Grace L. Reynolds

Male-to-female transgender and transsexual clients of HIV service programs in Los Angeles County, California

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse.

Development of the Perceived Risk of HIV Scale

Past studies have used various methods to assess perceived risk of HIV infection; however, few have included multiple items covering different dimensions of risk perception or have examined the characteristics of individual items. This study describes the use of Item Response Theory (IRT) to develop a short measure of perceived risk of HIV infection scale (PRHS). An item pool was administered by trained interviewers to 771 participants. Participants also completed the risk behavior assessment (RBA) which includes items measuring risky sexual behaviors, and 652 participants completed HIV testing. The final measure consisted of 8 items, including items assessing likelihood estimates, intuitive judgments and salience of risk. Higher scores on the PRHS were positively associated with a greater number of sex partners, episodes of unprotected sex and having sex while high. Participants who tested positive for HIV reported higher perceived risk. The PRHS demonstrated good reliability and concurrent criterion-related validity. Compared to single item measures of risk perception, the PRHS is more robust by examining multiple dimensions of perceived risk. Possible uses of the measure and directions for future research are discussed.ResumenEstudios previos han utilizado varios métodos para evaluar los riesgos percibidos de la infección del VIH; sin embargo, pocos han incluido los varios elementos que cubren las diferentes dimensiones de la percepción del riesgo o han examinado las características de los elementos individuales. Este estudio describe el uso del “Item Response Theory” (IRT) para desarrollar una medida básica del riesgo percibido de la infección del VIH (PRHS). A 771 participantes se les administro un sorteo de elementos a mano de entrevistadores calificados. Los participantes también rellenaron evaluaciones de riesgo que incluyen elementos para evaluar comportamiento de riesgo sexual, y 652 de los participantes tomaron pruebas para el VIH. La medida definitiva constaba de 8 elementos, elementos que incluyeron la evaluación de la estimación de probabilidad, juicios intuitivos, prominencia de riesgo. Las puntaciones más altas fueron asociadas con un número más elevado de parejas sexuales, relaciones sexuales sin protección, y relaciones sexuales bajo el influjo. Los participantes que resultaron seropositivos para el VIH reportaron niveles altos de riesgo percibido. El PRHS demostró buena fiabilidad y validez de criterio relacionado concurrente. En comparación con los métodos de evaluación del riesgo percibido de un solo elemento, el PRHS es más robusto en examinar dimensiones múltiples de riesgo percibido. Usos posibles de la evaluación y direcciones para investigaciones en el futuro son discutidos.

Use of crystal methamphetamine, Viagra, and sexual behavior.

Purpose of review Methamphetamine (meth) use has been shown in the literature to be associated with high-risk sexual behavior for both homosexual (MSM) and heterosexual samples for over a decade. The use of Viagra has also been shown to be associated with high-risk sexual behavior. The purpose of this review is to update the record on Viagra and on the combination of Viagra and meth use. Recent findings There is now strong evidence that the use of Viagra is associated with HIV seroconversion in MSM. The combination of taking both meth and Viagra is strongly associated with much higher sexually transmitted disease and HIV rates. There is some evidence that Viagra is associated with insertive and meth is associated with receptive anal intercourse by men. Summary The evidence is strong to support the relationship between Viagra use and HIV seroconversion now that more sophisticated analyses have been done. The meth–Viagra recreational drug combination is of very high risk. More research is needed to generate longitudinal and event-level data that are necessary to answer fine-grained questions about drug combinations and the relationship with sexual behavior.

Reliability, sensitivity and specificity of self-report of HIV test results

Abstract The objective of the study was to assess the reliability and validity of self-report of HIV testing questions on the Risk Behavior Assessment and Risk Behavior Follow-up Assessment. Study 1 had 219 injection drug users and crack cocaine smokers. Study 2 had 259 injection drug users and crack cocaine smokers. Study 3 had data from 17,408 injection drug users and crack cocaine smokers. When the question ‘Have you ever been told that you were infected with the AIDS virus’ was compared to ELISA result, the specificity was over 99% for both baseline and follow-up. The sensitivity was 32% on the Risk Behavior Assessment, but 61% on the Risk Behavior Follow-up Assessment. Those who were HIV positive at Risk Behavior Assessment (baseline) were less likely to have received their previous HIV test result. Two-thirds of the HIV test-related questions on the Risk Behavior Assessment and Risk Behavior Follow-up Assessment had acceptable reliability. The low sensitivity at Risk Behavior Assessment was probably due to the participants’ failure to receive their previous test results.

Convergent and discriminant validity of three measures of stage of change.

The University of Rhode Island Change Assessment (E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983), the Stages of Change Readiness and Treatment Eagerness Scale (W. R. Miller & J. S. Tonigan, 1996), and the Readiness to Change Questionnaire (S. Rollnick, N. Heather, R. Gold, & W. Hall, 1992) are commonly used multidimensional measures of stage of change. The authors examined the convergent and discriminant validity of drug-use versions of these 3 measures through multitrait-multimethod analysis in a population of indigent, out-of-treatment drug users (N = 377). Agreement in stage-of-change assignment and the relationship between stage of change and drug-use behaviors were also examined. Confirmatory factor analysis suggests that the Stages of Change Readiness and Treatment Eagerness Scale may have questionable convergent validity with the University of Rhode Island Change Assessment and Readiness to Change Questionnaire. There was moderate agreement in stage assignment. Analysis of behavior did provide some support for the construct validity of the measures. The results suggest that these drug-use stage-of-change measures may not be equivalent.

Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California.

Abstract This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV. A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high.

Internet Access and Use among Homeless and Indigent Drug Users in Long Beach, California

There has been a growing interest in using the Internet to access a variety of populations for prevention education and health care. It is not clear that this is viable for homeless and other marginalized populations. The purpose of this study was to describe Internet access and use among a sample of homeless and indigent drug users. A brief questionnaire was developed to assess computer ownership, use, email, and Internet access and use. Participants were recruited through a community-based human immunodeficiency virus (HIV) prevention program. 265 participants completed the questionnaire. While 55% had ever used a computer in their lifetime, only 25% had ever owned a computer, 24% had ever had their own email account, 33% had access to a working computer in the last 30 days, 10% had sent or received email in the last 30 days, and 19% had surfed or accessed information on the Internet in the last 30 days. Logistic regression predicting lifetime use of a computer showed predictive factors of having completed high school (Odds Ratio [OR] = 4.5; 95% Confidence Interval [CI] = 2.41, 8.38) and number of days used amphetamines in the last 30 days, per 5 days of use (OR = 1.64; 95% CI = 1.18, 2.27). Inversely related were age, per 5 years of age (OR = 0.78; 95% CI = 0.65, 0.93) and number of days used marijuana in the last 30 days, per 5 days of use (OR = 0.97; 95% CI = 0.76, 0.99). Very low access and usage suggest that Internet-based public health education models be reexamined for this population. The association with amphetamine use may indicate a facilitating effect of amphetamine by heightening awareness and increasing wakefulness.

Reliability of Arrest and Incarceration Questions on the Risk Behavior Assessment

We examined 48-hour test-retest reliability of the arrest and incarceration questions on the Risk Behavior Assessment (RBA; National Institute on Drug Abuse, 1993). Participants were 229 street-drug users recruited in 11 cities throughout the United States. Results revealed that lifetime arrest and incarceration items demonstrated good to excellent reliability. The 30-day arrest and incarceration items provided such poor reliabilities that they would yield unreliable data with limited research or clinical use. Future research needs to identify alternative items that can yield reliable data regarding recent arrest history; until then, it is recommended that the recent arrest items be used with caution.

Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests.

Background New rapid point-of-care (POC) tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California. Methods Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP) Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA), rapid plasma reagin (RPR), HCV enzyme immunoassay (EIA), and HIV-1/2 EIA. Results A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7–100% and the specificity was 99.7–100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0–52.7% and specificity was 98.7–99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥1∶8. Conclusions The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

Who Chooses a Rapid Test for HIV in Los Angeles County, California?

The purpose of this study was to determine who chooses a rapid test for HIV when given a choice in a community-based or mobile van setting in Long Beach, California. Individuals were given a choice of either rapid or standard HIV testing either alone or in conjunction with testing for sexually transmitted diseases (STD). Of the 2,752 HIV tests performed between March 2005 and March 2009, 917 (33%) were rapid tests. Preference for rapid HIV testing was among men who have sex with men (MSM), who reported using alcohol in the last 48 hr but who did not endorse the use of illicit drugs; individuals reporting sex trading were also more likely to choose the rapid HIV test. African Americans, regardless of sexual identification, were significantly less likely to choose an HIV rapid test. Strategies are needed to encourage HIV rapid testing among both noninjection and injection drug users, and other at-risk groups.