Drugs and Behavior

Background

As the founding PI of the Chicago MACS (1983-1985), then co-PI of the Coping & Change Study of Men in the Chicago MACS (1985-1999), Founder and Chair of the Behavioral Working Group (BWG) of the MACS from 1991 to 2012, I am intimately familiar with the relationship between sexual behavior, non-intravenous drug use and the evolution of HIV Prevention Research among MSM since the beginning of the epidemic. In June 2011, on the occasion of the 25th Anniversary of the Chicago MACS, I received the “Founding PI Award” at a reception honoring the participants in the Chicago MACS. I have published over 175 peer-reviewed papers and book chapters and presented 50+ times at the International AIDS Conferences on HIV behavioral and prevention research, including the discovery of the link between non-injection drug use and HIV infection among MSM (1985), and more recently the fact that the majority of recent HIV infections in the MACS are associated with the use of specific combinations of “sex-drugs”-2010. I have been either an Investigator or consultant on most of the NIDA-NIMH funded studies of drugs, alcohol and HIV in the MACS, and have overseen the long-term strategic planning that has charted the course of behavioral and HIV Prevention research among MSM participating in the MACS and now the Social and Risk Network (SRN) study of younger Black MSM in Chicago (2011-2014). In 1982, I founded the Chicago Health Department’s Office of AIDS. Since 1996, I have developed several versions of the Mens’ Attitude Survey (MAS), to plot changes in attitudes, beliefs and individual traits predisposing to increased sexual and drug risk taking and HIV infection rates among MSM since the introduction of highly affective anti-retroviral therapy (HAART) in 1996. A recently updated version of the MAS was developed by Dr. Ostrow to also measure the knowledge of, belief in, and use of new risk reduction practices with the advent of PrEP, sero-adaptative strategies known as “sero-sorting” and “sero-positioning,” and the use of microbicidal lubricants for anal intercourse. The “mixed methods” research used in the development of these surveys have become the standard for obtaining valid responses from both “hard to reach” populations and surveys of “sensitive” behaviors, such as sexual behavior, illicit and licit drug use, and decision-making that either increases the risk of disease transmission or can significantly reduce risk depending on the type of partner, circumstances and types of drugs shared in before or during sex (“sex-drugs”).

Founding PI (1983-1985), then Sr Behavioral Investigator, Chicago MACS

May 1983 – Present (31 years 7 months) Greater Chicago Area and the full Multicenter AIDS Cohort Study dataset, including up to 7,000 participants from SF, LA, Chicago, Baltimore/DC, and Pittsburgh.
Dr Ostrow designed, funded and implemented specific studies of changing risk behaviors and risk-reduction strategies by MACS participants; develop innovative survey methodologies for understanding causes and potential intervention strategies among specific higher risk subgroups of men who have sex with men (MSM), and applied those new methods to the MACS and other disadvantaged subgroups of MSM and women in the US; co-discovered (with Ronald C Stall) the strong association between the use of non-injectable psychoactive drugs and increased risk for HIV transmission and infection among men in the MACS (Stall, McKusick, Ostrow, et. al., 1984; Ostrow, Fox, et. al., 1985), wrote up and published these findings in appropriate peer reviewed journals or textbooks for dissemination to healthcare professionals for their education, application of findings to ending similar health disparities in their own communities, and to other researchers and community support organizations for validation and extension of findings to the prevention of drug-related disease transmission among disadvantaged, stigmatized and marginalized populations.

Chair, Behavioral Working Group (BWG) of the MACS

1991 – 2011 (20 years)
Coordinated all behavioral and HIV prevention research related to the largest longitudinal study of gay/bisexual men, both with and without HIV infection, based in Chicago, Pittsburgh, Baltimore/DC and LA. Conducted monthly meetings of all members of the BWG and outside investigators interested in working with MACS behavioral data, wrote semi-annual progress reports on all BWG research activities involving MACS subjects or data and prepared Behavioral and HIV Prevention Research sections of MACS funding renewal applications. Major accomplishments included launching first studies of the behavioral, attitudinal and sexual practice implications of the new anti-retroviral treatments beginning in 1996 (Ostrow, Silverberg, et. al., 2008); obtaining funding from NIDA/NIMH for an additional 12 add-on projects to study the role of drugs and mental health in HIV infection and disease progression among men in the MACS (2009-2012); and the demonstration that 2/3rds of all new recent HIV infections in the MACS were associated with the use of stimulants, poppers or erectile dysfunction drugs, either alone or in combination (Ostrow, Plankey, et.al., 2011)

Certification in Addiction Medicine

American Society of Addiction Medicine

October 1998 – October 2008