HIV and Illicit Drugs Interact to Affect Verbal Learning and Memory

HIV infection and illicit drug use—usually smoking crack cocaine—appeared to have a compound negative impact on verbal learning and memory in a study of almost 1,400 women with and without HIV in the US Women’s Interagency HIV Study (WIHS). Research shows that HIV infection and illicit drug use can each contribute to diminished cognitive performance. To examine the impact of HIV and illicit drugs, alone and together, on cognitive function, WIHS researchers studied 952 women with HIV and 443 HIV-negative women with a socioeconomic background similar to the HIV-positive women. All women completed the Hopkins Verbal Learning Test-Revised and the Stroop Test of processing speed and executive function.
The WIHS investigators divided women into three groups: 140 with recent drug use (cocaine or heroin in the past 6 months), 651 former drug users (lifetime cocaine or heroin use but not in the past 6 months), and 604 nonusers (no lifetime use of cocaine or heroin).
Study participants averaged 42.8 years in age and 64% were African American. The most frequent recent drug use pattern was daily or weekly crack cocaine smoking.
HIV infection and recent illicit drug use were both linked to significantly worse verbal learning and memory scores on the Hopkins Verbal Learning Test-Revised (P < 0.05). Recent illicit drug use (compared with nonuse) had a negative effect on verbal learning and memory only in HIV-positive women (P < 0.01), a result indicating an interaction between HIV status and recent drug use.
The study yielded no evidence of an interaction between HIV status and illicit drug use on processing speed or executive function measured by the Stroop test.
The WIHS team proposes that “the interaction between HIV serostatus and recent illicit drug use on verbal learning and memory suggests a potential synergistic neurotoxicity that may affect the neural circuitry underlying performance on these tasks.”
Source: Vanessa J. Meyer, Leah H. Rubin, Eileen Martin, Kathleen M. Weber, Mardge H. Cohen, Elizabeth T. Golub, Victor Valcour, Mary A. Young, Howard Crystal, Kathryn Anastos, Bradley E. Aouizerat, Joel Milam, Pauline M. Maki. HIV and recent illicit drug use interact to affect verbal memory in women. JAIDS. 2013; 63: 67-76.
Written by Mark Mascolini on behalf of the International AIDS Society


Factors Tied to Anal Sex and HIV Testing in Just-Diagnosed MSM: NYC



Recent HIV testing and substance use during sex were associated with unprotected (condom-free) anal intercourse in a study of 150 young men who have sex with men (MSM) recently diagnosed with HIV infection in New York City. Employed men and those who had unprotected anal sex were more likely to get tested for HIV. In the United States and many other countries with similar HIV epidemics, MSM account for the highest proportion of new HIV infections. Although health authorities encourage sexually active MSM to get tested for HIV yearly or more often, the interplay between testing, risk behavior, and substance use remains poorly understood in this high-risk group.
The study involved 150 MSM diagnosed with HIV within the past 3 months at a community clinic in New York City. Researchers interviewed the men about sexual behavior and substance use in the 3 months before their diagnosis. Relevant clinical characteristics were extracted from medical records. Statistical analyses probed for factors associated with (1) unprotected anal sex in the 3 months before HIV diagnosis and (2) a negative HIV test in the 12 months before diagnosis.
The men averaged 32.5 years in age (standard deviation 8.8), and 62% belonged to a racial or ethnic minority. Almost all men, 95%, had a prior negative HIV test, and 55% had a negative test within the last 12 months. Although almost half of the men (48%) had at least a college education, 71% of these men earned only $30,000 a year or less, low by New York City standards.
Statistical analysis linked unprotected anal sex to recent HIV testing and substance use during sex. Recent testing was associated with being employed or a student, having unprotected anal sex, and a higher CD4 count.
Source: Anya S. Drabkin, Kathleen J. Sikkema, Patrick A. Wilson, Christina S. Meade, Nathan B. Hansen, Allyson DeLorenzo, Arlene Kochman, Jessica C. MacFarlane, Melissa H. Watt, Frances M. Aunon, Krista W. Ranby, Gal Mayer. Risk patterns preceding diagnosis among newly HIV-diagnosed men who have sex with men in New York City. AIDS Patient Care and STDs. 2013; 27: 333-341.

Obamacare Canvassers Seek Out Florida’s Uninsured




BOCA RATON, Fla. – Tammy Spencer did a double take when she read the address on her paper and looked at the house in front of her. Spencer, a volunteer with the nonprofit Enroll America, was spending a hot and humid Saturday morning knocking on doors in this mostly posh South Florida city looking for people without health coverage. She wanted to let them know about new online insurance marketplaces that open for enrollment Oct. 1. The spacious house was on the Intracoastal Waterway, complete with its own boat dock. The woman who answered the door said she already had coverage through Medicare, and Spencer went on to the next house.
After two hours of canvassing, she found one uninsured woman and got contacts for three others. “It was worth it,” said the 51-year-old insurance agent. “But next time, we need to go to a poorer area, or set up a table in the mall.”
Spencer is one of hundreds of volunteers for Enroll America’s “Get Covered America” campaign, which canvassed neighborhoods across Florida, New Jersey, Ohio and several other states Saturday to kick off several months of outreach efforts. The group, which is funded by health insurers, hospitals, philanthropies and others, has close ties to the Obama administration. It’s trying to educate consumers about new insurance options and drive enrollment in the new marketplaces opening this fall for coverage that takes effect in January.
The work is desperately needed as surveys show most people are unaware of the new marketplaces which will sell coverage to individuals and small employers and offer government subsidies to anyone making less than 400 percent of the federal poverty level, or $94,000 for a family of four.
Many people are also unaware that insurers will no longer be able to deny coverage for pre-existing conditions, or charge higher rates to people based on their health status. The Obama administration hopes to get 7 million people enrolled in the first year of open enrollment which ends in March.
Leaders of Enroll America say its volunteers aren’t knocking on doors randomly but are relying on Census data and information from telephone surveys to pinpoint neighborhoods and houses where people are mostly likely to be uninsured. But the canvassing in Boca Raton showed how challenging the work can be, in part because people move frequently.
Florida is one of the target states for Enroll America because it has nearly four million uninsured residents, and it is relying on the federal government to run its Obamacare marketplace, and as a result has limited federal dollars for outreach efforts.
In addition to Boca Raton, canvassers Saturday went to 14 other Florida cities including Miami, Fort Lauderdale, Tampa, Jacksonville and Delray Beach.
“We’ve been building our efforts on the ground in Florida to engage folks in their homes and communities,” said Nick Duran, who directs Enroll America’s operations in Florida. He said the group, which has 27 paid staff in the state, already has hundreds of volunteers and hopes to recruit a few thousand more in coming months.
“The way we gauge success is helping millions of Floridians who lack coverage learn about their new options,” Duran said. “We want to maximize the number of Floridians who sign up. That is our mission.”
He said he does not have a target for how many Floridians he hopes to enroll.
Florence French, field organizer for Palm Beach County, said Boca was on the list because it has uninsured residents, as well as a volunteer network willing to help.
One of them was Mark Powell, 56, who works the deli counter at Publix grocery store, and says he does not have insurance because he can’t afford his company’s plan. He learned about Enroll America when he searched for information about the law and he thought their campaign could help him and others.
“People can see that I am sincere about this when I talk to them,” he said.
Also canvassing was Yves Laplanche, 62, an engineer, who had worked as a volunteer for both of Barack Obama’s election campaigns. He said he remembers how years ago, his mother struggled without health insurance and he wanted to tell people about a law that might help them if they signed up for coverage.
Laplanche and other volunteers were given a sample script to approach people, explaining what Enroll America is and that they are not selling anything. They were instructed to avoid talking about Medicaid, the state-federal health program for the poor, which is not being expanded in Florida next year under the health law because state lawmakers did not approve it.
“Don’t get into any political conversations,” French told the nine volunteers who met outside the city’s new library.
Jennifer Depaz, 25, was one of those who came to the door and was willing to engage volunteers in conversation.
“Health care is so expensive here I had to go back to Guatemala to have my wisdom teeth out,” said Depaz, who works at a nearby ice cream shop and has no insurance.
Spencer took down her information and left her an Enroll America brochure.
“This is good to know,” Depaz said.
By Phil Galewitz KHN Staff Writer
This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.