Faculty Bibliography

As part of a network study of HIV infection among people who inject drugs (PWID) and their contacts, we discovered a connected subcomponent of 29 uninfected PWID. In the context of a just-declining large epidemic outbreak, this raised a question: What explains the existence of large pockets of uninfected people? Possible explanations include "firewall effects" (Friedman et al., 2000; Dombrowski et al., 2017) wherein the only HIV+ people that the uninfected take risks with have low viral loads; "bottleneck effects" wherein few network paths into the pocket of non-infection exist; low levels of risk behavior; and an impending outbreak. We considered each of these. Participants provided information on their enhanced sexual and injection networks and assisted us in recruiting network members. The largest connected component had 241 members. Data on risk behaviors in the last 6 months were collected at the individual level. Recent infection was determined by LAg (Sedia^TM Biosciences Corporation), data on recent seronegative tests, and viral load. HIV RNA was quantified using Artus HI Virus-1 RG RT-PCR (Qiagen). The 29 members of the connected subcomponent of uninfected participants were connected (network distance = 1) to 17 recently-infected and 24 long-term infected participants. Fourteen (48%) of these 29 uninfected were classified as "extremely high risk" because they self-reported syringe sharing and had at least one injection partner with viral load >100,000 copies/mL who also reported syringe sharing. Seventeen of the 29 uninfected were re-interviewed after 6 months, but none had seroconverted. These findings show the power of network research in discovering infection patterns that standard individual-level studies cannot. Theoretical development and exploratory network research studies may be needed to understand these findings and deepen our understanding of how HIV does and does not spread through communities. Finally, the methods developed here provide practical tools to study "bottleneck" and "firewall" network hypotheses in practice.

BACKGROUND:TRIP (Transmission Reduction Intervention Project) was a network-based, contact tracing approach to locate and link to care, mostly people who inject drugs (PWID) with recent HIV infection. OBJECTIVE:We investigated whether sequences from HIV-infected participants with high viral load cluster together more frequently than what is expected by chance. METHODS:Paired end reads were generated for 104 samples using Illumina MiSeq next-generation sequencing. RESULTS:63 sequences belonged to previously identified local transmission networks of PWID (LTNs) of an HIV outbreak in Athens, Greece. For two HIV-RNA cut-offs (105 and 106 IU/mL), HIV transmissions were more likely between PWID with similar levels of HIV-RNA (p<0.001). 10 of the 14 sequences (71.4%) from PWID with HIV-RNA >106 IU/mL were clustered in 5 pairs. For 4 of these clusters (80%), there was in each one of them at least one sequence from a recently HIVinfected PWID. CONCLUSION:We showed that transmissions are more likely among PWID with high viremia.

BACKGROUND:Treatment for opioid use disorder involving opioid-based pharmacotherapies is considered most effective when accompanied by psychosocial interventions. Peer-led support groups are widely available and have been described by many as fundamental to the recovery process. However, some individuals using medications face stigma in these settings, which can be contradictory and counterproductive to their recovery. METHODS:This paper describes the development of the "Ability, Inspiration and Motivation" or "AIM" group, an alternative peer support group that aims to remove medication stigma from peer recovery. Qualitative interviews with staff, peers, and clients of a community-based buprenorphine treatment program were used to establish the core components of the curriculum to support client needs. RESULTS:Staff, peers, and clients of the buprenorphine program indicated a need and desire to establish a peer recovery group that recognizes persons on medication as being in recovery and destigmatizes use of medication to treat opioid addiction. A respectful environment, holistic perspective on health, spirituality, sharing, and celebration were all established as necessary pillars of the AIM group curriculum. CONCLUSIONS:The community-based effort to establish and develop the AIM group demonstrates that combining the strengths of a peer support with evidence-based medication treatment is both possible and desirable. Shifting the culture of peer recovery groups to support the use of medications may have implications for improving treatment retention and should be considered as a potential strategy to reduce the burden of the opioid epidemic.

Background: Legalization of marijuana has been accompanied by a growing number of Americans using marijuana, marijuana-related media coverage and marketing directed at consumers. Thus, understanding the public's current perceptions of the risks and benefits of marijuana is important. National surveys have examined "perceived risks" (e.g., great risk, moderate risk, low risk) from marijuana use, but little is known about views towards several other important domains including beliefs about benefits, prevention of health problems, perceived risk compared to tobacco and wine, and societal effects (e.g. secondhand smoke or driving under the influence). To further our understanding of the public's views about the risks and benefits of marijuana use, we conducted a national survey of US adults. Methods: We developed a survey and specifically addressed content not covered by federally sponsored surveys. We surveyed 16,000 US adults 18 years and older in September 2017 using GFK's KnowledgePanel, a probability-based, nationally representative online sample of the US population. To assess the extent to which our respondents were comparable to those of the National Survey on Drug Abuse and Health (NSDUH), we compared their socio-demographic characteristics. Descriptive statistics were calculated for all items. For the multivariable logistic regression analyses, we combined respondents who agreed with a statement and compared their baseline characteristics to respondents with all other viewpoints. Results: The response rate was 56.3% (n=9,003). The mean age of the sample was 48 years. Respondents were 52% female and 64% white. Respondent socio-demographic characteristics were similar to NSDUH. About 80% of US adults identified at least one benefit of marijuana while 17% stated it had no benefit. A third of Americans believe that marijuana improves sleep and about half believe it offers relief from stress, anxiety, and depression. About 91% of US adults identified at least one risk from marijuana while 9% stated it had no risks. Over a quarter of US adults agreed that marijuana had preventive health benefits. A third of US adults believe that smoking one marijuana joint a day is safer than smoking one cigarette a day and that secondhand smoke from marijuana is safer than secondhand smoke from tobacco. About 1 in 8 Americans believe that smoking one marijuana joint per day is safer than drinking one glass of wine per day. A quarter of Americans believe it is safer to drive under the influence of marijuana compared to under the influence of alcohol. Younger Americans 18 to 34 years old were about three times more likely to view smoking one marijuana joint a day as safer than smoking one cigarette a day compared to adults 65 years and older [OR 3.09, 95% CI (2.64, 3.62)]. Conclusions: Americans have a more favorable view of marijuana use than is supported by current evidence, with many believing it is safer than alcohol or tobacco. These findings should be a cause for concern to US policymakers

The objectives of this study were to: (1) describe the quantity and quality of social support networks of Latino immigrants living in a new receiving environment, and (2) determine the role such networks play in their HIV/STI risk behaviors, including substance use. Double incentivized convenience sampling was used to collect egocentric social support network data on 144 Latino immigrants. Latent class analysis was used for data reduction and to identify items best suited to measure quality and quantity of social support. Moderate and high quantity and quality of social support were protective of HIV/STI sexual risk behavior compared to low quantity and quality of support, after adjustment for gender, years in New Orleans and residing with family. Neither measure of social support was associated with binge drinking. The findings suggest that increased quantity and quality of social support decrease HIV/STI sexual risk behaviors but do not influence binge drinking. Interventions that improve the quantity and quality of social support are needed for Latino immigrants.

We described drug use, sex risk, and STI/HIV among men who have sex with men and women (MSMW) and their female partners. We used the Network, Norms and HIV/STI Risk among Youth (NNAHRAY) study to evaluate drug use, sex risk, and biologically-confirmed STI/HIV in (1) MSMW and men who had sex with men only (MSMO) versus men who had sex with women only (MSWO) and (2) female partners of MSMW versus female partners of MSWO (N = 182 men, 152 women). MSMW versus MSWO had 30 to 60% increased odds of substance use, over twice the odds of multiple partnerships, and almost five times the odds of sex trade and HIV infection. Female partners of MSMW versus female partners of MSWO had approximately twice the odds of substance use and 1.5-2 times the odds of multiple partnerships and sex trade. Interventions should address STI/HIV risk among MSMW and their female partners.