Sexual minority (e.g., non-heterosexual) populations experience higher rates of substance use, problematic substance use, mental health disorders, and health related distress and problems. Unique stressors such as discriminatory experiences, expectations of discrimination, internalization of social stigma, and concealment of sexual orientation, collectively termed sexual minority stress, are the primary explanatory model for these health disparities. The overall goal of this proposal is to build on the candidate's demonstrated track record of working with sexual minority populations by developing expertise in bio-behavioral and clinical research to optimize HIV/AIDS prevention in HIV+, substance-using men who have sex with men (MSM). The career development plan includes advanced training in 1) gene expression, 2) clinical research with substance-using MSM, and 3) advanced statistical methods.
Aim 1 of the proposed study will examine the direct and indirect pathways (i.e., through stimulant use) whereby sexual minority stress may be associated with gene expression related to functional inflammatory processes among HIV+, methamphetamine-using MSM. Leveraging the infrastructure of an existing randomized controlled trial with HIV-positive, methamphetamine-using MSM (R01-DA033854; Carrico, PI), the cross- sectional associations among sexual minority stress, stimulant use, and the expression of inflammatory genes will be examined.
Aim 2 will develop and pilot test a 10 session, individually-delivered, cognitive-behavioral intervention focused on modifying sexual minority stress responses among HIV-positive MSM who engage in episodic and binge patterns of substance use. This intervention development work will culminate in a pilot randomized controlled trial to test whether this novel sexual minority stress intervention (compared to an attention-control condition) can boost and extend the effects of personalized cognitive counseling, a single session intervention that has demonstrated efficacy for reducing substance use among MSM who are not seeking formal substance abuse treatment. Using outcome data from this pilot randomized controlled trial, the potential clinical utility of the sexual minority stress intervention will be examined with respectto reductions in substance use, sexual minority stress, and inflammatory gene expression. Taken together, this research and training plan will lay the foundation for a planned randomized controlled trial to examine the efficacy of this sexual minority stress intervention for targeting he interrelated epidemics of substance use and HIV/AIDS among MSM.

Public Health Relevance

This study will identify how stress experiences specific to sexual minority (e.g., non-heterosexual) people may contribute to the greater rates of substance use and poorer health outcomes observed among this diverse population. This study will also develop an individually delivered intervention targeting stress to reduce substance use, HIV transmission risk, and inflammation and will test this intervention on HIV positive individuals who use substances. Taken together, the two components of this study have the potential to reduce the higher rates of substance use and poorer health outcomes among sexual minority individuals and improve health among HIV positive persons, thereby improving the health of these diverse populations and reducing the risk of onward HIV transmission.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DA039800-03
Application #
9303332
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Lin, Yu
Project Start
2015-07-15
Project End
2020-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Carrico, Adam W; Flentje, Annesa; Kober, Kord et al. (2018) Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV infection. Brain Behav Immun 71:108-115
Flentje, Annesa; Kober, Kord M; Carrico, Adam W et al. (2018) Minority stress and leukocyte gene expression in sexual minority men living with treated HIV infection. Brain Behav Immun 70:335-345
Kim, Jin E; Flentje, Annesa; Tsoh, Janice Y et al. (2017) Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 94:514-524
Young, Dmitri A; Shumway, Martha; Flentje, Annesa et al. (2017) The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. Psychol Trauma 9:613-621
Livingston, Nicholas A; Flentje, Annesa; Heck, Nicholas C et al. (2017) Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals. J Consult Clin Psychol 85:1131-1143
Heck, Nicholas C; Mirabito, Lucas A; LeMaire, Kelly et al. (2017) Omitted data in randomized controlled trials for anxiety and depression: A systematic review of the inclusion of sexual orientation and gender identity. J Consult Clin Psychol 85:72-76
Flentje, Annesa; Shumway, Martha; Wong, Lauren H et al. (2017) Psychiatric Risk in Unstably Housed Sexual Minority Women: Relationship between Sexual and Racial Minority Status and Human Immunodeficiency Virus and Psychiatric Diagnoses. Womens Health Issues 27:294-301
Carrico, Adam W; Storholm, Erik David; Flentje, Annesa et al. (2017) Spirituality/religiosity, substance use, and HIV testing among young black men who have sex with men. Drug Alcohol Depend 174:106-112
Gómez, Walter; Flentje, Annesa; Schustack, Amy et al. (2016) Navigating Barriers to Vocational Rehabilitation for HIV-Positive Persons. AIDS Behav 20:1132-42
Flentje, Annesa; Livingston, Nicholas A; Sorensen, James L (2016) Meeting the Needs of Lesbian, Gay, and Bisexual Clients in Substance Abuse Treatment. Counselor (Deerfield Beach) 17:54-59

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