# Presentation: 786415

## Influences of Marijuana Use on Adolescent HIV/STI Acquisition and Care

- Jonathan M. Ellen, MD
- Johns Hopkins School of Medicine

## Marijuana and HIV/STI Risk

- Indirect effects:
- Predisposition for risky behaviors
- Drug using social networks
- High risk sexual networks
- Direct effect:
- Executive function and decision making

## Objective 1

- To highlight findings from Bayview Network Study (NIAID-funded) on link between marijuana and HIV/STI risk networks

## Objective 2

- To highlight findings from Adolescent HIV Prevention Trials Network (ATN) Study 009 (NIDA- and NICHD-funded) on link between marijuana and appointment keeping in HIV infected young women

## Bayview Network Study

## Objective

- To determine the association between sexual networks and STIs in African-American adolescents, 15-19 years old, residing in Bayview area of San Francisco, CA

**Notes:**
I will be basing my thesis on data collected as part of the Bayview Network Study, which took place in San Francisco, CA

This was a longitudinal study of risk factors for STDs in adolescents in San Francisco, CA, which was particularly interested in the roles of high risk adults in the maintenance of high rates of STDs in high-risk adolescents.

I will be using the baseline data which was collected in 2000-2001.

## Gonorrhea rates in adolescents, San Francisco, 2000

**Cases per 100,000**

**Bayview **
**Hunter’s Point**

**Notes:**
The district of Bayview-Hunter’s point is the southeastern most part of San Francisco. It is one of SF’s only neighborhoods with high percentages of African Americans. AAs came to BVHP in large numbers starting after the 2nd world war, attracted by jobs in the naval shipyard that was located there. Through the 50s and 60s the neighborhood was a working class neighborhood. In the 70s, the shipyard closed however and the district has declined economically since then. Nowadays, it is a mixture of working class neighborhoods and public housing complexes that suffer from the problems typically found in poor urban neighborhoods, in particular high rates of youth violence. This area of the city also has some of the highest rates of gonorrhea and chlamydia in adolescent populations.  

## BASELINE

**Gen 1 SEX PARTNERS **

**FRIENDS**

_**BASELINE**_
_**2000-2001**_

**Gen 3 SEX PARTNERS **

**Gen 2 SEX PARTNERS **

_**12 MONTH FOLLOW-UP **_
_**2001-2002**_

**INDEXES**

**Gen 1 SEX PARTNERS **

**FRIENDS**

**Gen 3 SEX PARTNERS **

**Gen 2 SEX PARTNERS **

**Notes:**
Point out:
- same indexes and friends at both waves, partners could be the same if they were still in a relationship
- referal period for f/u is longer than at baseline, although doesn’t seem to have made much of a difference

## Network position

| Position | Individual | Partner |
| --- | --- | --- |
| 1 | 1 | 1 |
| 2 | 1 | ? |
| 3 | 1 | >1 |
| 4 | >1 | 1 / ? |
| 5 | >1 | >1 |

**Notes:**
This composite measure is a measure of network position that depends on two characteristics: the number of partners an individual had and the umber of partners that individual’s partners had.

## Logistic regression results

| OR* [95%CI] |
| --- |
| Reference |
| 2.8 [0.9- 9.4] |
| 4.3 [1.4-13.5] |
| 6.6 [2.1-20.9] |
| 6.4 [2.1-19.0] |

- * Adjusted for age, gender, condom use, study wave and participant type

## Simplified network position

| OR [95%CI] | 3 level |
| --- | --- |
| Reference | Low |
| 2.8 [0.9- 9.4] | Moderate |
| 4.3 [1.4-13.5] |  |
| 6.6 [2.1-20.9] | High |
| 6.4 [2.1-19.0] |  |

## Drug-Related Risks(n=1107)

| Drug Economy |  |
| --- | --- |
|     None | 64% |
|     Jail Only | 23% |
|     Gang or Drug Dealing    | 13% |
| Drug Use |  |
|     None | 45% |
|     MJ only | 47% |
|     Other Drugs | 8% |

## Multivariate Associations

- Multinomial logistic regression, cluster robust standard errors, adjusted for age, sex, partner type, study wave

## Summary

- Network position is associated with STI risk
- Marijuana use is associated with being in STI risk position in network (center of network)

**Notes:**
Bring it back to introduction.

## ATN 009

## Objective

- To determine whether marijuana use, independent of mental health disorders and social support predict HIV-infected females adherence to scheduled HIV appointment

## Study Design and Methods

- Sexually HIV-infected adolescent females age 13-24 years old recruited between 1/30/2003 and 12/9/2004
- Interviewed at baseline and every three months for 18 months

## Baseline Index Interview

- ACASI
- DISC
- computer-administered mental health diagnostic interview
- Urine drug screening
- Debriefing/referral

## Health Care Utilization

- Staff review of appointment activity weekly
- Scheduled and unscheduled visits
- Appointments made or missed

## Participant Characteristics (N=178)

| Age, mean  | 20.6 years  |
| --- | --- |
| Race/ethnicity |  |
|    African American | 92% |
|    Other | 8% |
| Viral Load, mean | 67,000 copies |
| CD4 Count, mean | 470 cells |
| HAART | 48% |

## Substance Use and Mental Health

|  | Baseline | Varied over time |
| --- | --- | --- |
| Marijuana use ≥ once in past 90 days* | 37.3% | 28% |
| THC on urine drug screening | 24.2% | N/A |
| Alcohol use ≥ once in past 90 days* | 46.6% | 38% |
| Mood disorder on DISC | 10.4% | N/A |
| CES-D score ≥ 16* | 42.1% | 39% |

- *Assessed every six months

## Other Baseline Variable

|  | Mean (SD) | Potential Range |
| --- | --- | --- |
| Social Network Support | 74.5 (11.3) | 24-96  |
| Health Care Satisfaction | 14.3 ( 4.3) | 11-45  |
| HIV Stigma | 58.4 (12.1) | 21-84 |

## Scheduled Visits

|   Number attended | 3.5 |
| --- | --- |
|   Number missed | 1.6 |
|   % Attended | 67.3 |

## Relative Risk of Number Visits Attended

|  | Unadjusted | Adjusted** |
| --- | --- | --- |
| CES-D | 0.95 |  |
| MJ use | 0.83* | 0.89* |
| Alcohol use | 0.94 |  |
| Mood Disorder | 0.95 |  |
| Social Support | 1.0 |  |
| Health Care Satisfaction | 1.0 |  |
| HIV Stigma | 1.0 |  |

- *p<0.05    **Adjusted for CD4 Count and ART

## Summary

- HIV infected adolescent and young adult females adhere to scheduled care ~ 67% of time
- Marijuana users 11% less likely to attend a scheduled appointment
- Other commonly reported predictors of adherence were not predictive in this study
- Chronic care versus routine care
- Adolescent females versus adults

## Conclusion

- Marijuana indirectly increases HIV/STI risk, in part, through its influence on sexual network position
- Marijuana use may also complicate care among those with HIV
- Further research into causal pathways are essential if we are to reduce risks for HIV/STIs associated with marijuana use

## Collaborators

- C. Fichtenberg
- D. Murphy
- G. Harper
- L. Leonard
- L. Perez
- G. Clum
- L. Muentz