Faculty Bibliography

Increasing attention to systemic racism in the United States in all aspects of life has sharpened focus on its effects on the health outcomes of Black, Latinx, and Indigenous populations. Racial disparities in substance use disorders remain a significant public health problem in mental health, and psychiatrists require sufficient knowledge and awareness to help address these disparities. First, this article reviews evidence of racial disparities in substance use disorders. We then discuss the historical and legal foundations of systemic racism and substance use disorder disparities and explore research examining the role of systemic racism in substance use disorder outcomes on structural and individual levels. Finally, we discuss recommendations for providing substance use disorder care in a more racially equitable manner.

BACKGROUND: Dihydroepiandrosterone (DHEA) has been investigated for its potential role in improving cognition in a number of patient populations. Treatment options are limited for HIV-associated neurocognitive disorders. OBJECTIVE: The authors tested the effect of DHEA administration on the cognitive functioning of HIV-positive subjects with non-major depression. METHOD: The neuropsychological testing data for 60 HIV-positive patients enrolled in a clinical trial for non-major depression were analyzed to determine if DHEA-treated patients demonstrated improved cognitive functioning versus placebo. RESULTS: At baseline, 80% of the sample met criteria for asymptomatic cognitive impairment. No benefit in cognitive performance was found on 16 of 17 neuropsychological measures evaluated. One measure showed a modest benefit for placebo-treated patients over DHEA. CONCLUSION: DHEA treatment was not associated with improved cognitive performance in HIV-positive patients with non-major depression.

Acute/early HIV infection is a period of high HIV transmission. Consequently, early detection of HIV infection and targeted HIV prevention could prevent a significant proportion of new transmissions. As part of an NIMH-funded multisite study, we used in-depth interviews to explore understandings of acute HIV infection (AHI) among 34 individuals diagnosed with acute/early HIV infection in six US cities. We found a marked lack of awareness of AHI-related acute retroviral symptoms and a lack of clarity about AHI testing methods. Most participants knew little about the meaning and/or consequences of AHI, particularly that it is a period of elevated infectiousness. Over time and after the acute stage of infection, many participants acquired understanding of AHI from varied sources, including the Internet, HIV-infected friends, and health clinic employees. There is a need to promote targeted education about AHI to reduce the rapid spread of HIV associated with acute/early infection within communities at risk for HIV.

OBJECTIVES: To examine data for human immunodeficiency virus (HIV)-positive patients in serodiscordant relationships to determine a) if depressive symptoms were associated with sexual risk behavior and b) if these relationships could be explained by changes in partner satisfaction. The relationship between depression symptoms and sexual risk behaviors within mixed HIV status couples is unknown. METHODS: HIV-positive and HIV-negative members of 197 serodiscordant couples (159 male/female, 38 male/male) were assessed using instruments measuring depressive symptoms, sexual risk, and couple satisfaction. RESULTS: HIV-positive partners with higher depression scores were less likely to be part of couples reporting unprotected sex, and HIV-positive partners' higher depression scores were associated with less unprotected intradyadic sex acts. This decrease in intradyadic sexual risk behavior was partially explained by a decrease in any sexual behavior within the couple. On the other hand, HIV-positive subjects with moderate or higher depression were more likely to have outside partners. Adding the partner satisfaction measure to the models was able to account for the relationship between the HIV-positive subjects' depression scores and outside partners, but not for that between higher depression score and reduced intradyadic sexual risk. CONCLUSIONS: HIV-positive individuals with more depressive symptoms may be less likely to engage in high-risk sexual behavior with their partners than those with less depressive symptoms, but more likely to have sexual partners outside the relationship. These findings suggest that the relationship between depressive symptoms and sexual risk behavior in this population may be mixed and complex, and suggest that clinicians should assess sexual risk behavior across the range of depression symptom severity