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Allen ST, Reid M, Harris SJ, Tomko C, Glick JL, Weir BW, Smith KC, Grieb SM. Lessons Learned Implementing Syringe Services Programs at Rural Health Departments in Kentucky. AIDS Behav 2024; 28:3051-3059. [PMID: 39001946 DOI: 10.1007/s10461-024-04389-w] [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: 05/22/2024] [Indexed: 07/15/2024]
Abstract
Until recently, most syringe services programs (SSPs) in the United States operated in metropolitan areas. This study explores how SSP implementers at rural health departments in Kentucky secured support for SSP operations. In late 2020, we conducted in-depth, semi-structured interviews with 18 people involved with rural SSP implementation in Kentucky. Participants were asked to reflect on their experiences building support for SSP operations among rural health department staff and community members. Participants reported that attitudes and beliefs about SSP implementation among rural health department staff shifted quickly following engagement in educational activities and interaction with SSP clients. Participants explained that successful SSP implementation at rural health departments required sustained educational activities among community members and authorizing authorities. Future work should explore how rural communities may advocate for low-threshold and evidence-based policies that support the provision of harm reduction services.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Molly Reid
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Jennifer L Glick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Brian W Weir
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Suzanne M Grieb
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
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Roth AM, Ward KM, Hensel DJ, Elliott L, Bennett AS. Exploration of weekly variation in naloxone possession and carriage among people who use opioids in New York City before, during, and after the COVID-19 pandemic. PLoS One 2024; 19:e0307151. [PMID: 39024257 PMCID: PMC11257247 DOI: 10.1371/journal.pone.0307151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Naloxone is critical for reversing opioid-related overdoses. However, there is a dearth of research examining how naloxone possession and carriage are impacted by time-varying individual and social determinants, and if this differed during the height of the COVID-related mitigation measures (e.g., shutdowns). METHODS We utilized weekly ecological momentary assessments (EMA) to measure factors associated with naloxone possession and carriage among 40 people who use illicit opioids in New York City, for 24 months. Descriptive statistics were used to explore the frequency of weeks with consistent naloxone possession and carriage. Mixed effects binary and multivariable logistic regression was used to test for the impact of time-varying EMA- and baseline-level factors on each outcome. RESULTS Approximately 70% of weekly EMAs were associated with consistent naloxone possession or carriage. In multivariable models, compared to during the height of the COVID-related shutdowns (March 12, 2020-May 19, 2021), the time before was associated with lower odds of consistent possession (Odds Ratio (OR) = 0.05, 95% Confidence Interval (CI) = 0.01-0.15) and consistent carriage (OR = 0.06, CI = 0.01-0.25). Additionally, being female (OR = 11.15, CI = 2.85-43.42), being White versus being Black or Hispanic/Latinx (OR = 8.05, CI = 1.96-33.06), and lifetime overdose (OR = 1.96, CI = 1.16-19.80) were associated with higher odds of consistent possession. Recent opioid injection (OR = 3.66, CI = 1.34-9.94), being female (OR = 7.91, CI = 3.91-8.23), and being White (OR = 5.77, CI = 1.35-24.55) were associated with higher odds of consistent carriage. Not wanting to be perceived as a drug user was reported in nearly one third (29.0%; 190/656) of EMAs where inconsistent possession was reported. CONCLUSIONS Our findings paint a relatively positive picture of possession and carriage during COVID-related shutdowns, particularly among white and female participants, and highlight the importance of capturing time-varying factors to understand naloxone-related behavior. To curb growing disparities, outreach to equip Black and Hispanic/Latinx people with naloxone is needed as well as interventions to reduce stigma as a barrier to naloxone engagement.
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Affiliation(s)
- Alexis M. Roth
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Kathleen M. Ward
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Devon J. Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Department of Sociology, Indiana University Indianapolis, Indianapolis, IN, United States of America
| | - Luther Elliott
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, United States of America
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, United States of America
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Sutherland R, King C, Karlsson A, Treloar C, Broady T, Chandrasena U, Salom C, Dietze P, Peacock A. Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia. Drug Alcohol Rev 2024; 43:1264-1279. [PMID: 38644679 DOI: 10.1111/dar.13846] [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] [Received: 09/25/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services. METHODS Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma. RESULTS Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. DISCUSSION AND CONCLUSIONS Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Antonia Karlsson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Udesha Chandrasena
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychology, University of Tasmania, Hobart, Australia
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Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024; 43:1071-1079. [PMID: 38271084 DOI: 10.1111/dar.13806] [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] [Received: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Broady TR, Valerio H, Alavi M, Wheeler A, Silk D, Martinello M, Conway A, Milat A, Dunlop A, Murray C, Henderson C, Amin J, Read P, Marks P, Degenhardt L, Stevens A, Prain B, Hayllar J, Reid D, Montebello M, Wade A, Christmass M, Cock V, Dore GJ, Treloar C, Grebely J. Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104468. [PMID: 38795465 DOI: 10.1016/j.drugpo.2024.104468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Heather Valerio
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Anna Conway
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Camperdown, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Murray
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | | | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annabelle Stevens
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Bianca Prain
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Mark Montebello
- North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexandra Wade
- Mid North Coast Local Health District, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Grebely J, Matthews S, Causer LM, Feld JJ, Cunningham P, Dore GJ, Applegate TL. We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what? Expert Rev Mol Diagn 2024; 24:177-191. [PMID: 38173401 DOI: 10.1080/14737159.2023.2292645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a 'game-changer.' These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations. AREAS COVERED This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests). EXPERT OPINION It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Louise M Causer
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Philip Cunningham
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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Broady TR, Brener L, Horwitz R, Cama E, Treloar C. Reducing stigma towards people living with HIV and people who inject drugs using social norms theory: An online study with Australian health care workers. Drug Alcohol Depend 2023; 249:109953. [PMID: 37302358 DOI: 10.1016/j.drugalcdep.2023.109953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite extensive evidence regarding the negative effects of stigma experienced by people living with HIV (PLHIV) and people who inject drugs within health care settings, comparatively little evidence exists regarding the effectiveness of initiatives to reduce this stigma. METHOD This study developed and assessed brief online interventions based on social norms theory with a sample of Australian health care workers (n=653). Participants were randomly allocated to either 1) HIV intervention group, or 2) injecting drug use intervention group. They completed baseline measures of their attitudes towards either PLHIV or people who inject drugs, matching measures of their perceptions of their colleagues' attitudes, plus a series of items reflecting behavioural intentions and agreement with stigmatising behaviour towards PLHIV or people who inject drugs. Participants were presented with a social norms video before completing the measures again. RESULTS At baseline, participants' agreement with stigmatising behaviour was correlated with their perceptions of how many of their colleagues would agree. After watching the video, participants reported more positive perceptions of their colleagues' attitudes towards PLHIV and people who inject drugs, as well as more positive personal attitudes towards people who inject drugs. Changes in perceptions of colleagues' support for stigmatising behaviour independently predicted changes in participants' personal agreement with that behaviour. CONCLUSION Findings suggest that interventions based on social norms theory that address health care workers' perceptions of their colleagues' attitudes can play an important role in contributing to broader initiatives to reduce stigma in health care settings.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, UNSW, Australia
| | - Robyn Horwitz
- Centre for Social Research in Health, UNSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Australia
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Broady TR, Brener L, Caruana T, Cama E, Treloar C. Factors associated with sharing equipment among people who inject drugs: The role of community attachment in harm reduction and health promotion. Drug Alcohol Rev 2023; 42:561-568. [PMID: 36729689 DOI: 10.1111/dar.13606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Sharing injecting equipment is a major route of transmission for blood borne viruses such as hepatitis C and HIV. Although needle and syringe programs are widely available throughout metropolitan Australia, rates of sharing equipment have not significantly changed in recent years. This study aimed to identify factors associated with recent equipment sharing among people who inject drugs in Australia. METHODS A paper-based survey was distributed via peer-based organisations between June and November 2018 and was completed by 603 participants. Survey questions addressed recent injecting experiences, equipment sharing, community attachment, stigma and wellbeing. Participants who had recently shared injecting equipment were compared with those who had not shared any equipment using multivariable logistic regression. RESULTS Recent equipment sharing was associated with recent heroin use, experiencing any past-year stigma related to injecting drug use, and higher levels of attachment to a community of people who inject drugs. An interaction effect showed increased community attachment was associated with increased odds of sharing equipment among young participants, but with decreased odds of sharing equipment among older participants. DISCUSSION AND CONCLUSIONS Community networks of people who inject drugs can play important roles in harm reduction initiatives. While being connected with a community of people who inject drugs increased the odds of sharing injecting equipment, this community connection also increases opportunities for social support, sharing information and mitigating the negative effects of stigma. Collaboratively and meaningfully engaging with communities of people who inject drugs has the potential to increase the reach and effectiveness of health promotion services.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Jaafar S, Torres-Leguizamon M, Duplessy C, Stambolis-Ruhstorfer M. Hormonothérapie injectable et réduction des risques : pratiques, difficultés, santé des personnes trans en France. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:109-122. [PMID: 37336724 DOI: 10.3917/spub.hs2.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Hormone therapy (HT) adherence practices among trans people are poorly studied. For a large proportion of these people, HT is administered parenterally. The unavailability of certain treatments in France, combined with poor institutional care, keeps injectors away from the health care system and encourages potentially risky injection practices. Following a significant increase in the number of trans people in its active list, the association Safe, coordinator of the remote harm reduction system in France, conducted a cross-sectional descriptive study from December 2020 to February 2021 using an anonymous self-administered online questionnaire. PURPOSE OF RESEARCH The objective is to better understand the profile of trans people who inject their HT and their injection practices. RESULTS We observed that a significant proportion of trans injectors do not benefit from professional support, either to obtain treatment or to carry out the injection. This situation can lead to certain misuses of medical supplies, such as needle sharing or reuse, which present significant health risks. This is especially true for injectors whose treatment is not legally available and who obtain it through parallel markets. This study also underlines the importance of self-support associations to accompany transition. CONCLUSIONS We therefore propose that a harm reduction policy adapted to the practices of trans people be implemented in order to better support this population and avoid the emergence of major health problems such as HIV infection.
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Holeksa J. Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city. Harm Reduct J 2022; 19:23. [PMID: 35246162 PMCID: PMC8894830 DOI: 10.1186/s12954-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. METHODS Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. RESULTS Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. CONCLUSION Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Citadellsvägen 7, 211 18, Malmö, Sweden.
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11
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Djordjevic F, Ryan K, Gunn J, Brener L, O'Keefe D, Draper B, Schroeder S, Gold J, Treloar C, Broady T, Dietze P, Hellard M, Pedrana A. Health service utilization and experiences of stigma amongst people who inject drugs in Melbourne, Australia. J Viral Hepat 2021; 28:1738-1743. [PMID: 34510655 DOI: 10.1111/jvh.13612] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 12/09/2022]
Abstract
Whilst the testing and treatment of people who inject drugs (PWID) in Australia is a priority for local hepatitis C (HCV) elimination efforts, perceived stigma related to injecting drug use (IDU) has been identified as a major barrier for PWID engaging in health services. We used data from the EC Experience cohort study to explore associations between IDU-related perceived stigma and the number of different health services accessed by PWID in Melbourne, Australia. Data from the baseline questionnaire were used. Primary outcome was self-reported experience of stigma due to IDU (never, rarely, sometimes, often, always) in the previous 12 months. An ordinal logistic regression model assessed the association between stigma experienced and the number of different health services used (1-2, 3-4, 5-6, 7-10 different services) adjusted for recent IDU and key socio-demographics. Between September 2018 and February 2020, 281 participants were recruited from four health services. Sixty-nine per cent were male, median age was 42, 83% reported past-month IDU, 34% had never tested/tested >12 months, 8% tested negative <12 months, 43% were HCV-positive but not treated and 16% had been treated. Those accessing 5-6 services had 2.2 times greater odds of experiencing stigma (95% CI 0.86-6.65) compared with those using <5 services and those reporting 7-10 services had 2.43 times greater odds of experiencing stigma (95% CI 0.85-6.92) compared with those accessing <7 services. In conclusion, experiences of stigma may not necessarily be a barrier for PWID to access health services, but high rates of health service use may further expose, exacerbate or exaggerate stigma amongst PWID. Further examination of how stigma may be in/directly impact on hepatitis C treatment uptake is important and place-based interventions aimed at reducing stigma experienced by PWID may be needed.
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Affiliation(s)
- Filip Djordjevic
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Vic., Australia
| | - Kathleen Ryan
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
| | - Jack Gunn
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Loren Brener
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - Daniel O'Keefe
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Vic., Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - Sophia Schroeder
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Judy Gold
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Carla Treloar
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - Tim Broady
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Vic., Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia.,Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia.,Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
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12
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Surratt HL, Otachi J, McLouth C, Vundi N. Healthcare stigma and HIV risk among rural people who inject drugs. Drug Alcohol Depend 2021; 226:108878. [PMID: 34214880 PMCID: PMC8355211 DOI: 10.1016/j.drugalcdep.2021.108878] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The HIV epidemic is increasingly penetrating rural areas of the U.S. due to evolving epidemics of injection drug use. Many rural areas experience deficits in availability of HIV prevention, testing and harm reduction services, and confront significant stigma that inhibits care seeking. This paper examines enacted stigma in healthcare settings among rural people who inject drugs (PWID) and explores associations of stigma with continuing high-risk behaviors for HIV. METHODS PWID participants (n = 324) were recruited into the study in three county health department syringe service programs (SSPs), as well as in local community-based organizations. Trained interviewers completed a standardized baseline interview lasting approximately 40 min. Bivariate logistic regression models examined the associations between enacted healthcare stigma, health conditions, and injection risk behaviors, and a mediation analysis was conducted. RESULTS Stigmatizing health conditions were common in this sample of PWID, and 201 (62.0 %) reported experiencing stigma from healthcare providers. Injection risk behaviors were uniformly associated with higher odds of enacted healthcare stigma, including sharing injection equipment at most recent injection (OR = 2.76; CI 1.55, 4.91), and lifetime receptive needle sharing (OR = 2.27; CI 1.42, 3.63). Enacted healthcare stigma partially mediated the relationship between having a stigmatizing health condition and engagement in high-risk injection behaviors. DISCUSSION Rural PWID are vulnerable to stigma in healthcare settings, which contributes to high-risk injection behaviors for HIV. These findings have critical public health implications, including the importance of tailored interventions to decrease enacted stigma in care settings, and structural changes to expand the provision of healthcare services within SSP settings.
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Affiliation(s)
| | | | - Chris McLouth
- University of Kentucky, Department of Behavioral Science
| | - Nikita Vundi
- University of Kentucky, Center for Health Services Research
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13
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Patel EU, Solomon SS, Lucas GM, McFall AM, Tomori C, Srikrishnan AK, Kumar MS, Laeyendecker O, Celentano DD, Thomas DL, Quinn TC, Mehta SH. Drug use stigma and its association with active hepatitis C virus infection and injection drug use behaviors among community-based people who inject drugs in India. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103354. [PMID: 34247900 DOI: 10.1016/j.drugpo.2021.103354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although drug use stigma is globally pervasive, quantitative evidence of its role in hepatitis C virus (HCV) transmission is limited. We evaluated the psychometric properties of a drug use stigma scale and examined the association between drug use stigma and active HCV infection among a community-based sample of people who inject drugs (PWID) in India. METHODS Between 8/2016 and 5/2017, a cross-sectional sample of PWID was recruited from 12 Indian cities (~1000/city) using respondent-driven sampling. Participants were ≥18 years old and reported injection drug use (IDU) in the past 2 years. Multivariable logistic regression with a random-intercept for each city was used to estimate adjusted odds ratios (aOR) of active HCV infection (RNA>30 IU/mL). Analyses incorporated RDS-II weights. RESULTS Of 11,663 participants, 73.1% reported IDU in the past 6 months and 33.8% had active HCV infection. Exploratory factor analysis yielded a four-factor solution of enacted, vicarious, felt normative and internalized drug use stigma with high internal consistency (Cronbach's α: 0.85-0.92). In analyses adjusted for age, gender, northeast region, education, homelessness, incarceration, alcohol dependence, HIV status, frequency of IDU, and ever sharing needles/syringes, PWID reporting any enacted stigma had greater odds of active HCV infection (aOR = 1.27 [95% CI = 1.13-1.43]) as did PWID with internalized stigma scores in the highest quartile (vs. lowest quartile; aOR = 1.69 [95% CI = 1.11-2.56]). Among PWID who reported IDU in the past 6 months, multiple forms of stigma were associated with higher frequency of IDU, sharing needles/syringes, having multiple injection partners, and IDU in public spaces. CONCLUSION Using a multidimensional drug use stigma scale, various forms of stigma were significantly associated with active HCV infection and injection drug use-related risk behaviors. Collectively, these data suggest that drug use stigma may play a role in HCV transmission and impede efforts to achieve HCV elimination. Strategies to diminish drug use stigma are warranted.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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14
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Meyers SA, Earnshaw VA, D’Ambrosio B, Courchesne N, Werb D, Smith LR. The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature. Drug Alcohol Depend 2021; 223:108706. [PMID: 33901753 PMCID: PMC8168566 DOI: 10.1016/j.drugalcdep.2021.108706] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use-related stigma is a significant barrier to care among persons who use drugs (PWUD). Less is known regarding how intersectional identities, like gender, shape experiences of substance use-related stigma. We sought to answer the following question: Do men or women PWUD experience more drug use stigma? METHODS Data were drawn from a systematic review of the global, peer-reviewed scientific literature on substance use-related stigma conducted through 2017 and guided by the Stigma and Substance Use Process Model and PRISMA guidelines. Articles were included in the present analysis if they either qualitatively illustrated themes related to the gendered nature of drug use-related stigma, or quantitatively tested the moderating effect of gender on drug use-related stigma. RESULTS Of the 75 studies included, 40 (53 %) were quantitative and 35 (47 %) were qualitative. Of the quantitative articles, 22 (55 %) found no association between gender and drug use-related stigma, 4 (10 %) identified women who use drugs (WWUD) were more stigmatized, and 2 (5 %) determined men who use drugs (MWUD) were more stigmatized. In contrast, nearly all (34; 97 %) of the qualitative articles demonstrated WWUD experienced greater levels of drug use-related stigma. CONCLUSION The quantitative literature is equivocal regarding the influence of gender on drug use-related stigma, but the qualitative literature more clearly demonstrates WWUD experience greater levels of stigma. The use of validated drug use-related stigma measures and the tailoring of stigma scales to WWUD are needed to understand the role of stigma in heightening the disproportionate harms experienced by WWUD.
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Affiliation(s)
- S. A. Meyers
- Department of Psychology, San Diego State University, 5500
Campanile Drive, San Diego, CA 92182, USA,Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
| | - V. A. Earnshaw
- Human Development and Family Sciences, University of Delaware,
Newark, DE, 19716, USA
| | - B. D’Ambrosio
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,School of Social Work, College of Health and Human Services,
San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N. Courchesne
- Department of Psychiatry, University of California San Diego,
9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. Werb
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,Centre for Urban Health Solutions, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - L. R. Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
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15
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Broady TR, Brener L, Vuong T, Cama E, Treloar C. Online interventions to reduce stigma towards population groups affected by blood borne viruses in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103292. [PMID: 34053824 DOI: 10.1016/j.drugpo.2021.103292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigmatising attitudes and behaviours by others can have a range of negative effects for population groups and individual people affected by blood borne viruses. The reduction of stigma is a major goal within current Australian national health strategies, however, there is a lack of evidence regarding effective interventions to achieve this goal. Drawing on Allport's (1954) intergroup contact theory, this study aimed to evaluate the effectiveness of an online stigma reduction intervention implemented with the Australian public. METHODS The study was conducted between February and May 2020. Australian adults recruited via Facebook advertising were randomly allocated to a control group (n=316) or one of five intervention groups: people living with HIV (n=320), people living with hepatitis C (n=347), people living with hepatitis B (n=333), people who inject drugs (n=316), or sex workers (n=296). Participants viewed a short video depicting lived experiences of their assigned group. Participants completed attitudinal measures about the group before and immediately after the video, and then at three-month follow-up. These measures related to overall attitudes towards the group, controllability of the stigmatised condition/behaviour, desire to maintain personal distance from the group, and opinions regarding treatment of the group in health care and public policy. Longitudinal changes in attitudes were analysed using a mixed effects regression model with maximum likelihood estimation. RESULTS Across each of the intervention groups, reductions in negative attitudes were found immediately after watching the videos on almost all outcome measures. By three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance compared to the control group, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance compared to the control group. Across intervention and control groups, long-term reductions in negative attitudes were found in relation to HIV controllability, hepatitis B controllability and opinions, hepatitis C controllability and opinions, and injecting drug use attitudes and opinions. CONCLUSION Brief online videos depicting priority populations groups demonstrated positive results in terms of reducing some stigmatising attitudes towards those groups amongst members of the Australian public. Online contact interventions have the potential to be scaled up and rolled out across jurisdictions at national and international levels. These findings suggest that these interventions could be an effective way to contribute to the reduction of stigma and discrimination towards populations affected by blood borne viruses.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Thu Vuong
- Social Policy Research Centre, UNSW Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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16
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Williams LD, Mackesy-Amiti ME, Latkin C, Boodram B. Drug use-related stigma, safer injection norms, and hepatitis C infection among a network-based sample of young people who inject drugs. Drug Alcohol Depend 2021; 221:108626. [PMID: 33689967 PMCID: PMC8041355 DOI: 10.1016/j.drugalcdep.2021.108626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Identifying risk for hepatitis C (HCV) infection is important for understanding recent increases in HCV incidence among young people who inject drugs (PWID) in suburban and rural areas; and for refining the targeting of effective HCV preventive interventions. Much of the extant research has focused on individual health behaviors (e.g., risky drug injection behaviors) as predictors of HCV infection. The present study examines two social factors (substance use-related stigma and injection-related social norms), and the interaction between these factors, as predictors of HCV infection. METHODS Baseline data were used from an ongoing longitudinal study of young PWID (N = 279; mean age = 30.4 years) from the Chicago suburbs and their injection risk network members. Adjusted logistic regression models were used to examine relationships among substance use-related stigma, safer injection norms, and HCV infection. RESULTS Despite a marginal bivariate association between less safe injection norms and HCV infection (OR = 0.74; 95 % CI[0.39, 1.02]; p = .071), a significant stigma X norms interaction (AOR = 0.68; 95 % CI[0.51, 0.90]) suggested that at high levels of stigma, probability of HCV infection was high regardless of injection norms. CONCLUSIONS Findings suggest that social factors - specifically, substance use-related stigma and injection norms - are important predictors of HCV infection risk. The interaction found between these social factors suggests that intervening only to change injection norms or behaviors is likely insufficient to reduce risk for HCV infection in high-stigma settings or among high-stigma populations. Future research should develop and evaluate stigma-reduction interventions in combination with safer-injection interventions in order to maximize HCV risk reduction.
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Affiliation(s)
- Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL
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17
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Mamdani Z, McKenzie S, Pauly B, Cameron F, Conway-Brown J, Edwards D, Howell A, Scott T, Seguin R, Woodrow P, Buxton JA. "Running myself ragged": stressors faced by peer workers in overdose response settings. Harm Reduct J 2021; 18:18. [PMID: 33573661 PMCID: PMC7877312 DOI: 10.1186/s12954-020-00449-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.
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Affiliation(s)
- Zahra Mamdani
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Sophie McKenzie
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, STN CSC, University of Victoria, Box 1700, Victoria, BC, Canada
| | - Fred Cameron
- SOLID Outreach Society, 1056 N Park St, Victoria, BC, V8T 1C6, Canada
| | | | - Denice Edwards
- RainCity Housing, 616 Powell St, Vancouver, BC, V6A 1H4, Canada
| | - Amy Howell
- SOLID Outreach Society, 1056 N Park St, Victoria, BC, V8T 1C6, Canada
| | - Tracy Scott
- RainCity Housing, 616 Powell St, Vancouver, BC, V6A 1H4, Canada
| | - Ryan Seguin
- SOLID Outreach Society, 1056 N Park St, Victoria, BC, V8T 1C6, Canada
| | - Peter Woodrow
- RainCity Housing, 616 Powell St, Vancouver, BC, V6A 1H4, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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18
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Grebely J, Cerdá M, Rhodes T. COVID-19 and the health of people who use drugs: What is and what could be? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102958. [PMID: 33183679 PMCID: PMC7837052 DOI: 10.1016/j.drugpo.2020.102958] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting ‘complex adaptive systems’: that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; London School of Hygiene and Tropical Medicine, London, UK
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19
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Depression, post-traumatic stress disorder, suicidality and self-harm among people who inject drugs: A systematic review and meta-analysis. Drug Alcohol Depend 2020; 207:107793. [PMID: 31874449 DOI: 10.1016/j.drugalcdep.2019.107793] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID. METHODS We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm. FINDINGS We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0 % (95 % confidence interval [CI] = 21.3, 62.8 %), and for a depression diagnosis was 28.7 % (95 % CI = 20.8, 36.6 %). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1 % (95 % CI = 19.3, 24.9 %). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID. INTERPRETATION Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.
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20
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Frequency of injecting among people who inject drugs: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102619. [PMID: 31864107 DOI: 10.1016/j.drugpo.2019.102619] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/29/2019] [Accepted: 12/03/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND People who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle-syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting. METHODS We conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle-syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence. RESULTS Our search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8-15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among samples with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with samples reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month. IMPLICATIONS WHO recently recommended a needle-syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment. FUNDING The Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales.
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Morris MD, Andrew E, Tan JY, Maher L, Hoff C, Darbes L, Page K. Injecting-related trust, cooperation, intimacy, and power as key factors influencing risk perception among drug injecting partnerships. PLoS One 2019; 14:e0217811. [PMID: 31150518 PMCID: PMC6544289 DOI: 10.1371/journal.pone.0217811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Sharing of injection drug use paraphernalia is a dyadic process linked to the transmission of HIV and hepatitis C virus (HCV). Despite this, limited research exists identifying specific dyadic interpersonal factors driving injecting partners' engagement in needle/syringe and ancillary injecting equipment sharing among young adults. Using semi-structured in-depth interview data collected between 2014 and 2015 from twenty-seven people who inject drugs (PWID), we applied an inductive approach to identify key injection drug-related interpersonal factors and developed a conceptual model integrating the findings based on interdependence theory. Interactions between injecting partners resulted in varying levels of injecting-related trust, cooperation, intimacy, and power. These factors interacted to collectively influence the type and level of risk perceived and enacted by injecting partners. The relationship between these injecting-related interpersonal factors, on the one hand, and risk perception on the other was dynamic and fluctuated between actions that protect the self (person-centered) and those that protect the partnership (partnership-centered). These findings indicate that the interpersonal context exerts substantial influence that shapes risk perception in all types of injecting partnerships. Partnership-focused prevention strategies should consider the dynamics of trust, cooperation, intimacy, and power, in characterizing dyadic risk perceptions and in understanding risky injecting practices among PWID.
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Affiliation(s)
- Meghan D. Morris
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States of America
| | - Erin Andrew
- Nursing Science, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Judy Y. Tan
- Center for AIDS Prevention Science, University of California, San Francisco, San Francisco, CA, United States of America
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Colleen Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, United States of America
| | - Lynae Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
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Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, Mimiaga MJ, Saitz R, Bazzi AR. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol Depend 2019; 198:80-86. [PMID: 30884432 PMCID: PMC6521691 DOI: 10.1016/j.drugalcdep.2019.01.037] [Citation(s) in RCA: 282] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast. METHODS We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 min exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization. RESULTS Among 33 PWID (55% male; age range 24-62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff. CONCLUSIONS Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.
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Affiliation(s)
- Dea L Biancarelli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States.
| | - Katie B Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States.
| | - Ellen Childs
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
| | - M Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.
| | - Peter Salhaney
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.
| | - Alberto Edeza
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States; Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States.
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States.
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States.
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Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:86-92. [PMID: 31026734 DOI: 10.1016/j.drugpo.2019.03.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs. METHODS We surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009 to 2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e., enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose. RESULTS Stigma was positively associated with experiencing a non-fatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1-2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1-2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, outside) where participants used drugs was also positively associated with experiencing an overdose. CONCLUSIONS Stigma related to drug use and using drugs in more settings may increase overdose risk. The effectiveness of overdose prevention and naloxone training may be improved by reducing discrimination against people who use drugs in community and medical settings and diversifying the settings in which overdose prevention trainings are delivered. These efforts may be enhanced by use of peer outreach approaches in which people who use drugs diffuse prevention messages through their social networks and within settings of drug consumption outside the medical setting.
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Day E, Broder T, Bruneau J, Cruse S, Dickie M, Fish S, Grillon C, Luhmann N, Mason K, McLean E, Trooskin S, Treloar C, Grebely J. Priorities and recommended actions for how researchers, practitioners, policy makers, and the affected community can work together to improve access to hepatitis C care for people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 66:87-93. [DOI: 10.1016/j.drugpo.2019.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
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Couto E Cruz C, Salom CL, Dietze P, Burns L, Alati R. The association between experiencing discrimination and physical and mental health among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 65:24-30. [PMID: 30590304 DOI: 10.1016/j.drugpo.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/14/2018] [Accepted: 12/06/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Discrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear. METHODS Data focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates. FINDINGS PWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI95 = 1.5-3.6) and mental health problems (ARRR = 1.4, CI95 = 1.2-1.7). The mental functioning (ARRR = 1.3, CI95 = 1.1-1.4) and physical functioning (ARRR = 1.1, CI95 = 1.1-1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores. CONCLUSION Self-reported experience of discrimination was associated with poor mental and physical health amongst PWID.
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Affiliation(s)
- Camila Couto E Cruz
- The University of Queensland, Institute for Social Science Research, 80 Meiers Road - Indooroopilly, QLD 4068, Australia.
| | - Caroline L Salom
- The University of Queensland, Institute for Social Science Research, 80 Meiers Road - Indooroopilly, QLD 4068, Australia
| | - Paul Dietze
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne VIC 3004, Australia
| | - Lucinda Burns
- University of New South Wales, National Drug and Alcohol Research Centre (NDARC), 22-32 King St, Randwick NSW 2031, Australia
| | - Rosa Alati
- The University of Queensland, Institute for Social Science Research, 80 Meiers Road - Indooroopilly, QLD 4068, Australia
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Broady TR, Cama E, Brener L, Hopwood M, de Wit J, Treloar C. Responding to a national policy need: development of a stigma indicator for bloodborne viruses and sexually transmissible infections. Aust N Z J Public Health 2018; 42:513-515. [DOI: 10.1111/1753-6405.12809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Elena Cama
- Centre for Social Research in Health; UNSW; New South Wales
| | - Loren Brener
- Centre for Social Research in Health; UNSW; New South Wales
| | - Max Hopwood
- Centre for Social Research in Health; UNSW; New South Wales
| | - John de Wit
- Centre for Social Research in Health; UNSW; New South Wales
| | - Carla Treloar
- Centre for Social Research in Health; UNSW; New South Wales
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Couto E Cruz C, Salom CL, Dietze P, Lenton S, Burns L, Alati R. Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing. Drug Alcohol Depend 2018; 190:188-194. [PMID: 30048872 DOI: 10.1016/j.drugalcdep.2018.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing. METHODS Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors. RESULTS Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes. CONCLUSIONS Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.
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Affiliation(s)
- Camila Couto E Cruz
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
| | - Caroline L Salom
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
| | - Paul Dietze
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Simon Lenton
- Curtin University, National Drug Research Institute, 10 Selby St, Shenton Park, WA 6008, Australia.
| | - Lucinda Burns
- University of New South Wales, National Drug and Alcohol Research Centre (NDARC), 22-32 King St, Randwick, NSW 2031, Australia.
| | - Rosa Alati
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
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Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:83-89. [DOI: 10.1016/j.drugpo.2017.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/01/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
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von Hippel C, Brener L, Horwitz R. Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs. Addict Behav 2018; 76:305-311. [PMID: 28889059 DOI: 10.1016/j.addbeh.2017.08.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) are stigmatized by society. Over time people may begin to internalize the stigma about their group. This research examines how implicit and explicit internalized stigma among PWID relates to health care and treatment access, psychosocial functioning, and engagement in risky behaviors. METHODS PWID were recruited from a needle and syringe program (NSP) located in Sydney, Australia. Participants completed a survey examining explicit and implicit internalized stigma, risky behaviors (e.g., sharing injecting equipment, unprotected sex), health care and treatment access (e.g., comfort attending NSPs), and psychosocial functioning (e.g., mental health). Detailed demographic variables were also collected. RESULTS A total of 115 clients completed the measures. To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending NSPs, had greater severity of dependence, and experienced more depressive symptoms. The implicit measure of internalized stigma was related to treatment engagement and needle sharing, although the direction of these effects was unexpected. CONCLUSIONS This research highlights the importance of ongoing research into the implications of internalized stigma for PWID. Assessing both explicit and implicit internalized stigma appears to be beneficial as these are related to different health and behavioral outcomes.
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Affiliation(s)
- Courtney von Hippel
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia.
| | - Loren Brener
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Robyn Horwitz
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
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Deryabina A, El-Sadr WM. Uptake of needle and syringe program services in the Kyrgyz Republic: Key barriers and facilitators. Drug Alcohol Depend 2017; 179:180-186. [PMID: 28787695 DOI: 10.1016/j.drugalcdep.2017.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/29/2017] [Accepted: 07/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Kyrgyzstan, injection drug use accounts for the majority of HIV infections. Needle and syringe programs (NSPs) are one of three core HIV interventions for people who inject drugs (PWID). However, in Kyrgyzstan all persons diagnosed with drug dependence are subject to compulsory registration for governmental drug dependence treatment services, which creates barriers for PWID to access any health services, including NSPs. METHODS In 2015, we conducted an assessment at 19 NSP sites in six cities to identify barriers and facilitators that affect PWID uptake of NSP services in Kyrgyzstan. The study involved the conduct of 10 focus groups with 99 PWID (62 males/37 females) and individual interviews with 24 full-time NSP staff. RESULTS We found that access of PWID to NSPs was limited by stigma and discrimination around drug use, fear of police encounters, inconvenient hours of operation, lack of information and motivation from PWID to use NSP services and a limited menu of available injection supplies. At the same time, availability of outreach services and additional health services were highly valued by PWID. CONCLUSIONS Stigma and discrimination, combined with the criminalization of drug use and the requirement for official registration of PWID remain key barriers to effective NSP utilization. Law enforcement and health care providers need to be sensitized about the unique context and needs of PWID.
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Affiliation(s)
- Anna Deryabina
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, United States; ICAP in Central Asia, Kazakhstan.
| | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, United States
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Grebely J, Dore GJ, Morin S, Rockstroh JK, Klein MB. Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there? J Int AIDS Soc 2017; 20:22146. [PMID: 28782335 PMCID: PMC5577699 DOI: 10.7448/ias.20.1.22146] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. DISCUSSION Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. CONCLUSIONS The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Executive Board, International Network on Hepatitis in Substance Users, Zurich, Switzerland
| | - Gregory J. Dore
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Executive Board, International Network on Hepatitis in Substance Users, Zurich, Switzerland
| | - Sébastien Morin
- HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | - Jürgen K. Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
- Governing Council, International AIDS Society, Geneva, Switzerland
| | - Marina B. Klein
- Governing Council, International AIDS Society, Geneva, Switzerland
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
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Community pharmacist experiences of providing needle and syringe programmes in Ireland. Res Social Adm Pharm 2017; 13:767-777. [DOI: 10.1016/j.sapharm.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/13/2016] [Accepted: 07/06/2016] [Indexed: 11/21/2022]
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Brener L, Cama E, Hull P, Treloar C. Evaluation of an online injecting drug use stigma intervention targeted at health providers in New South Wales, Australia. Health Psychol Open 2017; 4:2055102917707180. [PMID: 28567299 PMCID: PMC5438038 DOI: 10.1177/2055102917707180] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
People who inject drugs are highly stigmatised. Discriminatory experiences are commonly reported, particularly in health care settings. This article evaluates an online stigma reduction training module targeting health providers working with people who inject drugs. A total of 139 participants completed a pre- and post-survey including attitude items and items depicting hypothetical scenarios and concerns around client behaviours. Participants' attitudes towards people who inject drugs were more positive and they showed less concerns about client behaviours after completing the online training module. Findings highlight the benefits of online training in reducing discriminatory attitudes towards people who inject drugs and improving confidence in working with this client group.
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Affiliation(s)
| | - Elena Cama
- The University of New South Wales, Australia
| | - Peter Hull
- The University of New South Wales, Australia
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Rowe R, Berger I, Yaseen B, Copeland J. Risk and blood-borne virus testing among men who inject image and performance enhancing drugs, Sydney, Australia. Drug Alcohol Rev 2017; 36:658-666. [PMID: 28244160 DOI: 10.1111/dar.12467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Needle and syringe program (NSP) workers have highlighted that people who inject image and performance enhancing drugs (IPED) in Australia are a younger and more culturally and linguistically diverse (CALD) group compared with other groups who inject drugs. Previous research has found riskier injecting practices and faster Hepatitis C acquisition rates among people who are new to injecting drugs and self-identify with CALD backgrounds, compared with their Anglo-Australian counterparts. Given recent indications of increasing IPED prevalence in Australia and elsewhere, this study sought to update knowledge of infection risk among a large group of IPED injectors, as well as explore sub-group differences. DESIGN AND METHODS A cross-sectional survey of men who inject IPEDs was conducted from September 2014 to January 2015 at nine NSP sites, across five local health districts in Sydney, Australia. RESULTS Six hundred and five people participated. Small proportions reported previous 12month needle or syringe sharing (2.3%), sharing vials (4.6%), injecting psychostimulants (5.1%) or personal needle or syringe reuse (5.2%). Participants from CALD backgrounds were more likely to report sharing needles or syringes (P = 0.004), and participants from Middle Eastern and North African backgrounds were less likely to have ever been tested for blood-borne viruses, compared with Anglo-Australian participants (P = 0.04). DISCUSSION AND CONCLUSIONS The findings show that some groups who inject IPEDs may be more vulnerable to blood-borne virus transmission and/or less likely to know their blood-borne virus status. From design to delivery, IPED harm minimisation strategies should pay attention to the needs of CALD groups.
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Affiliation(s)
- Rachel Rowe
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Israel Berger
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Bilal Yaseen
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Jan Copeland
- National Cannabis Prevention and Information Centre, UNSW Medicine, Sydney, Australia
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Abstract
BACKGROUND Perceived experiences of stigma have been found to be associated with poorer psychosocial outcomes and engagement in risk practices among people who inject drugs. Yet the extent to which people internalize or accept the stigma surrounding their injecting drug use, and whether this is associated with risky injecting practices, is not well known. OBJECTIVES The aim of this study was to assess the extent of internalized stigma among a sample of people who inject drugs in Australia and identify socio-demographic, injecting risk, and mental health correlates. METHODS People who inject drugs were recruited from a needle and syringe program located in Sydney, Australia to complete a brief survey. The survey included measures of internalized stigma, severity of drug dependence, self-esteem, depression, and shared use of injecting equipment. RESULTS The sample comprised 102 people who inject drugs. Internalized stigma was higher among participants who reported being depressed in the past month, and was also associated with greater severity of drug dependence and diminished self-esteem. There was no relationship between internalized stigma and shared use of needles or other injecting equipment in the past month. Conclusions/Importance: Findings underscore the need for further investigation of internalized stigma among people who inject drugs. In particular, future research should assess the impact of implicit (i.e., subconscious) internalized stigma on mental health.
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Affiliation(s)
- Elena Cama
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
| | - Loren Brener
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
| | - Hannah Wilson
- a Centre for Social Research in Health , University of New South Wales , Sydney , Australia
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Treloar C, Mao L, Wilson H. Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need. Harm Reduct J 2016; 13:18. [PMID: 27246345 PMCID: PMC4886397 DOI: 10.1186/s12954-016-0107-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 01/14/2023] Open
Abstract
Background Despite high levels of equipment distribution through Needle and Syringe Programmes (NSPs) in Australia, the levels of reuse of equipment among people who inject drugs remain concerning. This paper used an exploratory analysis to examine the needs of NSP client that could be addressed by NSPs to enhance service impact and blood-borne virus risk practices. Methods People who inject drugs were recruited from six NSP sites in Sydney, Australia, to undertake a self-completed survey. Results Using the responses of 236 NSP client participants, three factors were identified in an exploratory factor analysis: recent risky injection (Eigenvalue 3.63, 20.2 % of variance); disadvantage and disability (Eigenvalue 2.26, 12.5 % of variance); and drug use milieu (Eigenvalue 1.50, 8.4 % of variance). To understand the distribution of these factors, the standardised factor scores were dichotomised to explore those participants with ‘above average’ vulnerability on each factor. A small group of NSP clients reported a cluster of vulnerability measures. Most participants (55.5 %) reported vulnerability on none or only one factor, indicating that 45.5 % could be considered as having double (35.6 %) or triple (8.9 %) vulnerability. Conclusions These results challenge NSPs to understand the heterogeneity among their client group and develop programmes that respond to their clients’ range of needs beyond those immediately associated with blood-borne virus (BBV) risk. This paper contributes to the growing evidence base regarding the need for BBV prevention efforts to examine strategies beyond equipment distribution.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia
| | - Hannah Wilson
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia
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Brener L, von Hippel C, Wilson H, Hopwood M. Health workers' support for hepatitis C treatment uptake among clients with a history of injecting. J Health Psychol 2016; 23:1012-1018. [PMID: 27098384 DOI: 10.1177/1359105316642002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus is stigmatised because of its association with injecting drug use. Although treatment is available, uptake remains low, especially among people who inject drugs. Ninety health workers completed a survey assessing attitudes towards people who inject drugs and support for treatment for three client scenarios: one who stopped injecting, one on methadone, and one continuing to inject. Support for hepatitis C virus treatment was significantly higher, where the client was not injecting. Participants who showed more negative attitudes towards people who inject drugs were less supportive of clients entering hepatitis C virus treatment, illustrating the influence of health workers' attitudes in determining treatment options offered to clients.
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Yang Y, Latkin CA, Luan R, Yang C. A cross-sectional study of the feasibility of pharmacy-delivered harm reduction services among people who inject drugs in Xichang, China. BMC Public Health 2015; 15:885. [PMID: 26370245 PMCID: PMC4570635 DOI: 10.1186/s12889-015-2236-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/07/2015] [Indexed: 12/02/2022] Open
Abstract
Background HIV prevalence is high in Liangshan, China (1.1 %). In 2012, people who inject drugs (PWID) in Xichang, the capital city, contributed to 60.0 % of the HIV infections. The goal of the current study was to examine the feasibility of implementing pharmacy-delivered harm reduction services (PDHRS) for PWID. Methods Face-to-face structured interviews with 403 PWID included questions on PWID’s experiences of syringe services and their specific experiences, acceptance, and potential usage of PDHRS. Results There were some reports of harassment/bad treatment from pharmacists (12.2 %) and police (17.6 %). Non-prescription syringe sales (NPSS) from pharmacies in single piece were the main source (82.1 %) of syringes. 72.5 % of PWID reported visiting 31.5 % of the identified pharmacies. Most (74.7 %) PWID disposed of their used syringes by throwing them away. Only one PWID brought used syringes back to a pharmacy in the past 30 days. Half of the PDHRS, such as printed materials about HIV, Hepatitis C and STIs; risk reduction services; (16.9 %) and sharps container to dispose of syringes (0.2 %) were offered by a few pharmacies (<20 % for each service). The acceptance rates among PWID toward currently offered services were high (≥91.1 %). All potential PDHRS were acceptable by most (68–95.3 %) PWID, and correspondingly 67–94.5 % of PWID reported they would use each service if offered. Conclusions NPSS from pharmacies provided many PWID in Liangshan with new syringes. However, disposal of used syringes was problematic. At the time of investigation, half of 16 assessed PDHRS were already available in pharmacies in Xichang. PWID were ready to use all the potential PDHRS and14 of 16 PDHRS were feasible to provide. HIV testing kits may be available in pharmacies in the future. Many pharmacy-delivered harm reduction services are feasible and acceptable among PWID in Xichang, China.
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Affiliation(s)
- Yi Yang
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, USA.
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, USA.
| | - Rongsheng Luan
- Department of Epidemiology and Biostatistics West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, 610041, China.
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, USA.
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Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:138-45. [PMID: 26394538 DOI: 10.1016/j.drugpo.2015.08.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 05/20/2015] [Accepted: 08/24/2015] [Indexed: 11/21/2022]
Abstract
AIMS Interest in health-care related trust is growing with the recognition that trust is essential for effective therapeutic encounters. While most trust-related research has been conducted with general patient groups, the experiences of people who inject drugs cannot be understood without acknowledging the critical role social stigma plays in shaping (mis)trust, both generally and in regards to health services specifically. This study examined the experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one area of Sydney, Australia. METHOD In-depth interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was informed by a five component model of trust, with particular emphasis on the notion of "global trust" as encompassing experiences of stigma and other negative social processes related to injecting drug use. Participant experiences of trust in NSPs were compared with those within other drug-related health services. Particular attention was paid to understanding the relationship between 'identity' (as a drug user) and 'legitimacy' (as a service user) and the centrality of this relationship to the experience of global trust for PWID. RESULTS Notions of identity and legitimacy were inextricably bound up with the stigmatisation of drug use, shaping participants' experiences and accounts of trust in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs, especially when compared with drug treatment services, describing being treated like "any other person" even when negotiating 'sensitive' issues. NSP staff participants described the establishment of trust as not only underpinning their work with clients but as something that required ongoing renewal and demonstration. CONCLUSION "Global trust" assists us to better understand the complex experiences shaping PWID decisions to engage with and trust health services. The high levels of trust reported between client and NSP need to be recognised as a valuable resource for the delivery of effective health care for people who inject drugs, including encouraging behaviours to support the prevention of blood-borne viruses.
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Yang Y, Latkin C, Luan R, Yang C. Reality and feasibility for pharmacy-delivered services for people who inject drugs in Xichang, China: Comparisons between pharmacy staff and people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:113-20. [PMID: 26123897 DOI: 10.1016/j.drugpo.2015.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/06/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2010, the reported overall HIV prevalence in Liangshan China (1.14%) was 19.7 times of the overall estimated prevalence in China (0.058%), and injection drug use contributed to 60.0% of overall HIV infections in Xichang, the Capital city of Liangshan. With one national methadone clinic and three outpatient service sites, and three NEP sites, the HIV prevalence among people who inject drugs (PWID) in Xichang was estimated as 18.0% (2.8 times of national HIV prevalence among PWID) in 2012. METHODS Face-to-face questionnaire interviews were used in a cross-sectional study to assess experience, attitudes, possibility and acceptability of implementing 8 pharmacy-delivered services among PWID (n=403). The concordance of attitudes, possibility and acceptability between PWID and pharmacy staff (n=50) was examined. RESULTS Rather than medical facility (23.1%), and NEP (8.9%), pharmacies were the main source of syringes for PWID in the last 12 months (82.1%), PWID (63.5%) reported syringes could be bought in single piece and at the price of $0.16 USD (59.3%). In the last 30 days, only 1 PWID brought used syringes back to a pharmacy. Pharmacy staff's attitudes were generally negative but nearly neutral (average score -0.18), discrimination/business concerns against pharmacy-delivered services existed, and 4 of 5 compared attitude questions between PWID and pharmacy staff were statistically different (p<0.01). 5 of 8 pharmacy-delivered services were available for PWID at low level (≤16.9%). Pharmacy staff's supportive perception for pharmacy-delivered services focused on pharmacies' initiate roles targeting on general population more than on PWID. PWID were more supportive and optimistic than pharmacy staff toward potential usage of pharmacy-delivered services (p<0.05). CONCLUSION Pharmacy-delivered services for PWID in Xichang were partly in reality, and could be feasible. It is urgently needed to address the legal requirements and remuneration for pharmacies. Pharmacy staff should receive additional training on services related knowledge and skills, cultural sensitivity toward PWID. Successful pharmacy-delivered services would benefit from identifying mutual interest and benefit between pharmacies and PWID.
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Affiliation(s)
- Yi Yang
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wengjiang District, Chengdu 611137, China; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, United States
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, United States.
| | - Rongsheng Luan
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2nd FL, Baltimore, MD 21205, United States
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