Renata Arrington-Sanders

Gender differences in health-related quality of life of adolescents with cystic fibrosis

BackgroundFemale patients with cystic fibrosis (CF) have consistently poorer survival rates than males across all ages. To determine if gender differences exist in health-related quality of life (HRQOL) of adolescent patients with CF, we performed a cross-section analysis of CF patients recruited from 2 medical centers in 2 cities during 1997–2001.MethodsWe used the 87-item child self-report form of the Child Health Questionnaire to measure 12 health domains. Data was also collected on age and forced expiratory volume in 1 second (FEV1). We analyzed data from 98 subjects and performed univariate analyses and linear regression or ordinal logistic regression for multivariable analyses.ResultsThe mean (SD) age was 14.6 (2.5) years; 50 (51.0%) were female; and mean FEV1 was 71.6% (25.6%) of predicted. There were no statistically significant gender differences in age or FEV1. In univariate analyses, females reported significantly poorer HRQOL in 5 of the 12 domains. In multivariable analyses controlling for FEV1 and age, we found that female gender was associated with significantly lower global health (p < 0.05), mental health (p < 0.01), and general health perceptions (p < 0.05) scores.ConclusionFurther research will need to focus on the causes of these differences in HRQOL and on potential interventions to improve HRQOL of adolescent patients with CF.

Older partner selection in young African-American men who have sex with men.

PURPOSE Young African-American (AA) men who have sex with men (YAAMSM) have experienced the greatest proportional increase in new HIV cases compared with other groups. Bridging sexual partnerships between YAAMSM and older aged cohorts with higher rates of primary HIV infection has emerged as an important independent risk factor for the development of HIV. We explored reasons young AAMSM cite for being attracted to and seeking an older partner and the interpersonal needs met within older sexual partnerships. METHODS Seventeen in-depth semistructured qualitative interviews were conducted in YAAMSM residing in a midsized urban city with high HIV prevalence. Two coders independently evaluated transcribed data to identify/collapse codes that emerged. We analyzed data using categorical and contextualizing analytic methods. RESULTS Two themes emerged from the text for seeking an older sexual partner: the emotional maturity the older partner represented and the ability of the older partner to expose the younger partner to more life experiences. In addition, two themes emerged around attraction: support and physical attractiveness of the older partner. Few men described seeking age-discordant relationships for the sole purpose of exchange sex. Older partners during first same-sex experience helped younger partners sort through sexual position and how to perform in relationships. CONCLUSIONS These interviews suggest that YAAMSM may be seeking older partners to fulfill desires to be in a stable, emotionally mature relationship and for exposure in the larger community. Prevention strategies aimed at targeting adolescent MSM age-discordant relationships will need to address the interpersonal needs met within older sexual partnerships.

Ritonavir-fluticasone interaction causing Cushing syndrome in HIV-infected children and adolescents.

Background: Ritonavir, a potent inhibitor of CYP3A4 enzyme, can lead to high systemic concentrations of fluticasone when these 2 drugs are coadministered. Exogenous Cushing syndrome (CS) in HIV-infected patients receiving ritonavir and fluticasone has been reported frequently in adults but not in children. Three patients, all receiving ritonavir–fluticasone, developed weight gain and altered fat distribution concerning for either lipodystrophy or CS. Methods: Three patients were initially identified by their clinicians as having weight gain and altered fat distribution concerning for either lipodystrophy or CS. All 3 patients were receiving fluticasone and ritonavir, leading to concern about a potential medication interaction. After suspecting exogenous CS, all patient medication lists were reviewed to identify all children prescribed ritonavir–fluticasone. Blood adrenocorticotropic hormone (ACTH) and cortisol were obtained during routine clinic visits. Medication history, laboratory data and physical examination findings were abstracted from medical records. Results: Seventeen (9%) of 189 patients in this pediatric HIV clinic had been prescribed ritonavir–fluticasone. Of 7 patients still taking ritonavir–fluticasone, CS features were present in 4 (57%) patients, including the 3 patients initially suspected of CS or lipodystrophy. Five (71%) patients, including all 4 with CS features, had low serum concentrations: median cortisol <0.2 μg/dL (normal, <0.2 μg/dL). Three of these 5 had ACTH measured, all of which were low: median ACTH 3.0 pmol/L (range, 2.2–<5.0 pmol/L). One patient taking ritonavir–fluticasone had suppressed cortisol but no CS features. The 2 patients with normal serum cortisol and ACTH values had persistent HIV viremia and were suspected of medication nonadherence. Clinical and laboratory abnormalities generally normalized in affected patients within 3 months after discontinuation of fluticasone alone (2) and ritonavir–fluticasone (3). Conclusions: Pediatric HIV physicians frequently prescribe fluticasone and ritonavir together. The combination can cause CS and adrenal suppression in children, potentially leading to misdiagnosis of lipodystrophy syndrome and to increased risk of adrenal crisis during acute illness. Alternatives to fluticasone should be used for treating children receiving ritonavir.

The Role of Sexually Explicit Material in the Sexual Development of Same-Sex-Attracted Black Adolescent Males

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15–19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one’s sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., “top” or “bottom”); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

Correlates of HIV Testing History among Urban Youth Recruited through Venue-Based Testing in 15 US Cities

Background: Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities. Methods: A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users. Results: Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care. Conclusions: More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.

Prevalence of Self-Reported Human Immunodeficiency Virus Testing Among a Population-Based Sample of Urban African-American Adolescents

We explored the prevalence of gender differences in human immunodeficiency virus (HIV) testing among a household sample of sexually active African-American adolescents. Females disproportionately self-report being tested for HIV more than males. This difference was not explained by age or receipt of services for sexually transmitted infection but was partially attributable to history of pregnancy.

HIV testing in adolescents and young adults receiving STI testing in an Urban primary care setting

IN THE UNITED STATES, an estimated 1 million people are infected with the humanimmunodeficiency virus (HIV) and one-quarter are unaware of their infection. 1 Rates of newinfections have increased among young persons with nearly half of all new HIV infections inthe US occurring in black adolescents and young adults aged 13 to 24.1-4Despite evidence that early diagnosis may have potential advantages in promoting prevention,5-8 improving immune restoration, and linking HIV-infected persons with care9 HIV testinghas been a controversial and difficult area to define and produce relevant guidelines. In 2001,the Centers for Disease Control and Prevention 10 (CDC) recommended universal HIV testingfor all persons who (a) live in communities with an HIV prevalence >1%; (b) have known riskfactors for HIV infection; and (c) request HIV testing. In September 2006, the guidelines forhealth care settings were modified to recommend that all persons aged 13 to 64 years be testedfor HIV.11Understanding risk-based care delivery patterns of providers who care for vulnerablepopulations is salient to understanding the acceptance of the current guidelines. The purposeof this study was to determine if care-seeking adolescents and young adults who were receivingsexually transmitted infection (STI) testing and living in a high-HIV–prevalent communitywere being tested for HIV according to CDC guidelines.To select adolescents who fall in the special CDC risk categories, medical records ofadolescents and young adults aged 11 to 24 years who were evaluated for an STI in a largeacademic ambulatory care facility in Baltimore, MD, between July 2003 and June 2004 werereviewed. This time frame was used to include time points in all seasons. This multidisciplinarypractice provides general pediatric care, adolescent medicine primary and subspecialty care,and HIV primary and specialty care as a 3-team structure. Most of the patients served by thisclinic are from the Baltimore metropolitan area. Baltimore is a large city on the east coast ofthe United States that is 64% black, has 23% of the population living below poverty level,12and an estimated community HIV incidence of 166.8 per 100,000 persons.13 The clinic isprimarily staffed by resident, fellow, and nurse practitioner providers supervised by attendingphysicians. Counselors are also available on-site to provide pre/posttest HIV counseling andgeneral STI/HIV risk reduction counseling to adolescents.Quality assurance (QA) laboratory logs were used to randomly identify patients who had STIand/or HIV testing during the study period. Inclusion criteria for chart review included (a) agebetween 11 and 24 years and (b) evidence of STI screening or testing at the visit during the

A systems approach to improve human immunodeficiency virus screening in sexually active youth in urban academic ambulatory settings

The 2006 Centers for Disease Control and Prevention human immunodeficiency virus testing guidelines, coupled with a quality improvement intervention, can increase the number of human immunodeficiency virus tests performed in sexually active youth aged 12 to 21 years. Such focused interventions may be helpful to promote recommended guidelines and can be an innovative approach to screen adolescents in urban primary care settings.

Factors Associated With Emotional Satisfaction During First Anal Intercourse in a Sample of YMSM

ABSTRACT We sought to determine, in a sample of 2,813 HIV seronegative young men who had sex with other men age 18–24, whether physical satisfaction would explain emotional satisfaction during first anal intercourse and whether emotional satisfaction would impact having sex with a partner a second time. Emotional satisfaction was explained mostly by physical satisfaction during the event, but partner type also had direct impact on emotional satisfaction. Our findings suggest that first anal intercourse experiences in young men are both emotionally and physically satisfying and may impact subsequent sexual behavior and partner decision-making.

What makes a teen get tested? A case of urban based sample of adolescents

Objective: Urban teens disproportionately impacted by HIV may not seek HIV testing. The objectives of this study are to determine factors that impact HIV testing among sexually active and non-sexually active teens seeking care in an urban academic setting; whether teens with high levels of self-efficacy are more likely to receive HIV testing; and whether an teens ability to cope impacts positive attitudes toward testing. Methods: We conducted a cross-sectional survey of 228 HIV negative adolescent and young adult participants age 12-21 who received care in an academic urban primary care clinic in Baltimore, Maryland. Results: Most youth reported being sexually active (N=146, 64%) and reported having been tested at that days visit (N=135, 85%). Provider recommendation was significantly associated with higher odds of testing among sexually active teens (OR 3.5, 95% CI 1.07-11.7) and those with no prior sexual history (OR 5.89, 95% CI 1.40-24.9), while high HIV stigma was associated with lower odds of testing (OR 0.17, 95% CI 0.04-0.77) among youth with no prior sexual history. Sexually active teens with a positive attitude toward HIV testing were more likely to be older (late: 6.3 (1.0-40)), report intention to be tested in 6 months (OR 7.11, 95% CI 1.48-34.2), and have higher HIV coping self-efficacy (OR 1.12, 95% CI 1.00-1.26). Conclusions: Provider recommendation may be the most important independent factor for testing in teens, regardless of sexual history, while HIV-related stigma may be an important factor for teens with no prior sexual history and thus may be perceived to have little or no risk for HIV acquisition. In sexually active youth, older age, intention to be tested for HIV and the ability to cope with a positive diagnosis likely dictates adolescent attitudes toward engagement in HIV testing, although it may not directly correspond with HIV testing behavior.