Introduction We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Method Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Results Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23% had moderate levels of all factors (Class 3); 25% had high mental illness (Class 2); 43% had moderate substance use/mental illness (Class 1; N=331). Compared to Classes 1–3, Class 4 was mostly female (p<.05), less likely to achieve viral suppression, and more likely to utilize acute care (p<.05). Discussion Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

Introduction Adolescent substance use has numerous consequences. Our goals in this paper are to compare the prevalence and correlates of substance use among ethnically diverse adolescents. Methods Data are from 2332 adolescents aged 15 – 19 years recruited via respondent driven sampling from disadvantaged settings in five cities. Multivariate logistic regression was used to identify correlates of current substance use. Results About half of the respondents were male. Most adolescents (73.4%) were currently enrolled in school; and identified a father (87.6%) and mother (89.6%) -figure and strong peer support (71.9%). About two-thirds reported lifetime use of at least one substance. Overall, the most common substances ever used were alcohol (44.6%), cigarette (26.2%) and marijuana (17.9%). Mean age at first use of alcohol was 14.2±3.1 years. Current alcohol use was highest in Johannesburg (47.4%) and lowest in Delhi (2.1%). The mean age at first use of cigarette was 14.4±2.8 years. Current cigarette smoking was highest in Johannesburg (32.5%) and lowest in Delhi (3.7%). Male gender predicted current alcohol use in all sites, while older age was a predictor in Baltimore. Male gender (Johannesburg and Shanghai), older age (Baltimore and Shanghai) and being out-of-school (Baltimore, Johannesburg and Shanghai) predicted current cigarette smoking. Absence of a caring father figure was predictive of current alcohol use in Baltimore and Shanghai. Strong peer support predicted alcohol (Johannesburg and Shanghai) and cigarette use (Johannesburg). Conclusion Substance use is still a major issue among adolescents around the world underscoring the need for continued research and interventions.

Objective The Tucker-Culturally Sensitive Health Care Provider Inventory – Patient Form (T-CSHCPI-PF) is an inventory for culturally diverse patients to evaluate provider cultural sensitivity in the health care process. The T-CSHCPI-PF is novel in that it assesses provider cultural sensitivity as defined by culturally diverse patients. The purpose of the present study was to determine the factor structure and internal consistency reliability of the T-CSHCPI-PF. Method A sample of 1648 adult patients was recruited by staff at 67 health care sites across the United States. These patients anonymously completed the T-CSHCPI-PF, a demographic data questionnaire, and a patient satisfaction questionnaire. Results Confirmatory factor analyses of the TCSHCPI-PF revealed that it has three factors with high internal consistency and validity. Conclusion It is concluded that the T-CSHCPI-PF is a psychometrically strong and useful inventory for assessing the cultural sensitivity of health care providers. Practical implications: The T-CSHCPI-PF may be a useful inventory for obtaining patients’ feedback on their providers’ cultural sensitivity and for assessing the effectiveness of trainings to promote patient centered cultural sensitivity among providers.

No abstract

Current or former injection drug using (IDU) persons with HIV/AIDS are at high risk for pain, which adversely affects quality of life and may increase risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among IDU study participants with HIV/AIDS and histories of heroin use. Using generalized estimating equations and controlling for prior substance use, pain in each six month period was associated with use of heroin and prescription opioids, but not use of non-opioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed in persons with HIV and a history of injection drug use, particularly those with chronic pain, for whom there is increased risk for heroin use.