1999 — 2002 |
Halkitis, Perry N |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Protease Inhibitor Adherence Among Drug Users @ New Jersey City University
This investigation seeks to achieve two main goals: (1) to examine the direct and indirect impact of drug use, as well as other socioeconomic, biomedical, cognitive, emotional, and behavioral factors nested within the structure of the Health Belief Model, on adherence to protease inhibitors (PIH) among HIV seropositive (HIV+) men who have sex with men (MSM) in New York City (NYC); and (2) to explore the consequences of PIH use on HIV transmission sexual risk behaviors in order to understand their role in the continuing epidemic. Our ultimate purpose is to gather information necessary to assist community-based organizations design and implement effective interventions to increase adherence to medication and decrease HIV transmission behaviors among drug using and abusing populations. This research will be undertaken by behavioral research psychologists at the Center for HIV/AIDS Educational Studies and Training (CHEST) at New Jersey City University (NJCU). In addition, researchers from the Columbia University HIV Center, University of California-San Francisco, and St. Lukes/Roosevelt AIDS Center will serve as consultants to the project. The study aims to recruit and then longitudinally follow a sample of 300 HIV+ MSM, stratified based on drug use (100 non drug users, 100 drug-users, and 100 drug abusers) for a 12 month period using both qualitative and quantitative methodologies, as well as electronic, self-report, and biological measures of adherence. Participants will be recruited through active and passive recruitment strategies, targeting AIDS Service Organizations (ASOs), Mainstream Gay Venues (MGVs) such as bars, bookstores, and street corners, and Public Sex Environments (PSEs), in order to obtain a diverse sample of HIV+ MSM in NYC. Generalized linear, Markov regression, and structural equation modeling will be used to achieve the study's goals.
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2000 — 2003 |
Halkitis, Perry N |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Club Drug Use and Men's Health--a Community Study @ New Jersey City University
DESCRIPTION: (Applicant's Abstract) The proposed investigation seeks to examine the use of "club" drugs among gay /bisexual men in New York City (NYC) and build upon the previous work of the investigators. We will undertake a longitudinal investigation guided by the following three aims: (1) to determine the individual differences and changes in club drug use among gay/bisexual men in NYC over the course of one year; (2) to determine the extent to which antecedent person factors, contextual factors, and coping factors explain differences in year-long club drug use trajectories of gay/bisexual men in NYC; and (3) to determine how individual changes in club drug use over the course of a year, in combination with antecedent person factors, contextual factors, coping factors, explain differences in sexual risk-taking patterns in the course of one year among gay/bisexual men in NYC. Our work will be guided by cognitive escape theory as we seek to determine how antecedents of club drug use influence the use of these substances, and how the interaction of these antecedents with actual use of club drugs leads to cognitive disengagement and sexual risk taking in terms of HIV infection and potentially reinfection. Our work will focus on five club drugs used primarily by gay/bisexual men in NYC: cocaine, GFIB, ketamine, MDMA, and methamphetamine. We will recruit 450 men into our investigation and undertake assessments of the antecedents, club drugs use, and sexual risk-taking behaviors 4 times over the course of one year, and utilize univariate and multivariate growth curve modeling to determine the relationships between these factors as a mean of undertaking theory testing; this will be complemented by our use of qualitative techniques, using the Critical Incident Measure, to provide us with episode-specific data to help realize the relationships that we are assessing as well as further develop the theory of cognitive escape. Our work will be conducted entirely with a community-based sample of seropositive, seronegative, and serostatus unknown gay/bisexual men and through our affiliations with the numerous mainstream gay venues, public sex environments, and community based organization that serve gay/bisexual men in NYC.
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2009 — 2013 |
Halkitis, Perry N |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Syndemic Production Among Emergent Adult Men
DESCRIPTION (provided by applicant): Recent trends in U.S. urban centers indicate a rise in the number of new HIV infections in the population of young men who have sex with men (YMSM). These trends suggest a high level of vulnerability to HIV seroconversion in YMSM through sexual behavior as they emerge into adulthood. In addition, acts of sexual risk taking in this population often function synergistically with illicit drug use, and mental health burden. Despite some success with HIV prevention in the MSM population during the last 25 years, these recent patterns suggest that a reexamination of our prevention strategies for this population, especially for YMSM of color, is needed. Given the interplay that exists between unprotected sexual behavior, illicit drug use, and mental health burden, all such efforts must consider how these overlapping epidemics (also known as syndemics) fuel each other in a cohort of YMSM as they emerge into adulthood. Thus, we will we will initiate a prospective longitudinal program of research to follow the development of syndemics in a racially/ethnically and economically diverse cohort of urban HIV-negative YMSM in New York City as they transition from adolescence into young adulthood, and apply, test, and further develop a theory of syndemic production to understand the development of both maladaptive and adaptive behavioral outcomes. Specifically we seek to (1) develop and test theoretically informed measurement models of the covariance of illicit drug use, unprotected sexual behavior, and mental health burden among emergent adult HIV-negative YMSM within and across time, (2) assess whether patterns of behavior are continuous, discontinuous, or some combination of both;(3) delineate the risk and protective bases-physical factors (i.e., pubertal onset, HIV status), relational factors (i.e., family history of psychopathology, current romantic relationships, peer support, and characteristics of residential, social, and sex neighborhoods), and psychosocial factors (i.e., sexual identity, internalized homophobia, hypermasculinity, racial identity, racial devaluation, HIV optimism) that predict the development of syndemics, and (4) determine the extent to which the development of syndemics varies by race/ethnicity, social class, and homelessness/housing stability in a cohort of HIV-negative YMSM. Using multiple measurement modalities, which include biological assays, calendar based methods, and self-reports, we will follow the development of 675, 18-year-old HIV-negative YMSM. Participants will be recruited through venue-based and respondent driven sampling, as they emerge into adulthood, over seven waves of data collection within a 36-month time frame. We will utilize Structural Equation and Latent Growth Curve Analysis to answer our four main research questions. PUBLIC HEALTH RELEVANCE: The goal of this project is to understand why a new generation of young men who have sex with other men place themselves at risk for HIV transmission. Knowledge which we will generate will help us understand how these young men emerge into adulthood, the choices they make about sexual behavior and illicit drug use, as well as how these two behaviors interact with their mental health. We seek to understand why some men exhibit risky behaviors as they emerge into adulthood while others do not. Working with community and municipal partners, we will draw from what we have learned from both groups to develop strategies for HIV prevention and intervention that are relevant to this current and developing generation who did not live through the devastation of the AIDS epidemic in the 1980's. In addition, we will add to the methodological literature based on our analysis of nested latent growth curve models.
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2014 — 2018 |
Halkitis, Perry N |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Syndemic Production in Emergent Adult Men
DESCRIPTION: In the last decade, HIV incidence rates among young men who have sex with men (YMSM) in U.S. urban centers have steadily increased. To shed light on these trends, since 2009, we have been conducting a cohort study of n = 600 racially/ethnically and socioeconomically diverse YMSM, informed by a theory of syndemics, to: (1) develop and test theoretically informed measurement models of the covariance of illicit drug use, unprotected sexual behavior, and mental health burden among emergent adult HIV-negative YMSM within and across time; (2) assess whether patterns of behavior are continuous, discontinuous, or some combination of both; (3) delineate the risk and protective base (physical, relational, and psychosocial factors) that predict the development of syndemics: and (4) determine the extent to which the development of syndemics is moderated by race/ethnicity, social class, and homelessness/housing stability. At baseline, participants were 18-19 years old and are returning for semi-annual follow-up visits; to date we have high levels of participant retention (e83%) across study visits. Presently, we seek to develop a more comprehensive understanding of the health of this new generation of YMSM. This will be accomplished by (a) continuing to investigate the original study aims as participants mature to ages 25-26; and (b) including two new, complementary study aims to: (1) describe the social and sexual networks of YMSM, and examine the relationship between social and sexual network-level structural characteristics, social support and normative influences on syndemic production in YMSM, singly and in combination with physical, psychosocial, and relational predictors, both within and across time; and (2) describe the acquisition of sexually transmitted infections (STIs), specifically, gonorrhea chlamydia, and syphilis, among YMSM within and across time, and to determine whether physical, relational, and psychosocial factors explain STI acquisition within and across time. We will continue to test syndemic production over time as well as to examine how this comprehensive range of physical, psychosocial, and relational predictors are related to syndemic production using additive and multiplicative (synergistic) models. Next, for YMSM in this study who have seroconverted as well as those who may seroconvert, we include an exploratory aim to describe HIV clinical treatment markers (i.e., HIV viral load, ART uptake and adherence, HIV care) and to assess the extent to which physical, relational, and psychosocial factors are associated with these clinical markers, both within and across time. We seek to extend our cohort study through the addition of semi- annual data collection for 7 additional waves of data collection. We will recruit an additional n = 329 to add to our extent study sample. New recruits will be 21-22 years old at enrollment, and with our original n=471 active and available YMSM participants, will yield a sample of n = 800 at the first assessment of our competing continuation study. As with our current study we will utilize complex modeling (Structural Equation and Latent Growth Curve Analysis and Survival Analysis) to answer our study questions.
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2015 — 2019 |
Halkitis, Perry N Kapadia, Farzana (co-PI) [⬀] Ompad, Danielle C |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. R56Activity Code Description: To provide limited interim research support based on the merit of a pending R01 application while applicant gathers additional data to revise a new or competing renewal application. This grant will underwrite highly meritorious applications that if given the opportunity to revise their application could meet IC recommended standards and would be missed opportunities if not funded. Interim funded ends when the applicant succeeds in obtaining an R01 or other competing award built on the R56 grant. These awards are not renewable. |
Application of a Syndemic Framework to Hpv and Hsv Infection in Emergent Adult Men
Abstract Human papilloma virus (HPV) and herpes simplex virus (HSV) infections account for significant morbidity in men who have sex with men (MSM). HPV is associated with oral, oropharyngeal, and anal cancers and a growing body of research suggests racial disparities in HIV burden may be partially attributed to HSV infection. Building on our ongoing cohort study (the P18 cohort study; R01DA025537) of young MSM (YMSM), we will assess anal and oral HPV, HSV-1, and HSV-2 over time. Applying a syndemic theory framework will allow examination of sociodemographic, biological, behavioral, psychosocial and structural determinants of these viral infections. Our work is informed by findings generated from the P18 cohort study including persistence of inadequate sexual health care in YMSM, incident HIV infections (7.2% to date), and a high level of infection with bacterial sexually transmitted infections (STIs) including chlamydia, gonorrhea, and syphilis. Moreover, recent evidence suggests YMSM have a very low likelihood of initiating HPV vaccination. Thus, understanding HPV and HSV infection as well as correlates and predictors will yield a more comprehensive understanding of the multiple health burdens impacting the health of YMSM. Second, understanding HPV and HSV infection in YMSM may shed light on the stark racial/ethnic disparities in HIV in YMSM. The proposed ancillary study is guided by the following aims: (1) To describe the epidemiology of overall, high-risk, low-risk, and vaccine preventable HPV infection as well as HPV vaccination uptake and completion in a racially/ethnically diverse sample of YMSM; specifically, to: (1a) estimate prevalence & incidence of anal, oral and paired co-infection of nonavalent vaccine-type HPV infection as well as correlates and risk factors for prevalent, incident, persistent, and cleared infections; (1b) prospectively estimate HPV infection and persistence as risk factors for HIV; and (1c) determine multi-level facilitators and barriers to HPV vaccination uptake and completion quantitatively and qualitatively via in-depth interviews with a sub-sample of study participants. (2) To describe the epidemiology of HSV-1 and HSV-2 in a racially/ethnically diverse sample of YMSM; specifically, to (2a) estimate prevalence & incidence of HSV-1 and HSV-2 as well as correlates and risk factors for prevalent and incident HSV-1 and HSV-2 mono- and co-infections; (2b) estimate HSV-1 and HSV-2 as risk factors for HIV acquisition, overall, and by race/ethnicity. (3) To determine prevalence and correlates of HSV/HPV co-infections and whether (a) HSV increases HPV risk, and (b) HPV infection or persistence increases HSV risk. An exploratory aim seeking to examine potential biological mechanisms linking HPV infection to HIV risk, will (1) compare local immunological response (measured via soluble cytokine levels) in the rectal microenvironment among those with and without HPV as a risk factor for HIV susceptibility. This study will provide much needed data on viral STIs in a racially/ethnically and socioeconomically diverse sample of YMSM as well as provide further insights on the potential for HPV, HSV-1, and HSV-2 to influence HIV transmission and acquisition risk.
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