Impact of abstinence and of reducing illicit drug use without abstinence on human immunodeficiency virus viral load

Background. Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods. This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results. The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4-2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions. Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions

A Song for My Supper: More Tales of the Field

This essay tries to be true to a podium talk I presented at a conference in March, 2008. But, of necessity, certain consolidation liberties are taken. Beginning with a brief and broad treatment of ethnography as a paired written representation of and lengthy personal experience in a particular social world, I move to consider why the former, the text, has been so infrequently examined in lieu of the latter, the so-called method. I then move to ethnographic texts themselves and look at what I take to be some broad changes the seem apparent — particularly within the organizational ethnography domain — over the past 20 or so years. Alongside these changes comes the emergence of several distinct genres treated only lightly (or not at all) in Tales of the Field. I end by considering what seems to have stayed the course in ethnography and why

The EXO-200 detector, part II: Auxiliary systems

The EXO-200 experiment searched for neutrinoless double-beta decay of 136Xe with a single-phase liquid xenon detector. It used an active mass of 110 kg of 80.6%-enriched liquid xenon in an ultra-low background time projection chamber with ionization and scintillation detection and readout. This paper describes the design and performance of the various support systems necessary for detector operation, including cryogenics, xenon handling, and controls. Novel features of the system were driven by the need to protect the thin-walled detector chamber containing the liquid xenon, to achieve high chemical purity of the Xe, and to maintain thermal uniformity across the detector.11Nsciescopu