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West BS, Agah N, Roth A, Conners EE, Staines-Orozco H, Magis-Rodriguez C, Brouwer KC. Sex Work Venue Disorder and HIV/STI Risk Among Female Sex Workers in Two México-US Border Cities: A Latent Class Analysis. AIDS Behav 2023; 27:82-95. [PMID: 35687193 PMCID: PMC10399957 DOI: 10.1007/s10461-022-03746-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Research increasingly recognizes the importance of social and built environments in shaping health, including risks for and outcomes related to HIV and sexually transmitted infections (STI), but research on sex work venues is limited. We use latent class analysis to identify patterns of sex work venue characteristics and factors associated with class membership in two México-US border cities. Among 603 female sex workers (FSW), three classes of sex work venues were identified: low, medium, and high disorder venues, characterized by level of violence, policing and drug activity. In multivariable analysis, risk exposures and outcomes varied by class, suggesting the need for place-based interventions that are tailored to specific venue profiles and that promote FSW health and safety in the workplace.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, 10027, NY, NY, USA.
| | - Niloufar Agah
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Alexis Roth
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Erin E Conners
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Hugo Staines-Orozco
- Department of Medical Sciences, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | - Carlos Magis-Rodriguez
- Centro Nacional para la Prevención y el Control del VIH y el SIDA (CENSIDA), México City, México
| | - Kimberly C Brouwer
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
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2
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Clark AD, Lucey JR. A Thematic Synthesis of the Roles of Nurses at Safer Consumption Sites. J Addict Nurs 2021; 32:235-248. [PMID: 34855322 DOI: 10.1097/jan.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Opioid use, particularly via injection, is associated with an increased risk of infection, injury, and death. Safer consumption sites (SCSs), where people may consume previously obtained drugs under observation, have been shown to reduce these risks among people who use drugs. Most SCSs employ nurses, but there is limited research into their roles. The objective of this article is to describe and synthesize the roles of nurses at SCSs to better understand their importance in a rapidly proliferating public health intervention. We extracted data from 48 qualitative, quantitative, peer-reviewed, and gray literature, as well as primary source narrative articles on SCSs, whether they were explicitly about nursing or not. We coded each mention of nurses or nursing in each article and identified 11 descriptive themes or roles that SCS nurses carry out. From these, we identified the following three analytical themes or hypotheses about the character of these roles: (a) The primary aim of SCS nursing care is to reduce morbidity and mortality; (b) SCS nurses create a therapeutic community; and (c) SCS nurses engage in research, professional activities, and activism to better understand and promote SCSs. More research into the roles of SCS nurses is needed to better serve a vulnerable population.
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Klein KS, Glick SN, Mauro PM. Anticipated use of a supervised drug consumption site among syringe services program clients in King County, Washington: Assessing the role of opioid overdose and injection behavior. Drug Alcohol Depend 2020; 213:108121. [PMID: 32585421 DOI: 10.1016/j.drugalcdep.2020.108121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND US jurisdictions are considering implementing supervised drug consumption sites (SCSs) to combat the overdose epidemic. No sanctioned SCS exists in the US, but King County, Washington has proposed Community Health Engagement Locations (CHELs), which would include supervised drug consumption. We assessed characteristics of people engaged in syringe services programs (SSPs) who anticipated SCS use. METHODS We estimated prevalence of anticipated SCS use in a 2017 cross-sectional sample of King County SSP participants (N = 377). We used Poisson regression with robust standard errors to estimate likelihood of anticipated SCS use by overdose history (experienced, witnessed only, neither), public injection frequency (always, some/most times, never), drug use behaviors, and sociodemographic characteristics. RESULTS The sample was primarily male (66.8 %), white (69.5 %), and averaged 37 years old. Almost two-thirds of participants witnessed or experienced an overdose in the past year (43.2 % witnessed only; 19.6 % experienced overdose). Four in five SSP participants (83.0 %) anticipated any SCS use. Anticipated SCS use was higher among participants who experienced an overdose (risk ratio [RR] = 1.14, 95 % CI = 1.04, 1.24) than those with no overdose experience. In multivariable analyses, anticipated SCS use was higher among people reporting injecting publicly (e.g., always vs. never: aRR = 1.26, 95 % CI = 1.11, 1.43), and lower among people primarily using methamphetamine (aRR = 0.80, 95 % CI = 0.67, 0.96) compared to people primarily using opioids. CONCLUSIONS In King County, SCS services would be used by people at high risk of overdose, including SSP participants reporting injecting in public. SCSs could be an important step to promote health and safety across communities.
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Affiliation(s)
- Kathryn S Klein
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States.
| | - Sara N Glick
- University of Washington School of Medicine, Division of Allergy and Infectious Diseases, 325 9th Ave., Box 359777, Seattle, WA, 98104, United States; Public Health--Seattle & King County, HIV/STD Program, 401 5th Ave., Seattle, WA, 98104, United States
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States
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Footer KHA, Lim S, Rael CT, Greene GJ, Carballa-Diéguez A, Giguere R, Martinez M, Bockting W, D'Aquila R, Sherman SG. Exploring new and existing PrEP modalities among female sex workers and women who inject drugs in a U.S. city. AIDS Care 2019; 31:1207-1213. [PMID: 30822101 DOI: 10.1080/09540121.2019.1587352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To address a shortage in research on Pre-Exposure Prophylaxis (PrEP) amongst women at high risk of HIV acquisition, this study explored the attitudes and preferences of female sex workers (FSW) (n = 15) and women who inject drugs (WWID) (n = 16) to existing (e.g., pill) and new (e.g., injection, implant) PrEP modalities, in Baltimore, Maryland, U.S.A. This study reports on seven focus groups conducted between December 2016 and April 2017 and aims to provide new insights into FSW and WWID attitudes and preferences towards three different PrEP delivery methods (i.e., PrEP pill, PrEP implant, PrEP injection). Results draw upon the PrEP care continuum framework and distill existing factors, including lack of control over side effects with new, longer lasting modalities, better privacy with injections, increased adherence with reduced dosing schedules from longer lasting PrEP and new factors such as perceptibility concerns with respect to the PrEP implant relevant to PrEP uptake and adherence among two important overlapping, at-risk populations. The study contributes to a better understanding of barriers and facilitators to uptake and adherence for FSW and WWID around both existing and new PrEP modalities, with implications for future clinical trials and PrEP interventions with at risk-populations.
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Affiliation(s)
| | - Sahnah Lim
- b Department of Population Health, NYU School of Medicine , Baltimore , MD , USA
| | - Christine Tagliaferri Rael
- c HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - George J Greene
- d Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Alex Carballa-Diéguez
- c HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Rebecca Giguere
- c HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Michelle Martinez
- e Program for the Study of LGBT Health, New York State Psychiatric Institute / Columbia Psychiatry with the Columbia University School of Nursing , New York , NY , USA.,f Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Walter Bockting
- e Program for the Study of LGBT Health, New York State Psychiatric Institute / Columbia Psychiatry with the Columbia University School of Nursing , New York , NY , USA
| | - Richard D'Aquila
- d Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Susan G Sherman
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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West BS. Social Networks of Substance-Using Populations: Key Issues and Promising New Approaches for HIV. Curr HIV/AIDS Rep 2019; 16:48-56. [PMID: 30659477 PMCID: PMC6420834 DOI: 10.1007/s11904-019-00425-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This paper presents recent literature on substance using networks and HIV, highlighting renewed and emerging themes in the field. The goal is to draw attention to research that holds considerable promise for advancing our understanding of the role of networks in shaping behaviors, while also providing critical information for the development of interventions, programs, and policies to reduce HIV and other drug-related harms. RECENT FINDINGS Recent research advances our understanding of networks and HIV, including among understudied populations, and provides new insight into how risk environments shape the networks and health of substance-using populations. In particular, the integration of network approaches with molecular epidemiology, research on space and place, and intervention methods provides exciting new avenues of investigation. Continued advances in network research are critical to supporting the health and rights of substance-using populations and ensuring the development of high-impact HIV programs and policies.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
- Division of Infectious Diseases and Global Public Health in the School of Medicine, University of California San Diego, San Diego, CA, USA.
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Mazhnaya A, Tobin KE, Owczarzak J. Association between injection in public places and HIV/HCV risk behavior among people who use drugs in Ukraine. Drug Alcohol Depend 2018; 189:125-130. [PMID: 29913323 DOI: 10.1016/j.drugalcdep.2018.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In Eastern Europe and Central Asia new HIV infections occur at a high rate among people who inject drugs (PWID). Injection risk behavior may be associated with injecting in public places. However, there is a lack of studies exploring this association in Ukraine, which has an HIV prevalence 21-42% among PWID. METHODS Data came from a baseline survey of PWID recruited to participate in a behavioral HIV prevention intervention. The association between HIV/HCV injection risk behavior and place of injection (private vs. public) was assessed using multivariable Poisson regression with robust variance estimate. RESULTS Most of the sample was male (73%), > 30 years (56%), and reported opioids as their drug of choice (55%). One in six participants (15.8%, n = 57) reported using a syringe after somebody, and 70% (n = 253) reported injecting in public places within last 30-days. In the adjusted model, injection risk behavior was associated with injecting in public places (PrR: 4.24, 95% CI: 1.76-10.20), unstable housing situation (PrR: 2.46, 95% CI:1.26-4.83), higher than secondary education (PrR:1.82, 95%CI:1.04-3.16), injecting with a sex partner day (PrR:2.13, 95% CI:1.28-3.56), and injecting with a stranger (PrR: 1.47, 95% CI: 0.93-2.31). CONCLUSIONS Injecting in a public place is associated with increased prevalence of risky behavior. Therefore, understanding and addressing place-based context should be part of the national strategy to fight HIV and HCV in Ukraine. National programs would benefit from expanding models to include contextual and structural determinants of health.
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Affiliation(s)
- Alyona Mazhnaya
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
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Tweed EJ, Rodgers M, Priyadarshi S, Crighton E. "Taking away the chaos": a health needs assessment for people who inject drugs in public places in Glasgow, Scotland. BMC Public Health 2018; 18:829. [PMID: 29973179 PMCID: PMC6030790 DOI: 10.1186/s12889-018-5718-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. METHODS We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. RESULTS Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services. CONCLUSIONS The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.
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Affiliation(s)
- Emily J Tweed
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK. .,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Mark Rodgers
- NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK.,School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Saket Priyadarshi
- NHS Greater Glasgow and Clyde Addictions Services, Festival Business Centre, 150 Brand Street, Glasgow, G51 1DP, UK
| | - Emilia Crighton
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK
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Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ. Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis. Drug Alcohol Depend 2017; 180:33-38. [PMID: 28865390 PMCID: PMC5811227 DOI: 10.1016/j.drugalcdep.2017.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND and Aims Injecting illicit drugs in public settings has been linked to a higher risk of a range of drug-related harms, including overdose and HIV infection. However, the factors associated with public injecting among HIV-positive individuals have not been previously explored. We investigated the links between public drug injecting, drug-related harm, and HIV treatment measures among a cohort of HIV-positive persons who inject drugs (PWID) in a Canadian setting. METHODS We used data from a prospective cohort of HIV-positive PWID recruited from community settings in Vancouver, Canada, linked to comprehensive clinical monitoring data in the context of an ongoing Treatment-as-Prevention (TasP) initiative to examine harms associated with public injecting. We used generalized linear mixed-effects analyses to identify longitudinal factors associated with self-reported public drug injection. RESULTS Between 2005 and 2014, 626 HIV-seropositive PWID were recruited, of whom 213 (34%) reported public injection in the preceding 180days. In a longitudinal multivariable model, public injection was positively associated with daily heroin injection (Adjusted Odds Ratio [AOR]=2.63), incarceration (AOR=1.78), and detectable plasma HIV-1 RNA viral load (VL, AOR=1.42). CONCLUSIONS Public injecting was linked to numerous drug-related harms among HIV-seropositive PWID in this setting. Given its link with detectable VL, an important marker of poor HIV treatment outcomes, our findings support prioritizing individuals engaged in public injecting with harm reduction strategies as well as clinical and social supports as a part of TasP-based efforts to prevent HIV-related morbidity and mortality, and HIV transmission.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
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Butler G, Chapman D, Terry P. Attitudes of intravenous drug users in London towards the provision of drug consumption rooms. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1252316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Georgia Butler
- Department of Psychology, Kingston University, Kingston-upon-Thames, UK
| | - Dita Chapman
- Department of Psychology, Kingston University, Kingston-upon-Thames, UK
| | - Philip Terry
- Department of Psychology, Kingston University, Kingston-upon-Thames, UK
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Green T, Hankins C, Palmer D, Boivin JF, Platt R. Ascertaining the Need for a Supervised Injecting Facility (SIF): The Burden of Public Injecting in Montreal, Canada. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260303300310] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Empirical evidence suggests that a key prerequisite for a supervised injection facility (SIF) utilization is the existence of an “open drug scene,” where users publicly inject drugs. This study seeks to determine the extent and profile of public injecting among injecting drug users (IDUs) in Montreal, Canada, where pilot SIFs are under consideration. A cross-sectional study of IDUs who injected publicly at least once in the previous month was appended to an HIV-risk surveillance study among Montreal IDUs (SurvUDI study). Of 650 SurvUDI participants interviewed between June 2001 and February 2002, 59% were eligible. A dose-response relationship emerged between intensity of public injecting and several drug-use and risk-related characteristics. Regardless of housing stability, IDUs persistently and, often preferably, publicly injected due to habit, dependence, or need to conceal their status. Despite lacking a classical open drug scene, public injecting is common among Montreal IDUs, warranting the consideration of an SIF for this population.
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Dickson-Gomez J, Bodnar G, Guevara A, Rodriguez K, Gaborit M. Crack Use Sites and HIV Risk in El Salvador. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260703700211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
“The Social Context of Crack Use and Related Sexual Risk in El Salvador” study was designed to increase knowledge of the locations where drugs are consumed in urban San Salvador, the social dynamics within such sites, and their implications for HIV risk and prevention efforts. In-depth interviews with crack smokers reveal several different types of sites where drugs are consumed and risky sex may occur including trances (generally houses where crack is sold and consumed), brothels, motels, drug users' own homes, abandoned buildings, the street, parks, or cantinas. These range from private sites, where site “gatekeepers” strictly control access, to public sites where access is more open. However, even in more public sites there is considerable social interaction, rules regarding site usage, and in some cases gatekeeper control of the site. Social dynamics already normative at drug use sites may support a site-based, peer-led intervention approach.
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Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to an Explosive HIV Epidemic Driven by Frequent Cocaine Injection: Is There a Role for Safe Injecting Facilities? JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260303300303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of SIF utilization, and methods of maximizing use among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety.
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Affiliation(s)
- Thomas Kerr
- Canadian HIV/AIDS Legal Network and Research Associate at the BC Centre for Excellence in HIV/AIDS
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS and coprincipal investigator of the Vancouver Injection Drug Users Study (VIDUS)
| | - Anita Palepu
- Internal medicine specialist and an assistant professor on the Faculty of Medicine at the University of British Columbia
| | - Dean Wilson
- Healthcare advocate and past president of the Vancouver Area Network of Drug Users (VANDU)
| | - Martin T. Schechter
- Department of Healthcare and Epidemiology at the University of British Columbia
| | - Mark W. Tyndall
- Faculty of Medicine at the University of British Columbia, and a research associate at the BC Centre for Excellence in HIV/AIDS
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Dickson-Gómez J, Weeks MR, Martinez M, Radda K. Reciprocity and Exploitation: Social Dynamics in Private Drug use Sites. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260403400410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Study of High Risk Drug Use Settings for HIV Prevention was designed to increase knowledge of urban social contexts in which drugs are consumed. In this article, we use ethnographic methods to focus on one subtype of drug use setting in Hartford, Connecticut, private sites with gatekeepers. We analyze the social interactions of drug users who use these sites to explore the contradictory social processes that sometimes facilitate and at other times impede intervention efforts. Gatekeepers are often interested in attracting customers to their “business” and therefore may be willing to provide ongoing site-based HIV prevention education and materials. On the other hand, exploitative business exchanges contradict ideals of reciprocity and may undermine trust between gatekeepers and drug users impeding harm reduction efforts. Further, being the gatekeeper of a drug use site often accelerates gatekeepers' addictions, making it difficult for them to implement harm reduction strategies.
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Abstract
Recognizing that HIV transmission occurs within situated interactions between two or more people, prevention research has increasingly begun to focus on identifying the influence of situations and settings on the spread of HIV. Examination of the social geography of risk has emerged as a powerful tool for understanding where and among whom risky practices occur. In this regard, shooting galleries represent interactional territories where the normative expectations of participation within their spatial boundaries can both encourage and reinforce sex- and drug-related risky behavior. Indeed, research shows that those who inject in shooting galleries tend to be at a higher risk of transmitting HIV than those who inject elsewhere. Drawing upon data from a sample of 1,113 active injecting drug users, we examined the demographic and psychosocial factors that predict shooting gallery use. Next, we compared shooting gallery users with nonusers in terms of drug use, followed by an examination of differences in sex- and drug-related HIV risk behaviors. Then, we explored preventive practices that possibly differentiate those who use shooting galleries from those who do not. We end our analysis by discussing the implications of our results for HIV prevention and social policy.
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Janulis P. The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:56-64. [PMID: 26530884 PMCID: PMC4715965 DOI: 10.1016/j.drugpo.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. METHODS Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. RESULTS Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner's gender showed no significant association with risk for male injectors. CONCLUSION These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm reduction approaches.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL 60611, United States.
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Roy E, Arruda N. Exploration of a crack use setting and its impact on drug users' risky drug use and sexual behaviors: the case of piaules in a Montréal neighborhood. Subst Use Misuse 2015; 50:630-41. [PMID: 25603495 DOI: 10.3109/10826084.2014.997825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
From July 2011, a one-year study based on ethnographic methodology was carried out in "crack houses" in the neighborhood of Hochelaga-Maisonneuve in Montréal, Canada. The study aimed to explore the operational style of a specific indoor drug use setting and its impact on users' risky sexual and drug use behaviors in a context of drug market change. A thematic analysis of observational and interview notes was conducted. This study stresses the importance to examine the role of environmental factors in relation to crack smoking's health-related risks and to complement individual-based interventions with structural strategies. The study's limitations are noted.
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Affiliation(s)
- Elise Roy
- 1Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec; Researcher, Research Chair on addiction, Université de Sherbrooke , Sherbrooke , Québec
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Latkin CA, Davey-Rothwell MA, Knowlton AR, Alexander KA, Williams CT, Boodram B. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S54-8. [PMID: 23673888 DOI: 10.1097/qai.0b013e3182928e2a] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Johns Hopkins Bloomberg School of Public Health, University of Pennsylvania, Baltimore, MD, USA.
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18
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Wagner KD, Moynihan MJ, Strathdee SA, Cuevas-Mota J, Clark M, Zúñiga ML, Volkmann TA, Teshale E, Garfein RS. The social and environmental context of cross-border drug use in Mexico: findings from a mixed methods study of young injection drug users living in San Diego, CA. J Ethn Subst Abuse 2013; 11:362-78. [PMID: 23216441 DOI: 10.1080/15332640.2012.735182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report the results of qualitative (n = 19) and quantitative (n = 545) interviews with young injection drug users (IDUs) in San Diego, California about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n = 365) used a variety of injection (54%) and noninjection (30%) drugs there and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included interactions among the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the United States and Mexican drug markets; and the experience of crossing the U.S.-Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border.
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Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 92093, USA.
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19
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Cain D, Pare V, Kalichman SC, Harel O, Mthembu J, Carey MP, Carey KB, Mehlomakulu V, Simbayi LC, Mwaba K. HIV risks associated with patronizing alcohol serving establishments in South African Townships, Cape Town. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 13:627-34. [PMID: 22992872 DOI: 10.1007/s11121-012-0290-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alcohol use has been closely linked with HIV risk behaviors in South Africa. The places where people drink are often the same settings in which they meet new sex partners and may contribute independently to sexual risk. This current study examines the independent effects of patronizing alcohol serving establishments (shebeens) and alcohol use in predicting HIV risk behaviors. Men (n = 981) and women (n = 492) were recruited from inside shebeens and surrounding areas proximal to shebeens in eight separate neighborhoods in a Township in Cape Town, South Africa. Anonymous community surveys measured demographic characteristics, alcohol use, shebeen attendance, and sexual risk behaviors. Comparisons of 1210 (82 %) participants who patronized shebeens in the past month with 263 (18 %) participants who did not patronize shebeens demonstrated higher rates of alcohol use frequency and quantity, more sexual partners, and higher rates of vaginal intercourse without condoms for the patrons. Multiple linear regression analysis found shebeen attendance in the past month predicted greater sexual risk for HIV beyond demographic characteristics and alcohol use. Social influences and environmental factors in shebeens could be contributing to sexual risk behavior independently of alcohol consumption. Further research is needed to understand the environmental factors of shebeens that promote and influence HIV risk behaviors.
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Affiliation(s)
- Demetria Cain
- Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269, USA.
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20
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Dickson-Gomez J, McAuliffe T, Rivas de Mendoza L, Glasman L, Gaborit M. The relationship between community structural characteristics, the context of crack use, and HIV risk behaviors in San Salvador, El Salvador. Subst Use Misuse 2012; 47:265-77. [PMID: 22217125 PMCID: PMC3263344 DOI: 10.3109/10826084.2011.635325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper explores community structural factors in different low-income communities in the San Salvador, El Salvador, that account for differences in the social context in which crack is used and HIV risk behaviors among crack users. Results suggest that both more distal (type of low-income community, level of violent crime, and poverty) and proximate structural factors (type of site where drugs are used, and whether drugs are used within or outside of community of residence) influence HIV risk behaviors among drug users. Additionally, our results suggest that community structural factors influence the historical and geographic variation in drug use sites.
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Affiliation(s)
- Julia Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwuakee, Wisconsin 53202, USA.
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21
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Yang C, Tobin K, Latkin C. Perceived serosorting of injection paraphernalia sharing networks among injection drug users in Baltimore, MD. AIDS Behav 2011; 15:16-21. [PMID: 20490907 DOI: 10.1007/s10461-010-9713-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined perceived serosorting of injection paraphernalia sharing networks among a sample of 572 injection drug users (IDUs). There was evidence for serosorting of high-risk injection behaviors among HIV-negative IDUs, as 94% of HIV-negative IDUs shared injection paraphernalia exclusively with perceived HIV-negative networks. However, 82% of HIV-positive IDUs shared injection paraphernalia with perceived HIV-negative networks. The findings indicate a potential risk of rapid HIV transmission. Future prevention efforts targeting IDUs should address the limitation of serosorting, and focus on preventing injection paraphernalia sharing regardless of potential sharing networks' perceived HIV status.
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22
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Hottes TS, Bruneau J, Daniel M. Gender-specific situational correlates of syringe sharing during a single injection episode. AIDS Behav 2011; 15:75-85. [PMID: 19224359 DOI: 10.1007/s10461-009-9530-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
Factors associated with syringe sharing differ between women and men; however, it is uncertain whether these hold within the setting of a single injection episode. A questionnaire eliciting information about the last injection episode with others present was administered to participants in a cohort of Montréal injection drug users (IDUs). Logistic regression was used to identify correlates of syringe sharing and to test potential gender differences in relation to syringe sharing. Data from 467 participants revealed significant differences between men and women with regard to situational factors; however, the relationships between situational factors and syringe sharing did not vary according to gender. In multivariate models including both genders, syringe sharing was associated with various attributes of other IDUs who were present as well as alcohol use during that specific episode. These results highlight the relevance of situational factors in injection drug use activity, regardless of gender.
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Robertson AM, Vera AY, Gallardo M, Pollini RA, Patterson TL, Case P, Nguyen L, Strathdee SA. Correlates of seeking injection assistance among injection drug users in Tijuana, Mexico. Am J Addict 2010; 19:357-63. [PMID: 20653644 DOI: 10.1111/j.1521-0391.2010.00053.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Assisted injection among injection drug users (IDUs) remains understudied. We recruited 1,056 IDUs using respondent-driven sampling in Tijuana, Mexico. Participants underwent HIV and syphilis testing and structured interviews. One-quarter (25%) sought injection assistance in the past 6 months. Seeking injection assistance was independently associated with being female (adjusted odds ratio [AOR]= 2.59; 95% confidence interval [CI]= 1.73-3.90), being born outside Baja California (AOR = 1.75; CI = 1.26-2.42), having recent abscesses (AOR = 2.59; CI = 1.93-3.47), using syringes previously used by others in the past 6 months (AOR = 1.99; CI = 1.45-2.71), and ever being arrested for carrying sterile syringes (AOR = 1.55; CI = 1.15-2.09).
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Affiliation(s)
- Angela M Robertson
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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24
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Abstract
The purpose of this study was to examine the association between social network characteristics and peer norms related to sharing needles and shooting gallery use. Multivariate logistic regression modeling was used to identify factors that were independently associated with shooting gallery use among a sample of injection drug users recruited in Baltimore, Maryland. Of 842 study participants, 35% reported attending a shooting gallery in the past 6 months. Social networks of shooting gallery users were larger, had a greater number of injectors and crack smokers, were younger and less dense with fewer kin members compared to networks of non-gallery attenders. A greater proportion of those who used a gallery perceived that their peers shared needles and that peers would not disapprove if they used a dirty needle. Future research is needed to understand how social networks and peer norms are specific to behavioral settings and how this may impede adoption of preventive behaviors.
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Rachlis BS, Wood E, Li K, Hogg RS, Kerr T. Drug and HIV-related risk behaviors after geographic migration among a cohort of injection drug users. AIDS Behav 2010; 14:854-61. [PMID: 18427970 DOI: 10.1007/s10461-008-9397-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 04/04/2008] [Indexed: 11/26/2022]
Abstract
To determine whether migration impacted on drug use and HIV-related risk behaviors among injection drug users (IDU), we identified participants in a prospective cohort of IDU (Vancouver Injection Drug User Study) who had reported migrating out of Greater Vancouver between May 1996 and November 2005. We compared risk behaviors before and after a move for individuals who migrated (movers) and for a similar period for non-movers using linear growth curve analyses. In total, 1,122 individuals were included, including 430 (38.3%) women and 331 (29.5%) Aboriginal participants. Among these, 192 (17.1%) individuals reported migrating out of Greater Vancouver between 1996 and 2005 while 930 (82.9%) did not. Movers were significantly younger than non-movers: 32.0 (Interquartile Range [IQR]: 24.3-39.2) and 34.6 (IQR: 26.9-40.8) respectively. A significant decrease in those reporting unstable housing, frequent heroin and cocaine injection occurred only in movers. Our findings suggest that, in this setting, risk-taking among IDU declines following periods of migration out of Greater Vancouver.
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Affiliation(s)
- Beth S Rachlis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y6
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Kral AH, Wenger L, Carpenter L, Wood E, Kerr T, Bourgois P. Acceptability of a safer injection facility among injection drug users in San Francisco. Drug Alcohol Depend 2010; 110:160-3. [PMID: 20303679 PMCID: PMC2885552 DOI: 10.1016/j.drugalcdep.2010.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 02/04/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Research has shown that safer injection facilities (SIFs) are successful at reducing public nuisance and enhancing public health. Since 2007 support for implementation of a SIF in San Francisco has been building. The objective of this study is to assess the acceptability of a SIF among injection drug users (IDUs) in San Francisco. METHODS IDUs were recruited in San Francisco using targeted sampling and interviewed using a quantitative survey (N=602). We assessed the prevalence of willingness to use a SIF as well as correlates of willingness among this group. RESULTS Eighty-five percent of IDUs reported that they would use a SIF, three quarters of whom would use it at least 3 days per week. In multivariate analysis, having injected in public and having injected speedballs were associated with intent to use a SIF. The majority of IDUs reported acceptability of many potential rules and regulations of a pilot SIF, except video surveillance, and being required to show identification. CONCLUSIONS Building on the success of SIFs in various international settings, IDUs in San Francisco appear interested in using a SIF should one be implemented.
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Affiliation(s)
- Alex H. Kral
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA, Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Lynn Wenger
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA
| | - Lisa Carpenter
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Philippe Bourgois
- Department of Anthropology, University of Pennsylvania, 415 Anthropology Museum, 3260 South Street, Philadelphia PA 19104-6398, USA
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Williams CT, Metzger DS. Race and distance effects on regular syringe exchange program use and injection risks: a geobehavioral analysis. Am J Public Health 2010; 100:1068-74. [PMID: 20395589 DOI: 10.2105/ajph.2008.158337] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted "geobehavioral" analyses by race to understand how distances among injection drug users' (IDUs') residences, drug purchase and use locations, and syringe exchange programs (SEPs) are associated with injection behaviors. METHODS Data were from the HIV Prevention Trial Network 037 (2002-2006) site in Philadelphia, Pennsylvania, a randomized study evaluating the efficacy of a network-oriented HIV prevention intervention for IDUs. At prescreening, participants were asked the nearest intersections to their residence, where they buy and use drugs, and about their injection behaviors. RESULTS Geographic distances had independent and interactive effects on injection risk behaviors and SEP use. Blacks, regardless of distance, were less likely than Whites to inject in public places (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.43, 0.90), to use syringes after someone else (OR = 0.27; 95% CI = 0.19, 0.38), and to access syringes from SEPs (OR = 2.08; 95% CI = 1.48, 2.92). Latinos' injection behaviors were more distance-dependent than Blacks' or Whites'. CONCLUSIONS Distances among IDUs' homes, drug purchase and injecting sites, and prevention resources affected safe injection practices differentially by race. Understanding individuals' geographic relation to the risks and resources that surround them is an important aspect of understanding effects of the environment on health and behavior and the development of targeted interventions.
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Affiliation(s)
- Chyvette T Williams
- University of Illinois School of Public Health, 1603 West Taylor St, M/C 923, Chicago, IL 60612, USA.
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Ramos R, Ferreira-Pinto JB, Brouwer KC, Ramos ME, Lozada RM, Firestone-Cruz M, Strathdee SA. A tale of two cities: Social and environmental influences shaping risk factors and protective behaviors in two Mexico-US border cities. Health Place 2009; 15:999-1005. [PMID: 19464228 PMCID: PMC2735581 DOI: 10.1016/j.healthplace.2009.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/06/2009] [Accepted: 04/14/2009] [Indexed: 11/22/2022]
Abstract
The economic, social, cultural, and political milieus that influence HIV risk behaviors along the US-Mexico border are understudied. In an effort to appropriately inform interventions targeting structural influences, we compared injecting drug using populations living in two cities--Ciudad Juárez, Chihuahua and Tijuana, Baja California--situated on the Mexico-US border. These populations presented with similar demographic profiles, but differed significantly in terms of social and environmental influences that can influence both risk and protective factors (e.g., family drug use, migration, drug use patterns). We observed distinct behavioral and structural influences in these two border cities that will require tailored intervention strategies to reduce HIV transmission.
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Affiliation(s)
- Rebeca Ramos
- US Mexico Border Health Association, El Paso, TX, USA
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Briggs D, Rhodes T, Marks D, Kimber J, Holloway G, Jones S. Injecting drug use and unstable housing: Scope for structural interventions in harm reduction. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630802697685] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bohnert ASB, Bradshaw CP, Latkin CA. A social network perspective on heroin and cocaine use among adults: evidence of bidirectional influences. Addiction 2009; 104:1210-8. [PMID: 19563564 PMCID: PMC2726044 DOI: 10.1111/j.1360-0443.2009.02615.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS While several studies have documented a relationship between initiation of drug use and social network drug use in youth, the direction of this association is not well understood, particularly among adults or for stages of drug involvement beyond initiation. The present study sought to examine two competing theories (social selection and social influence) in the longitudinal relationship between drug use (heroin and/or cocaine) and social network drug use among drug-experienced adults. DESIGN Three waves of data came from a cohort of 1108 adults reporting a life-time history of heroin and/or cocaine use. SETTING Low-income neighborhoods with high rates of drug use in Baltimore, Maryland. PARTICIPANTS Participants had weekly contact with drug users and were 18 years of age or older. MEASUREMENTS Drug use data were self-report. Network drug use was assessed through a social network inventory. Close friends were individuals whom the participant reported seeing daily or rated as having the highest level of trust. Findings Structural equation modeling indicated significant bidirectional influences. The majority of change in network drug use over time was due to change in the composition of the network rather than change in friends' behavior. Drug use by close peers did not influence participant drug use beyond the total network. CONCLUSIONS There is evidence of both social selection and social influence processes in the association between drug use and network drug use among drug-experienced adults.
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Affiliation(s)
- Amy S B Bohnert
- VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center (11H), 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Parkin S, Coomber R. Informal 'Sorter' Houses: A qualitative insight of the 'shooting gallery' phenomenon in a UK setting. Health Place 2009; 15:981-9. [PMID: 19427256 DOI: 10.1016/j.healthplace.2009.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/20/2009] [Accepted: 03/30/2009] [Indexed: 01/31/2023]
Abstract
This paper considers the 'shooting gallery' phenomenon and presents findings from a sample of injecting drug users with experience of attending such premises in the South-West of England (UK). Due to the reciprocal relationship within these settings, involving the provision of drugs for place, the term Informal Sorter House has been coined by the authors. The social organisation and associative health risks within Informal Sorter Houses were found to have resounding similarities with those previously identified within American settings. However, several differences were also noted. Namely, Informal Sorter Houses appear to be located within a continuum of control that contains regulated, unregulated, and restored injecting environments and accordingly, it is suggested that such environments are in constant flux. A further difference relates to drug-user activism identified within such settings. This involves the establishment of an informal, street-based harm reduction practice that provides potential for future service development.
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Affiliation(s)
- Stephen Parkin
- School of Law and Social Science, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
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Rachlis BS, Wood E, Zhang R, Montaner JS, Kerr T. High rates of homelessness among a cohort of street-involved youth. Health Place 2009; 15:10-7. [PMID: 18358759 PMCID: PMC2606292 DOI: 10.1016/j.healthplace.2008.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 01/18/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
Abstract
Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20-24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.
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Affiliation(s)
- Beth S. Rachlis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Ruth Zhang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
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Azim T, Chowdhury EI, Reza M, Faruque MO, Ahmed G, Khan R, Rahman M, Pervez MM, Jana S, Strathdee SA. Prevalence of infections, HIV risk behaviors and factors associated with HIV infection among male injecting drug users attending a needle/syringe exchange program in Dhaka, Bangladesh. Subst Use Misuse 2008; 43:2124-44. [PMID: 19085439 DOI: 10.1080/10826080802344583] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted.
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Affiliation(s)
- Tasnim Azim
- HIV/AIDS Programme, Laboratory Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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Injecting and sexual risk behaviours, sexually transmitted infections and HIV prevalence in injecting drug users in three states in India. AIDS 2008; 22 Suppl 5:S59-68. [PMID: 19098480 DOI: 10.1097/01.aids.0000343764.62455.9e] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe and compare sexual and injecting risk behaviours and sexually transmitted infections (STI), hepatitis C virus (HCV) and HIV prevalence in injecting drug users (IDU) in six districts in three states of India: Manipur, Nagaland, and Maharashtra. METHOD The respondent-driven sample consisted of 2075 IDU. Consenting participants were administered a structured questionnaire and samples of blood and urine were collected to test for HIV and STI. Data were analysed using RDSAT. RESULTS In two districts in Manipur, 77 and 98% of IDU injected heroin, whereas the main injecting drug in Nagaland was dextropropoxyphene (99%). In Mumbai/Thane, Maharashtra, the majority of respondents reported using chlorpheniramine (87%) and heroin (99%). In all districts, almost half of IDU reported generally sharing needles and syringes; consistent condom use with non-paid female partners was also low. Approximately one-quarter of IDU in Mumbai/Thane visited a paid partner in the past year. IDU with reactive syphilis serology were higher in Nagaland (7 and 19%) than in Manipur and Maharashtra. HIV in two districts of Manipur (23%, 32%) and Mumbai/Thane (16%) was greater than Nagaland (<2%). HCV prevalence was more than 50% in Mumbai/Thane and Manipur. CONCLUSION Irrespective of regional differences, high-risk behaviour of needle sharing and low condom use makes IDU a critical subpopulation for HIV prevention interventions. Interventions need to address the differing drug use patterns in the regions and transmission prevention among non-paid regular and casual female partners of IDU in the northeast districts and paid female partners in Mumbai/Thane.
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Fast D, Small W, Wood E, Kerr T. The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Harm Reduct J 2008; 5:32. [PMID: 18957139 PMCID: PMC2605439 DOI: 10.1186/1477-7517-5-32] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/29/2008] [Indexed: 11/24/2022] Open
Abstract
Background Unsafe injection practices are prevalent among injection drug users (IDU) and have resulted in numerous forms of drug-related harm including HIV/HCV transmission and other bacterial and viral infections. North America's first supervised injection facility (SIF) was established in Vancouver in order to address injection-related harms among IDU. This study sought to examine injection drug users' experiences receiving safer injecting education in the context of a SIF. Methods Semi-structured qualitative interviews were conducted with 50 individuals recruited from a cohort of SIF users known as the Scientific Evaluation of Supervised Injection (SEOSI) cohort. Audio recorded interviews elicited IDU perspectives regarding the provision of safer injecting education within the context of a SIF. Interviews were transcribed verbatim and a thematic analysis was conducted. Results Participant narratives indicate that significant gaps in knowledge regarding safer injecting practices exist among local IDU, and that these knowledge deficits result in unsafe injecting practices and negative health outcomes. However, IDU perspectives reveal that the SIF allows clients to identify and address these gaps in knowledge through a number of mechanisms that are unique to this facility, including targeted educational messaging that occurs as a part of the drug use cycle and not outside of it, in situ demonstration of safer injecting techniques that takes place the moment a client is experiencing difficulties, and enhanced opportunities to seek help from 'expert' healthcare professionals. Importantly, study participants indicated that the overall environment of the SIF promotes the adoption of safer injecting practices over time, both within and outside of the facility. Conclusion We conclude that the SIF has been particularly effective in transmitting educational messages targeting unsafe and unhygienic injection practices to a population of active IDU. Consistent with previous work, results of this study indicate that SIFs represent a unique 'micro-environment' that can facilitate the reduction of numerous drug related harms.
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Affiliation(s)
- Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, British Columbia, Canada.
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Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women's experiences in North America's first supervised injection facility. Soc Sci Med 2008; 67:817-23. [DOI: 10.1016/j.socscimed.2008.05.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Indexed: 11/24/2022]
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Andía JF, Deren S, Robles RR, Kang SY, Colón HM. Peer norms and sharing of injection paraphernalia among Puerto Rican injection drug users in New York and Puerto Rico. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:249-257. [PMID: 18558821 DOI: 10.1521/aeap.2008.20.3.249] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamón, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing was associated with indirect sharing in both locations. Prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors.
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Affiliation(s)
- Jonny F Andía
- National Development and Research Institutes, Inc., Center for Drug Use and HIV Research, New York, NY 10010, USA
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Todd CS, Abed AMS, Scott PT, Botros BA, Safi N, Earhart KC, Strathdee SA. Correlates of receptive and distributive needle sharing among injection drug users in Kabul, Afghanistan. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2008; 34:91-100. [PMID: 18161647 DOI: 10.1080/00952990701764771] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We describe receptive and distributive needle/syringe sharing among injection drug users (IDUs) in Kabul, Afghanistan. In this cross-sectional study, IDUs completed an interviewer-administered questionnaire. Logistic regression identified correlates of needle sharing in the last six months. Receptive and distributive sharing in the last six months were reported by 28.2% and 28.7% of participants, respectively, and were both independently associated with reported difficulty obtaining new syringes (Receptive sharing: AOR = 2.60, 95% CI: 1.66-4.06; Distributive: AOR = 1.56, 95% CI: 1.02-2.39). Receptive and distributive sharing are common among IDU in Kabul; scaling up availability of sterile, no-cost injecting equipment is urgently needed.
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Affiliation(s)
- Catherine S Todd
- Division of International Health and Cross-Cultural Medicine, University of California, San Diego, La Jolla, California 92093-0622, USA.
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Strathdee SA, Lozada R, Pollini RA, Brouwer KC, Mantsios A, Abramovitz DA, Rhodes T, Latkin CA, Loza O, Alvelais J, Magis-Rodriguez C, Patterson TL. Individual, social, and environmental influences associated with HIV infection among injection drug users in Tijuana, Mexico. J Acquir Immune Defic Syndr 2008; 47:369-76. [PMID: 18176320 PMCID: PMC2752692 DOI: 10.1097/qai.0b013e318160d5ae] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined correlates of HIV infection among injection drug users (IDUs) in Tijuana, Mexico, a city bordering the United States, which is situated on major migration and drug trafficking routes. METHODS IDUs aged > or =18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection. RESULTS Of 1056 IDUs, the median age was 37 years, 86% were male, and 76% were migrants. HIV prevalence was higher in female participants than in male participants (8% vs. 3%; P = 0.01). Most IDUs testing HIV-positive were previously unaware of their serostatus (93%). IDUs reported injecting with a median of 2 people in the prior 6 months and had been arrested for having injection stigmata (ie, "track-marks") a median of 3 times. Factors independently associated with HIV infection were being female, syphilis titers consistent with active infection, larger numbers of recent injection partners, living in Tijuana for a shorter duration, and being arrested for having track-marks. CONCLUSIONS Individual, social, and environmental factors were independently associated with HIV infection among IDUs in Tijuana. These findings suggest the need to intervene not solely on individual risk behaviors but on social processes that drive these behaviors, including problematic policing practices.
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Affiliation(s)
- Steffanie A Strathdee
- Division of International Health and Cross Cultural Medicine, University of California San Diego School of Medicine, La Jolla, CA 92093, USA.
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Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodriguez C, Case P, Burris S, Pu M, Frost SDW, Palinkas LA, Miller C, Strathdee SA. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction 2008; 103:101-8. [PMID: 18028520 PMCID: PMC2214830 DOI: 10.1111/j.1360-0443.2007.02051.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing. DESIGN Cross-sectional study. SETTING Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua. PARTICIPANTS IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent-driven sampling (RDS). IDUs were > or = 18 years and had injected illicit drugs in the past month. MEASUREMENTS An interviewer-administered survey was used to collect quantitative data on socio-demographic, behavioral and contextual characteristics, including self-reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment. FINDINGS Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69). CONCLUSIONS We documented high levels of syringe-related arrests in two Mexican-US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices.
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Affiliation(s)
| | | | | | - Rebeca Ramos
- United States-Mexico Border Health Association, USA
| | | | | | | | | | - Minya Pu
- School of Medicine, University of California San Diego, USA
| | | | - Lawrence A. Palinkas
- School of Medicine, University of California San Diego, USA,University of Southern California, USA
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Thiede H, Hagan H, Campbell JV, Strathdee SA, Bailey SL, Hudson SM, Kapadia F, Garfein RS. Prevalence and correlates of indirect sharing practices among young adult injection drug users in five U.S. cities. Drug Alcohol Depend 2007; 91 Suppl 1:S39-47. [PMID: 17466464 DOI: 10.1016/j.drugalcdep.2007.03.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 03/02/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sharing of drug paraphernalia to prepare, measure and divide drugs for injection remains an important residual risk factor for hepatitis C and other blood-borne infections among injection drug users (IDUs) especially as sharing of syringes for injection decreases. METHODS We analyzed data from five U.S. cities to determine the prevalence and independent correlates of non-syringe paraphernalia-sharing (NSPS) and syringe-mediated drug-splitting (SMDS) among 15-30-year-old IDUs who reported not injecting with others' used syringes (receptive syringe-sharing, RSS). RESULTS NSPS was reported by 54% of IDUs who did not practice RSS and was independently associated (p<0.05) with having > or =5 injection partners, injecting with sex partners or regular injection partners, injecting in shooting galleries, peers' sharing behaviors, lower self-efficacy for avoiding NSPS, and less knowledge of HIV and HCV transmission. SMDS was reported by 26% of IDUs who did not practice RSS, and was independently associated with having > or =5 injection partners, injecting in shooting galleries, and inversely associated with unknown HIV status. CONCLUSIONS NSPS and SMDS were common among young adult IDUs. Increased efforts to prevent these risky practices should address social and environmental contexts of injection and incorporate knowledge and skills building, self-efficacy, and peer norms.
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Affiliation(s)
- Hanne Thiede
- HIV/AIDS Epidemiology Program, Public Health-Seattle & King County, 400 Yesler Way, 3rd Floor, Seattle, WA 98104, USA.
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De P, Cox J, Boivin JF, Platt RW, Jolly AM. The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction 2007; 102:1730-9. [PMID: 17935581 DOI: 10.1111/j.1360-0443.2007.01936.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment. METHODS A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles. RESULTS Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing. CONCLUSIONS Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.
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Affiliation(s)
- Prithwish De
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
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Coady MH, Latka MH, Thiede H, Golub ET, Ouellet L, Hudson SM, Kapadia F, Garfein RS. Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS Behav 2007; 11:854-63. [PMID: 17551825 DOI: 10.1007/s10461-007-9248-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 04/30/2007] [Indexed: 11/30/2022]
Abstract
Using cross-sectional analysis we examined residential status and associated differences in HIV risk behaviors among 3266 young IDUs enrolled in an HIV prevention trial. A three-level outcome (homeless (37%), equivocally housed (17%), housed (46%)) was defined based on responses to two questions assessing subjective and objective criteria for homelessness: "equivocally housed" participants were discordant on these measures. In multivariate analysis, antecedents of homelessness were having lived in an out-of-home placement, been thrown out of the home or in juvenile detention, and experienced childhood abuse; while correlates included receiving income from other and illegal sources, drinking alcohol or using methamphetamine at least daily, using shooting galleries, backloading, and sex work. A subset of these variables was associated with being equivocally housed. HIV risk varies by housing status, with homeless IDUs at highest risk. Programs for IDUs should utilize a more specific definition of residential status to target IDUs needing intervention.
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Affiliation(s)
- Micaela H Coady
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA.
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Roy É, Nonn É, Haley N, Cox J. Hepatitis C meanings and preventive strategies among street-involved young injection drug users in Montréal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:397-405. [DOI: 10.1016/j.drugpo.2007.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 02/02/2007] [Accepted: 02/12/2007] [Indexed: 12/11/2022]
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Kimber J, Dolan K. Shooting gallery operation in the context of establishing a medically supervised injecting center: Sydney, Australia. J Urban Health 2007; 84:255-66. [PMID: 17273925 PMCID: PMC2231637 DOI: 10.1007/s11524-006-9145-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Shooting galleries (SGs) are illicit off-street spaces close to drug markets used for drug injection. Supervised injecting facilities (SIFs) are low threshold health services where injecting drug users (IDUs) can inject pre-obtained drugs under supervision. This study describes SG use in Kings Cross, Sydney before and after the opening of the Sydney Medically Supervised Injecting Centre (MSIC), Australia's first SIF. Operational and environmental characteristics of SGs, reasons for SG use, and willingness to use MSIC were also examined. An exploratory survey of SG users (n = 31), interviews with SG users (n = 17), and drug workers (n = 8), and counts of used needles routinely collected from SGs (6 months before and after MSIC) and visits to the MSIC (6 months after MSIC) were triangulated. We found five SGs operated during the study period. Key operational characteristics were 24-h operation, AUS $10 entry fee, 30-min time limit, and dual use for sex work. Key reasons for SG use were to avoid police, a preference not to inject in public, and assistance from SG operators in case of overdose. SG users reported high levels of willingness to use the MSIC. The number of used needles collected from SGs decreased by 69% (41,819 vs. 12,935) in the 6 months after MSIC opened, while MSIC visits increased incrementally. We conclude that injections were transferred from SGs to the MSIC, but SGs continued to accommodate injections and harm reduction outreach should be maintained.
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Affiliation(s)
- Jo Kimber
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK.
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Small W, Rhodes T, Wood E, Kerr T. Public injection settings in Vancouver: Physical environment, social context and risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:27-36. [DOI: 10.1016/j.drugpo.2006.11.019] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 11/28/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
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Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M, Holloway G. Public injecting and the need for 'safer environment interventions' in the reduction of drug-related harm. Addiction 2006; 101:1384-93. [PMID: 16968336 DOI: 10.1111/j.1360-0443.2006.01556.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND One key structural dimension in the distribution of drug-related harm associated with injecting drug use is the injecting environment. Epidemiological evidence associates elevated blood-borne viral risk with injecting in 'public' and 'semipublic' environments. Yet the quality of evidence on public injecting and related viral risk is variable, and is lacking in many countries such as the United Kingdom. AIM This commentary considers the micro-injecting environment as a critical dimension of risk, exploring the need for 'safer injecting environment interventions'. METHODS We draw upon published research evidence and qualitative case examples. RESULTS We note the limits in epidemiological evidence on public injecting and emphasize the need for ethnographic research to determine the 'social relations' of how drug users and risk practices interact with injecting environments. We identify three main forms of 'safer environment intervention': purpose-built drug consumption rooms; interventions within existing spatial relations; and spatial programming and urban design. While drug consumption rooms find evidence-based support, they are not a panacea. We emphasize the potential of interventions embedded within existing spatial and social relations. These include low-cost pragmatic interventions enhancing facilities and safety at public and semipublic injecting sites and, primarily, peer-based interventions, including peer-supervised injecting sites. We caution against spatial programming and urban design interventions which can cause the displacement of socially marginalized populations and the redistribution of harm. CONCLUSIONS Public health interventions in the addictions field have in the past focused upon individual behavioural change at the cost of social interventions and environmental change. We wish to focus greater attention on reducing risks related to public injecting and encourage greater debate on 'safer environment interventions' in harm reduction.
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Affiliation(s)
- Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
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Abstract
AIMS While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. DESIGN Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. FINDINGS Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. CONCLUSIONS The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.
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Affiliation(s)
- Elizabeth C Costenbader
- Substance Abuse Treatment Evaluations and Interventions Program, Research Triangle Institute, International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
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Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2005.12.005] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Harm reduction by a “user-run” organization: A case study of the Vancouver Area Network of Drug Users (VANDU). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.01.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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