Associations of Intimate Partner Violence and Drug Use on Viral Suppression Among Women Living With HIV in South Florida: A Secondary Analysis.

ABSTRACT: Suboptimal viral suppression is associated with worse outcomes and increased HIV transmission among women with HIV (WWH). Based on syndemic theory, we hypothesized that women exposed to recent intimate partner violence (IPV) and current drug use would be most likely to have suboptimal HIV viral suppression. We analyzed baseline data from a longitudinal clinical trial (WHAT-IF? Will Having Alcohol Treatment Improve My Functioning?) that enrolled WWH from Miami, FL, who reported heavy drinking. Bivariate logistic regression was done, mean age was 48 years ( n = 194; SD : 8.7), 40% had current drug use (other than alcohol), and 14% reported recent IPV. WWH who reported both IPV and drug use had the highest rate of suboptimal viral suppression (45%), but these differences were not statistically significant. The high rates of suboptimal viral suppression, drug use, and IPV suggest a need to include screening for IPV in clinical guidelines related to HIV care in women.

Mental health, substance use, and risky sexual behaviors among women living with HIV.

INTRODUCTION: Risky sexual behavior has been explored in women living with HIV (WLHIV) internationally but is not well studied in WLHIV in the United States (U.S.). This merits further investigation due to the negative reproductive and HIV health outcomes associated with risky sexual behavior, such as the increased risk for HIV transmission and infertility from sexually transmitted infections (STIs). The aims of this study are to (1) describe sexual behaviors in a cohort of WLHIV in Florida, (2) determine whether demographic characteristics, substance use, and mental health symptoms are associated with risky sexual behavior in a cohort of WLHIV in Florida, and (3) explore whether the relationship between substance use and mental health symptoms and risky sexual behavior differs in reproductive-age (age 18-49), compared to non-reproductive-age WLHIV (age 50+). DESIGN: This was a cross-sectional analysis of data from a multisite cohort study done in Florida. METHODS: Data were collected from a sample of 304 participants who were recruited into the Florida Cohort Study from 9 clinical and community sites in Florida between 2014 to 2017. The predictor variables of interest were mental health symptoms, substance use, and demographic variables. The outcome variable of interest was risky sexual behavior which was defined as reporting ≥1 of the following: (1) at least one STI diagnosis in the past 12 months, (2) two or more sexual partners in the past 12 months, or (3) any inconsistent condom use in the past 12 months. Descriptive statistics, bivariate analysis, and logistic regression (p < 0.1) were conducted on the variables of interest. RESULTS: The mean age of the sample was 47.8 years, and approximately half (51.6%) of the sample was of reproductive-age. Reporting ≥1 risky sexual behavior was reported in over half (51.6%) of the reproductive-age WLHIV in the sample and 32% of the non-reproductive-age WLHIV in the sample. Binge drinking, alcohol-related problems, marijuana use, and age were all significantly associated with self-reporting ≥1 risky sexual behaviors in all WLHIV. Self-reporting binge drinking, marijuana use, and a high alcohol-related problems score respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior in all WLHIV. Neither mental health symptoms nor race/ethnicity or education were significantly associated with self-reporting ≥1 risky sexual behavior in all WLHIV. Self-reporting severe anxiety symptoms and high alcohol-related problems scores respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior only in reproductive-age WLHIV from the sample. CONCLUSION: Marijuana use, binge drinking, and alcohol-related problems appear to have a relationship with risky sexual behavior in WLHIV regardless of age. Reproductive-age also appears to influence risky sexual behavior in WLHIV, and specific reporting severe anxiety symptoms and high alcohol-related problems in reproductive-age WLHIV increases the odds of engaging in risky sexual behavior. CLINICAL SIGNIFICANCE: This study holds clinical significance for nurses and other clinicians working in reproductive health settings and clinics with WLHIV. Results indicate that it could be beneficial to do more screening for mental health symptoms (particularly anxiety) and alcohol use in younger reproductive-age WLHIV.

Body Composition, Metabolism, and Inflammation in Breast Cancer Survivors and Healthy Age-matched Controls: A Cross-Sectional Analysis.

Breast cancer survivors (BCS) experience treatment induced alterations in body composition including the loss of bone mineral density (BMD) and lean soft tissue (LST). These changes can affect the metabolism and the systemic inflammatory environment of BCS. OBJECTIVE: To evaluate the differences in body composition, resting energy expenditure (REE), and inflammation in BCS and age-matched women without a prior cancer diagnosis (control). METHODS: Seventeen postmenopausal BCS (stages 0-III; age: 59 ± 9 years) and 18 (59 ± 6 years) controls had their total body and regional (lumbar spine, femur, and forearm) BMD, LST and fat mass measured via DXA. REE was assessed via 35 minutes of indirect calorimetry. Serum concentrations of human C-reactive protein (CRP) were measured via ELISA to assess inflammation. Data were analyzed via ANOVAs. RESULTS: There were no significant differences between BCS and controls in body composition, metabolic measures and CRP. However, when REE was adjusted for LST, the BCS had a significantly greater REE when compared to the controls (p = 0.015). DISCUSSION: Our findings suggest that BCS that were on average five years into survivorship appear to have similar body composition, and CRP as age-matched women without a prior cancer diagnosis, but significantly different relative REE.

Comparison of forward and backward gait characteristics between those with and without a history of breast cancer.

BACKGROUND: Decreased muscular strength and poorer postural stability impact the physical function of breast cancer survivors (BCS) and increases their risk of falls. Gait assessment, particularly in the backward direction, is often used as an indicator of fall risk in several populations. However this information is unknown in BCS. RESEARCH QUESTION: What are the differences in forward, backward, and accelerated forward walking in BCS in comparison to individuals without a prior cancer diagnosis? METHODS: 17 postmenopausal BCS (mean age: 58.5 (8.5) years) and 17 age-matched women without a prior cancer diagnosis (mean age: 59.11 (5.55) years) completed 5 trials each of forward, backward, and fast forward walking conditions. Absolute (Means) and variability (Coefficient of variation) estimates were obtained for spatio-temporal gait parameters. Lower body, upper body and handgrip strengths were measured. RESULTS: For absolute estimates of gait, significant group main effects indicated that BCS had 7% shorter step length (P = 0.019) and 8% slower gait speed (P = 0.048). For variability estimates of gait, there was a significant interaction for stance time (P = 0.035). BCS had greater stance time variability during forward and fast forward conditions, but lesser variability during backward condition. Averaged across all the conditions, BCS had 38% greater step length variability (P = 0.043), 50% greater gait speed variability (P = 0.028), and 28.5% greater single support time variability (P = 0.004). Averaged across both the groups, all the variables except for swing time variability were significantly different among the conditions (all P< = 0.013). BCS also had significantly reduced upper body strength (P = 0.036). SIGNIFICANCE: Slower and shorter steps while walking both forwards and backwards could be indicative of a more cautious gait strategy by BCS. Also, BCS possibly focused on controlling spatial parameters during forward walking but temporal parameters while backward walking. Whether these alterations are related to an increased fall risk within BCS needs to be determined.