Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Sex Transm Dis ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31923138

RESUMO

BACKGROUND: In the United States, cisgender men who have sex with men (MSM) who use methamphetamine are at substantial risk of HIV and can benefit from pre-exposure prophylaxis (PrEP). METHODS: We used data from the National HIV Behavioral Surveillance (NHBS) 2017 survey from Seattle, WA; Portland, OR; and Denver, CO to estimate PrEP awareness and use in the past 12 months among MSM who use methamphetamine. We then compared these estimates to participants who do not use methamphetamine but meet other criteria for PrEP use (i.e., condomless anal sex or a bacterial sexually transmitted infection). We explored reasons for not using PrEP and challenges using PrEP. RESULTS: Of the 1,602 MSM who participated in the 2017 NHBS survey in Seattle, WA; Portland, OR; and Denver, CO, 881 met inclusion criteria for this study, of whom 88 (10%) reported methamphetamine use in the past 12 months. Most (95%) participants had heard of PrEP, and 35% had used it in the past 12 months. PrEP awareness was lower among MSM who used methamphetamine (p=.01), but use was not different (p=.26). Among those who had not used PrEP, the most common reason for not using it was not thinking one's HIV risk was high enough (50%). MSM who used methamphetamine were more likely to report that they were not sure PrEP would prevent them from getting HIV (38% vs 19%, p=.002). CONCLUSIONS: These results highlight the need for continued efforts to educate and promote PrEP uptake among MSM, particularly those who use methamphetamine.

2.
Arch Sex Behav ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897832

RESUMO

Sexual and gender identity have frequently been assessed in public health research as static states. However, a substantial and growing body of evidence indicates that both identities may have greater potential for change over time than once supposed. Despite this evidence, research into adult identity change remains relatively limited. Using longitudinal data from 1553 Black men who have sex with men (BMSM) aged 18-68 years and recruited from study locations in six major cities across the country, we examined changes in sexual and gender identities over a period of 12 months. The results showed that sexual and gender identity did indeed change among adult BMSM. Additionally, we explored internalized homophobia (IH) as a potential driver of identity change and found that IH significantly impacts the degree and direction of change, with individuals who reported higher baseline IH more likely to demonstrate a shift toward a heterosexual/straight identity at 6 and 12 months. The results are discussed in light of what is known and unknown regarding identity change, and potential avenues for future research are explored.

3.
Subst Abus ; : 1-9, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31403907

RESUMO

Background: Clinic-imposed barriers can impede access to medication for opioid use disorder (MOUD). We evaluated a low-barrier buprenorphine program that is co-located with a syringe services program (SSP) in Seattle, Washington, USA. Methods: We analyzed medical record data corresponding to patients who enrolled into the buprenorphine program in its first year of operation. We used descriptive statistics and tests of association to longitudinally evaluate retention, cumulative number of days buprenorphine was prescribed, and toxicology results. Results: Demand for buprenorphine among SSP clients initially surpassed programmatic capacity. Of the 146 enrolled patients, the majority (82%) were unstably housed. Patients were prescribed buprenorphine for a median of 47 days (interquartile range [IQR] = 8-147) in the 180 days following enrollment. Between the first and sixth visits, the percentage of toxicology tests that was positive for buprenorphine significantly increased (33% to 96%, P < .0001) and other opioids significantly decreased (90% to 41%, P < .0001) and plateaued thereafter. Toxicology test results for stimulants, benzodiazepines, and barbiturates did not significantly change. Conclusions: SSP served as an effective point of entry for a low-barrier MOUD program. A large proportion of enrolled patients demonstrated sustained retention and reductions in opioid use, despite housing instability and polysubstance use.

4.
Sex Transm Dis ; 46(10): 676-682, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356530

RESUMO

BACKGROUND: Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve. METHODS: From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health-Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days. RESULTS: Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5-9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2-6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5-11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11-17); it was 16 days (95% CI, 12-18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. CONCLUSIONS: Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.

5.
MMWR Morb Mortal Wkly Rep ; 68(15): 344-349, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-30998671

RESUMO

Although diagnoses of human immunodeficiency virus (HIV) infection among persons who inject drugs in the United States are declining, an HIV outbreak among such persons in rural Indiana demonstrated that population's vulnerability to HIV infection (1). In August 2018, Public Health-Seattle and King County (PHSKC) identified a cluster of cases of HIV infection among persons living homeless, most of whom injected drugs. Investigation identified 14 related cases diagnosed from February to mid-November 2018 among women who inject drugs and men who have sex with women (MSW) who inject drugs and their sex partners. All 14 persons were living homeless in an approximately 3-square-mile area and were part of a cluster of 23 cases diagnosed since 2008. Twenty-seven cases of HIV infection were diagnosed among women and MSW who inject drugs in King County during January 1-November 15, 2018, a 286% increase over the seven cases diagnosed in 2017. PHSKC has alerted medical and social service providers and the public about the outbreak, expanded HIV testing among persons who inject drugs or who are living homeless, and is working to increase the availability of clinical and prevention services in the geographic area of the outbreak. This outbreak highlights the vulnerability of persons who inject drugs, particularly those who also are living homeless, to outbreaks of HIV infection, even in areas with high levels of viral suppression and large syringe services programs (SSPs).


Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , Heterossexualidade/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Washington/epidemiologia , Adulto Jovem
6.
Sex Transm Dis ; 46(4): 240-245, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870325

RESUMO

BACKGROUND: Mississippi has the 10th highest rate of new human immunodeficiency virus (HIV) infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case finding strategy has not been evaluated. METHODS: We identified all early syphilis (primary, secondary, and early latent) case records reported from July 1, 2014, to December 31, 2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview as the number of syphilis index case patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. RESULTS: A total of 1535 (95%) of the 1619 early syphilis index case patients were interviewed for PS. These case patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745 (56%) of 1321 partners not previously diagnosed with HIV were tested for HIV. Partner services identified 696 new early syphilis case patients (46%) and 24 (3.2%) new HIV case patients among partners. Sixty-four index case patient interviews were needed to identify 1 new case of HIV, and 2 interviews were needed to identify 1 new case of syphilis among partners. CONCLUSIONS: Syphilis PS allowed MSDH to interact with 1592 men who have sex with men over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case patients could increase HIV case finding in Mississippi.

7.
Drug Alcohol Depend ; 195: 114-120, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611979

RESUMO

BACKGROUND: To describe the "continuum of care" for hepatitis C virus (HCV) and related health service utilization among persons who inject drugs (PWID) in the Seattle metropolitan area. METHODS: The study analyzed data from the 2015 National HIV Behavioral Surveillance system focused on PWID, which included local questions on HCV treatment and testing. We calculated respondent driven sampling (RDS)-adjusted percentages of participants who had completed each step of the care continuum and compared healthcare harm reduction services among participants who were HCV + vs. HCV- using bivariate analyses. RESULTS: 513 PWID were screened for HCV antibodies (Ab). Of those, 59.7% were HCV Ab+. Among those HCV Ab+, 86.4% had been tested for HCV at least once; 69.9% reported a previous diagnosis. Of those diagnosed, 55.9% had received a confirmatory test, 17.2% had ever received any medications for HCV, and 7.2% had completed treatment. The majority of HCV Ab + participants had seen a health care provider in the past 12 months (85.6%). CONCLUSIONS: There is a large gap between HCV screening and treatment among Seattle area PWID.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Redução do Dano , Hepatite C/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Feminino , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/terapia , Inquéritos e Questionários , Washington/epidemiologia , Adulto Jovem
8.
Sex Transm Dis ; 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30516727

RESUMO

BACKGROUND: Mississippi (MS) has the 10th highest rate of new HIV infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case-finding strategy has not been evaluated. METHODS: We identified all early syphilis (primary, secondary, and early latent) case records reported from 7/1/2014-12/31/2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview (NNTI) as the number of syphilis index case-patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. RESULTS: A total of 1535 of the 1619 early syphilis index case-patients (95%) were interviewed for PS. These case-patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745/1321 (56%) partners not previously diagnosed with HIV were tested for HIV. PS identified 696 new early syphilis case-patients (46%) and 24 new HIV case-patients (3.2%) among partners. Sixty-four index case-patient interviews were needed to identify one new case of HIV, and two interviews were needed to identify one new case of syphilis among partners. CONCLUSION: Syphilis PS allowed MSDH to interact with 1592 MSM over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case-patients could increase HIV case finding in MS.

9.
AIDS Patient Care STDS ; 32(6): 223-233, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29851502

RESUMO

Methamphetamine use is a key driver of HIV transmission among men who have sex with men (MSM). We evaluated trends in incident HIV diagnosis rates among methamphetamine using and nonusing MSM and assessed the relationship between methamphetamine use and demographic, behavioral, and clinical characteristics among MSM newly diagnosed with HIV. We analyzed several sources of HIV and behavioral surveillance data to estimate incident rates of HIV diagnoses and the population attributable risk percent corresponding to methamphetamine use among MSM in King County, Washington. Missing values were recovered through multiple imputation. We report descriptive statistics and adjusted odds ratios yielded from multivariable logistic regression models. Between 2010 and 2015, the HIV diagnosis rate among methamphetamine-using MSM declined from 31.2 to 11.5 per 1000 MSM (vs. 6.4-3.9 per 1000 MSM overall), and the percent of new diagnoses attributable to methamphetamine use declined from 25% to 13%. During the same period, methamphetamine use among HIV-negative MSM remained relatively stable. Among MSM newly diagnosed with HIV, methamphetamine-using MSM were more likely to be unstably housed (24% vs. 6%), to have engaged in transactional sex (19% vs. 4%), and to have had female partners (17% vs. 10%). Methamphetamine-using MSM were less likely to be virally suppressed at 6 (31% vs. 54%) and 12 (59% vs. 73%) months following an HIV diagnosis. The declining HIV diagnosis rate among methamphetamine-using MSM is encouraging, but this subgroup continues to have considerable HIV risk and health disparities.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Metanfetamina/efeitos adversos , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Feminino , Infecções por HIV/diagnóstico , Homossexualidade Masculina/psicologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Assunção de Riscos , Parceiros Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sexo sem Proteção , Washington/epidemiologia
10.
Subst Abus ; 39(1): 83-88, 2018 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-28796591

RESUMO

BACKGROUND: There has been a rise in opioid abuse and related injection drug use in the United States, and treatment for opioid use disorders may be underutilized. The study aim was to describe utilization of opioid agonist therapy (OAT), and assess factors associated with utilization of OAT, among persons who inject drugs (PWID) in the Seattle metropolitan area. METHODS: Data were obtained from the 2015 National HIV Behavioral Surveillance (NHBS) system among PWID in the Seattle area. Persons aged ≥18 years who injected drugs in the past year were recruited using respondent-driven sampling. Local supplemental questions assessed whether participants had received methadone or buprenorphine treatment in the past year. The analysis was restricted to participants who reported use of any opioids in the past year. Analyses compared the demographic, health insurance status, duration of injection drug use, prior history of overdose, prior receipt of hepatitis C virus/human immunodeficiency virus (HCV/HIV) testing (self-report), and screening positive for HCV/HIV via study testing between methadone- or buprenorphine-treated and untreated PWID. Multivariate logistic models were performed to assess adjusted associations with receipt of any OAT. RESULTS: The sample included 487 PWID who used opioids in the past year, of whom 27.1% (95% confidence interval [CI]: 23.1-31.1) reported past-year treatment with methadone and 4.7% (95% CI: 2.8-6.6) reported treatment with buprenorphine. There were no significant differences in demographics among participants who did and did not report past-year OAT; however, participants who were treated with methadone were more likely to be insured and have hepatitis C. After adjustment for other covariates, having health insurance was strongly associated with receipt of OAT (adjusted odds ratio [aOR] = 18.6; 95% CI: 2.5-138.7). CONCLUSIONS: OAT, in particular buprenorphine, has been underutilized by opioid-using PWID in the Seattle area. Health insurance is a critical factor for enabling PWID to utilize OAT treatment for opioid use disorders.


Assuntos
Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Antagonistas de Entorpecentes/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA