Objectives. To describe and control an outbreak of HIV infection among people who inject drugs (PWID). Methods. The investigation included people diagnosed with HIV infection during 2015 to 2018 linked to 2 cities in northeastern Massachusetts epidemiologically or through molecular analysis. Field activities included qualitative interviews regarding service availability and HIV risk behaviors. Results. We identified 129 people meeting the case definition; 116 (90%) reported injection drug use. Molecular surveillance added 36 cases to the outbreak not otherwise linked. The 2 largest molecular groups contained 56 and 23 cases. Most interviewed PWID were homeless. Control measures, including enhanced field epidemiology, syringe services programming, and community outreach, resulted in a significant decline in new HIV diagnoses. Conclusions. We illustrate difficulties with identification and characterization of an outbreak of HIV infection among a population of PWID and the value of an intensive response. Public Health Implications. Responding to and preventing outbreaks requires ongoing surveillance, with timely detection of increases in HIV diagnoses, community partnerships, and coordinated services, all critical to achieving the goal of the national Ending the HIV Epidemic initiative.
Discussion: Intermittent and daily light smokers differ on several tobacco-related and psychosocial variables. Attending to these factors in prevention and cessation programs may enhance abstinence in both groups. IntroductionSmoking is the leading cause of preventable death in the United States ( Centers for Disease Control and Prevention, 2004 ). Despite a decrease in smoking among middle-aged and older adults, young adult smoking prevalence declines are smaller, and reductions in moderate to heavy smoking have been accompanied by an increase in prevalence of light and intermittent smoking ( Pierce, White, & Messer, 2009 ). One group of young adults who demonstrate high rates of smoking are individuals serving in the military ( Bray et al., 2006 ;Nelson & Pederson, 2008 ).Two subgroups of smokers who have received growing attention ( Fiore et al., 2008 ) and have yet to be examined among military personnel are light and intermittent (i.e., nondaily) smokers. Both young adults ( Substance Abuse and Mental Health Services Agency, 2004 ) and ethnic minorities ( Ahluwalia et al., 2006 ;Rodriguez-Esquivel, Cooper, Blow, & Resor, 2009 ;Trinidad et al., 2009 ) are predominant in the military and evidence high rates of low-level smoking. Therefore, light and intermittent smoking are likely to be especially common in this group.A pattern of maintaining low levels of smoking has multiple implications. First, relative to never smoking, even light smoking is deleterious to health such that light smokers are at increased Abstract Introduction: Few studies have assessed differences between intermittent and light smokers, particularly among young adults. Exploring these differences promotes a systematic approach to research and treatment in low-level smokers. This study explored demographic, tobacco-related, and psychosocial predictors of intermittent nondaily smoking relative to light smoking among basic military training (BMT) recruits. The impact of smoking status on abstinence rates at follow-up was also assessed.Methods: Participants were 5,603 U.S. Air Force BMT intermittent nondaily ( n = 3,134) or light daily ( n = 2,469) smoking recruits participating in a population-based group randomized trial targeting tobacco use prevention and cessation , Effi cacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. Journal of Consulting and Clinical Psychology , 74,[295][296][297][298][299][300][301][302][303][304][305][306]. Participants completed baseline measures assessing demographics; tobacco use and history; and common social, attitudinal, and behavioral risk factors for tobacco use. Flights of recruits were randomly assigned to a tobacco use intervention or health education control intervention. At the 1-year follow-up, participants reported 7-day point prevalence and continuous abstinence. Results:Intermittent nondaily smoking relative to light daily smoking was associated with lesser perceived addiction, intermittent and daily use of smokeless tobacco, nonsmoking male and fe...
In 2014, Black/African-American and Hispanic/Latino men who have sex with men (BLMSM) comprised 64.1% of HIV diagnoses among MSM in the U.S. Routine HIV testing allows earlier diagnosis, linkage to care, and improved health outcomes. HIV testing campaigns may increase HIV awareness and testing behaviors, but perceptions of these campaigns by BLMSM have been understudied. We explored perceptions of HIV testing campaigns with BLMSM in New York City (NYC) to inform campaign strategies that target BLMSM for HIV testing. Using respondent-driven sampling methods, we conducted semi-structured interviews from 2011 to 2012 with BLMSM in NYC who participated in a larger HIV research study. Interview responses from 108 participants were examined for main themes using computer-assisted thematic analyses. The four main themes identified were that HIV testing campaigns should: (1) use non-stereotypical messages and images on the basis of race and sexuality, (2) use non-gay identified images, (3) be maximally inclusive and visible, and (4) raise risk perception of HIV. These findings can inform future campaigns for strengthening HIV testing among BLMSM in support of earlier diagnosis, linkage to care, and reduced disparities.
Objective To determine the effectiveness of the Metropolitan Atlanta Community Adolescent Rapid Testing Initiative (MACARTI) intervention relative to standard of care (SOC), in achieving early diagnosis, linkage and retention among HIV-infected youth ages 18-24 years. Design MACARTI was a pilot single-center, prospective, non-randomized study Methods MACARTI combined non-traditional venue HIV testing, motivational interviewing and case management. We collected demographic, clinical variables and calculated linkage and appointment adherence rates. We obtained SOC data from an adolescent HIV clinic. Longitudinal data were analyzed using inverse propensity-treatment weighted linear growth models; medians, interquartile ranges (IQR), means and 95% confidence intervals (CI) are provided. Results MACARTI screened 435 participants and identified 49 (11.3%) HIV infections. The SOC arm enrolled 49 new HIV-infected individuals. The 98 participants, (49 in each arm) were: 85% male; 91% Black; mean age=21 years (SD:1.8). Overall, 63% were linked within three months of diagnosis; linkage was higher for MACARTI compared with SOC (96% vs. 57%, p<0.001). Median linkage time for MACARTI participants compared to SOC was 0.39 (IQR:0.20-0.72) vs. 1.77 (IQR:1.12-12.65) months (p<0.001). MACARTI appointment adherence was higher than SOC (86.1% vs. 77.2%, p=0.018). In weight-adjusted models, mean CD4+T-cell counts increased and mean HIV-1 RNA levels decreased in both arms over 12 months, but the differences were more pronounced in the MACARTI arm. Conclusions MACARTI successfully identified and linked HIV-infected youth in Atlanta. MACARTI may serve as an effective linkage and care model for clinics serving HIV-infected youth.
This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions.
Black and Latino men who have sex with men (BLMSM) are disproportionately infected with HIV; they comprised 66% of HIV diagnoses among men who have sex with men (MSM) in the United States in 2015. Risk factors for HIV infection among BLMSM include a high community prevalence of diagnosed and undiagnosed HIV/STDs, and dense sex partner networks. Perceptions of HIV risk among BLMSM were explored to inform HIV prevention efforts. During 2011–2012, semistructured interviews were conducted with BLMSM in New York City. Using computer-assisted thematic analyses (NVivo), transcribed interview responses to questions regarding HIV risk for main themes were examined. Interview data were available for 108 BLMSM: 86% Black, 13% Latino, 26% aged 18–24 years, 59% self-identified as “gay,” and 33% self-identified as “bisexual.” The main emergent theme was stigma. Subthemes related to stigma included: (a) homophobia in the Black and Latino community, (b) fear of losing support from family and friends, and (c) lack of support leading to low self-esteem. Addressing the stigma felt by BLMSM may be an important strategy to facilitate improved HIV prevention efforts, HIV care and treatment, and to decrease HIV-related disparities.
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