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Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework

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Abstract

We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1–3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

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References

  • Ahn, J., McCombs, J. S., Jung, C., Croudace, T. J., McDonnell, D., Ascher-Svanum, H., et al. (2008). Classifying patients by antipsychotic adherence patterns using latent class analysis: characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program. Value in Health, 11, 48–56.

    Article  PubMed  Google Scholar 

  • Akaike, H. (1973). Information theory and an extension of the maximum likelihood principle. Budapest, Hungary: In Second International Symposium on Information Theory.

    Google Scholar 

  • Bastard, M., Koita, F. M., Laniece, I., Taverne, B., Desclaux, A., Ecochard, R., et al. (2011). Revisiting long-term adherence to HAART in Senegal using latent class analysis. Journal of Acquired Immune Deficiency Syndrome, 57, 55–61.

    Article  Google Scholar 

  • Bennett, D. A. (2001). How can I deal with missing data in my study? Australian and New Zealand Journal of Public Health, 25, 464–469.

    Article  PubMed  CAS  Google Scholar 

  • Blank, M. B. (2014). Homelessness, mental illness, substance abuse, and HIV: An insidious syndemic. HIV/AIDS Research & Treatment Open Journal, 1, e001–e004.

    Google Scholar 

  • Blashill, A. J., Bedoya, C. A., Mayer, K. H., O’Cleirigh, C., Pinkston, M. M., Remmert, J. E., et al. (2014). Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS and Behavior, 19, 981–986.

    Article  Google Scholar 

  • Brinkley-Rubinstein, L., & Craven, K. (2014). A latent class analysis of stigmatizing attitudes and knowledge of HIV risk among youth in South Africa. PLoS ONE, 9, e89915.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buseh, A. G., & Stevens, P. E. (2008). Constrained but not determined by stigma: Resistance by African-American women living with HIV. Women and Health, 44, 1–18.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention [CDC]. (2012). HIV in the United States: The stages of care, 2012. Retrieved 17 Sept 2014, from http://ww w.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-Care FactSheet-508.pdf.

  • Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. New York, NY: Wiley.

    Google Scholar 

  • Fremont, A., Young, A., Chinman, M., Pantoja, P., Morton, S. C., Koegel, P., et al. (2007). Differences in HIV care between patients with and without severe mental illness. Psychiatric Services, 58, 681–688.

    Article  PubMed  Google Scholar 

  • Freudenberg, N., Fahs, M., Galea, S., & Greenberg, A. (2006). The impact of New York city’s 1975 fiscal crisis on the tuberculosis, HIV, and homicide syndemic. American Journal of Public Health, 96, 424–434.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gielen, A. C., McDonnell, K. A., O’Campo, P. J., & Burke, J. G. (2005). Suicide risk and mental health indicators: Do they differ by abuse and HIV status? Women’s Health Issues, 15, 89–95.

    Article  PubMed  Google Scholar 

  • González-Guarda, R. M., McCabe, B. E., Florom-Smith, A., Cianelli, R., & Peragallo, N. (2011). Substance abuse, violence, HIV, and depression an underlying syndemic factor among latinas. Nursing Research, 60, 182–189.

    Article  PubMed  PubMed Central  Google Scholar 

  • González-Guarda, R. M., Ortega, J., Vasquez, E. P., & De Santis, J. (2010). La mancha negra: Substance abuse, violence, and sexual risks among Hispanic males. Western Journal of Nursing Research, 32, 128–148.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gullette, D. L., Wright, P. B., Booth, B. M., & Stewart, K. E. (2010). Stages of change, decisional balance, and self-efficacy in condom use among rural African-American stimulant users. Journal of Associated Nurses AIDS Care, 20, 428–441.

    Article  Google Scholar 

  • Halkitis, P. N., Kupprat, S. A., Hampton, M. B., Perez-Figueroa, R., Kingdon, M., Eddy, J. A., & Ompad, D. C. (2012). Evidence for a syndemic in aging HIV-positive gay, bisexual, and other MSM: Implications for a holistic approach to prevention and healthcare. Natural Resource Modeling, 36, 1–21.

    Google Scholar 

  • Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Storholm, E. D., Solomon, T. M., & Bub, K. L. (2013). Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS and Behavior, 17, 662–673.

    Article  PubMed  PubMed Central  Google Scholar 

  • Havlik, R. J., Brennan, M., & Karpiak, S. E. (2011). Comorbidities and depression in older adults with HIV. Sexual Health, 8, 551–559.

    Article  PubMed  Google Scholar 

  • Horner, P., & Nassiri, R. (2013). Social cultural stressors in dominican republic HIV/AIDS prevention and treatment. Journal of AIDS & Clinical Research, 4, 1–6.

    Google Scholar 

  • Illangasekare, S., Burke, J., Chander, G., & Gielen, A. (2013). The syndemic effects of intimate partner violence, HIV/AIDS, and substance abuse on depression among low-income urban women. Journal of Urban Health, 90, 934–937.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, W. D., Diaz, R. M., Flanders, W. D., Goodman, M., Hill, A. N., Holtgrave, D., et al. (2008). Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database of Systematic Reviews, 3, CD001230.

  • Jones, D. J., Beach, S. R., Forehand, R., & Foster, S. E. (2003). Self-reported health in HIV-positive African-American women: The role of family stress and depressive symptoms. Journal of Behavioral Medicine, 26, 577–599.

    Article  PubMed  Google Scholar 

  • Kaaya, S., Eustache, E., Lapidos-Salaiz, I., Musisi, S., Psaros, C., & Wissow, L., (2013). Grand challenges: Improving HIV treatment outcomes by integrating interventions for co-morbid mental illness. PL0S Medicine, 10(5), e1001447.

  • Keiser, O., Spycher, B., Rauch, A., Calmy, A., Cavassini, M., Glass, T. R., et al. (2012). Outcomes of antiretroviral therapy in the swiss HIV cohort study: Latent class analysis. AIDS & Behavior, 16, 245–255.

  • Knowlton, A. R., Yang, C., Bohnert, A., Wissow, L., Chander, G., & Arnsten, J. A. (2011). Main partner factors associated with worse adherence to ART among women in Baltimore, Maryland: A preliminary study. AIDS Care, 23(9), 1102–1110.

    Article  Google Scholar 

  • Konda, K. A., Celentano, D. D., Kegeles, S., Coates, T. J., Caceres, C. F., & NIMH Collaborative HIV/STD Prevention Trial Group. (2011). Latent class analysis of sexual risk patterns among esquineros (street corner men) a group of heterosexually identified, socially marginalized men in Urban Coastal Peru. AIDS & Behavior, 15, 862–868.

  • Latkin, C. A., Forman, V., Knowlton, A., & Sherman, S. (2002). Norms, social networks, and HIV-related behaviors among urban disadvantaged drug users. Social Science and Medicine, 56, 465–476.

    Article  Google Scholar 

  • Li, L., Ji, G., Ding, Y., Tian, J., & Lee, A. (2012). Perceived burden in adherence of antiretroviral treatment in rural China. AIDS Care, 24, 502–508.

    PubMed  PubMed Central  Google Scholar 

  • MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002). On the practice of dichotomization of quantitative variables. Psychological Methods, 7, 19–40.

    Article  PubMed  Google Scholar 

  • Marcus, R. (2014). Women’s discourse on the homeless experience: It’s about love and loss. Retrieved 9 June 2015 from http://digitalcommons.uconn.edu

  • McDaid, L. M., & Hart, G. (2010). Sexual risk behaviour for transmission of HIV in men who have sex with men: recent findings and potential interventions. Current Opinion in HIV & AIDS, 5, 311–315.

    Article  Google Scholar 

  • McNutt, L., Wu, C., Xue, X., & Hafner, J. P. (2003). Estimating the relative risk in cohort studies and clinical trials of common outcomes. American Journal of Epidemiology, 157, 940–943.

    Article  PubMed  Google Scholar 

  • Mendenhall, E. (2013). Syndemic suffering: Social distress, depression, and diabetes among mexican immigrant women. Walnut Creek, CA: Left Coast Press.

    Google Scholar 

  • Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science and Medicine, 103, 126–133.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meyer, J. P., Springer, S. A., & Altice, F. L. (2011). Substance abuse, violence, and HIV in women: A literature review of the syndemic. Journal of Women’s Health, 20, 991–1006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Milstein, B. (2001). Introduction to the syndemics prevention network. Retrieved 14 Sept 2014 from http://www.cdc.gov/syndemics/

  • Minze, L. C., McDonald, R., Rosentraub, E. L., & Jouriles, E. N. (2010). Making sense of family conflict: Intimate partner violence and preschoolers’ externalizing problems. Journal of Family Psychology, 24, 5–11.

    Article  PubMed  Google Scholar 

  • Mitrani, V. B., McCabe, B. E., Burns, M. J., & Feaster, D. J. (2012). Family mechanisms of structural ecosystems therapy for HIV-seropositive women in drug recovery. Health Psychology, 31, 591–600.

    Article  PubMed  Google Scholar 

  • Mizuno, Y., Purcell, D. W., Knowlton, A. R., Wilkinson, J. D. Gourevitch, M. N., & Knight, K. R. (2014). Syndemic vulnerability, sexual and injection risk behaviors, and HIV continuum of care outcomes in HIV-positive injection drug users. AIDS & Behavior. doi:10.1007/s10461-014-0890-0

  • Muthén, L. K., & Muthén, B. O. (2011). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén.

    Google Scholar 

  • Nicholas, P. K., Willard, S., Thompson, C., Dawson-Rose, C., Corless, I. B., Wantland, D. J., et al. (2014). Engagement with care, substance use, and adherence to therapy in HIV/AIDS. AIDS Research & Treatment, 2014, 1–7.

    Article  Google Scholar 

  • Noor, S. W. B., Ross, M. W., Lai, D., & Risser, J. M. (2014). Use of latent class analysis approach to describe drug and sexual HIV risk patterns among injection drug users in Houston, Texas. AIDS and Behavior, 18, S276–S283.

    Article  Google Scholar 

  • Ostrach, B., & Singer, M. (2012). At special risk: Biopolitical vulnerability and HIV syndemics among women. Health Sociology Review, 21, 258–271.

    Article  Google Scholar 

  • Prejean, J., Song, R., Hernandez, A., Ziebell, R., Green, T., Walker, F., et al. (2011). Estimated HIV incidence in the United States, 2006–2009. PLOS ONE, 6(8), e17502.

  • Rasch, G. (1980). Probabilistic models for some intelligence and attainment tests. Chicago, IL: University of Chicago Press.

    Google Scholar 

  • Rolland, J. S. (1994). Families, illness and disability. New York: Basic Books.

    Google Scholar 

  • Sanders-Phillips, K. (2002). Factors influencing HIV/AIDS in women of color. Public Health Reports, 117(Suppl 1), S151–S156.

    PubMed  PubMed Central  Google Scholar 

  • Schumacher, W. E., Frick, M., Kauselmann, V., Maier-Hoyle, R., van der Vliet, R., & Babiel, R. (2007). Fully automated quantification of human immunodeficiency virus (HIV) type 1 RNA in human plasma by the COBAS AmpliPrep/COBAS Taqman system. Journal of Clinical Virology, 38, 304–312.

    Article  PubMed  CAS  Google Scholar 

  • Semple, S. J. (1992). Conflict in Alzheimer’s caregiving families: Its dimensions and consequences. The Gerontologist, 32, 648–655.

    Article  PubMed  CAS  Google Scholar 

  • Semple, S. J., Patterson, T. L., Temoshok, L. R., Straits-Tröster, K., Atkinson, J. H., Koch, W., & Grant, I. (1997). Family conflict and depressive symptoms: A study of HIV-seropositive men. AIDS and Behavior, 1, 53–60.

    Article  Google Scholar 

  • Senn, T. E., & Carey, M. P. (2008). HIV, STD, and sexual risk reduction for individuals with a severe mental illness: Review of the intervention literature. Current Psychiatry Review, 4, 87–100.

    Article  Google Scholar 

  • Senn, T., Carey, M., & Variable, P. (2010). The intersection of violence, substance use, negative affect, and STDs: Testing of a syndemic pattern among patients attending an urban STD clinic. Journal of the National Medical Association, 102, 614–620.

    Article  PubMed  PubMed Central  Google Scholar 

  • Singer, M. (1996). A dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology, 24, 99–110.

    Google Scholar 

  • Singer, M. (2009). Introduction to syndemics: A critical systems approach to public and community health. San Francisco, CA: Jossey-Bass Books.

    Google Scholar 

  • Singer, M., & Clair, S. (2003). Syndemics and public health: reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17, 423–441.

    Article  PubMed  Google Scholar 

  • Singer, M., & Romero-Daza, N. (1997). A notable connection between substance abuse, violence, and AIDS: Initial findings from research in the Puerto Rican community of Hartford. Hartford, CT: Hispanic Health Council.

    Google Scholar 

  • Stall, R., Mills, T. C., & Williamson, J. (2003). Association of cooccurring psychosocial health problems and increased vulnerability to HIV & AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942.

    Article  PubMed  PubMed Central  Google Scholar 

  • StataCorp. (2009). Stata statistical software, Rel. 11. College Station, TX: StataCorp LP.

  • Straus, M. A. (1979). Measuring intra family conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage & the Family, 41, 75–88.

    Article  Google Scholar 

  • Sullivan, K. A., Messer, L. C., & Quinlivan, E. B. (2015). Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color. AIDS Patient Care and STDs, 29, S42–S48.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tobin, K. E., Kuramoto, S. J., Davey-Rothwell, M. A., & Latkin, C. A. (2011). The STEP into action study: A peer-based, personal risk network-focused HIV prevention intervention with injection drug users in Baltimore, Maryland. Addiction, 106, 366–375.

    Article  PubMed  PubMed Central  Google Scholar 

  • Towner, W. J. (2008). The changing face of HIV infection. Permanente Journal, 12, 60–64.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tracy, E. M., & Martin, T. C. (2007). Children’s roles in the social networks of women in substance abuse treatment. Journal of Substance Abuse Treatment, 32, 81–88.

    Article  PubMed  Google Scholar 

  • Wyatt, G. E. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zea, M., Reisen, C., Poppen, P., Bianchi, F., & Echeverry, J. (2005). Disclosure of HIV status and psychological well-being among Latino gay and bisexual men. AIDS and Behavior, 9, 15–26.

    Article  PubMed  Google Scholar 

  • Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by grants from the National Institutes of Health (R01 DA019413 and R01 NR14050-01). This research was also supported by the Johns Hopkins Center for AIDS Research (1P30AI094189).

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  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Schools of Medicine and Public Health, Center for Surgery and Public Health, One Brigham Circle, 1620 Tremont Street, Suite BC-4-020-U, Boston, MA, 02134, USA

    Allysha C. Robinson

  2. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Amy R. Knowlton & Andrea C. Gielen

  3. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Joseph J. Gallo

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  1. Allysha C. Robinson
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Correspondence to Allysha C. Robinson.

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Allysha C. Robinson, Amy R. Knowlton, Andrea C. Gielen and Joseph J. Gallo declares that they have no conflict of interest.

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Robinson, A.C., Knowlton, A.R., Gielen, A.C. et al. Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework. J Behav Med 39, 1–12 (2016). https://doi.org/10.1007/s10865-015-9670-1

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