Nicole Ennis

Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women.

OBJECTIVE Risk for developing cervical neoplastic disease is greatly increased in women infected with oncogenic sexually transmitted human papillomaviruses (HPVs) and who have lowered cellular immunity due to coinfection with human immunodeficiency virus (HIV) infection. The majority of these individuals are low-income minority women. Factors associated with promotion of HPV to cervical neoplasia in HIV-infected populations include degree of immunosuppression as well as behavioral factors such as tobacco smoking and psychological stress. This study examined the effects of a cognitive behavioral stress management (CBSM) intervention on life stress and cervical neoplasia in HIV+ minority women. METHODS Participants were 39 HIV+ African-American, Caribbean, and Hispanic women with a recent history of an abnormal Papanicolaou smear. Participants underwent colposcopic examination, psychosocial interview, and peripheral venous blood draw at study entry and 9 months after being randomly assigned to either a 10-week CBSM group intervention (n=21) or a 1-day CBSM workshop (n=18). RESULTS Women assigned to the 10-week group-based CBSM intervention reported decreased perceived life stress and had significantly lower odds of cervical neoplasia over a 9-month follow-up. CBSM effects on life stress and neoplasia appeared independent of presence of neoplasia at study entry, HPV type, CD4+CD3+ cell count, HIV viral load, and substance use. Furthermore, CBSM intervention effects on cervical neoplasia were especially pronounced among women with residual life stress at follow-up. CONCLUSION These findings suggest that stress management decreases perceived life stress and may decrease the odds of cervical neoplasia in women with HIV and a history of abnormal Papanicolaou smears. Although preliminary, these findings suggest the utility of stress management as a cancer prevention strategy in this high-risk population.

Depressive symptoms, intrusive thoughts, sleep quality and sexual quality of life in women co-infected with human immunodeficiency virus and human papillomavirus

Background: Women infected with human immunodeficiency virus (HIV) experience major challenges and often report marked decreases in sexual functioning and quality of life (QOL). HIV-infected women also face challenges concerned with other commonly observed concomitant sexually transmitted organisms, such as human papillomavirus (HPV), which may further affect sexual QOL. Despite advances made in understanding factors that predict sexual functioning and QOL in men with HIV, relatively little is understood about the role of behavioural and emotional factors in women. Methods: As a preliminary inquiry into this question, this study related depressive symptoms, AIDS-related intrusive thoughts and sleep quality with sexual QOL reports in 21 HIV +HPV+ women. Results: We found that depressive symptoms, intrusive thoughts and sleep quality individually predicted poorer sexual QOL. Further analyses suggested that depression mediated the relationship between intrusive thoughts and sexual QOL. Discussion: Implications for further work and clinical interventions to address depressive symptoms in this population are discussed.

Association between alcohol consumption trajectories and clinical profiles among women and men living with HIV

ABSTRACT Background: Alcohol use is common among persons living with HIV (PLWH). It is unclear how alcohol consumption changes over time and if these changes are associated with clinical profiles. Objective: We aimed to describe the association between longitudinal patterns of alcohol consumption and the clinical profiles of PLWH. Methods: Data from the Women’s Interagency HIV Study (n = 1123 women) and Multicenter AIDS Cohort Study (n = 597 men) from 2004 to 2013 were utilized. Group-based trajectory models were used to assess alcohol consumption patterns across 10 years. Generalized estimating equations were used to identify associations between clinical factors and alcohol consumption. All analyses were stratified by sex. Results: Four trajectories of alcohol use were identified in women and men (women: abstinent 38%, low: 25%, moderate: 30%, heavy: 7%; men: abstinent 16%, low: 69%, moderate: 9%, heavy: 5%). The Framingham Risk Score (women: adjusted odds ratio [AOR] 1.07, 95% confidence interval [CI] 1.04–1.09), years on ART (women: AOR 1.02, CI 1.00–1.05; men: AOR 1.05, CI 1.01–1.09), suboptimal ART adherence (men: AOR 1.23, CI 1.07–1.42), and unsuppressed viral load (women: AOR 1.82, CI 1.56–2.13; men: AOR 1.36, CI 1.17–1.58) were associated with increased odds for moderate drinking. The Framingham Risk Score (women: AOR 1.10, CI 1.07–1.14; men: AOR 1.12, CI 1.06–1.20), suboptimal adherence (women: AOR 1.25, CI 1.04–1.51), and unsuppressed viral load (women: AOR 1.78, CI 1.42–2.24) were associated with increased odds for heavy drinking. Conclusions: Clinicians should consider screening patients for alcohol consumption, particularly if patients have comorbid medical conditions, suboptimal antiretroviral adherence, and/or detectable viral load.

Value of perceived support on depressive symptoms and hazardous drinking among underserved HIV+ adults 50 and older

ABSTRACT The current study examined the association between perceived social support, depressive symptoms and alcohol use among people living with HIV (PLWH) 50 and older who identified as Black. Participants included 96 men and women ages 50 and older. Participants completed an interviewer-administered assessment examining mental and behavioral health functioning. Mediation analyses examined whether perceived support mediated the association between depressive symptoms and hazardous drinking. Depressive symptoms were significantly associated with hazardous drinking (B = .068, SE = .035, t = 1.92, p = 0.05) and negatively associated with having the desired amount of contact with a primary supporter (B = −.072, SE = .018, z = −3.96, p < 0.001). In addition, having the desired amount of contact with a confidant was negatively associated with hazardous drinking (B = −.543, SE = .208, t = −2.61, p 0 < .01). The effect of depressive symptoms on hazardous drinking when controlling for having adequate contact with a primary supporter was not significant (B = .033, SE = .04, t = .829, p = 0.41). Having a valued confidant mediated the association between depressive symptoms and hazardous drinking. Thus, social support interventions may be an effective method of reducing hazardous drinking among older PLWH.

The association of therapeutic versus recreational marijuana use and antiretroviral adherence among adults living with HIV in Florida

Purpose Marijuana use is common among people living with HIV (PLWH), but its association with antiretroviral therapy (ART) adherence is unclear. This study examined the association between reason for marijuana use and ART adherence in a sample of adults living with HIV. Patients and methods Participants (N=703) recruited from seven community health centers in Florida completed a 45-minute questionnaire assessing demographics, symptoms of anxiety and depression, ART adherence, and substance use, including reasons for marijuana use. ART adherence was defined as the proportion of days in the last 30 days participants did not miss any medication and dichotomized as optimal (≥95%) and suboptimal (<95%). Multivariate logistic regression analysis assessed the association between therapeutic marijuana use to manage HIV symptoms (ie, improve appetite/gain weight, induce sleep, relieve nausea/vomiting, relieve pain, relieve anxiety/depression/stress) versus recreational marijuana use and ART adherence. Results Approximately one third (33.2%) of the participants reported using marijuana in the past 3 months. Of marijuana users, 21.8% reported using marijuana only for therapeutic purposes to manage HIV-associated medical symptoms, while 78.2% reported recreational use. After controlling for covariates, therapeutic use of marijuana was not associated with ART adherence (AOR =1.19, 95% CI =0.60–2.38, p=0.602) while recreational marijuana users showed significantly greater odds of suboptimal ART adherence compared to nonusers (AOR =1.80, 95% CI =1.18–2.72, p=0.005). Conclusion Our results suggest differences in ART adherence between individuals who report recreational versus therapeutic marijuana use. Continued research examining the health implications of marijuana use among adults living with HIV is important as legalization of recreational and medical marijuana proliferates in the United States.

Non-planning Impulsivity But Not Behavioral Impulsivity is Associated with HIV Medication Non-adherence

Despite advances in HIV antiretroviral medications, some patients do not achieve adequate medication adherence or suppressed viral load. The aim of this study was to identify the relationship between factors of impulsivity and medication non-adherence. It was hypothesized that impulsivity would have a direct association with non-adherence, after accounting for other known correlates. Participants included 322 HIV positive individuals (M age = 49, 56% male, 64% Black/African American). Impulsivity was measured using the Barratt Impulsiveness Scale-Brief (BIS-Brief). Factor analysis was conducted to determine if BIS-Brief resulted in a unidimensional or multi-factor solution. Results were suggestive of a two-factor solution: behavioral impulsivity and non-planning impulsivity. Structural equation modeling found non-planning impulsivity was associated with non-adherence (β = 0.18, p = 0.016), while no significant association was observed for behavioral impulsiveness. Results suggest that strategies related to planning for future consequences may be beneficial for impulsive persons with medication adherence difficulties.ResumenA pesar de los avances en los medicamentos antirretrovirales contra el VIH, algunos no logran una adherencia adecuada a los medicamentos ni suprimen la carga viral. El objetivo de este estudio fue identificar la relación entre los factores de impulsividad y la adherencia a la medicación. Se formuló la hipótesis de que la impulsividad tendría una asociación directa con la falta de adherencia, después de tener en cuenta otros correlativos conocidos. Los participantes incluyeron 322 individuos VIH positivos (M edad = 49, 56% hombres, 64% Black/African American). La impulsividad se midió usando la Barratt Impulsiveness Scale-Brief (BIS-Brief). El análisis factorial se realizó para determinar si BIS-Brief dio como resultado una solución unidimensional o multifactorial. Los resultados sugirieron una solución de dos factores: impulsividad conductual e impulsividad no planificada. El modelado de ecuaciones estructurales encontró que la impulsividad no planificada se asoció negativamente con la adherencia (β = 0.18, p = 0.02), mientras que no se observó una asociación significativa para la impulsividad conductual. Los resultados sugieren que las estrategias relacionadas con la planificación de las consecuencias futuras pueden ser beneficiosas para las personas impulsivas con dificultades de adherencia.

The prevalence and patterns of substance use by birth cohort among HIV-positive adults in Florida

ABSTRACT Objectives: Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida. Methods: PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use. Results: The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group. Conclusion: The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH.

Types and delivery of emotional support to promote linkage and engagement in HIV care

Purpose Despite recommendations for early entry into human immunodeficiency virus (HIV) care, many people diagnosed with HIV delay seeking care. Multiple types of social support (ie, cognitive, emotional, and tangible) are often needed for someone to transition into HIV care, but a lack of emotional support at diagnosis may be the reason why some people fail to stay engaged in care. Thus, the purpose of this study was to identify how people living with HIV conceptualized emotional support needs and delivery at diagnosis. Method We conducted a secondary analysis of qualitative data from 27 people living with HIV, many of whom delayed entry into HIV care. Results Participants described their experiences seeking care after an HIV diagnosis and identified components of emotional support that aided entry into care – identification, connection, and navigational presence. Many participants stated that these types of support were ideally delivered by peers with HIV. Conclusion In clinical practice, providers often use an HIV diagnosis as an opportunity to educate patients about HIV prevention and access to services. However, this type of social support may not facilitate engagement in care if emotional support needs are not met.