HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial

Jayelin N Parker, Seul Ki Choi, Jose A Bauermeister, Erin E Bonar, Adam W Carrico, Rob Stephenson, Jayelin N Parker, Seul Ki Choi, Jose A Bauermeister, Erin E Bonar, Adam W Carrico, Rob Stephenson

Abstract

Background: Gay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education.

Objective: We explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan.

Methods: We analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors.

Results: Our findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs.

Conclusions: This study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines.

Trial registration: ClinicalTrials.gov NCT02945436; https://ichgcp.net/clinical-trials-registry/NCT02945436.

International registered report identifier (irrid): RR2-10.2196/resprot.9414.

Keywords: sexual minority; social determinants; substance use; testing.

Conflict of interest statement

Conflicts of Interest: None declared.

©Jayelin N Parker, Seul Ki Choi, Jose A Bauermeister, Erin E Bonar, Adam W Carrico, Rob Stephenson. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 01.07.2022.

References

    1. HIV and transgender communities. Centers for Disease Control and Prevention. 2019. [2020-07-30]. .
    1. HIV News Media Resources. Centers for Disease Control and Prevention. 2017. Jul 27, [2021-04-02]. .
    1. Basic Statistics. Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. 2020. [2020-07-30]. .
    1. Lauby J, Zhu L, Milnamow M, Batson H, Bond L, Curran-Groome W, Carson L. Get real: evaluation of a community-level HIV prevention intervention for young MSM who engage in episodic substance use. AIDS Educ Prev. 2017 Jun;29(3):191–204. doi: 10.1521/aeap.2017.29.3.191.
    1. U.S. Statistics. . 2021. Mar 17, [2021-04-02]. .
    1. Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006-2017. Am J Public Health. 2019 Jan;109(1):e1–8. doi: 10.2105/AJPH.2018.304727.
    1. Johnson AS, Hall HI, Hu X, Lansky A, Holtgrave DR, Mermin J. Trends in diagnoses of HIV infection in the United States, 2002-2011. JAMA. 2014 Jul;312(4):432–4. doi: 10.1001/jama.2014.8534. 1889120
    1. Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic--how are we doing? N Engl J Med. 2015 Dec 03;373(23):2281–7. doi: 10.1056/NEJMms1513641.
    1. Brewer TH, Schillinger J, Lewis FM, Blank S, Pathela P, Jordahl L, Schmitt K, Peterman TA. Infectious syphilis among adolescent and young adult men: implications for human immunodeficiency virus transmission and public health interventions. Sex Transm Dis. 2011 May;38(5):367–71. doi: 10.1097/OLQ.0b013e3181ffa7b0.
    1. Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 States. Ann Intern Med. 2011 Aug 02;155(3):145–51. doi: 10.7326/0003-4819-155-3-201108020-00004.155/3/145
    1. Sexually transmitted disease surveillance 2018. Centers for Disease Control and Prevention. 2018. [2021-07-30]. .
    1. Van Gerwen OT, Jani A, Long DM, Austin EL, Musgrove K, Muzny CA. Prevalence of sexually transmitted infections and human immunodeficiency virus in transgender persons: a systematic review. Transgend Health. 2020 Jun 8;5(2):90–103. doi: 10.1089/trgh.2019.0053. 10.1089/trgh.2019.0053
    1. Volkow ND, Montaner J. Enhanced HIV testing, treatment, and support for HIV-infected substance users. JAMA. 2010 Apr 14;303(14):1423–4. doi: 10.1001/jama.2010.421. 303/14/1423
    1. Pantin M, Leonard NR, Hagan H. Sexual HIV/HSV-2 risk among drug users in New York City: an HIV testing and counseling intervention. Subst Use Misuse. 2013 Apr;48(6):438–45. doi: 10.3109/10826084.2013.778279.
    1. Gamarel KE, Brown L, Kahler CW, Fernandez MI, Bruce D, Nichols S, Adolescent Medicine Trials Network for HIV/AIDS Intervention Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depend. 2016 Dec 01;169:11–8. doi: 10.1016/j.drugalcdep.2016.10.002. S0376-8716(16)30934-6
    1. Jadwin-Cakmak L, Reisner SL, Hughto JM, Salomon L, Martinez M, Popoff E, Rivera BA, Harper GW. HIV prevention and HIV care among transgender and gender diverse youth: design and implementation of a multisite mixed-methods study protocol in the U.S. BMC Public Health. 2019 Dec 15;19(1):1531. doi: 10.1186/s12889-019-7605-4. 10.1186/s12889-019-7605-4
    1. Kelley CF, Kraft CS, de Man TJ, Duphare C, Lee HW, Yang J, Easley KA, Tharp GK, Mulligan MJ, Sullivan PS, Bosinger SE, Amara RR. The rectal mucosa and condomless receptive anal intercourse in HIV-negative MSM: implications for HIV transmission and prevention. Mucosal Immunol. 2017 Jul;10(4):996–1007. doi: 10.1038/mi.2016.97. mi201697
    1. Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, Weir SS. Understanding the high prevalence of HIV and other sexually transmitted infections among socio-economically vulnerable men who have sex with men in Jamaica. PLoS One. 2015 Feb 6;10(2):e0117686. doi: 10.1371/journal.pone.0117686. PONE-D-13-45969
    1. Garofalo R, Hotton AL, Kuhns LM, Gratzer B, Mustanski B. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. J Acquir Immune Defic Syndr. 2016 May 01;72(1):79–86. doi: 10.1097/QAI.0000000000000933.
    1. Hoenigl M, Chaillon A, Morris SR, Little SJ. HIV infection rates and risk behavior among young men undergoing community-based testing in San Diego. Sci Rep. 2016 May 16;6:25927. doi: 10.1038/srep25927. doi: 10.1038/srep25927.srep25927
    1. Stephenson R, White D, Darbes L, Hoff C, Sullivan P. HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS Behav. 2015 Mar;19(3):553–60. doi: 10.1007/s10461-014-0862-4.
    1. Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Perceived barriers to HIV prevention services for transgender youth. LGBT Health. 2018;5(6):350–8. doi: 10.1089/lgbt.2017.0098.
    1. Reisner SL, Jadwin-Cakmak L, White Hughto JM, Martinez M, Salomon L, Harper GW. Characterizing the HIV prevention and care continua in a sample of transgender youth in the U.S. AIDS Behav. 2017 Dec;21(12):3312–27. doi: 10.1007/s10461-017-1938-8. 10.1007/s10461-017-1938-8
    1. Shoptaw S, Montgomery B, Williams CT, El-Bassel N, Aramrattana A, Metsch L, Metzger DS, Kuo I, Bastos FI, Strathdee SA. Not just the needle: the state of HIV-prevention science among substance users and future directions. J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2(0 2):S174–8. doi: 10.1097/QAI.0b013e3182987028. 00126334-201307012-00012
    1. Mitchell CG, Oltean A. Integrating HIV prevention into substance user treatment: current practices and challenges. Subst Use Misuse. 2007;42(14):2173–82. doi: 10.1080/10826080701663190.788720813
    1. Elkbuli A, Polcz V, Dowd B, McKenney M, Prado G. HIV prevention intervention for substance users: a review of the literature. Subst Abuse Treat Prev Policy. 2019 Jan 03;14(1):1. doi: 10.1186/s13011-018-0189-7. 10.1186/s13011-018-0189-7
    1. DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, Tailor A, Dumitru G, Mullins MM, Hutchinson AB, Lansky A. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017 Aug 11;66(31):830–2. doi: 10.15585/mmwr.mm6631a3. doi: 10.15585/mmwr.mm6631a3.
    1. Sanchez TH, Zlotorzynska M, Sineath RC, Kahle E, Tregear S, Sullivan PS. National trends in sexual behavior, substance use and HIV testing among United States men who have sex with men recruited online, 2013 through 2017. AIDS Behav. 2018 Aug;22(8):2413–25. doi: 10.1007/s10461-018-2168-4.10.1007/s10461-018-2168-4
    1. Eklund AC, Dillon FR, Ebersole RC. Individual and structural factors predicting HIV testing among Latinx MSM: substance use as a moderator. AIDS Care. 2020 Feb;32(2):193–201. doi: 10.1080/09540121.2019.1619664.
    1. Starks TJ, Dellucci TV, Gupta S, Robles G, Stephenson R, Sullivan PS, Parsons JT. A pilot randomized trial of intervention components addressing drug use in Couples HIV Testing and Counseling (CHTC) with male couples. AIDS Behav. 2019 Sep;23(9):2407–20. doi: 10.1007/s10461-019-02455-2. 10.1007/s10461-019-02455-2
    1. Morgan E, Skaathun B, Lancki N, Jimenez AD, Ramirez-Valles J, Bhatia R, Masiello-Schuette S, Benbow N, Prachand N, Schneider JA. Trends in HIV risk, testing, and treatment among MSM in Chicago 2004-2014: implications for HIV elimination planning. J Urban Health. 2017 Oct;94(5):699–709. doi: 10.1007/s11524-017-0175-9. 10.1007/s11524-017-0175-9
    1. Nerlander LM, Hoots BE, Bradley H, Broz D, Thorson A, Paz-Bailey G, NHBS Group HIV infection among MSM who inject methamphetamine in 8 US cities. Drug Alcohol Depend. 2018 Sep 1;190:216–23. doi: 10.1016/j.drugalcdep.2018.06.017.S0376-8716(18)30378-8
    1. Pitasi MA, Oraka E, Clark H, Town M, DiNenno EA. HIV testing among transgender women and men - 27 states and Guam, 2014-2015. MMWR Morb Mortal Wkly Rep. 2017 Aug 25;66(33):883–7. doi: 10.15585/mmwr.mm6633a3. doi: 10.15585/mmwr.mm6633a3.
    1. Sevelius JM, Poteat T, Luhur WE, Reisner SL, Meyer IH. HIV testing and PrEP use in a national probability sample of sexually active transgender people in the United States. J Acquir Immune Defic Syndr. 2020 Aug 15;84(5):437–42. doi: 10.1097/QAI.0000000000002403. 00126334-202008150-00001
    1. Dillon FR, Eklund A, Ebersole R, Ertl MM, Martin JL, Verile MG, Gonzalez SR, Johnson S, Florentin D, Wilson L, Roberts S, Fisher N. Heterosexual self-presentation and other individual- and community-based correlates of HIV testing among Latino men who have sex with men. Psychol Men Masc. 2019 Apr;20(2):238–51. doi: 10.1037/men0000166.
    1. Clark HA, Oraka E, DiNenno EA, Wesolowski LG, Chavez PR, Pitasi MA, Delaney KP. Men who have sex with men (MSM) who have not previously tested for HIV: results from the MSM testing initiative, United States (2012-2015) AIDS Behav. 2019 Mar;23(2):359–65. doi: 10.1007/s10461-018-2266-3. 10.1007/s10461-018-2266-3
    1. Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS. 2013 Nov;27(11):621–7. doi: 10.1089/apc.2013.0245.
    1. Jürgensen M, Tuba M, Fylkesnes K, Blystad A. The burden of knowing: balancing benefits and barriers in HIV testing decisions. a qualitative study from Zambia. BMC Health Serv Res. 2012 Jan 05;12:2. doi: 10.1186/1472-6963-12-2. 1472-6963-12-2
    1. Prestage G, Brown G, Keen P. Barriers to HIV testing among Australian gay men. Sex Health. 2012 Dec;9(5):453–8. doi: 10.1071/SH12033.SH12033
    1. Schwarcz S, Richards TA, Frank H, Wenzel C, Hsu LC, Chin CS, Murphy J, Dilley J. Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing. AIDS Care. 2011 Jul;23(7):892–900. doi: 10.1080/09540121.2010.534436.935085586
    1. Goldenberg T, Jadwin-Cakmak L, Popoff E, Reisner SL, Campbell BA, Harper GW. Stigma, gender affirmation, and primary healthcare use among black transgender youth. J Adolesc Health. 2019 Oct;65(4):483–90. doi: 10.1016/j.jadohealth.2019.04.029. S1054-139X(19)30250-2
    1. Logie CH, Lacombe-Duncan A, Brien N, Jones N, Lee-Foon N, Levermore K, Marshall A, Nyblade L, Newman PA. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc. 2017 Apr 04;20(1):21385. doi: 10.7448/IAS.20.1.21385.
    1. Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among Black men who have sex with men. J Natl Med Assoc. 2004 Jan;96(1):97–107.
    1. Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008 Aug 30;372(9640):764–75. doi: 10.1016/S0140-6736(08)60887-9.S0140-6736(08)60887-9
    1. Detroit metro area HIV surveillance report new diagnoses and prevalence tables. Michigan Department of Health and Human Services. 2019. Jul 1, [2021-07-30]. .
    1. Stephenson R, Bonar EE, Carrico A, Hunter A, Connochie D, Himmelstein R, Bauermeister J. Intervention to increase HIV testing among substance-using young men who have sex with men: protocol for a randomized controlled trial. JMIR Res Protoc. 2018 Apr 30;7(4):e114. doi: 10.2196/resprot.9414. v7i4e114
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.166/10/1092
    1. Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993 May;5(2):179–93. doi: 10.1177/089826439300500202.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction. 1993 Jul;88(6):791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
    1. WHO ASSIST Working Group The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002 Sep;97(9):1183–94. doi: 10.1046/j.1360-0443.2002.00185.x.185
    1. Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institutes of Health, American Academy of HIV Medicine, Association of Nurses in AIDS Care, International Association of Providers of AIDS Care, the National Minority AIDS Council, and Urban Coalition for HIV/AIDS Prevention Services. 2014. Dec 11, [2021-07-30]. .
    1. Phillips 2nd G, Ybarra ML, Prescott TL, Parsons JT, Mustanski B. Low rates of human immunodeficiency virus testing among adolescent gay, bisexual, and queer men. J Adolesc Health. 2015 Oct;57(4):407–12. doi: 10.1016/j.jadohealth.2015.06.014. S1054-139X(15)00259-1
    1. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Youth risk behavior surveillance - United States, 2015. MMWR Surveill Summ. 2016 Jun 10;65(6):1–174. doi: 10.15585/mmwr.ss6506a1.
    1. Sharma A, Kahle E, Todd K, Peitzmeier S, Stephenson R. Variations in testing for HIV and other sexually transmitted infections across gender identity among transgender youth. Transgend Health. 2019 Feb 20;4(1):46–57. doi: 10.1089/trgh.2018.0047. 10.1089/trgh.2018.0047
    1. Rosengren AL, Davy-Mendez T, Hightow-Weidman LB. Online sex partner seeking and HIV testing frequency among young Black sexual minority men. J HIV AIDS Soc Serv. 2020;19(1):42–54. doi: 10.1080/15381501.2019.1692749.
    1. Pharr JR, Lough NL, Ezeanolue EE. Barriers to HIV testing among young men who have sex with men (MSM): experiences from Clark County, Nevada. Glob J Health Sci. 2015 Nov 03;8(7):9–17. doi: 10.5539/gjhs.v8n7p9. doi: 10.5539/gjhs.v8n7p9.
    1. Nelson KM, Pantalone DW, Gamarel KE, Carey MP, Simoni JM. Correlates of never testing for HIV among sexually active Internet-recruited gay, bisexual, and other men who have sex with men in the United States. AIDS Patient Care STDS. 2018 Jan;32(1):9–15. doi: 10.1089/apc.2017.0244.
    1. Bauermeister JA, Eaton L, Andrzejewski J, Loveluck J, VanHemert W, Pingel ES. Where you live matters: structural correlates of HIV risk behavior among young men who have sex with men in metro Detroit. AIDS Behav. 2015 Dec;19(12):2358–69. doi: 10.1007/s10461-015-1180-1. 10.1007/s10461-015-1180-1
    1. Stephenson R, Metheny N, Sharma A, Sullivan S, Riley E. Providing home-based HIV testing and counseling for transgender youth (Project Moxie): protocol for a pilot randomized controlled trial. JMIR Res Protoc. 2017 Nov 28;6(11):e237. doi: 10.2196/resprot.8562. v6i11e237
    1. Bauermeister JA, Golinkoff JM, Horvath KJ, Hightow-Weidman LB, Sullivan PS, Stephenson R. A multilevel tailored Web app-based intervention for linking young men who have sex with men to quality care (get connected): protocol for a randomized controlled trial. JMIR Res Protoc. 2018 Aug 02;7(8):e10444. doi: 10.2196/10444. v7i8e10444
    1. Kuhns LM, Garofalo R, Hidalgo M, Hirshfield S, Pearson C, Bruce J, Batey DS, Radix A, Belkind U, Jia H, Schnall R. A randomized controlled efficacy trial of an mHealth HIV prevention intervention for sexual minority young men: MyPEEPS mobile study protocol. BMC Public Health. 2020 Jan 15;20(1):65. doi: 10.1186/s12889-020-8180-4. 10.1186/s12889-020-8180-4
    1. Fisher CB, Fried AL, Macapagal K, Mustanski B. Patient-provider communication barriers and facilitators to HIV and STI preventive services for adolescent MSM. AIDS Behav. 2018 Oct;22(10):3417–28. doi: 10.1007/s10461-018-2081-x. 10.1007/s10461-018-2081-x
    1. Martin-Smith HA, Okpo EA, Bull ER. Exploring psychosocial predictors of STI testing in university students. BMC Public Health. 2018 May 29;18(1):664. doi: 10.1186/s12889-018-5587-2. 10.1186/s12889-018-5587-2
    1. Bonar EE, Cunningham RM, Chermack ST, Blow FC, Barry KL, Booth BM, Walton MA. Prescription drug misuse and sexual risk behaviors among adolescents and emerging adults. J Stud Alcohol Drugs. 2014 Mar;75(2):259–68. doi: 10.15288/jsad.2014.75.259.
    1. Hambrick HR, Park SH, Schneider JA, Mayer KH, Carrico AW, Sherman SE, Duncan DT. Poppers and PrEP: use of pre-exposure prophylaxis among men who have sex with men who use inhaled nitrites. AIDS Behav. 2018 Nov;22(11):3658–72. doi: 10.1007/s10461-018-2139-9. 10.1007/s10461-018-2139-9
    1. Schwartz C, Fast D, Knight R. Poppers, queer sex and a Canadian crackdown: examining the experiences of alkyl nitrite use among young sexual minority men. Int J Drug Policy. 2020 Mar;77:102670. doi: 10.1016/j.drugpo.2020.102670.S0955-3959(20)30011-6
    1. Chandwani S, Abramowitz S, Koenig LJ, Barnes W, D'Angelo L. A multimodal behavioral intervention to impact adherence and risk behavior among perinatally and behaviorally HIV-infected youth: description, delivery, and receptivity of adolescent impact. AIDS Educ Prev. 2011 Jun;23(3):222–35. doi: 10.1521/aeap.2011.23.3.222.10.1521/aeap.2011.23.3.222
    1. Hoth AB, Shafer C, Dillon DB, Mayer R, Walton G, Ohl ME. Iowa TelePrEP: a public-health-partnered telehealth model for human immunodeficiency virus preexposure prophylaxis delivery in a rural state. Sex Transm Dis. 2019 Aug;46(8):507–12. doi: 10.1097/OLQ.0000000000001017.00007435-201908000-00004
    1. Johnson MC, Chung R, Leung SY, Edelstein Z, Yuan Y, Flavin SM. Combating stigma through HIV self-testing: New York state's HIV home test giveaway program for sexual minorities. J Public Health Manag Pract. 2022;28(2):174–83. doi: 10.1097/PHH.0000000000001138. 00124784-202203000-00012
    1. Simons JS, Wills TA, Emery NN, Marks RM. Quantifying alcohol consumption: self-report, transdermal assessment, and prediction of dependence symptoms. Addict Behav. 2015 Dec;50:205–12. doi: 10.1016/j.addbeh.2015.06.042. S0306-4603(15)00240-3
    1. Williams RJ, Nowatzki N. Validity of adolescent self-report of substance use. Subst Use Misuse. 2005;40(3):299–311. doi: 10.1081/ja-200049327.
    1. Nichols SL, Lowe A, Zhang X, Garvie PA, Thornton S, Goldberger BA, Hou W, Goodenow MM, Sleasman JW. Concordance between self-reported substance use and toxicology among HIV-infected and uninfected at risk youth. Drug Alcohol Depend. 2014 Jan 01;134:376–82. doi: 10.1016/j.drugalcdep.2013.11.010. S0376-8716(13)00478-X

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