Sherry Larkins

Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men

Medication adherence among persons with HIV infection is important not only because of the effect of non-adherence on an individuals health but also because non-adherence can lead to medication-resistant viral strains. However, adherence to HIV medications is difficult due to complex dosing regimens and side effects. This paper is a qualitative analysis of HIV medication adherence among gay and bisexual methamphetamine-abusing men enrolled in an outpatient drug treatment research project. As part of an open-ended, semi-structured interview, 23 HIV-infected men discussed the effects of their methamphetamine use on their medication adherence. Substance-use barriers to adherence were coded into two main themes: (1) planned non-adherence and (2) unplanned non-adherence. Planned non-adherence was a strategy for coping with demanding HIV medication schedules, or was linked to sexual behaviours while using methamphetamine or to fears of interaction effects from mixing methamphetamine with HIV medications. Participants did not define their medication regimen adjustments as non-adherence but as a way to achieve a sense of control over their lives. Unplanned non-adherence was linked to methamphetamine-related disruptions in food and sleep schedules. Findings are helpful in designing culturally specific HIV medication adherence interventions for this population.

Changes in the Meaning of Sexual Risk Behaviors Among Gay and Bisexual Male Methamphetamine Abusers Before and After Drug Treatment

Methamphetamine is widely used among gay and bisexual men in the West Coast of the United States, and is often used in combination with high-risk sexual activities. This study combined quantitative and qualitative research methodologies to examine sexual risk behaviors among gay and bisexual male methamphetamine abusers as they entered treatment and at 1-year follow-up evaluations. Findings from the quantitative follow-up data demonstrate that gay and bisexual men reduce sexual risk behaviors and sustain those reductions following substance abuse treatment, and qualitative data reveal the meaning of these behavior changes from the perspective of the participant. At 1-year evaluations, associated behaviors of methamphetamine use and sexual risk behaviors were lessened. Although condom use decreased slightly, participants reported fewer anonymous sexual partners, reductions in episodes of both receptive and insertive anal intercourse, and an increased sense of responsibility to disclose their HIV status. This study further demonstrates the value of coupling quantitative with qualitative data in understanding the meanings behind reductions in high-risk behaviors.

Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men

This project evaluated two behavioral therapies for substance abuse and concomitant sexual risk behaviors applied to primarily stimulant-abusing gay and bisexual men in Los Angeles. One hundred twenty-eight participants were randomly assigned to 16 weeks of a gay-specific cognitive-behavioral therapy (GCBT, n = 64) or to a gay-specific social support therapy (GSST; n = 64), with follow-up evaluations at 17, 26, and 52 weeks after randomization. No overall statistically significant differences were observed between conditions along retention, substance use, or HIV-related sexual risk behaviors. All participants showed a minimum of twofold reductions in substance use and concomitant sexual risk behaviors from baseline to 52-week evaluations. Among methamphetamine-using participants, the GCBT condition showed significant effects over GSST for reducing and sustaining reductions of methamphetamine. Findings replicate prior work and indicate that GCBT produces reliable, significant, and sustained reductions in stimulant use and sexual risk behaviors, particularly in methamphetamine-abusing gay and bisexual men.

Methamphetamine-dependent gay men's disclosure of their HIV status to sexual partners

Disclosure of ones HIV status to a potential sexual partner has important HIV prevention implications. This paper qualitatively evaluates the social and sexual contexts that influence disclosure of HIV status among methamphetamine-dependent gay men enrolled in an outpatient drug treatment research program. As part of an open-ended, semi-structured interview, 34 HIV-positive and HIV-negative men discussed how, when, to whom and under what circumstances they reveal information about their HIV status. The four factors that influence participants’ decision to disclose include: (1) an HIV-negative sexual partners disclosure; (2) sexual venue (private versus public); (3) primary versus non-primary partner; and (4) the perceived risk of the sexual act. Sexual encounters among the men in this sample often occurred in public environments with non-primary partners, and involved use of illicit substances. In these social and sexual contexts, both HIV-positive and HIV-negative participants believed that it is HIV-negative rather than HIV-positive men who should initiate safer sex dialogue and safer sex practices. Findings are helpful in crafting HIV-prevention interventions targeting substance-using gay men whose sexual practices place them at high-risk for HIV-infection.

Factors Associated with HIV Viral Load in a Respondent Driven Sample in Los Angeles

This study used a modified version of the Behavioral Model for Vulnerable Populations to examine the predisposing, enabling, and need factors associated with detectable viral load (VL). HIV status was measured using saliva and confirmed by blood. Of 797 persons enrolled, 193 were HIV positive and provided VL counts. A hierarchical multivariate logistic regression approach demonstrated that the predisposing factors of homelessness and recent substance abuse, particularly methamphetamine abuse, had a negative association with VL. The negative association of homelessness on VL was weakened with the introduction of enabling and need utilization factors. Mediation analysis indicated homelessness and HIV medication taking significantly associated with methamphetamine use as a predictor of detectable viral load. Guided policy to address substance abuse among those who are HIV positive is needed to improve biological outcomes.

Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs

Objective: Improved understanding of the relative strengths and weaknesses of treatment organizations’ dual diagnosis capability is critical in order to guide efforts to improve services. This study assesses programs’ capacity to meet the needs of clients with dual diagnosis, identifies areas where they are well equipped to serve these clients, and determines where programmatic improvement is needed. The study also undertakes an initial exploration of the potential impact that funding sources have on dual diagnosis capability. Methods: We administered Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments at 30 treatment programs in two California counties. Seven of the programs received funding to provide both mental health and substance use disorder services, 13 received funding to provide mental health services, and 10 received funding to provide substance use disorder services. Results: The mean DDCAT/DDCMHT score of programs in the sample was 2.83, and just over 43% of the sample met or exceeded DDCAT/DDCMHT criteria for dual diagnosis capability. Programs scored highest and had the highest rates of dual diagnosis capability in domains related to assessment, training, and staffing, whereas scores were weakest and rates of dual diagnosis capability were lowest in the program structure, treatment, and continuity of care domains. Programs that received funding to provide both mental health and substance use disorder services consistently scored higher than the other programs in the sample, and mental health programs scored higher than substance use disorder treatment programs both on the overall assessments and in most domains. Conclusions: Findings suggest that programs in the sample are functioning at a nearly dual diagnosis–capable level. However, structural barriers continue to limit providers’ capacity to serve clients with co-occurring mental health and substance use disorders, and many organizations have not yet translated their potential to deliver dual diagnosis–capable services into practice. By enhancing their program structure, treatment services, and continuity of care services, these treatment organizations should be able to deliver fully dual diagnosis–capable services. Observed differences in dual diagnosis capability based on funding source indicate a need for further research to better understand the impact that funding streams have on dual diagnosis capability.

HIV Risk Behaviors Among Gay Male Methamphetamine Users: Before and After Treatment

SUMMARY Methamphetamine-using gay men are at high risk for HIV transmission, largely due to the high-risk sexual risk behaviors they engage in while using the drug. Gay men who use the drug frequently report that it enables them to have intense, long-lasting sexual encounters. Substance abuse treatment interventions that target both substance use and sexual behavior have been successful in helping gay men reduce their sexual risks including: reducing the number of sexual partners, reducing the frequency of unprotected anal intercourse, and reducing frequency of public sex encounters. Such treatments have the potential to curtail the spread of HIV and other sexually-transmitted infections (STIs), while simultaneously treating the substance abuse disorder.

The role of the illusion in the construction of erotic desire: narratives from heterosexual men who have occasional sex with transgender women

Abstract Little is known about men’s sexual desire for and erotic attraction to male-to-female transgender women. To better understand how erotic desire is constructed, this study examined the narratives of a sample of heterosexual men who had had an occasional sexual encounter with a transgender woman. Open-ended qualitative interviews were conducted with 16 heterosexual men who reported at least one sexual encounter with a transgender woman in the previous 12 months. Using principles of Grounded Theory, three themes emerged: (1) the erotic desire that transpired from a transgender woman’s construction of her femininity, (2) the sexual act that dictated the specific navigation of a transgender woman’s penis and (3) the sexual dissonance that resulted from being a heterosexually identified man having sex with a partner who had a penis. These themes reflected how the participants defined and negotiated their sexual encounters, both psychologically through their understanding of sex with a transgender woman with a penis, and physically through the navigation of specific sex acts. The role of the ‘illusion’ was central to the meaning and construction of erotic desire. These narratives provided another framework for continuing discourse on the complexity of erotic desire.

Disclosure of Male Sexual Partnering and HIV Serostatus Among a Sample of Heterosexually Identified Men Who Have Sex With Men and Women.

This study employed qualitative methods to understand better the disclosure practices of men with their male and female sexual partners. Open-ended, in-depth, semi-structured interviews were conducted with 21 heterosexually identified men who reported at least one sexual encounter with a male in the previous year but not more than one sexual encounter with a male per month. Fifty-eight percent of the participants were HIV infected. Most HIV-infected participants reported disclosure of their HIV serostatus to their female sexual partners but did not disclose that they engaged in occasional sexual encounters with a male partner. Disclosure of HIV serostatus to male sexual partners was minimal and inconsistent.