With the success of HIV prevention and treatment efforts in the United States (US), disparities in HIV incidence and prevalence have grown. HIV is now considered an epidemic of the socially marginalized and disenfranchised, with cases concentrated in racial and sexual minorities in impoverished neighborhoods, particularly African Americans and men who have sex with men (MSM). The rates of substance use, like stimulant use, are high within these groups and further increase engagement in risky sexual behaviors. Neurobehavioral researchers are elucidating brain regions involved in risky decision making, and factors like drug use, socioeconomic disadvantage, and social marginalization have been linked to alterations in these regions. Understanding how substance use and social inequalities influence decision making facilitates our ability to tailor HIV prevention interventions to high-rik groups;however socially disadvantaged substance users are rarely included in neuroimaging research, partly due to a deficiency in recruitment strategies. The proposed project integrates training and research designed to develop the applicant's expertise in functional magnetic resonance imaging (fMRI) design and analysis with disadvantaged stimulant users. The proposed project will build on the applicant's strong foundation in clinical psychology, by providing mentored training in (1) neurobehavioral aspects of substance use and HIV/AIDS, (2) fMRI design, analysis, and interpretation, (3) respondent-driven sampling (RDS) and other strategies for recruiting disadvantaged substance users for neuroimaging research. The training plan includes coursework, participation in seminars, directed readings, mentored research, attendance at national conferences, and mentored grant writing. The proposed research will examine the main and interaction effects of socioeconomic status and cocaine use on risky decision making and associated neural activation using data collected from NIDA-funded fMRI research overseen by the applicant's mentor. It is hypothesized that cocaine use and low SES will be associated with riskier decision making and decreased neural activation during an experimental loss aversion task. Additionally, RDS will be used to recruit 100 MSM cocaine users to determine its feasibility and to identify factors associated with willingness to participae in fMRI research. This research will inform patient-oriented research aimed at reducing HIV disparities among disadvantaged substance users. At the culmination of this fellowship, the applicant will have specialized expertise in an area of critical need and will be prepared to begin a program of patient- oriented research in the fields of neuroAIDS and drug abuse.

Public Health Relevance

HIV is now considered an epidemic of the socially disadvantaged, with cases concentrated among racial and sexual minorities and substance users in impoverished areas. The proposed fellowship will provide research and training in applying fMRI technology to examine risky decision making and neural activation among disadvantaged stimulant users. The results have implications for the development of behavioral interventions designed to reduce high-risk sexual and drug use behaviors for substance users disproportionately burdened by HIV-infection.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZRG1)
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Lin, Yu
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Duke University
Schools of Medicine
United States
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Hobkirk, Andréa L; Nichols, Travis T; Foulds, Jonathan et al. (2018) Changes in resting state functional brain connectivity and withdrawal symptoms are associated with acute electronic cigarette use. Brain Res Bull 138:56-63
Watt, Melissa H; Guidera, Kathryn E; Hobkirk, Andréa L et al. (2017) Intimate partner violence among men and women who use methamphetamine: A mixed-methods study in South Africa. Drug Alcohol Rev 36:97-106
Meade, Christina S; Hobkirk, Andrea L; Towe, Sheri L et al. (2017) Cocaine dependence modulates the effect of HIV infection on brain activation during intertemporal decision making. Drug Alcohol Depend 178:443-451
Berg, Martha K; Hobkirk, Andréa L; Joska, John A et al. (2017) The role of substance use coping in the relation between childhood sexual abuse and depression among methamphetamine users in South Africa. Psychol Trauma 9:493-499
Hobkirk, Andréa L; Watt, Melissa H; Myers, Bronwyn et al. (2016) A qualitative study of methamphetamine initiation in Cape Town, South Africa. Int J Drug Policy 30:99-106
Meade, Christina S; Cordero, Daniella M; Hobkirk, Andrea L et al. (2016) Compensatory activation in fronto-parietal cortices among HIV-infected persons during a monetary decision-making task. Hum Brain Mapp 37:2455-67
Hobkirk, Andréa L; Starosta, Amy J; De Leo, Joseph A et al. (2015) Psychometric validation of the BDI-II among HIV-positive CHARTER study participants. Psychol Assess 27:457-66
Towe, Sheri L; Hobkirk, Andréa L; Ye, Daniel G et al. (2015) Adaptation of the Monetary Choice Questionnaire to accommodate extreme monetary discounting in cocaine users. Psychol Addict Behav 29:1048-55
Meade, Christina S; Towe, Sheri L; Watt, Melissa H et al. (2015) HIV testing behaviors and attitudes among community recruited methamphetamine users in a South African township. AIDS Behav 19:186-91
Hobkirk, Andréa L; Towe, Sheri L; Lion, Ryan et al. (2015) Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings. Curr HIV/AIDS Rep 12:406-12

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