Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study.

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.

A Content Analysis of HIV-Related Stigmatizing Language in the Scientific Literature, From 2010-2020: Findings and Recommendations for Editorial Policy.

Despite negative effects of HIV-related stigma on people with HIV, some scientific literature continues to use stigmatizing terms. Our study aimed to explore the use of HIV-related stigmatizing language in the scientific literature between 2010 and 2020 based on 2015 UNAIDS terminology guidelines. We searched for articles with the stigmatizing term "HIV/AIDS-infected" or any variations that were peer-reviewed, published between 2010 and 2020, and in English or with an English translation. Our search yielded 26,476 articles that used the stigmatizing term of interest. Frequencies on the variables of interest (journal, year, and country) were run. The use of these terms increased from 2010 to 2017 and decreased from 2018 to 2020. Most journals using the terms were HIV/AIDS specific or on infectious diseases, but the journal with the greatest frequency of use was on general science and medicine. Thirty-six percent of the articles emanated from the United States. To reduce the use of stigmatizing language in the HIV literature, action should be taken by authors, reviewers, editors,educators, and publishers should create formal policies promoting use of non-stigmatizing language.

Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change.

Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.

Changes in Mental Health Among People with HIV During the COVID-19 Pandemic: Qualitative and Quantitative Perspectives.

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.

Implementation of a computerized tool to address barriers to academic success among college students.

OBJECTIVE: Academic assistance professionals work with college students to address barriers to academic success, although few assessment tools exist. This feasibility study examined the results of implementing a computerized tool for academic assistance professionals to help students. The Measure of Obstacles to Succeeding Academically in College (MOSAIC) is a 31-item risk assessment tool used to characterize academic barriers. It utilizes a tailored computer algorithm on a mobile device to match students with resources to address academic barriers. METHODS: The MOSAIC was customized and administered at seven universities around the United States. Student responses were analyzed in Microsoft Excel. Academic assistance professionals were asked about implementation in unstructured interviews. RESULTS: Stress and study skill concerns were the most reported barriers. The MOSAIC was well received, especially among students experiencing academic difficulties, but integration into routine workflow was an obstacle to sustained implementation. CONCLUSIONS: The MOSAIC holds promise in addressing issues impeding academic success.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment.

BACKGROUND: A minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment. METHODS: PWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels. RESULTS: A quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care. CONCLUSIONS: PWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone?

BACKGROUND: Many women living with HIV (WLWH) experience pain. Alcohol use with the intent to treat pain could lead to hazardous drinking and difficulty in reducing drinking. Naltrexone acts on opioid receptors important for pain regulation and is an approved treatment for alcohol use disorder. In this secondary analysis of a randomized double-blind placebo-controlled naltrexone clinical trial, the goals were to (1) compare alcohol reduction between women who drank to treat pain and those who did not and (2) examine differences in alcohol reduction by both drinking intention and treatment arm. METHODS: Women living with HIV (N = 194, mean age 48.3 years, 83% non-Hispanic Black, 11% Hispanic) with hazardous drinking (>7 drinks/week) were randomized to receive daily treatment with naltrexone 50 mg or placebo for 4 months. Study visits occurred at baseline and 2, 4, and 7 months (posttreatment). The number of drinks/week was measured using the Timeline Follow Back. Use of alcohol to treat pain was self-reported. Participants were categorized as using alcohol to treat pain or not and in the naltrexone or placebo group. Chi-square, t-test, MANOVA, and sequential mixed effects models were used to determine group differences in demographic factors, mean/drinks per week, and percent change in mean drinks/week at baseline and each follow-up visit. RESULTS: There was a consistent decrease in drinking throughout the study. There was not a significant difference in mean drinks/week at any point in the study between women who used alcohol to treat pain and those who did not. When considering treatment arm, at 2 months only those who did not use alcohol to treat pain in the naltrexone group had a significantly lower mean drinks/week than the other groups (p = 0.007); all groups had similar decreases in drinking from 4 months onward. CONCLUSION: In the naltrexone group, WLWH who drank to treat pain reduced their alcohol consumption more slowly than WLWH who did not drink to treat pain. Replication of these findings would suggest that alcohol treatment guidelines should address pain as a factor in drinking outcomes.

Drug use and severe outcomes among adults hospitalized with influenza, 2016-2019.

BACKGROUND: Influenza is a persistent public health problem associated with severe morbidity and mortality. Drug use is related to myriad health complications, but the relationship between drug use and severe influenza outcomes is not well understood. The study objective was to evaluate the relationship between drug use and severe influenza-associated outcomes. METHODS: Data were collected by the Influenza Hospitalization Surveillance Network (FluSurv-NET) from the 2016-2017 through 2018-2019 influenza seasons. Among persons hospitalized with influenza, descriptive statistics and logistic regression models were used to analyze differences in demographic characteristics, risk and behavioral factors, and severe outcomes (intensive care unit [ICU] admission, mechanical ventilation, or death) between people who use drugs (PWUD), defined as having documented drug use within the past year, and non-PWUD. RESULTS: Among 48,430 eligible hospitalized influenza cases, 2019 were PWUD and 46,411 were non-PWUD. PWUD were younger than non-PWUD and more likely to be male, non-Hispanic Black or Hispanic/Latino, smoke tobacco, abuse alcohol, and have chronic conditions including asthma, chronic liver disease, chronic lung disease, or immunosuppressive conditions. PWUD had greater odds of ICU admission and mechanical ventilation, but not death compared with non-PWUD; however, these findings were not statistically significant after adjustment. Opioid use specifically was associated with increased risk of ICU admission and mechanical ventilation. CONCLUSION: These results support targeted initiatives to prevent influenza in this population, including influenza vaccination, which remains one of the most important tools to prevent influenza infection and associated severe outcomes.

Risks associated with alcohol and marijuana use among college student athletes: The case for involving athletic personnel in prevention and intervention.

The purpose of this study was to describe alcohol and marijuana use patterns and related consequences among student athletes. A total of 12,510 students (n=1,233 athletes) completed four cross-sectional online annual surveys as part of a multi-site campus initiative. Chi-square tests of independence, t-tests, and regression models evaluated differences in alcohol and marijuana use between athletes and non-athletes. The prevalence of binge drinking and high intensity drinking was significantly higher among student athletes than non-athletes, even after controlling for demographic characteristics. Thirteen percent of student athletes experienced an alcohol-related injury during the past year; this was more common among binge drinkers than non-binge drinkers (20.5% and 2.6%, respectively). Among student athletes, past-month binge drinking and past-year marijuana use were significantly associated with lowered GPA (ps<.01). Skipping class was twice as prevalent among student athletes who used marijuana as compared with athletes who did not use marijuana, but no differences were found related to binge drinking. Components for a training for athletic personnel to reduce risks for alcohol-related injury and academic consequences that are associated with alcohol and marijuana use among student athletes are described. Involving athletic personnel might be an important strategy to identify and intervene with high-risk student athletes.