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Ivsins A, Bonn M, McNeil R, Boyd J, Kerr T. A qualitative study on perceptions and experiences of overdose among people who smoke drugs in Vancouver, British Columbia. Drug Alcohol Depend 2024; 258:111275. [PMID: 38581922 PMCID: PMC11088499 DOI: 10.1016/j.drugalcdep.2024.111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Smoking unregulated drugs has increased substantially in British Columbia. Intersecting with the ongoing overdose crisis, drug smoking-related overdose fatalities have correspondingly surged. However, little is known about the experiences of overdose among people who smoke drugs accessing the toxic drug supply. This study explores perceptions and experiences of overdose among people who smoke drugs. METHODS We conducted interviews with 31 people who smoke drugs. Interviews covered a range of topics including overdose experience. Thematic analysis was used to identify themes related to participant perceptions and experiences of smoking-related overdose. RESULTS Some participants perceived smoking drugs to pose lower overdose risk relative to injecting drugs. Participants reported smoking-related overdose experiences, including from underestimating the potency of drugs, the cross-contamination of stimulants with opioids, and responding to smoking-related overdose events. CONCLUSIONS Findings highlight the impact the unpredictable, unregulated, and toxic drug supply is having on people who smoke drugs, both among people who use opioids, and among those who primarily use stimulants. Efforts to address smoking-related overdose could benefit from expanding supervised smoking sites, working with people who use drugs to disseminate accurate knowledge around smoking-related overdose risk, and offering a smokable alternative to the unpredictable drug supply.
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Affiliation(s)
- Andrew Ivsins
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Matt Bonn
- Canadian AIDS Society, Ottawa, ON, Canada
| | - Ryan McNeil
- General Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Chayama KL, Ng C, Fleming T, Small W, Sue KL, McNeil R. Housing-based syringe services programs to improve access to safer injecting equipment for people who inject drugs in Vancouver, Canada: a spatially oriented qualitative study. Harm Reduct J 2023; 20:126. [PMID: 37679789 PMCID: PMC10483728 DOI: 10.1186/s12954-023-00862-2] [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: 04/19/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Housing environments shape injection drug-related risks and harms and thus represent a critical implementation setting for syringe services programs (SSPs). As critical harm reduction measures, SSPs provide safe injecting equipment to people who inject drugs (PWID). Vancouver, Canada, has well-established syringe distribution programs through which PWID have low-threshold access to unlimited syringes and related injecting equipment, including through non-profit operated supportive housing and single-room occupancy hotels. This study examines the role of housing-based SSPs in distributing injecting equipment to PWID in Vancouver. METHODS Between January and March 2020, semi-structured, in-depth interviews were conducted in Vancouver with 26 PWID. Interviews were audio-recorded, transcribed, and coded. Salient themes were identified using inductive and deductive approaches. RESULTS Many participants accessed SSPs in housing facilities and expressed preference for these programs over those offered at other locations and through other health and social services. Three major themes emerged to explain this preference. First, most participants injected in the buildings where they resided, and housing-based SSPs made injecting equipment available when and where it was most needed. Second, many participants preferred to avoid carrying syringes outside of the places where they inject due to fears that syringe possession may lead to criminal charges or confiscation of syringes and/or illicit drugs by police. Third, for some participants, anti-drug user stigma and concerns over unwillingly disclosing their drug use hindered access to SSPs outside of housing settings. Programs operated within housing facilities often offered greater client anonymity along with more supportive and less stigmatizing environments, particularly in the presence of peer staff. CONCLUSION The current study advances understanding of access to injecting equipment in a setting with city-wide syringe distribution programs. Our findings underscore the benefits of housing-based SSPs and encourage the expansion of such services to maximize access to harm reduction supports for PWID.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, Canada
| | - Kimberly L Sue
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada.
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA.
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA.
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3
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The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review. AIDS Behav 2022; 26:2279-2298. [PMID: 35034238 PMCID: PMC9163023 DOI: 10.1007/s10461-022-03583-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
The purpose of this scoping review is to establish the state of the art on economic evaluations in the field of HIV/STI prevention in high-income countries with concentrated epidemic settings and to assess what we know about the cost-effectiveness of different measures. We reviewed economic evaluations of HIV/STI prevention measures published in the Web of Science and Cost-Effectiveness Registry databases. We included a total of 157 studies focusing on structural, behavioural, and biomedical interventions, covering a variety of contexts, target populations and approaches. The majority of studies are based on mathematical modelling and demonstrate that the preventive measures under scrutiny are cost-effective. Interventions targeted at high-risk populations yield the most favourable results. The generalisability and transferability of the study results are limited due to the heterogeneity of the populations, settings and methods involved. Furthermore, the results depend heavily on modelling assumptions. Since evidence is unequally distributed, we discuss implications for future research.
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Andraka-Christou B, Nguyen T, Harris S, Atkins DN, Totaram R, Golan O, Koval A, Madeira J. Harm Reduction Policy Support among Students at Two U.S. Universities. Subst Use Misuse 2022; 57:1185-1195. [PMID: 35491710 DOI: 10.1080/10826084.2022.2069265] [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] [Indexed: 10/18/2022]
Abstract
Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA.,Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA
| | - Thuy Nguyen
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Shana Harris
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida, USA.,Department of Anthropology, University of Central Florida, Orlando, Florida, USA
| | - Danielle N Atkins
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Olivia Golan
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Andriy Koval
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Jody Madeira
- Maurer School of Law, Indiana University-Bloomington, Bloomington, Indiana, USA
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Haritavorn N. Unintended harm: A qualitative study of "harm" upon people who inject drugs in Bangkok, Thailand. Health (London) 2021; 27:525-539. [PMID: 34523372 DOI: 10.1177/13634593211046841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given the highly pervasive health threats faced by people who inject drugs, harm reduction has been implemented in Thailand. Although harm reduction is a particularly effective public health strategy for reducing risky behavior, it is currently practiced with minimal understanding of unintended harm-drug policy, social exclusion, stigma, and discrimination-for people who inject drugs (PWID) in Thailand. This study aims to understanding the "unintended harm" encountered by people who inject drugs in Bangkok in their everyday lives through social interaction at all levels of society from macro, micro, and individual levels. In-depth interviews were conducted with 28 people who inject drugs in Bangkok (21 men and 7 women) and 4 people who are a nurse, a community leader, a policeman, and a family member (2 men and 2 women). The result shows that individuals, society, and politics are not separable phenomena and all produce harm upon people who inject drugs. These unintended harms on the macro, micro, and individual level are closely linked; each in their own way poses a threat to the health and well-being of people who inject drugs and embody negative social responses as the people who inject drugs become typecast as "deviants." In conclusion, there is an urgent need to develop a "harm reduction" model that addresses unintended harm and could be integrated within the existing socio-cultural context of Thai society.
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Drug Injection-Related and Sexual Behavior Changes in Drug Injecting Networks after the Transmission Reduction Intervention Project (TRIP): A Social Network-Based Study in Athens, Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052388. [PMID: 33804500 PMCID: PMC7967732 DOI: 10.3390/ijerph18052388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022]
Abstract
The Transmission Reduction Intervention Project (TRIP) was a network-based, enhanced contact tracing approach, targeting recently HIV-infected people who inject drugs (PWID) in Athens, Greece (2013–2015). This analysis examines behavioral changes of participants in TRIP and their determinants between baseline and follow-up visits to the program. All participants of TRIP were tested for HIV and interviewed using a questionnaire with items on drug injection-related and sexual behaviors. Multivariable logistic regression models were used to examine potential relationships between participants’ behaviors and sociodemographic or other characteristics. The analysis included 292 participants. At follow-up, the percentage of participants who injected drugs decreased [92.5%, n = 270 versus 72.3%, n = 211 (p < 0.001)], and more participants adopted safer behaviors. Employment, age, and gender were significantly associated with some behavioral changes. For instance, unemployed participants were half as likely as the employed to stop drug injection [adjusted odds ratio (aOR): 0.475, 95% confidence interval (CI): 0.228, 0.988]. Increasing age was associated with lower probability of sharing syringes at follow-up (aOR: 0.936, 95%CI: 0.887, 0.988). Finally, females were less likely than males to improve their behavior related to sharing cookers, filters, or rinse water (aOR: 0.273, 95% CI: 0.100, 0.745). In conclusion, adoption of safer behaviors was observed following TRIP implementation. Future prevention programs should focus on younger PWID and especially females. Social efforts to support employment of PWID are also important.
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Macias-Konstantopoulos W, Heins A, Sachs CJ, Whiteman PJ, Wingkun NJG, Riviello RJ. Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use. Ann Emerg Med 2021; 77:479-492. [PMID: 33579588 DOI: 10.1016/j.annemergmed.2020.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/05/2020] [Accepted: 11/12/2020] [Indexed: 01/29/2023]
Abstract
Injection drug use is a major public health problem in the United States. Cocaine, heroin, and methamphetamine are the most commonly injected illicit drugs, whereas opioids are responsible for the majority of overdose fatalities. Although recent emergency department (ED) efforts have focused on expanding capacity for buprenorphine induction for opioid use disorder treatment, the injection of illicit drugs carries specific health risks that require acknowledgment and management, particularly for patients who decline substance use treatment. Harm reduction is a public health approach that aims to reduce the harms associated with a health risk behavior, short of eliminating the behavior itself. Harm-reduction strategies fundamental to emergency medicine include naloxone distribution for opioid overdose. This clinical Review Article examines the specific health complications of injection drug use and reviews the evidence base for 2 interventions effective in reducing morbidity and mortality related to drug injection, irrespective of the specific drug used, that are less well known and infrequently leveraged by emergency medicine clinicians: syringe service programs and supervised injection facilities. In accordance with the recommendations of health authorities such as the Centers for Disease Control and Prevention, emergency clinicians can promote the use of harm-reduction programs in the community to reduce viral transmission and other risks of injection drug use by providing patients with information about and referrals to these programs after injection drug use-related ED visits.
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Affiliation(s)
| | - Alan Heins
- Department of Emergency Medicine, University of South Alabama College of Medicine, Mobile, AL
| | - Carolyn J Sachs
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Paula J Whiteman
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Neil-Jeremy G Wingkun
- Department of Emergency Medicine, University of Texas MD Anderson Cancer Center and Houston Methodist Hospital, Houston, TX
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX
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Scheibe A, Sibeko G, Shelly S, Rossouw T, Zishiri V, Venter WD. Southern African HIV Clinicians Society guidelines for harm reduction. South Afr J HIV Med 2020; 21:1161. [PMID: 33391833 PMCID: PMC7756663 DOI: 10.4102/sajhivmed.v21i1.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Andrew Scheibe
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shaun Shelly
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Vincent Zishiri
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D.F. Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Calls for Access to Safe Injecting Supplies as a Critical Public Health Measure During the COVID-19 Pandemic. J Addict Med 2020; 14:e142-e143. [PMID: 32769778 DOI: 10.1097/adm.0000000000000712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
: More than 3 decades of research has provided compelling evidence regarding the effectiveness, safety, and cost-effectiveness of needle and syringe programs in reducing syringe-sharing and transmission of HIV, HCV, and other bloodborne infections. However, repressive drug policies and drug law enforcement practices around the world continue to undermine their operations and scale-up, as well as access to harm reduction among people who inject drugs. The COVID-19 pandemic has heightened access barriers to needle and syringe programs, raising concerns about unsafe injecting practices due to inadequate access to safe injecting supplies. This commentary discusses the robust public health responses that are needed at this particularly vulnerable and critical juncture to ensure access to safe injecting supplies and minimize the risk for transmission of bloodborne infections among people who inject drugs.
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10
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Davidson P, Chakrabarti P, Marquesen M. Impacts of mandated data collection on syringe distribution programs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102725. [PMID: 32259770 PMCID: PMC7308185 DOI: 10.1016/j.drugpo.2020.102725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Syringe Distribution Programs (SDPs) are a well-proven public health response to the spread of HIV and other blood borne illnesses among people who inject drugs. Many SDPs in the United States are required to collect data from service users as a condition of either legal authorization to operate or as a condition of funding. We sought to describe the prevalence of such externally mandated data collection and impact on service delivery at syringe distribution programs (SDPs) in the United States via an online survey. METHODS Online survey of SDPs in the US. RESULTS 63 SDPs participated. 95•2% collected data about individual service users, with 76•7% being mandated to do so by an external entity as a condition of legal authorization, and/or as a condition of funding. Only 21•7% of mandated respondents received any report back on how data was used. 60•0% reported that data collection acted as a barrier to providing syringes to people who use drugs due to service user fears about loss of anonymity and/or law enforcement. 33•3% reported that the computer literacy and language skills required to collect data meant otherwise appropriate members of the community could not he hired as staff or volunteers. CONCLUSIONS Data collection at SDPs may act as a barrier to service provision to populations at high risk for HIV and other blood born viruses, and place considerable logistic burdens on often under-resourced public health programs. Further, it is often unclear to SDPs what purpose their data is being put to. We argue that to be ethical, the purpose of data collection should be carefully considered and regularly reviewed to ensure data is being put to meaningful purpose which is commensurate with impacts on service delivery.
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Affiliation(s)
- Peter Davidson
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States.
| | - Priya Chakrabarti
- Department of Obstetrics and Gynecology, Loma Linda University Health, Loma Linda, CA, United States
| | - Michael Marquesen
- Los Angeles Community Health Project, Los Angeles, CA, United States
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Feuerstein-Simon R, Lowenstein M, Sharma M, Dupuis R, Luna Marti X, Cannuscio CC. Local health departments and the implementation of evidence-based policies to address opioid overdose mortality. Subst Abus 2020; 41:468-474. [PMID: 32213045 DOI: 10.1080/08897077.2019.1709250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods: We surveyed health departments in 180 United States counties with high overdose mortality rates. Results: Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1-25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions: Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret Lowenstein
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Sharma
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Lancaster KE, Cooper HLF, Browning CR, Malvestutto CD, Bridges JFP, Young AM. Syringe Service Program Utilization, Barriers, and Preferences for Design in Rural Appalachia: Differences between Men and Women Who Inject Drugs. Subst Use Misuse 2020; 55:2268-2277. [PMID: 32748730 PMCID: PMC7584727 DOI: 10.1080/10826084.2020.1800741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Carlos D Malvestutto
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - John F P Bridges
- Departments of Biomedical Informatics and Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
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Distributive Syringe Sharing and Use of Syringe Services Programs (SSPs) Among Persons Who Inject Drugs. AIDS Behav 2019; 23:3306-3314. [PMID: 31512066 DOI: 10.1007/s10461-019-02615-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Monitoring distributive syringe sharing (DSS) and syringe services program (SSP) use among persons who inject drugs (PWID) is important for HIV prevention. PWID aged ≥ 18 in 20 US cities were recruited for National HIV Behavioral Surveillance in 2015 using respondent-driven sampling, interviewed and offered HIV testing. Bivariate and multivariable analyses via log-linked Poisson regression with generalized estimating equations were conducted to examine associations between demographic and behavioral variables and DSS. Effect of SSP use on DSS by HIV sero-status was assessed by including an interaction between SSP and sero-status. Analyses were adjusted for sampling design. Among 10,402 PWID, 42% reported DSS. DSS was less likely to be reported among HIV-positive compared to HIV-negative PWID (aPR = 0.51, CI 0.45-0.60), and among those who primarily obtained syringes from SSPs versus those who did not (aPR = 0.82, 95% CI 0.77-0.88). After adjustment, those who primarily used SSPs were less likely to report DSS than those who did not among both HIV-negative PWID (aPR = 0.84, 95% CI 0.78-0.90) and HIV-positive PWID (aPR = 0.54, 95% CI 0.39-0.75). Findings support expansion of SSPs, and referrals to SSPs by providers working with PWID.
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Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B. Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization. Addict Behav 2019; 98:106037. [PMID: 31330467 PMCID: PMC6708724 DOI: 10.1016/j.addbeh.2019.106037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
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Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, PA, United States of America.
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | | | | | | | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States of America.
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15
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Syringe Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm Reduction Coalition. Curr HIV/AIDS Rep 2019; 15:276-282. [PMID: 29740734 DOI: 10.1007/s11904-018-0397-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Syringe access programs (SAPs) are cornerstone harm reduction interventions for combatting the national opioid epidemic. The goal of this paper is to describe effective advocacy strategies for enacting syringe decriminalization legislation to foster the expansion of SAPs in high-need areas amidst political opposition. RECENT FINDINGS Decades or research shows that SAPs prevent the transmission of HIV among people who inject drugs (PWID) and are a cost-effective tool for linking PWID to medical care, health education, and social services. In the USA, state laws criminalizing distribution and possession of syringes impede the expansion of SAPs into areas where they are sorely needed. In 2016, North Carolina became the first state to legalize SAPs with a Republican super majority. This paper distills strategies for community organizations seeking to advance syringe decriminalization legislation in politically conservative states with histories of prioritizing punitive sanctions over public health responses to drug use.
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16
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Strike C, Watson TM. Losing the uphill battle? Emergent harm reduction interventions and barriers during the opioid overdose crisis in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:178-182. [PMID: 30975595 DOI: 10.1016/j.drugpo.2019.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/25/2019] [Accepted: 02/18/2019] [Indexed: 01/08/2023]
Abstract
Canada continues to experience an escalating opioid overdose crisis that has claimed more than 8000 lives in the country since 2016. The presence of the synthetic opioid fentanyl and its analogues is a central contributor to the increases in preventable opioid-related deaths. However, a number of converging social-structural factors (e.g., the continued criminalisation of drug use, political changes) and political barriers are also complicating and contributing to the current crisis. We briefly outline four harm reduction interventions (i.e., injectable opioid agonist treatment, naloxone distribution programs, overdose prevention sites, and drug checking services) as emerging and rapidly expanding responses to this crisis in Canada. These examples of innovation and expansion are encouraging but also occurring at the same time that the opioid overdose crisis shows few signs of abating. To truly address the crisis, Canada needs political environments at all government levels that are responsive and foster harm reduction innovation and drug policy experimentation.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
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17
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Lazarus JV, Safreed-Harmon K, Hetherington KL, Bromberg DJ, Ocampo D, Graf N, Dichtl A, Stöver H, Wolff H. Health Outcomes for Clients of Needle and Syringe Programs in Prisons. Epidemiol Rev 2018; 40:96-104. [PMID: 29659780 DOI: 10.1093/epirev/mxx019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/22/2017] [Indexed: 01/29/2023] Open
Abstract
High levels of drug dependence have been observed in the prison population globally, and the sharing of injecting drug equipment in prisons has contributed to higher prevalence of bloodborne diseases in prisoners than in the general population. Few prison needle and syringe programs (PNSPs) exist. We conducted a systematic review to assess evidence regarding health outcomes of PNSPs. We searched peer-reviewed databases for data relating to needle and syringe programs in prisons. The search methodology was conducted in accordance with accepted guidelines. Five studies met review inclusion criteria, and all presented evidence associating PNSPs with one or more health benefits, but the strength of the evidence was low. The outcomes for which the studies collectively demonstrated the strongest evidence were prevention of human immunodeficiency virus and viral hepatitis. Few negative consequences from PNSPs were observed, consistent with previous evidence assessments. More research is needed on PNSP effectiveness, and innovative study designs are needed to overcome methodological limitations of previous research. Until stronger evidence becomes available, policymakers are urged to recognize that not implementing PNSPs has the potential to cause considerable harm, in light of what is currently known about the risks and benefits of needle and syringe programs and PNSPs and about the high prevalence of human immunodeficiency virus and viral hepatitis in prisons.
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Affiliation(s)
- Jeffrey V Lazarus
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Barcelona Institute of Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Kelly Safreed-Harmon
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Barcelona Institute of Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Kristina L Hetherington
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel J Bromberg
- Barcelona Institute of Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Denise Ocampo
- Barcelona Institute of Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Niels Graf
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Anna Dichtl
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Heino Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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18
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Ashford RD, Curtis B, Brown AM. Peer-delivered harm reduction and recovery support services: initial evaluation from a hybrid recovery community drop-in center and syringe exchange program. Harm Reduct J 2018; 15:52. [PMID: 30348170 PMCID: PMC6198436 DOI: 10.1186/s12954-018-0258-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recovery from substance use disorder (SUD) is often considered at odds with harm reduction strategies. More recently, harm reduction has been categorized as both a pathway to recovery and a series of services to reduce the harmful consequences of substance use. Peer recovery support services (PRSS) are effective in improving SUD outcomes, as well as improving the engagement and effectiveness of harm reduction programs. Methods This study provides an initial evaluation of a hybrid recovery community organization providing PRSS as well as peer-based harm reduction services via a syringe exchange program. Administrative data collected during normal operations of the Missouri Network for Opiate Reform and Recovery were analyzed using Pearson chi-square tests and Monte Carlo chi-square tests. Results Intravenous substance-using participants (N = 417) had an average of 2.14 engagements (SD = 2.59) with the program. Over the evaluation period, a range of 5345–8995 sterile syringes were provided, with a range of 600–1530 used syringes collected. Participant housing status, criminal justice status, and previous health diagnosis were all significantly related to whether they had multiple engagements. Conclusions Results suggest that recovery community organizations are well situated and staffed to also provide harm reduction services, such as syringe exchange programs. Given the relationship between engagement and participant housing, criminal justice status, and previous health diagnosis, recommendations for service delivery include additional education and outreach for homeless, justice-involved, LatinX, and LGBTQ+ identifying individuals.
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Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, 2111, Philadelphia, PA, 19131, USA.
| | - Brenda Curtis
- Center on the Continuum of Care in the Addictions, Psychiatry - Addictions, University of Pennsylvania, Philadelphia, PA, 19131, USA
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, 30144, USA
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19
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Strike C, Watson TM. Relationships, Training, and Formal Agreements Between Needle and Syringe Programs and Police. Health Promot Pract 2018; 19:741-746. [PMID: 29884081 DOI: 10.1177/1524839918778554] [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] [Indexed: 11/15/2022]
Abstract
Needle and syringe programs (NSPs) are key public health and HIV prevention programs. We sought to compare over time the quality of relationships between NSPs and police, and implementation of best practices. We conducted cross-sectional surveys in 2008 ( n = 32) and 2015 ( n = 28) with NSP managers in Ontario, Canada. Participants were recruited via e-mail to complete an online survey. Over the period studied, self-reported quality of NSP-police relationships did not change-roughly two thirds of NSP managers reported a positive/mostly positive relationship. In 2015, higher proportions of programs offered training to police about the following: the purpose and goals of NSPs (48% vs. 41% in 2008), NSP effectiveness (55% vs. 34%), the health and social concerns of people who use drugs (52% vs. 40%), and needlestick injury prevention (44% vs. 31%). Few managers reported formal conflict resolution procedures with the police (22% in 2015, 9% in 2008). Our findings show that NSP-police relationships did not deteriorate during a time when such programs fell into disfavor with the federal government. More research is needed to understand if and when formal versus informal agreements with police serve the needs of NSPs.
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Affiliation(s)
- Carol Strike
- 1 University of Toronto, Toronto, Ontario, Canada
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20
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Bosque-Prous M, Brugal MT. [Harm reduction interventions in drug users: current situation and recommendations]. GACETA SANITARIA 2018; 30 Suppl 1:99-105. [PMID: 27837802 DOI: 10.1016/j.gaceta.2016.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/12/2023]
Abstract
Harm reduction encompasses interventions, programmes and policies that seek to reduce the negative consequences of the consumption of both legal and illegal drugs on the individual and public health. Harm reduction looks to mitigate the harm suffered by drug users through drug use monitoring and prevention, and promotes initiatives that respect and protect the human rights of this population. The harm reduction policies that have proven effective and efficient are: opioid substitution maintenance therapy (methadone); needle and syringe exchange programmes; supervised drug consumption rooms; and overdose prevention through peer-based naloxone distribution. In order to be effective, these policies must have comprehensive coverage and be implemented in areas where the target population is prevalent. Resident-based opposition to the implementation of these policies is known as the NIMBY (Not In My Back Yard) phenomenon, which is characterised by being against the implementation of new measures in a particular place, but does not question their usefulness. Given that any NIMBY phenomenon is a complex social, cultural and political phenomenon, it is important to conduct a thorough analysis of the situation prior to implementing any of these measures. Harm reduction policies must be extended to other substances such as alcohol and tobacco, as well as to other conditions beyond infectious/contagious diseases and overdose.
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Affiliation(s)
- Marina Bosque-Prous
- Agencia de Salut Pública de Barcelona, Barcelona; Institut d'Investigació Biomèdica Sant Pau, Barcelona; Universitat Pompeu Fabra, Barcelona, España
| | - María Teresa Brugal
- Agencia de Salut Pública de Barcelona, Barcelona; Institut d'Investigació Biomèdica Sant Pau, Barcelona; Universitat Pompeu Fabra, Barcelona, España.
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21
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Zule WA, Pande PG, Otiashvili D, Bobashev GV, Friedman SR, Gyarmathy VA, Des Jarlais DC. Options for reducing HIV transmission related to the dead space in needles and syringes. Harm Reduct J 2018; 15:3. [PMID: 29334973 PMCID: PMC5769352 DOI: 10.1186/s12954-017-0207-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND When shared by people who inject drugs, needles and syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently. METHODS We measured dead space in 56 needle and syringe combinations obtained from needle and syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing. RESULTS Syringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space syringes with permanently attached needles, 13 μL in high dead space syringes with low dead space needles, 45 μL in low dead space syringes with high dead space needles, and 99 μL in high dead space syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space syringes with permanently attached needles and highest for low dead space syringes with high dead space needles. CONCLUSION The dead space in different low dead space needle and syringe combinations varied substantially. To reduce HIV transmission related to syringe sharing, needle and syringe programs need to combine this knowledge with the needs of their clients.
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Affiliation(s)
- William A. Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
| | - Poonam G. Pande
- Integrated CMC Solutions, LLC, 1289 Fordham Blvd Suite 201, Chapel Hill, NC 27514 USA
| | - David Otiashvili
- Addiction Research Center—Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177 Tbilisi, Georgia
| | - Georgiy V. Bobashev
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
| | - Samuel R. Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, 71 West 23d Street, 4th floor, New York, NY 10010 USA
| | - V. Anna Gyarmathy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
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22
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Klein CH, Kuhn T, Huxley D, Kennel J, Withers E, Lomonaco CG. Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study. JMIR Public Health Surveill 2017; 3:e78. [PMID: 29066422 PMCID: PMC5676034 DOI: 10.2196/publichealth.7933] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM. OBJECTIVE The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices. METHODS The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment. RESULTS A total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=-0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=-0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=-0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=-0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement "I will sometimes lie about my HIV status with people I am going to have sex with" (mean difference=-0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies. CONCLUSIONS Our findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk's modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.
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Affiliation(s)
- Charles H Klein
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Tamara Kuhn
- dfusion, Oakland, CA, United States.,ETR, Scotts Valley, CA, United States
| | - Danielle Huxley
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Jamie Kennel
- Department of Emergency Medical Services, Oregon Health & Sciences University, Portland, OR, United States.,Department of Emergency Medical Services, Oregon Institute of Technology, Klamath Falls, OR, United States.,Department of Sociology, Portland State University, Portland, OR, United States
| | - Elizabeth Withers
- Department of Sociology, Portland State University, Portland, OR, United States
| | - Carmela G Lomonaco
- University of California, San Francisco, San Francisco, CA, United States
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23
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Ibragimov U, Cooper HL, Haardörfer R, Dunkle KL, Zule WA, Wong FY. Stigmatization of people who inject drugs (PWID) by pharmacists in Tajikistan: sociocultural context and implications for a pharmacy-based prevention approach. Harm Reduct J 2017; 14:64. [PMID: 28915888 PMCID: PMC5602909 DOI: 10.1186/s12954-017-0190-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022] Open
Abstract
Background Pharmacies are an important source of sterile syringes for people who inject drugs (PWID) in Tajikistan who are under high risk of HIV and hepatitis C virus. Accessibility of sterile syringes at pharmacies without prescription may depend on pharmacists’ attitudes towards PWID. This qualitative inquiry examines meanings and processes of stigmatization of PWID among pharmacists and pharmacy students in Tajikistan. Methods We conducted semi-structured interviews with 19 pharmacists and 9 students (N = 28) in the cities of Dushanbe and Kulob, Tajikistan. The interview topics included personal attitudes towards drug use and PWID, encounters with PWID, awareness and beliefs related to drug dependence and HIV, and attitudes and practices related to providing syringes to PWID. Interview transcripts were analysed using thematic analysis methods. Results The main themes included the significance of religion in defining attitudes towards drug use, labelling of PWID, negative stereotypes (PWID are prone to crime, violence, and irrational aggression; inflict harm to families and society; are able to control drug use), emotions triggered by PWID (fear, sympathy) and discrimination against PWID (rejection, isolation, ostracism, limiting resources to PWID). The religious ban on drug use and pharmacists’ moral and legal responsibility for the consequences of drug use were frequently mentioned as reasons for rejecting syringe sales. Still, many participants acknowledged the need for distributing syringes to PWID to prevent HIV. Conclusions Stigma against PWID in Tajikistan plays an important role in shaping pharmacists’ attitudes towards provision of services to this population. Local sociocultural context, in particular religious beliefs and social conservatism, may facilitate stigmatizing beliefs.
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Affiliation(s)
- Umedjon Ibragimov
- HIV/AIDS and Harm Reduction Association of Tajikistan, 73/3 I. Somoni Str., office 59, 734064, Dushanbe, Tajikistan. .,Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA.
| | - Hannah L Cooper
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA
| | - Kristin L Dunkle
- Gender and Health Division, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, PO Box 19070, Cape, Tygerberg, 7505, South Africa
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Frank Y Wong
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo St, Honolulu, HI, 96813, USA.,School of Public Health, Fudan University, 220 Handan Rd, WuJiaoChang, Yangpu Qu, Shanghai Shi, 200433, China
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24
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Animal house: University risk environments and the regulation of students’ alcohol use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:18-25. [DOI: 10.1016/j.drugpo.2017.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 05/05/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022]
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25
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Edwards J, Bates D, Edwards B, Ghosh S, Yarema M. PHArmacists' perspective oN the Take hOme naloxone prograM (The PHANTOM Study). Can Pharm J (Ott) 2017; 150:259-268. [PMID: 29163727 PMCID: PMC5684980 DOI: 10.1177/1715163517711960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate pharmacists' attitudes toward the Take Home Naloxone (THN) program and identify areas that could be improved to support pharmacists' involvement. METHODS Pharmacists on the Alberta College of Pharmacists' directory were invited to complete an online survey between July 10 and August 8, 2016. The survey consisted of 19 questions. Descriptive statistics were used to analyze the data. RESULTS Four hundred seventy pharmacists completed the survey (response rate = 11.2%). A total of 76.8% of respondents strongly agreed or agreed that pharmacists should be screening patients to identify those at risk of opioid overdose. Full-time pharmacists were more likely to agree (p = 0.02). A total of 79.8% of respondents strongly agreed or agreed that pharmacists should be recommending THN kits. Pharmacists working in large population centres (p = 0.008) and full-time pharmacists (p = 0.02) were more likely to agree with this statement. Furthermore, 60.6% of pharmacists were extremely willing or very willing to participate in the THN program. Pharmacists in practice for ≤15 years were more willing to participate in the THN program than pharmacists in practice >15 years (p = 0.03). The most common perceived barriers to implementation of the THN program were lack of time in pharmacists' current work environment and education about the program. CONCLUSIONS Overall, pharmacists had positive attitudes toward screening patients to identify those at risk of opioid overdose, recommending THN kits and willingness to participate in the program. Factors that may facilitate increased participation in the program include addressing time issues and improving education about the THN program.
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Affiliation(s)
| | - Duane Bates
- Pharmacy Services (J. Edwards, Bates), Alberta Health Services, Calgary
- PGY2 Internal Medicine (B. Edwards), Alberta Health Services, Calgary
- CancerCare (Ghosh) and Poison and Drug Information Service (Yarema), Alberta Health Services, Calgary
- Department of Emergency Medicine (Yarema), University of Calgary, Calgary, Alberta
| | - Brett Edwards
- Pharmacy Services (J. Edwards, Bates), Alberta Health Services, Calgary
- PGY2 Internal Medicine (B. Edwards), Alberta Health Services, Calgary
- CancerCare (Ghosh) and Poison and Drug Information Service (Yarema), Alberta Health Services, Calgary
- Department of Emergency Medicine (Yarema), University of Calgary, Calgary, Alberta
| | - Sunita Ghosh
- Pharmacy Services (J. Edwards, Bates), Alberta Health Services, Calgary
- PGY2 Internal Medicine (B. Edwards), Alberta Health Services, Calgary
- CancerCare (Ghosh) and Poison and Drug Information Service (Yarema), Alberta Health Services, Calgary
- Department of Emergency Medicine (Yarema), University of Calgary, Calgary, Alberta
| | - Mark Yarema
- Pharmacy Services (J. Edwards, Bates), Alberta Health Services, Calgary
- PGY2 Internal Medicine (B. Edwards), Alberta Health Services, Calgary
- CancerCare (Ghosh) and Poison and Drug Information Service (Yarema), Alberta Health Services, Calgary
- Department of Emergency Medicine (Yarema), University of Calgary, Calgary, Alberta
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26
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Franck C, Filion KB, Kimmelman J, Grad R, Eisenberg MJ. Ethical considerations of e-cigarette use for tobacco harm reduction. Respir Res 2016; 17:53. [PMID: 27184265 PMCID: PMC4869264 DOI: 10.1186/s12931-016-0370-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/26/2016] [Indexed: 02/11/2023] Open
Abstract
Due to their similarity to tobacco cigarettes, electronic cigarettes (e-cigarettes) could play an important role in tobacco harm reduction. However, the public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. We identified the major ethical considerations surrounding the use of e-cigarettes for tobacco harm reduction, including product safety, efficacy for smoking cessation and reduction, use among non-smokers, use among youth, marketing and advertisement, use in public places, renormalization of a smoking culture, and market ownership. Overall, the safety profile of e-cigarettes is unlikely to warrant serious public health concerns, particularly given the known adverse health effects associated with tobacco cigarettes. As a result, it is unlikely that the population-level harms resulting from e-cigarette uptake among non-smokers would overshadow the public health gains obtained from tobacco harm reduction among current smokers. While the existence of a gateway effect for youth remains uncertain, e-cigarette use in this population should be discouraged. Similarly, marketing and advertisement should remain aligned with the degree of known product risk and should be targeted to current smokers. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals.
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Affiliation(s)
- Caroline Franck
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Jonathan Kimmelman
- Biomedical Ethics Unit, McGill University Montreal, Montreal, QC, Canada
- Department of Social Studies and Medicine, McGill University, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite H-421.1, Montreal, Quebec, H3T 1E2, Canada.
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McCormack AR, Aitken CK, Burns LA, Cogger S, Dietze PM. Syringe Stockpiling by Persons Who Inject Drugs: An Evaluation of Current Measures for Needle and Syringe Program Coverage. Am J Epidemiol 2016; 183:852-60. [PMID: 27049004 DOI: 10.1093/aje/kwv259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/17/2015] [Indexed: 11/14/2022] Open
Abstract
Needle and syringe program (NSP) coverage is commonly used to assess NSP effectiveness. However, existing measures don't capture whether persons who inject drugs (PWIDs) stockpile syringes, an important and novel aspect of NSP coverage. In this study, we determine the extent of stockpiling in a sample of Australian PWIDs and assess whether including stockpiling enhances NSP coverage measures. As part of the Illicit Drug Reporting System study, PWIDs reported syringes procured and given away, total injections in the last month, and syringes currently stockpiled in 2014. We calculated NSP coverage with and without stockpiling to determine proportional change in adequate NSP coverage. We conducted receiver operating characteristic curve analysis to determine whether inclusion of stockpiled syringes in the measure improved sensitivity in discriminating cases and noncases of risky behaviors. Three-quarters of the sample reported syringe stockpiling, and stockpiling was positively associated with nonindigenous background, stable accommodation, no prison history, longer injecting careers, and more frequent injecting. Compared with previous measures, our measure was significantly better at discriminating cases of risky behaviors. Our results could inform NSP policy to loosen restricted-exchange practice, allowing PWIDs greater flexibility in syringe procurement practices, promoting greater NSP coverage, and reducing PWIDs' engagement in risky behaviors.
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Strike C, Rotondi NK, Watson TM, Kolla G, Bayoumi AM. Public opinions about supervised smoking facilities for crack cocaine and other stimulants. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:8. [PMID: 26860540 PMCID: PMC4748465 DOI: 10.1186/s13011-016-0052-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/03/2016] [Indexed: 11/11/2022]
Abstract
Background The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada. Methods We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights. Results A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs. Conclusions Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Nooshin Khobzi Rotondi
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Gillian Kolla
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Ahmed M Bayoumi
- Centre for Research on Innercity Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. .,Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Canada. .,Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
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Kulesza M, Teachman BA, Werntz AJ, Gasser ML, Lindgren KP. Correlates of public support toward federal funding for harm reduction strategies. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:25. [PMID: 26122408 PMCID: PMC4490612 DOI: 10.1186/s13011-015-0022-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/26/2015] [Indexed: 12/31/2022]
Abstract
Background Historically, US federal policy has not supported harm reduction interventions, such as safe injection facilities (SIFs) and needle and syringe programs (NSPs), which can reduce the burden associated with injection drug use. Given recent increases in abuse of both legal and illegal opioids, there has been a renewed debate about effective ways to address this problem. The current study (1) assessed participants’ support for SIFs and NSPs, and (2) evaluated several demographic factors (e.g., age, gender, race, education, political ideology, and religiosity) and individual differences in stigmatizing beliefs about people who inject drugs (PWID) that might relate to support for these interventions. Methods U.S. adults (N = 899) completed a web-based study that assessed self-reported support for NSPs and SIFs, and stigma about PWID. Results The majority of participants were at least somewhat supportive of both NSPs and SIFs. Regression analyses indicated greater support for NSPs and SIFs was predicted by more liberal political ideology, more agreement that PWID deserve help rather than punishment, older age, and male gender. Also, participants who endorsed lower stigma about PWID were more supportive of NSPs and SIFs. Race, religiosity, and education did not predict support for NSPs and SIFs. Conclusions Most participants tended to report support for harm reduction strategies. Age, political ideology, and individual differences in stigmatizing beliefs about PWID were significantly associated with support. Given the potential malleability of stigmatizing beliefs, efforts that seek to shift stigma about PWID could have important implications for public policy towards harm reduction strategies for PWID.
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Affiliation(s)
- Magdalena Kulesza
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA. .,RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Alexandra J Werntz
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Melissa L Gasser
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
| | - Kristen P Lindgren
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
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Ramjee G, Naidoo S. The road ahead: working towards effective clinical translation of biomedical HIV prevention strategies. Future Virol 2015. [DOI: 10.2217/fvl.14.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Emerging evidence from several randomized controlled trials show that antiretroviral-based biomedical HIV prevention interventions are efficacious in preventing HIV if they are taken as directed, and could potentially reduce the number of new HIV infections globally. Strategies such as treatment as prevention and use of oral pre-exposure prophylaxis for HIV prevention have shown great promise, yet have raised important implementation concerns around awareness and acceptance, delivery, adherence, side effects, risk compensation, cost–effectiveness and drug resistance. In order to address these issues, a number of treatment as prevention and pre-exposure prophylaxis demonstration projects have been initiated to assess the feasibility of introducing these interventions in ‘real-world’ settings. These projects will be instrumental in determining best practices for optimal delivery and sustainability of these HIV prevention interventions. The road to effective translation to clinical setting is promising, but comes with challenges which are not insurmountable.
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Affiliation(s)
- Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
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Luo W, Wu Z, Poundstone K, McGoogan JM, Dong W, Pang L, Rou K, Wang C, Cao X. Needle and syringe exchange programmes and prevalence of HIV infection among intravenous drug users in China. Addiction 2015; 110 Suppl 1:61-7. [PMID: 25533865 DOI: 10.1111/add.12783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/23/2014] [Accepted: 09/12/2014] [Indexed: 11/29/2022]
Abstract
AIM To examine the association between needle and syringe exchange programme (NSEP) participation and human immunodeficiency virus (HIV) infection among intravenous drug users (IDUs) in China. DESIGN Cross-sectional survey study design. SETTING Six counties with active NSEP were selected from each of the seven provinces with active NSEP sampled, resulting in a sample of 42 counties in China. PARTICIPANTS Subjects were aged more than 18 years and had injected drugs in the past month before the survey, but were excluded if they were currently enrolled in methadone maintenance treatment in order to avoid mixed effects. MEASUREMENTS HIV prevalence was the primary measure. Odds ratios (ORs), 95% confidence intervals (CIs) and P-values were calculated to evaluate associations between HIV infection and NSEP participation. FINDINGS A total of 3494 IDUs were interviewed, of whom 1928 (55.2%) were NSEP attendees (meaning they had attended NSEP at least once in their life-time). The unadjusted HIV prevalence was 13.9% among NSEP attendees and 16.5% among NSEP non-attendees (meaning IDUs who had never used NSEP services). After adjusting for potential confounders and taking into account the variation between counties, NSEP non-attendees were 1.67 times more likely to be HIV-positive compared to NSEP attendees (OR=1.67, CI=1.19-2.32, P=0.0031). CONCLUSIONS Participation in needle and syringe exchange programmes was associated with a substantially lower risk of HIV infection among intravenous drug users in China. Needle and syringe exchange programmes should be expanded to include those who are needle and syringe exchange programme non-attendees.
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Affiliation(s)
- Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Wilson DP, Donald B, Shattock AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26 Suppl 1:S5-11. [PMID: 25727260 DOI: 10.1016/j.drugpo.2014.11.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.
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Affiliation(s)
| | | | | | - David Wilson
- Global HIV/AIDS Program, World Bank, United States
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Nguyen TQ, Weir BW, Des Jarlais DC, Pinkerton SD, Holtgrave DR. Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment. AIDS Behav 2014; 18:2144-55. [PMID: 24824043 DOI: 10.1007/s10461-014-0789-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To examine whether increasing investment in needle/syringe exchange programs (NSPs) in the US would be cost-effective for HIV prevention, we modeled HIV incidence in hypothetical cases with higher NSP syringe supply than current levels, and estimated number of infections averted, cost per infection averted, treatment costs saved, and financial return on investment. We modified Pinkerton's model, which was an adaptation of Kaplan's simplified needle circulation theory model, to compare different syringe supply levels, account for syringes from non-NSP sources, and reflect reduction in syringe sharing and contamination. With an annual $10 to $50 million funding increase, 194-816 HIV infections would be averted (cost per infection averted $51,601-$61,302). Contrasted with HIV treatment cost savings alone, the rate of financial return on investment would be 7.58-6.38. Main and sensitivity analyses strongly suggest that it would be cost-saving for the US to invest in syringe exchange expansion.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
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Pauly BB, Reist D, Belle-Isle L, Schactman C. Housing and harm reduction: what is the role of harm reduction in addressing homelessness? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:284-90. [PMID: 23623720 DOI: 10.1016/j.drugpo.2013.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 03/11/2013] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
Abstract
Homelessness and drug use often overlap and the harms of substance use are exacerbated by homelessness. Responding to the twin problems of homelessness and substance use is an important aspect of strategies to end homelessness. The introduction and development of ten year plans to end homelessness in North America heralds a new era of systemic responses to homelessness. Central to many of these plans is the adoption of 'Housing First' as a policy response. Housing First focuses directly on housing people regardless of current patterns of substance use. As such, harm reduction is a key principle of Housing First. In this paper, we examine Housing First as an example of the integration of housing and harm reduction and then put forth a community level policy framework to further promote the integration of harm reduction as part of a response to homelessness. Drawing on Rhodes' risk environment framework and current evidence of Housing First and harm reduction, we describe four key policy areas for action: (1) social inclusion policies; (2) adequate and appropriate supply of housing; (3) on demand harm reduction services and supports and (4) systemic and organizational infrastructure. We conclude by identifying areas for future research.
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Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:1-7. [DOI: 10.1016/j.drugpo.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/03/2012] [Accepted: 07/04/2012] [Indexed: 11/17/2022]
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Negotiating access: social barriers to purchasing syringes at pharmacies in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:286-94. [PMID: 22676968 DOI: 10.1016/j.drugpo.2012.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND One common public health response to the emergence of HIV has been the provision of sterile syringes to people who inject drugs. In Mexico specialized syringe exchanges are rare, and the sale of needles through pharmacies is often the only way people who inject drugs can obtain sterile syringes. However, people who inject drugs in Tijuana, Mexico report considerable social barriers to successfully purchasing syringes at pharmacies. METHODS Between October 2008 and March 2009 we conducted seven in-depth focus groups with 47 people who inject drugs in Tijuana, Mexico. Focus group transcripts were analysed using a descriptive and thematic approach rooted in grounded theory. RESULTS We found that injectors offered a number of explanations for why pharmacies were reluctant to sell them syringes, including fear of police; attitudes toward drug use; fear of stereotypical drug user behaviour such as petty theft, violence, or distressing behaviour; and related fears that an obvious drug using clientèle would drive away other customers. Injectors described a range of ways of attempting to re-frame or negotiate interactions with pharmacy staff so that these and related concerns were ameliorated. These included tactics as simple as borrowing cleaner clothing, through to strategies for becoming 'known' to pharmacy staff as an individual rather than as a member of a stigmatized group. CONCLUSION Increasing the ability of pharmacy staff and people who inject drugs to successfully negotiate syringe sales are highly desirable. Interventions designed to improve this likelihood need to capitalize on existing solutions developed ad hoc by people who inject drugs and pharmacy staff, and should focus on broadening the range of 'identities' which pharmacy staff are able to accept as legitimate customers. Approaches to achieve this end might include sensitizing pharmacy staff to the needs of people who inject drugs; facilitating individual drug users meeting individual pharmacy staff; and working with drug users to reduce behaviours seen as problematic by pharmacy staff.
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Ti L, Buxton J, Wood E, Shannon K, Zhang R, Montaner J, Kerr T. Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting. Drug Alcohol Rev 2012; 31:890-6. [PMID: 22462808 DOI: 10.1111/j.1465-3362.2012.00446.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada. DESIGN AND METHODS Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes. RESULTS Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%). DISCUSSION AND CONCLUSIONS A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.
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Affiliation(s)
- Lianping Ti
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Disproportionate impact of combination antiretroviral therapy on AIDS incidence in Australia: results from a modified back-projection model. AIDS Behav 2012; 16:360-7. [PMID: 21598032 DOI: 10.1007/s10461-011-9969-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of the current study is to describe the impact of Combination antiretroviral therapy (cART) on trends in AIDS incidence over time for selected population groups in Australia, specifically, men who have sex with men (MSM) and injecting drug users (IDUs). A modified back-projection modeling technique was used to predict the number of AIDS diagnoses without cART based on Australia's HIV/AIDS surveillance system database. Modelled estimates indicate that since 1996, the effective cART has reduced overall AIDS cases by ~70 and ~10% among MSM and IDUs respectively. The predicted reduction in AIDS cases among IDUs aged less than 40 years was 36% while there was no reduction predicted for those aged 40 years or older. The impact of cART on AIDS diagnoses has been modest among IDUs. Late presentation, poor access to health services and barriers to uptake of cART may account for the divergence between these population groups.
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Ivsins A, Chow C, Macdonald S, Stockwell T, Vallance K, Marsh DC, Michelow W, Duff C. An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:338-40. [PMID: 22280916 DOI: 10.1016/j.drugpo.2011.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/14/2011] [Accepted: 11/21/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BC's only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures. METHODS Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n=579) in Victoria and Vancouver between late 2007 and late 2010. RESULTS Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing. CONCLUSIONS The closure of Victoria's fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure.
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Affiliation(s)
- Andrew Ivsins
- Centre for Addictions Research of British Columbia, University Victoria, PO Box 1700 STN CSC, Victoria, BCV8Y 2E4, Canada.
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Lee HY, Yang YH, Yu WJ, Su LW, Lin TY, Chiu HJ, Tang HP, Lin CY, Pan RN, Li JH. Essentiality of HIV testing and education for effective HIV control in the national pilot harm reduction program: the Taiwan experience. Kaohsiung J Med Sci 2012; 28:79-85. [PMID: 22313534 DOI: 10.1016/j.kjms.2011.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 07/07/2011] [Indexed: 10/14/2022] Open
Abstract
In 2005, a national pilot harm reduction program (PHRP), which mainly included a methadone maintenance treatment program (MMTP) and a needle/syringe exchange program (NSP), was implemented in Taiwan. We conducted this study to evaluate the effectiveness of harm reduction measures on HIV control among injecting drug users (IDUs) between PHRP and nonPHRP. The data on HIV, collected from incumbent Taiwanese authorities, were analyzed for their associations, risk and protective factors with PHRP measures. While the monthly HIV incidences did not show significant differences before and after PHRP in the four areas with PHRP (Taipei City, Taipei County, Taoyuan County and Tainan County), a significant increase in the HIV incidence was found in the 21 areas without PHRP. Hence, the implementation of the PHRP did result in a significant difference in the monthly HIV incidence between areas with and without the PHRP. Mandatory HIV testing was significantly associated with the HIV incidence according to the generalized estimation equations (GEE) model. With adjustments of time period and area with PHRP, and urban area, protective factors associated with HIV incidence were: educational materials, condoms, dilution water, and alcohol sponges/swabs. MMTP contributed to a higher HIV incidence, probably due to the concurrent HIV testing upon admission. Since HIV testing was not required in the NSP, the HIV testing-dependent MMTP may explain the association of the PHRP intervention and an increased HIV incidence. In summary, HIV testing and education were essential for effective HIV control upon implementing the PHRP.
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Affiliation(s)
- Hsin-Ya Lee
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tross S, Campbell ANC, Calsyn DA, Metsch LR, Sorensen JL, Shoptaw S, Haynes L, Woody GE, Malow RM, Brown LS, Feaster DJ, Booth RE, Mandler RN, Masson C, Holmes BW, Colfax G, Brooks AJ, Hien DA, Schackman BR, Korthuis PT, Miele GM. NIDA's Clinical Trials Network: an opportunity for HIV research in community substance abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:283-93. [PMID: 21854270 DOI: 10.3109/00952990.2011.596977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. RESULTS While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. CONCLUSION/SIGNIFICANCE While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032, USA.
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Ramjee G. Antiretroviral-based microbicides and oral pre-exposure prophylaxis for HIV prevention. Future Virol 2011. [DOI: 10.2217/fvl.11.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Numerous HIV prevention options have been tested, with limited success. Microbicides have been the focus of research specifically targeted to prevent new infections among women. After decades of research using non-HIV-specific microbicides, we now have proof of concept for antiretroviral-based microbicides. Issues of drug resistance, frequency of HIV testing and adherence to treatment remain to be explored. Drugs used for HIV treatment and with good safety profiles have been shown to provide protection to men who have sex with men. Ethical issues surrounding cost, access, future design of HIV prevention trials and composition of the prevention package offered to trial participants remain. The role of advocacy and market research will be crucial to ensure effective interventions are accessed and supported. There is renewed hope in the HIV prevention field with collective efforts needed to ensure we get the new prevention tools and options into the hands of men and women at risk of HIV infection. The purpose of this paper is to provide a review of existing research and identify issues for future enquiry.
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Affiliation(s)
- Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa and Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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McKeganey N. From harm reduction to drug user abstinence: a journey in drug treatment policy. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.580228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Structural interventions change the environment in which people act to influence their health behaviors. Most structural interventions research for HIV infection has focused on developing countries, with the United States receiving substantially less attention. This article identifies some social determinants of HIV vulnerability in the United States and structural interventions to address them. METHODS Review of the medical, public health, and social science literature. RESULTS Evidence supports widespread implementation of a number of structural interventions in the United States clearly proximate to HIV, including comprehensive sex education, universal condom availability, expanded syringe access for drug users, health care coverage, and stable housing. Sociological plausibility supports evaluation and implementation of other interventions that target social determinants more distal but of relevance to HIV, such as initiatives to eliminate racial and ethnic disparities in criminal sentencing, to promote early childhood education and to decrease poverty. CONCLUSIONS Structural interventions that address social determinants of HIV infection may be among the most cost effective methods of preventing HIV infection in the United States over the long term.
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Auerbach J. Transforming social structures and environments to help in HIV prevention. Health Aff (Millwood) 2011; 28:1655-65. [PMID: 19887406 DOI: 10.1377/hlthaff.28.6.1655] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interest in social and structural interventions for HIV prevention is growing. Such approaches modify social norms, institutions, laws, and policies to reduce vulnerability and create environments in which individuals can protect themselves against HIV infection. Examples include expanding access to sterile syringes for injecting drug users and subsidizing stable housing for low-income people. Evidence of the effectiveness of such interventions is emerging despite scientific and political obstacles to their development, implementation, and evaluation. The U.S. government can help build the evidence base for such interventions. It can also implement those with demonstrated or promising results as part of a cost-effective HIV prevention strategy domestically and globally.
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Affiliation(s)
- Judith Auerbach
- Science and Public Policy, at San Francisco AIDS Foundation in San Francisco, California, USA.
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Davidson PJ, Scholar S, Howe M. A GIS-based methodology for improving needle exchange service delivery. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:140-4. [PMID: 21112757 DOI: 10.1016/j.drugpo.2010.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/11/2010] [Accepted: 10/18/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND A variety of legal, social and logistical factors can prevent individuals from accessing formal needle exchange programmes. One common solution to this problem is satellite exchange, which involves collaborating with people who already use an exchange to deliver needles and other supplies to those unable to access the exchange. While this approach can be very successful, one potential problem is that those most willing to deliver needles to their peers are often members of social networks that are already well connected with the needle exchange, leading to duplication of effort. In this paper we describe a simple and novel method for identifying groups of people who are demonstrably in need of improved access to needles, and for re-targeting efforts to meet the needs of those people. The method described was piloted at the Homeless Youth Alliance, San Francisco, USA, and further refined at Clean Needles Now, Los Angeles, USA. METHODS People accessing needle exchange sites were asked to participate in a survey with two questions: "where were you and what time was it last time someone borrowed a needle from you?" and "where were you and what time was it last time you had to borrow a needle from someone else?" Responses were geocoded, and maps produced showing 'hotspots' where people were frequently finding themselves without needles. RESULTS Satellite needle exchange was refined from an ad-hoc activity into one which focused on delivering needles to those with empirically demonstrable need. Maps produced in the process also proved valuable in discussions with local officials and other agencies about funding, as well as needle provision policy and practices. CONCLUSION We describe a method for rapidly assessing, describing, and responding to unmet and under-met need among injecting drug users. The method is particularly well-suited to organizations with extremely limited resources.
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Affiliation(s)
- Peter J Davidson
- Division of Global Public Health, School of Medicine, University of California, San Diego. 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA.
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Cooper HLF, Des Jarlais DC, Ross Z, Tempalski B, Bossak B, Friedman SR. Spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes as predictors of drug injectors' use of sterile syringes. Am J Public Health 2010; 101:1118-25. [PMID: 21088267 DOI: 10.2105/ajph.2009.184580] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined relationships of spatial access to syringe exchange programs (SEPs) and pharmacies selling over-the-counter (OTC) syringes with New York City drug injectors' harm reduction practices. METHODS Each year from 1995 to 2006, we measured the percentage of 42 city health districts' surface area that was within 1 mile of an SEP or OTC pharmacy. We applied hierarchical generalized linear models to investigate relationships between these exposures and the odds that injectors (n = 4003) used a sterile syringe for at least 75% of injections in the past 6 months. RESULTS A 1-unit increase in the natural log of the percentage of a district's surface area within a mile of an SEP in 1995 was associated with a 26% increase in the odds of injecting with a sterile syringe; a 1-unit increase in this exposure over time increased these odds 23%. A 1-unit increase in the natural log of OTC pharmacy access improved these odds 15%. CONCLUSIONS Greater spatial access to SEPs and OTC pharmacies improved injectors' capacity to engage in harm reduction practices that reduce HIV and HCV transmission.
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Affiliation(s)
- Hannah L F Cooper
- Dept of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Rd NE, Room 526, Atlanta, GA, 30322, USA.
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Zamani S, Vazirian M, Nassirimanesh B, Razzaghi EM, Ono-Kihara M, Mortazavi Ravari S, Gouya MM, Kihara M. Needle and syringe sharing practices among injecting drug users in Tehran: a comparison of two neighborhoods, one with and one without a needle and syringe program. AIDS Behav 2010; 14:885-90. [PMID: 18483849 DOI: 10.1007/s10461-008-9404-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 04/28/2008] [Indexed: 10/22/2022]
Abstract
This study was conducted to compare needle and syringe sharing practices among injecting drug users (IDUs) in two neighborhoods, one with and one without a needle and syringe program (NSP). In 2005, 419 street-based IDUs were interviewed at specific locations in two neighborhoods where IDUs are known to congregate. We compared self-reported needle and syringe access and use between IDUs from a neighborhood with an active NSP to IDUs from a neighborhood without such an intervention. A significantly smaller proportion of IDUs from the former neighborhood reported having used a shared needle/syringe over a 1-month period (21.0%) compared to IDUs from the latter neighborhood (39.9%; adjusted odds ratio, 0.24; 95% confidence interval, 0.13-0.45). These findings indicate that access to an NSP may reduce needle and syringe sharing practices. Therefore, these programs should be intensified in settings with concentrated HIV epidemics among IDUs in Iran.
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Strike C, Watson TM, Lavigne P, Hopkins S, Shore R, Young D, Leonard L, Millson P. Guidelines for better harm reduction: evaluating implementation of best practice recommendations for needle and syringe programs (NSPs). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:34-40. [PMID: 20413288 DOI: 10.1016/j.drugpo.2010.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/16/2010] [Accepted: 03/16/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations. METHODS An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document. RESULTS The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n=28) and satellite NSPs (84%, n=52) distributed cookers following the dissemination of the document. All core NSPs (100%, n=32) and nearly all satellite NSPs (97%, n=60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n=27) distributed glass stems than the core NSPs (16%, n=5). Commonly cited implementation barriers included funding, senior management and decision-making. CONCLUSION Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.
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Affiliation(s)
- Carol Strike
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada.
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