses. This study, of 48 HIV-seronegative people who inject drugs, examines this relationship controlling for hepatitis C virus viremia.

Chronic Hepatitis C Virus Infection and the Proinflammatory Effects of Injection Drug Use.

Background:  Chronic inflammation, as defined by persistent immune activation, is associated with adverse clinical outcomes. People who inject drugs (PWID) have evidence of persistent immune activation. Here, in a cohort of PWID with or without hepatitis C virus (HCV) infection, we sought to dissect out the contribution of chronic HCV infection (common in PWID) from the effects of injection drug use itself.

Challenges in Recruiting People Who Use Drugs for HIV-Related Biomedical Research: Perspectives from the Field.

Recruitment of people who use drugs (PWUD) for HIV-related research has been undertaken since early in the epidemic. In early studies, recruitment was often performed by outreach workers with familiarity with the target population, who distributed risk reduction materials, and administered the surveys being conducted on drug use and risk behaviors. The evolution of effective treatments for HIV has provided opportunities for PWUD to participate in biobehavioral studies testing the efficacy of medical treatment advances and exploring the underlying biomedical basis for prevention and treatment efforts.

Behavioural, Mucosal and Systemic Immune Parameters in HIV-infected and Uninfected Injection Drug Users.

Objective: Injection drug use (IDU) remains a major risk factor for HIV-1 acquisition. The complex interplay between drug use, non-sterile injection, and Hepatitis C remains poorly understood. We conducted a pilot study to determine the effect of IDU on immune parameters among HIV-uninfected and -infected individuals.

Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City.

Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18-29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions.

Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions.

The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs.

Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue.

Latinas with elevated fasting plasma glucose: an analysis using NHANES 2009-2010 data.

For Latinas with fasting plasma glucose (FPG) levels in the prediabetes and diabetes ranges, early detection can support steps to optimize their health. Data collected in 2009-2010 indicate that 36.7% of Latinas in the United States had elevated FPG levels.

Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.

Objective: To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs.

Design: Systematic review and meta-analysis of prospective published and unpublished observational studies.

Data Sources: Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction.

HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group.

HIV risk behaviors, susceptibility to HIV acquisition, progression of disease after infection, and response to antiretroviral therapy all vary by age. In those living with HIV, current effective treatment has increased the median life expectancy to >70 years of age. Biologic, medical, individual, social, and societal issues change as one ages with HIV infection, but there has been only a small amount of research in this field.

Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs.

Purpose Of Review: There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities.

Attitudes of methadone program staff toward provision of harm-reduction and other services.

Objective: The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes).

Methods: A staff survey was conducted in 8 methadone maintenance clinics in the New York/New Jersey area to assess attitudes toward the provision of harm reduction and other services in methadone clinics, and the relationship of these attitudes to other variables.

Differential gender effects of depression on use of HIV medications among HIV-positive Puerto Rican drug users.

Many barriers to the use of HIV medications have been identified. Research findings have also shown a gender disparity in HIV care behaviors. However, interaction effects of gender with the potential barriers to use of HIV medications among HIV-positive minority drug users remain under-studied.

Associations between political/civic participation and HIV drug injection risk.

Background: Participating in civic activities has been found to be related to positive health outcomes.

Objective: This study examines associations between injection drug use health variables (sharing paraphernalia, using shooting galleries) and political/civic engagement (identifying with any political party, attention paid to politics and being registered to vote).

Methods: Participants (N = 162) were recruited at 6 New York City (NYC) methadone programs as part of an HIV intervention (86% male).

Conducting peer outreach to migrants: outcomes for drug treatment patients.

Peer outreach models have been successful in addressing HIV risk behaviors of drug users. Patients in methadone maintenance treatment programs who were migrants from Puerto Rico and/or familiar with drug use there were trained to conduct HIV-related peer outreach. A group randomized design was implemented; patients in the Experimental (E) condition (n = 80) received training and conducted 12 weeks of outreach.

HIV and Drug Use in Puerto Rico: Findings from the ARIBBA Study.

This paper presents findings from the Alliance for Research in El Barrio and Bayamón (ARIBBA) research study, which compared HIV-related risk behaviors, HIV infection rates, and mortality rates of 800 Puerto Rican injection drug users and crack smokers in East Harlem, New York, with 399 of their counterparts in Bayamón, Puerto Rico. The study was conducted from 1996 to 2004 and is among the most comprehensive ever undertaken on HIV risk behaviors of drug users in Puerto Rico. This paper presents the main findings, many of which have been published in scientific journals.

Current and emerging research needs in studying the NYC HIV-drug use epidemic.

As we begin the fourth decade of the epidemic, it is clear that, as demonstrated by the articles in this Special Issue, much has been learned about factors contributing to the decline in HIV prevalence among drug users in New York. However, there are a number of outstanding research questions that remain or are emerging. Following is a summary of some of the topics requiring further research.

HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity.

The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.

Challenges in recruiting and training drug treatment patients as peer outreach workers: a perspective from the field.

Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey.