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Adolescent Substance Use and HIV Risk: Event Analysis

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu

Date: September 1, 2004 to August 30, 2006
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R21AA015040)
Categories: Sexual Behavior and HIV Risk


Description: The purpose of this project is to examine the relationship of substance use to HIV risk behavior among adolescents in their first sexual encounters compared to more recent encounters. Reviews of studies of substance use and condom use in specific sexual encounters suggest that drinking is associated with nonuse of condoms or other contraception at first intercourse, but not in other kinds of sexual encounters. However, this proposition has not been explicitly tested. Using other drugs, either alone or with alcohol, might be associated with nonuse of condoms, but many existing studies do not separate the effects of alcohol and different types of drugs. In this project, we will use the National Longitudinal Study of Adolescent Health (Add Health), a large, nationally representative study of adolescents in grades 7 to 12, to investigate the role of drinking and other drug use in the use of condoms and other contraceptives in first and recent sexual encounters. We will: 1. Describe patterns of drinking, other drug use, and contraceptive use in the first sexual experience and the most recent sexual experience; 2. Use appropriate multilevel statistical techniques to assess the association of substance use and contraceptive use in these events; and 3. Investigate potential reasons for differences in the role of substance use and risk behavior in the two events, including the age of the respondent, the characteristics of the sexual partner, and the sexual experience of the partners.

Alcohol and Acquaintance Assault Risk Perception

Principal Investigator:
Jeanette Norris, PhD
Senior Scientist
Alcohol and Drug Abuse Institute
norris@u.washington.edu

Date: February 3, 2000 to May 31, 2005
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R01AA012219)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Kristen Mariano - Research Coordinator; Kim Nomensen - Research Assistant; Margaret Thomas - Research Assistant


Description: Sexual assault by acquaintances is a serious problem for young women. Approximately one in four experiences either rape or attempted rape, the overwhelming majority of which are committed by acquaintances. Alcohol consumption by the victim, assailant, or both is involved in more than half of these assaults.

One key element of sexual assault prevention is early perception of risk, which enables a woman to respond effectively and extricate herself from the situation before it escalates. In assessing risk and responding to it, women make a series of primary and secondary cognitive appraisals. Primary appraisals are those directed specifically to acknowledging and assessing the level of risk in a particular situation. Secondary appraisals involve weighing the ability to respond effectively against psychological barriers. A woman's own alcohol consumption and her perception of the assailant's consumption can affect this cognitive appraisal process.

This project, funded by NIAAA, will investigate alcohol's physiological, psychological, and expectancy effects on cognitive appraisals and responses to sexual assault. It will employ theoretical models of cognitive appraisal and coping and response conflict related to alcohol consumption. Data collection for the project is now complete, and data analysis is proceeding.

Alcohol and Condom Use: Different Levels of Measurement

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu

Date: August 1, 2002 to July 31, 2005
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R01AA013688)
Categories: Sexual Behavior and HIV Risk


Description: The purpose of this project is to examine the relationship of alcohol use to condom use from a methodological perspective. Studies on the link between drinking and risky sex have yielded inconsistent results that vary depending upon the method used to analyze the relationship. Although correlational studies show that heavier drinkers have more unprotected sex, studies of specific sexual encounters find that drinking reduces condom use only among adolescents, and studies that incorporate multiple sexual encounters per person show no relationship of drinking to condom use. Thus, measuring alcohol use and sexual behavior at different levels-the person level, the event level, and within person-results in different findings, but this variation in has not been studied systematically. The proposed study offers a unique opportunity to address an important substantive and methodological issue by explicitly examining how and why different methods used to examine the relationship between drinking and condom use have produced different results. In this project, we will: (1) Combine data from several general population surveys that use the same measures (2). Describe the relationship of drinking to unsafe sex at three different levels: the person level, the event level, and within person (3). Systematically investigate reasons for differences in findings from the three methods, including the presence of nondrinkers in the samples and the role of confounding individual differences (4). Examine the role of individual and situational factors-including sexual attitudes, expectancies about drinking and sex, and perception of risk-in explaining the alcohol-risky sex link at different levels.

Related Web Sites:
NIH RePORTER Record

Alcohol and Condom Use Resistance in Sexually Coercive/Violent Men

Principal Investigator:
Kelly Cue Davis, PhD
Research Assistant Professor
Social Work
kcue@u.washington.edu

Date: March 10, 2009 to March 31, 2014
Sponsor: National Institute on Alcohol Abuse and Alcoholism (5R01AA017608-02)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Jeanette Norris, PhD (ADAI Senior Research Scientist) (Co-Investigator)


Description: Emerging scientific evidence demonstrates that men's use of sexual coercion/violence (SCV) against women plays a critical role in risky sexual decision-making processes. Moreover, independent streams of research implicate alcohol intoxication in both violent and risky sexual behavior. Although the linkages among heterosexual women's alcohol use, SCV victimization, and sexual risk have received modest research consideration, the interplay of heterosexual men's alcohol intoxication, SCV perpetration, and risky sexual behavior has received little empirical attention. The overarching objectives of the proposed research are 1) to augment our understanding of the alcohol-SCV-risky sexual behavior nexus through an empirical examination of the influence of men's alcohol intoxication on their commission of risky and violent sexual behaviors and 2) to investigate the effects of alcohol intoxication and SCV history on men's responses to a variety of women's condom use requests.

Drawing upon Alcohol Myopia Theory, Alcohol Expectancy Theory, and the Theories of Reasoned Action and Planned Behavior (TRA/TPB), two experiments are proposed to investigate the influence of alcohol [Sober, Placebo (expect .04%), Moderate Dose (.04%), and High Dose (.08%)] and SCV-related factors on high risk men's outcome and normative beliefs, attitudes, norms, perceived behavioral control, and intentions regarding condom use resistance, unprotected sex, and SCV perpetration in a hypothetical sexual situation with a female partner. Female partner condom request factors, such as risk rationale (Experiment 1) and condom request style (Experiment 2), will also be manipulated between subjects. The role of background factors, such as SCV history, SCV-related attitudes, and alcohol expectancies, will also be assessed. We hypothesize that acute alcohol intoxication, as well as SCV-related factors, will influence TRA/TPB-related constructs and that measurement of these constructs in an intoxicated state will best predict real-world intoxicated sexual risk behavior as examined through 6-week and 3-month follow-up behavioral surveys of experiment participants. Findings from the proposed research will refine TRA/TPB models of risky and violent sexual behavior in three important ways: (1) by examining the influence of alcohol and SCV-related factors on relevant social cognitive constructs, (2) by allowing a novel examination of these TRA/TPB constructs in the context of in-the-moment intoxicated vs. sober states, and (3) by assessing the effects of condom request factors on men's condom use resistance and risky/violent sexual intentions. Findings have implications for preventions programs and clinical interventions, particularly those regarding alcohol- influenced risky sexual behavior and sexual violence.

RELEVANCE: Two major public health concerns in the United States involve sexual behavior: sexual coercion/violence and sexually transmitted infections. Alcohol intoxication in men has been linked to increased sexual violence and increased risky sexual behavior. The proposed project thus has relevance for both women's and men's health by seeking to close key knowledge gaps regarding the relationships among men's intoxication, sexual violence, and sexual risk behavior in ways informative to sexual risk and sexual violence prevention efforts.

Related Web Sites:
NIH RePORTER record

Alcohol and HIV/AIDS Risk-Taking

Principal Investigator:
William H. George, PhD
Associate Professor
Psychology
bgeorge@u.washington.edu

Date: September 26, 2001 to August 31, 2006
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R01AA013565)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Jeanette Norris, PhD (ADAI Senior Research Scientist)


Description: Alcohol has emerged as a critical cofactor in HIV infection. Yet we still lack an understanding of how in-the-moment forces -- such as acute intoxication -- affect a person's decision to engage in risky behaviors. Our long-term goal is to illuminate the role played by intoxication in decision-making related to infectious diseases. Perhaps there exist heretofore-uninvestigated biphasic effects that would clarify paradoxical evidence of alcohol-induced suppression and associated outcomes. Such consideration may expand our understanding of alcohol and risky outcomes. The specific aims are (1) to examine the linkages among alcohol and risky behavior; (2) to evaluate the viability of the alcohol myopia model for explaining postdrinking attitudes and behavior; (3) to investigate alcohol impairment of behavior control; and (4) to expand the currently scant fund of experimental data about women after drinking by evaluating for systematic gender differences in these relationships for intoxication and risky behavior. To address these aims, six controlled laboratory experiments are planned systematically manipulating alcohol (alcohol, none), BAC limb (ascending, descending), dosage (moderate, high), behavioral activation (maximize, none, suppress), and conflict (high, low). The sample will be elevated-risk, unmarried men and women attending urban university campuses and/or residing in urban census tracts. The overarching hypothesis is that alcohol impairs the capacity to inhibit behavior and that it directly and indirectly (through its impairment of inhibition) impairs the capacity to inhibit risk-taking. Alcohol should interact with limb such that ascending exceeds descending impact and should interact such that alcohol fosters riskier outcomes under high conflict. In concert with personality and other factors, the data may inform key knowledge gaps, advance theory, and foster refinement of existing prevention approaches and formulation of new ones.

Alcohol and Women's Cognitive Mediation of HIV Risk Taking

Principal Investigator:
Jeanette Norris, PhD
Senior Scientist
Alcohol and Drug Abuse Institute
norris@u.washington.edu

Date: September 22, 2003 to August 31, 2009
Sponsor: National Institute on Alcohol Abuse and Alcoholism (5R01AA014512-05)
Categories: Sexual Behavior and HIV Risk

Other Investigators: George, William H PhD (Psychology); Morrison, Diane M PhD (School of Social Work); Zawacki, Tina PhD (University of Texas San Antonio)


Description: This project will experimentally investigate alcohol's physiological and expectancy set effects in young women of drinking age, as well as the role of alcohol expectancies in 18-20 year old women, regarding their appraisals of HIV risk, condom negotiation, and sexual decision making.

The proportion of all AIDS cases reported among women has more than tripled since 1985. It appears that relationships with men are the greatest source of HIV risk for women. Women's ability to successfully negotiate is an important component of the process. Although the ultimate decision to use preventative measures is the man's, in a consensual encounter, there is still an opportunity for a woman to insist or influence that decision. Alcohol consumption can interfere with the effectiveness of a woman's negotiation and the decision not to be involved in risky behavior.

We propose that these outcomes are cognitively mediated by a series of primary and secondary appraisals during these encounters. Primary appraisals are those directed toward recognizing that a situation is likely to lead to these inevitable men-women encounters. Secondary appraisals involve assessing the advantages and disadvantages of engaging in negotiation, and can influence the effectiveness of the negotiation. In addition to being influenced by alcohol, both directly through actual consumption and indirectly through expectancies, these secondary appraisals and subsequent negotiation can be influenced by the type of relationship the woman has with the man and her knowledge about his relationship history. Ultimately these will lead to her decision whether to have unprotected relationship.

Theoretical models of cognitive mediation and the effects of alcohol consumption and expectancies provide the foundation for this work. Four experiments are proposed to investigate physiological and expectancy set effects in young women of drinking age. An additional four experiments will investigate the role of alcohol expectancies in 18-20 year old women. Manipulated variables in the between-subjects experimental design include relationship type and knowledge of partner's relationship history, depending on the experiment. The role of background factors related to the relational self, and victimization history will also be examined. This work will provide important information about how women's alcohol consumption and expectancies about relationships affect their assessment of situations, negotiation, and decisions about unprotected involvement. Findings have implications for designing prevention interventions, especially related to alcohol's role as a risk factor for contracting HIV.

Related Web Sites:
NIH RePORTER record

Alcohol and Women's Health Risk Reduction: An Innovative Experimental Approach

Principal Investigator:
Tina M. Zawacki, PhD (University of Texas San Antonio)

Date: July 20, 2010 to June 30, 2012
Sponsor: National Institute on Alcohol Abuse and Alcoholism (1R21AA018403-01A1)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Jeanette Norris, PhD (ADAI Senior Research Scientist)


Description: Sexually transmitted diseases pose an increasingly serious health threat to women, and alcohol consumption may increase women's risky decision-making and behavior with regard to these risks. The proposed project will examine this major public health concern by studying the influence of alcohol on risk reduction skills.

The goal of the proposed research is to reduce the risk of sexually transmitted diseases by delineating the mechanisms through which alcohol affects risk reduction behavioral skills. Rates of sexually transmitted diseases remain high. Survey research suggests that young women are not skilled at behaviors that reduce this risk, and alcohol consumption may further impair these behavioral skills. Although previous studies have contributed valuable information about alcohol's relationship to unsafe sex, there is a paucity of experimental research involving actual behavioral responses during social interactions. The proposed study utilizes experimental methods in order to investigate alcohol's effects on women's behavioral skills at negotiating safe sex during a face-to-face role-play with an opposite-sex actor.

The theoretical underpinnings of the proposed research are the Cognitive Mediation Model of Sexual Decision Making (Norris, Masters, & Zawacki, 2004), Alcohol Myopia Theory (Taylor & Leonard, 1983), and Alcohol Expectancy Theory (MacAndrew & Edgerton, 1969). The proposed study is a laboratory experiment using a 3 (Alcohol condition of participant: No Alcohol, Placebo, Alcohol - .08 BAC) X 2 (Relationship Context: New, Established) design. Alcohol consumption and characteristics of the role-play contexts are manipulated in the proposed laboratory experiment. Manipulated characteristics of the role-play reflect aspects of sexual decision-making that may create response conflict for women. Theories about alcohol's effects on cognition suggest that it is high response conflict situations that are especially vulnerable to alcohol-related risk taking. Each laboratory session will be videotaped and coded in order to assess participants' risk reduction behavior during the role-play. Self-report dependent measures will assess constructs of a recently developed Cognitive Mediation Model so that its utility in explaining alcohol- involved risk taking can be tested. Prior to the laboratory session, participants' alcohol expectancies will be assessed as a potential moderator of alcohol's effects on participants' negotiation behavior and cognitive model variables. The study paradigm was designed to simulate real situations in which safer-sex negotiations commonly occur. The results can be used to develop prevention programs that reduce women's risk taking when drinking. These results will be most informative for programs aimed at the reduction of risk for sexually transmitted diseases.

Related Web Sites:
NIH RePORTER record

Alcohol Effects on Cognitive and Affective Mediation of Women's Decision-Making (Project WIN)

Principal Investigator:
Jeanette Norris, PhD
Senior Scientist, Alcohol and Drug Abuse Institute
norris@u.washington.edu
http://bit.ly/adaistaff_norris

Date: September 30, 2009 to August 31, 2014
Sponsor: National Institute on Alcohol Abuse and Alcoholism (2R01AA014512-06A1)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Devon Abdallah, PhD (Project Manager); Anita Rocha (Data Manager); Joy Chan; Tina M. Zawacki, PhD (Co-Principal Investigator)


Description: Alcohol consumption increases risk-related behavior, and decision-making is cognitively and emotionally complex when a person is intoxicated. Understanding in-the-moment processes affecting women’s decisions while intoxicated is critical to informing prevention efforts.

This study will examine relationships among alcohol consumption, a partner’s coercion, and women’s risk-related decisions. It will draw on four theoretical lines: 1) the Cognitive Mediation Model (Norris et al., 2004), which examines the extent to which cognitive appraisals mediate the influence of background and situational factors on emotional and risk-related decisions ; 2) Alcohol Myopia Theory (Taylor & Leonard, 1983), which explicates the influence of alcohol-related cognitive impairment on behavior; 3) the Appraisal-Disruption Model (Sayette, 1993), which addresses alcohol’s cognitive impairment effects on emotional responding; and 4) Alcohol Expectancy Theory (Goldman, 1999; MacAndrew & Edgerton, 1969), which describes how alcohol influences behavior through cultural and individual expectations about alcohol’s effects.

The study will include a laboratory-based alcohol administration experiment to establish causal connections between manipulated situational factors, including alcohol consumption, and cognitive appraisals, emotional responses, and in-the-moment risk-related decisions. It will also employ a longitudinal survey to examine how in-the-moment decisions translate to actual situations. Structural equation modeling will be used to examine background and situational factors, as well as situationbased cognitive and emotional mediators, as predictors of in-the-moment decisions. Background and situational models will be examined using longitudinal data analytic techniques, including survival analysis, latent transition analysis, and growth curve modeling.

Related Web Sites:
NIH RePORTER record

Alcohol's Influence on Women's Cognitive Appraisals of Sexual Assault Risk and Subsequent Responses

Principal Investigator:
Jeanette Norris, PhD
Senior Scientist
Alcohol and Drug Abuse Institute
norris@u.washington.edu

Date: Project completed
Sponsor: Alcohol and Drug Abuse Institute
Categories: Sexual Behavior and HIV Risk


Description: Sexual assault by acquaintances is a serious problem for young women. Approximately 1 in 4 experience either rape or attempted rape, the overwhelming majority of which are committed by acquaintances. Alcohol consumption by the victim, assailant or both is involved in more than half. One key element of sexual assault prevention is early perception of risk, which enables women to respond effectively and extricate herself from the situation before it escalates. In assessing risk and responding to it, women make a series of primary and secondary cognitive appraisals. Primary appraisals are those directed specifically to acknowledging and assessing the level of risk in a particular situation. Secondary appraisals involve weighing the potential to respond effectively against psychological barriers preventing effective responding. Both women's own alcohol consumption and their perception of the assailant's consumption can affect this cognitive appraisal process. Theoretical models of cognitive appraisal and coping and response conflict related to alcohol consumption provide the foundation for the proposed work. One experiment will investigate alcohol's physiological effects on women's primary and secondary cognitive appraisals to a sexual assault scenario and subsequent responses. In addition to women's alcohol consumption, manipulated variables include the level of prior relationship between the woman and the assailant and the assailant's alcohol consumption. This work will provide important information about how women's alcohol consumption affects perception of risk and subsequent responding to it. Findings have implications for designing prevention interventions, especially related to alcohol's role as a risk factor for sexual assault.

Community-Based Study of Gay Men, HIV, and Drugs

Principal Investigator:
Michael E. Gorman, PhD, MPH, MSW
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: National Institute on Drug Abuse
Categories: Sexual Behavior and HIV Risk


Description: This study, funded by NIDA, uses ethnographic methods including focus groups, observation and structured interviewing to describe ways in which methamphetamine use contributes to HIV risk through injection drug use and unprotected sex. This exploratory study conducts interviews with homosexually active methamphetamine injectors in Seattle in order to:

Describe factors influencing the natural history of methamphetamine injection among homosexually active men (MSMs);

Characterize and describe common behaviors and social patterns which provide the contexts for this drug use regarding unprotected sex and needle sharing;

Describe preliminary typologies of social networks of MSM methamphetamine injectors and determine whether common injection patterns link gay and bisexual men with heterosexual men and women via sex and/or injection;

Identify intervention points so as to inform the development of prevention and intervention strategies targeted to MSMs who use methamphetamines.

Computerized Assistance for Treatment Professionals in Assessment of Sexual Risk

Principal Investigator:
Donald A. Calsyn, PhD
Research Scientist
Alcohol and Drug Abuse Institute
dcalsyn@u.washington.edu
http://bit.ly/adaistaff_calsyn

Date: September 28, 2007 to August 31, 2010
Sponsor: National Institute on Drug Abuse (5R21DA022940-02)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Bryan Hartzler, PhD (ADAI Research Scientist)


Description: The proposed work represents the first steps in the development of a larger program to change the context in which sexual risk assessment and sexual risk reduction interventions occur in substance abuse treatment agencies. Previous research in addiction treatment and primary care settings suggests that clients in substance abuse treatment engage in high risk sexual behaviors; that sexual risk behaviors show some decline simply with engagement in treatment; and that professionals can be trained to implement risk-reduction interventions. This is important in the context of reducing risks of HIV and STD transmission in this population. A multi-phase program is proposed with the goal of pilot testing a low-cost, brief HIV risk assessment and prevention intervention with adults in treatment. Phase 1: Develop an audio computer-assisted self-interviewing (ACASI) based HIV risk assessment and feedback tool. A tool previously used in a multi-site, randomized clinical trial, the Sexual Behavior Inventory (SBI), will be modified for use as a brief assessment and feedback tool, Being Safe in Treatment (BEST). Modifications will include shortening the assessment and adding a client and a staff feedback report. The client report will identify behaviors that put them at risk for HIV and other STDs and will include suggestions for reducing risks. The staff report will include the same client report information plus suggested approaches for addressing sexual risk behaviors. Phase 2: Determine the acceptability of the BEST for use by both clients and counselors. The BEST assessment will be administered to 16 men and 16 women enrolled in substance abuse treatment. Both clients and treatment providers will be provided with the BEST feedback reports based on client responses to the assessment. Four focus groups will be conducted with clients completing BEST, and two focus groups will be conducted with staff who will review sample BEST feedback reports. Clients completing the BEST will answer a brief survey regarding the ease of completing the assessment tool. Based on the feedback, the BEST will then be modified to improve question clarity, delete any sections deemed irrelevant, or add sections which respondents felt were lacking. The above process will be repeated with 16 additional men and 16 women in treatment and their counselors in the effort to finalize the tool. Phase 3: Conduct a pilot study on the effectiveness of the BEST to increase client HIV knowledge, motivation for sexual risk reduction, condom use skills, and counselor-client communication about HIV risk behaviors. The BEST assessment will be administered to 200 clients newly admitted to treatment. The assessment will be repeated after three months. Clients will be randomized to one of 4 conditions in a 2 (client feedback) by 2 (counselor feedback) design. We hypothesize that the combination of BEST assessment with feedback to both clients and counselors will be more effective at increasing: HIV/AIDS knowledge, motivation to reduce sexual risk, condom use skills, and communication about sexual issues than assessment only or assessment with feedback to only the client or the counselor.

Results: Hartzler B, Beadnell, B, Calsyn DA. Use of sexual risk assessment and feedback at intake to promote counselor awareness of subsequent client risk behavior during early treatment. Subst Use Misuse 2014 (in press) doi: 10.3109/10826084.2014.891622

Related Web Sites:
NIH RePORTER record

Daily Event Analysis of Alcohol/Drug Use and Risky Sex

Principal Investigator:
Mary L. Gillmore, PhD
Professor, Social Work

Date: July, 1994 to June, 2000
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Sexual Behavior and HIV Risk

Other Investigators: Barbara C. Leigh, PhD, MPH (ADAI Senior Research Scientist, Co-Investigator)


Description: This study seeks to understand the nature of the relationship between substance use (alcohol and drugs) and sexual risk taking in four groups of persons believed to be at risk of AIDS and other sexually transmitted diseases (STD). The four groups are: adolescents and adults attending a public health STD clinic, university students, and gay men attending the STD clinic or an AIDS prevention project. The study also seeks to determine which method, either daily diaries or daily telephone interviews, is best for obtaining daily event data on risky behaviors. The ultimate aim of the study is to provide useful data for AIDS education and prevention efforts.

Related Web Sites:

Enhancing Recall of Sexual and Drug Injection Partners

Principal Investigator:
Devon D. Brewer, PhD
Research Scientist
Alcohol and Drug Abuse Institute
http://faculty.washington.edu/ddbrewer/

Date: Project completed
Sponsor: National Institute on Drug Abuse
Categories: Sexual Behavior and HIV Risk

Other Investigators: Sharon Garrett (Research Consultant)


Description: Individuals are asked to recall their sexual and drug injection partners in interviews for HIV partner notification and social network research on HIV transmission. Research suggests that the recall of this information may be incomplete, which may hamper efforts to understand and prevent HIV transmission. The first phase of this NIDA-funded project is a study to estimate the magnitude of the incompleteness of recall of sexual and drug injection partners, identify the factors involved with not naming partners, and describe patterns in the recall of partners. In the second project phase, the results from the first study will be used to develop and pilot test different recall strategies and cues for enhancing recall of partners. Promising recall strategies and cues will be included in a systematic interview procedure for enhancing recall of sexual and drug injection partners. In the final phase of the project, the effectiveness of this new procedure will be evaluated in partner notification and social network research contexts. Subjects for all three phases will be recruited from a large study of drug injectors in Seattle and the largest clinic for HIV testing and counseling in the Seattle metropolitan area.

HIV, Drugs, and Sexual Risk in DUMSMs: A Community Study

Principal Investigator:
Michael E. Gorman, PhD, MPH, MSW
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor:
Categories: Sexual Behavior and HIV Risk


Description: Men who have sex with men and who abuse drugs (DUMSM) have not received the same research attention as other drug users. In light of alarmingly high HIV seroprevalence among this hidden and multifaceted population, especially among DUMSM who inject drugs, this ethnographic study in metropolitan Seattle, Washington seeks to better understand this high risk group. The study will focus in particular on the use of methamphetamines among this population and its correlation with HIV infection. This study builds on the findings of an earlier exploratory study, and especially on the directions for community prevention research which have emerged from that project.

HIV, Hepatitis, STD and Reproductive Health Risk Behaviors among Female Seattle Methamphetamine Users

Principal Investigator:
Michael E. Gorman, PhD, MPH, MSW
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: UW Center for AIDS Research
Categories: Sexual Behavior and HIV Risk


Description: Methamphetamine use has increased rapidly in the Seattle area and in other regions of the U.S. in recent years. Within the growing epidemic, women appear to be at increased risk for both methamphetamine use and HIV, as indicated by rising treatment admissions (a 1240% increase between 1992 and 1998). This project, funded by the UW Center for AIDS Research, expands on earlier research by collecting data on 25 female methamphetamine users in Seattle. Participants will be interviewed about their drug use patterns, sexual behavior, reproductive health and risk, HIV/AIDS, hepatitis and other STD risk behavior, and quality of life including the presence of violence. The study will provide a profile of female methamphetamine users that could support the generation of effective intervention strategies.

Implicit Cognition and HIV Risk Behavior in Drug Users

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu

Date: August 1, 1998 to July 31, 2005
Sponsor: National Institute on Drug Abuse (R01DA012101)
Categories: Sexual Behavior and HIV Risk


Description: In recent years, a growing body of research has demonstrated that the use of alcohol or drugs with sex is related to the occurrence of unsafe sexual activities-notably unprotected intercourse-that place an individual at risk for pregnancy or disease transmission, however, contradictory findings also exist (Leigh & Stall, 1993). Despite an explosion of research in recent years of research on this topic, there has yet been no attempt to identify all existing studies, suggest factors that may affect heterogeneity among study findings, and analyze these factors quantitatively. The objectives of the proposed research are to further explore the relationship of substance use to risky sexual behavior by conducting a meta-analysis of existing studies of this relationship. The results of this analysis can enhance understanding the dynamics of the relationship of substance use to risky sexual behavior, thereby contributing to research, preventive and education efforts to contain the spread of AIDS.

Related Web Sites:
NIH RePORTER Record

Informing Dissemination of Behavior Therapies to Enhance HIV Care Among Substance Abusers

Principal Investigator:
Bryan Hartzler, PhD
Research Scientist
Alcohol and Drug Abuse Institute
hartzb@u.washington.edu

Date: April, 2015 to March, 2017
Sponsor: National Institute on Drug Abuse (NIDA R03DA039719)
Categories: Clinical and Health Services | Sexual Behavior and HIV Risk

Other Investigators: Blair Beadnell, Heidi Crane, Julia C. Dombrowski, Dennis M. Donovan


Description: Substance abuse and HIV infection are a domestic health syndemic that compromises universal test-and-treat approaches for preventing HIV transmission and precipitates calls for quality improvement across the HIV Care Continuum. Dissemination of an empirically-supported behavior therapy to prompt HIV testing in addiction care settings is a large-scale effort, but with benefits attenuated by substance abusers’ poor clinic attendance and antiretroviral (ARV) therapy adherence. Thus, expanded transport of available empirically-supported behavior therapies to HIV care settings is needed to pre-empt such care disengagement. To identify a candidate therapy compatible for HIV care, one must consider with whom and with what intent the HIV workforce is to intervene. Extant prevalence rates for substance use disorders (SUDs) among HIV care enrollees are drawn from single-site trials, and vary by selected patient demography and history. Corresponding sample sizes often preclude analysis at a substance-specific level, even as some substances carry distinct considerations for transmission and course of HIV. Likewise, single-site trials evaluating impacts of substance abuse on patient adherence and response to HIV care offer limited generalizability. Fortunately, a coordinated multisite HIV care repository, governed by Center for AIDS Research Network of Integrated Clinical Systems (CNICS), incorporates data from sites across the U.S. and offers opportunity to determine the scope and impact of substance-specific SUDs in a large, diverse population of patients linked to HIV care. Proposed analyses will focus on care engagement, defined as a two-year period following HIV diagnosis and linkage to care. An available CNICS sample of ~10,000 patients will enable computation of broadly representative prevalence rates for substance-specific SUDs and comparisons of such SUD subgroups to non-SUD patients on key outcomes like cumulative viral burden, clinic attendance, ARV adherence, health risks, and quality-of-life. Relative to non-SUD counterparts, SUD subgroups are expected to exhibit greater viral burden, poorer clinic attendance and ARV adherence, more health risks, and lesser quality-of-life. In response to NIDA PA-12-282 (AIDS-Science Track Award for Research Transition), a New Investigator to HIV Research proposes to complement these CNICS-based analyses by gathering of dissemination-focused data during site visits to regional HIV care clinics. Data will be collected from site directors and direct-care staff via mixed-method procedures, with intent to identify from among NIDA-endorsed candidate behavior therapies an approach perceived as contextually-compatible. This low-cost, high-yield approach will advance knowledge of the SUD-HIV syndemic, and inform a future R01 testing implementation of an empirically-supported behavior therapy to engage substance abusers in HIV care.

Interviewer Factors in the Elicitation of HIV Risk Networks

Principal Investigator:
Devon D. Brewer, PhD
Research Scientist
Alcohol and Drug Abuse Institute
http://faculty.washington.edu/ddbrewer/

Date: Project completed
Sponsor:
Categories: Sexual Behavior and HIV Risk


Description: Social network studies of HIV transmission and partner notification disease control activities are crucial for understanding and preventing transmission of HIV and other infections. Both efforts involve the elicitation of HIV risk network data (i.e., names of and other information about specific sexual and drug injection partners). The success of these efforts in providing insight on and controlling the spread of HIV depends heavily on the completeness, reliability, and validity of these self-reported, recall-based data. Research shows that the recall of sexual and injection partners is substantially incomplete. The overall goal of this small grant project is to improve interviewing procedures and techniques to maximize the completeness, reliability, and validity of recall-based data on sexual and drug injection partners in both research and partner notification contexts. This project focuses on the interviewing situation, including interviewer characteristics and interviewer behaviors, as it influences the quality and quantity of HIV risk network data elicited. The project consists of three main activities: 1) examination of interviewer effects on the completeness and reliability of HIV risk network data in secondary analysis of three extensive data sets (from two research studies and one data base of partner notification records); 2) qualitative description of the interviewing techniques used by veteran Disease Intervention Specialists (DIS) in their partner notification interviews; and 3) a randomized controlled trial of supplementary interviewing techniques and procedures, based in part on the results of the first two activities, for enhancing recall of sexual and drug injection partners in a partner notification context.

Maximizing the Patient-counselor Relationship to Reduce Sexual Risk Behavior [Being Safe in Treatment (BEST)]

Principal Investigator:
Mary Hatch-Maillette, PhD
Research Scientist
Alcohol and Drug Abuse Institute

Date: September 23, 2014 to May 31, 2018
Sponsor: National Institute on Drug Abuse (1R01HD078163-01A1)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Co-Principal Investigator: Elizabeth Wells, PhD


Description: Achieving sexual risk reduction among people suffering from substance use disorders (SUDs) has proven challenging but not impossible. Substance abuse treatment presents an opportunity to intervene, and there is a need for continued development of sexual risk reduction interventions that can be integrated into treatment settings. Our research group developed the “Being Safe in Treatment” (BEST) sexual risk assessment and feedback tool with funds from an R21 grant “Computerized assistance for treatment professionals in the assessment of sexual risk” (Donald Calsyn, PI; DA022940). The BEST uses the audio computer-assisted self-interviewing (ACASI) method to determine sexual risk in substance abuse treatment patients. It provides a personalized feedback report for the patient and the patient’s counselor that summarizes the assessment and offers suggestions for reducing sexual risk. The primary goal of the BEST tool is to assist patients in reducing sexual risk behavior or maintaining low risk behavior. The hypothesized change mechanism is enhanced communication between counselor and patient about sexual risk. We seek funding for next steps in testing this intervention. In the R21 BEST development studies, we obtained qualitative feedback about the BEST from potential consumers (substance abuse treatment patients and their counselors) and conducted a brief pilot study on the impact of using the BEST in a methadone maintenance clinic. From these studies we received and then incorporated suggestions on ways to improve the BEST, such as reducing the time needed to take the BEST and adjusting the feedback report to better incorporate the reduced risk associated with long term monogamy. In the pilot study, receiving a BEST feedback report was associated with increased counselor knowledge about patient sexual risk behavior and an increase in patient-counselor discussions about sexual issues. However, many counselors felt unprepared to discuss sexual issues with their patients, suggesting a need for counselor training and providing the impetus for the current proposal. We propose to conduct a 2 x 2 clinical trial in which half of study counselors are randomly assigned to 1) a control condition (a 2 hour training on utilizing a BEST feedback report or 2) the same 2 hour training plus an 8 hour workshop on discussing sexual issues followed by twice monthly coaching. Patients of participating counselors will complete the BEST assessment and will be randomly assigned to receive no feedback or the BEST feedback which includes a personalized report for them and a report to their counselor. Data collection will occur for patients at baseline, 3-months, and 6-months, and for counselors at baseline, post-workshop and 3-months. The primary outcome is the number of unprotected sexual occasions in the prior 3 months and number of counseling sessions in which sexual issues were addressed. Counselor level outcomes of interest include change in counselor sexual knowledge, self-efficacy for addressing sexual matters, and skills for ddressing sexual issues in counseling sessions.

Substance Use and HIV Risk

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu
http://bit.ly/adaistaff_leigh

Date: May 1, 2005 to April 30, 2010
Sponsor: National Institute on Alcohol Abuse and Alcoholism (K05 AA015050)
Categories: Sexual Behavior and HIV Risk


Description: Goals for the five-year period include a) investigating the relationship of substance use to HIV risk behavior from a methodological perspective, incorporating person-level, event- level, and within-person analyses; b) studying the association of alcohol and other drug use to risk behavior in a national sample of adolescents; and d) developing new projects to expand research in both these areas. The career plan also includes continued collaboration with local and international colleagues in scientific activities, and expansion of mentoring and science education.

Related Web Sites:
NIH RePORTER record

Substance Use and Predictors of Risk Behavior

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu

Date: May 1, 1994 to April 30, 2005
Sponsor: National Institute on Alcohol Abuse and Alcoholism (K02AA000183)
Categories: Sexual Behavior and HIV Risk


Description: This project is an Independent Scientist Award allowing Dr. Leigh to continue her program of research on substance use and risk behavior. The major goal for this award period is to explore different methodological approaches to examining substance use and risky sexual behavior. The research program includes a meta-analysis of existing studies on the relationship of substance use to risky sexual behavior and a study that uses a daily event data collection methodology to investigate the nature of relationships between substance use and risky sexual behavior. Plans for career enhancement include further training in epidemiology and biostatistics and collaboration with colleagues in public health disciplines.

Tailoring "Real Men Are Safe" for African American and Hispanic Men

Principal Investigator:
Donald A. Calsyn, PhD
Research Scientist
Alcohol and Drug Abuse Institute
dcalsyn@u.washington.edu
http://bit.ly/adaistaff_calsyn

Date: September 30, 2009 to August 31, 2011
Sponsor: National Institute on Drug Abuse (5RC1DA028245-02)
Categories: Sexual Behavior and HIV Risk | CTN (NIDA Clinical Trials Network)

Other Investigators: Mary Hatch-Maillette and Lynette Wright


Description: Prior research has demonstrated that the Real Men Are Safe (REMAS) HIV prevention intervention has been effective in helping men in substance abuse treatment lessen their sexual risk behavior. However, the intervention appeared to be more effective with whites as compared to African Americans and possibly Hispanics. The goal of this research is to develop a version of REMAS culturally tailored to be appropriate with African American and Hispanic men.

The Center for Disease Control and Prevention (CDC) reports that Blacks and Hispanics are overrepresented among men with HIV infection compared to Whites. The Clinical Trial Network (CTN) of the National Institute on Drug Abuse (NIDA) recently completed a randomized clinical trial evaluating the utility of the REMAS HIV prevention intervention targeting men in substance abuse treatment. Men assigned to the REMAS groups engaged in fewer unprotected vaginal and anal intercourse occasions during the 90 days prior to the 3- and 6-month post-intervention follow-ups than men assigned to a standard HIV Education group. Post hoc analyses suggest Whites benefited more from the intervention than African Americans, and possibly Hispanics. The challenge proposed in this application is to revise the REMAS intervention, shown to be effective in the multisite CTN trial, to be more culturally relevant to African American and Hispanic participants. A two phase study is proposed for revising the REMAS intervention. In Phase 1 we will conduct formative research by convening a panel of academic and community based experts knowledgeable in HIV prevention in African American and Hispanic communities. Utilizing the Delphi process panel members will review the REMAS materials and make suggestions for revisions. The panel will be asked to help develop a revised version of the REMAS intervention which would be culturally viable for a mixed group of whites, African Americans and Hispanics. In phase 2 the revised REMAS version would be pilot tested for feasibility and acceptability in four community treatment programs within the NIDA CTN which have high percentages of either African American and/or Hispanic clientele.

Related Web Sites:
Original REMAS protocol in CTN Library
"Real Men Are Safe" (REMAS) Manual
NIH RePORTer record

Women's HIV Risk: Alcohol Intoxication, Victimization History, & Partner Factors

Principal Investigator:
William H. George, PhD
Associate Professor
Psychology
bgeorge@u.washington.edu

Date: September 27, 2007 to August 31, 2012
Sponsor: National Institute on Alcohol Abuse and Alcoholism (5R01AA016281-04)
Categories: Sexual Behavior and HIV Risk

Other Investigators: Jeanette Norris, PhD (ADAI Senior Research Scientist) (Co-Investigator)


Description: HIV infection is currently the 6th leading cause of death among American women aged 25-34 years, and heterosexual contact accounts for 80% of HIV infections in women. Highly controlled laboratory experiments have indicated that alcohol intoxication fosters HIV-related risk behaviors; this may be particularly true among women with a history of child sexual abuse (CSA) or later sexual assault (SA), who it is estimated comprise over 20% of all women. Research has also shown CSA-positive (CSA+) and SA-positive (SA+) women are at higher risk of HIV infection than those without such a history. This heightened risk may in part be related to alcohol use. Because the bulk of the extant research has been descriptive and correlational, virtually nothing is known about how alcohol and contextual factors such as partner characteristics operate in-the-moment to affect sexual decision-making (SDM) processes of CSA+/SA+ women, potentially increasing their risk of contracting HIV. The present project addresses this knowledge gap. Two large scale alcohol administration experiments will examine risky SDM processes among female social drinkers, aged 21-30, with and without victimization histories, in an experimental dating analogue. Drawing on existing theory, one type of partner characteristic will be manipulated in each experiment: a recent partner's relationship potential (low v. high); and an ongoing partner's pressure to have unprotected intercourse (low pressure vs. high pressure). Alcohol myopia theory will be employed as a potentially useful theoretical framework. Possible mediators of the risky SDM-alcohol connection that will be investigated in-the-moment include risk perception, self-efficacy, and anticipated partner reaction to condom negotiation. Potential moderating influences of background characteristics will also be explored, including alcohol expectancies and drinking habits, sensation seeking, traumatic sexualization, condom attitudes and sexual experiences, as well as prior victimization factors, such as type, age, and severity.

Relevance: The proposed studies will advance our understanding of in-the-moment dynamics of risky HIV-related decision-making and behavior in intoxicated and sober binge-drinking women who have and have not been sexually victimized. Findings will greatly inform designers of prevention programs, who remain frustrated in their efforts to stem the spread of HIV in women and eager to learn of new and promising targets for intervention. The information gleaned from the proposed studies could be used to design HIV prevention programs that work for social-drinking women, particularly those with a history of victimization, a substantial but underserved population.

Related Web Sites:
NIH RePORTER Record


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