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Maarefvand M, Ghiabi M. The cultural turn in understanding 'addiction'. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104473. [PMID: 38875879 DOI: 10.1016/j.drugpo.2024.104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024]
Abstract
In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' - as in 'addiction' - has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions.
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Affiliation(s)
- Masoomeh Maarefvand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Bailey K, Abramovitz D, Rangel G, Harvey-Vera A, Vera CF, Patterson TL, Arredondo Sánchez-Lira J, Davidson PJ, Garfein RS, Smith LR, Pitpitan EV, Goldenberg SM, Strathdee SA. Safe Injection Self-Efficacy is associated with HCV and HIV seropositivity among people who inject drugs in the San Diego-Tijuana border region. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.21.24307696. [PMID: 38826285 PMCID: PMC11142293 DOI: 10.1101/2024.05.21.24307696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. Methods PWID were recruited via street outreach for a longitudinal cohort study from October 2020 - September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE scores (low, medium, high) using ordinal logistic regression. Results Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. Conclusions We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to intervene upon the risk environment.
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Affiliation(s)
- Katie Bailey
- Department of Medicine, University of California, San Diego, USA
- School of Social Work, San Diego State University, USA
| | | | - Gudelia Rangel
- Colegio de la Frontera Norte Mexico, Tijuana, Mexico
- Comisión de Salud Fronteriza México-Estados Unidos, Sección Mexicana, Tijuana, Mexico
| | | | - Carlos F. Vera
- Department of Medicine, University of California, San Diego, USA
| | | | | | | | - Richard S. Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA
| | - Laramie R. Smith
- Department of Medicine, University of California, San Diego, USA
| | - Eileen V. Pitpitan
- Department of Medicine, University of California, San Diego, USA
- School of Social Work, San Diego State University, USA
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Blank L, Bandyopadhyay S, Yang H, Williams G, Cerulli C, Verma S, Anson J, Connor M, Morse DS. Motivation and accessing care among drug treatment court involved women: A sequential, mixed-methods approach. JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 52:105-133. [PMID: 37792561 PMCID: PMC10843018 DOI: 10.1002/jcop.23088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
Drug treatment courts (DTC) address substance use disorders (SUD) but not cooccurrencing HIV or hepatitis C virus (HCV). This pilot explored feasibility and preliminary outcomes of the Women's Initiative Supporting Health (WISH) intervention and health-related motivation, both based in self-determination theory (SDT) regarding HIV/HCV and SUD treatment. WISH feasibility study: 79 DTC women completed a one-time survey regarding motivation and willingness to engage in future interventions. WISH intervention: 22 women from DTC with SUD and HIV or HCV received a 6-session, peer motivational enhancement health behavior-oriented interventions. Recruitment strategies were feasible. SDT-based measures demonstrated internal consistency in this under-studied population, with perceived competence/autonomy associationed with motivation to reduce HIV/HCV/SUD risk. Women DTC participants indicated acceptance and showed internally consistent results in SDT-based motivation measures These WISH feasibility and intervention pilot studies lay a foundation for future studies addressing motivation to access healthcare among women DTC participants.
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Affiliation(s)
- Lilo Blank
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Hongmei Yang
- University of Rochester Medical Center, Rochester, New York, USA
| | - Geoffrey Williams
- Department of Medicine and Center for Community Health and Prevention, University of Rochester, New York, USA
| | - Catherine Cerulli
- University of Rochester Medical Center, Rochester, New York, USA
- Department of Medicine and Center for Community Health and Prevention, University of Rochester, New York, USA
| | - Shelley Verma
- Medical School Buffalo, University of Buffalo, New York, USA
| | | | - Meghan Connor
- University of Rochester Medical Center, Rochester, New York, USA
| | - Diane S Morse
- University of Rochester Medical Center, Rochester, New York, USA
- Department of Medicine and Center for Community Health and Prevention, University of Rochester, New York, USA
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Lin Q, Aguilera JAR, Williams LD, Mackesy-Amiti ME, Latkin C, Pineros J, Kolak M, Boodram B. Social-spatial network structures among young urban and suburban persons who inject drugs in a large metropolitan area. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104217. [PMID: 37862848 DOI: 10.1016/j.drugpo.2023.104217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Recent studies underscore the significance of adopting a syndemics approach to study opioid misuse, overdose, hepatitis C (HCV) and HIV infections, within the broader context of social and environmental contexts in already marginalized communities. Social interactions and spatial contexts are crucial structural factors that remain relatively underexplored. This study examines the intersections of social interactions and spatial contexts around injection drug use. More specifically, we investigate the experiences of different residential groups among young (aged 18-30) people who inject drugs (PWID) regarding their social interactions, travel behaviors, and locations connected to their risk behaviors. By doing so, we aim to achieve a more comprehensive understanding of the multidimensional risk environment, thereby facilitating the development of informed policies. METHODS We collected and examined data regarding young PWID's egocentric injection network and geographic activity spaces (i.e., where they reside, inject drugs, purchase drugs, and meet sex partners). Participants were stratified based on the location of all place(s) of residence in the past year i.e., urban, suburban, and transient (both urban and suburban) to i) elucidate geospatial concentration of risk activities within multidimensional risk environments based on kernel density estimates; and ii) examine spatialized social networks for each residential group. RESULTS Participants were mostly non-Hispanic white (59%); 42% were urban residents, 28% suburban, and 30% transient. We identified a spatial area with concentrated risky activities for each residential group on the West side of Chicago in Illinois where a large outdoor drug market area is located. The urban group (80%) reported a smaller concentrated area (14 census tracts) compared to the transient (93%) and suburban (91%) with 30 and 51 tracts, respectively. Compared to other areas in Chicago, the identified area had significantly higher neighborhood disadvantages. Significant differences were observed in social network structures and travel behaviors: suburban participants had the most homogenous network in terms of age and residence, transient participants had the largest network (degree) and more non-redundant connections, while the urban group had the shortest travel distance for all types of risk activities. CONCLUSION Distinct residential groups exhibit varying patterns of network interaction, travel behaviors, and geographical contexts related to their risk behaviors. Nonetheless, these groups share common concentrated risk activity spaces in a large outdoor urban drug market area, underscoring the significance of accounting for risk spaces and social networks in addressing syndemics within PWID populations.
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Affiliation(s)
- Qinyun Lin
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg.
| | | | - Leslie D Williams
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago.
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago.
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Juliet Pineros
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago.
| | - Marynia Kolak
- Department of Geography and GIScience, University of Illinois, Urbana-Champaign.
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago.
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Aung SWKH, Kingston H, Mbogo LW, Sambai B, Monroe-Wise A, Ludwig-Barron NT, Bukusi D, Sinkele W, Gitau E, Masyuko S, Herbeck JT, Farquhar C, Guthrie BL. Prevalence and correlates of violence among sexual and injecting partners of people who inject drugs living with HIV in Kenya: a cross-sectional study. Harm Reduct J 2023; 20:164. [PMID: 37919736 PMCID: PMC10623850 DOI: 10.1186/s12954-023-00895-7] [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: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In Kenya, violence is common among people who inject drugs (PWID) living with HIV and their sexual and injecting partners and may lead to decreased uptake of HIV services, increased HIV risk behaviors, and increased HIV transmission. Violence is defined as any physical harm, threatened harm, or forced sexual acts inflicted on a person in the past year. Understanding the nature of violence and its correlates among PWID and their partners will inform population-specific public health interventions and policy recommendations. METHODS This is a cross-sectional study nested in a prospective cohort study conducted in eight public health centers, methadone clinics, and needle syringe programs in Nairobi, Kilifi, and Mombasa counties in Kenya. 3,302 sexual and/or injecting partners of PWID living with HIV were recruited through assisted partner services and participated in the study. Prevalence and correlates of violence were identified using the Wald test and negative binomial regression. RESULTS Out of 3302 study participants, 1439 (44%) had experienced violence within the past year. Physical violence was the most common form of violence experienced (35%), followed by being threatened (23%) or subjected to sexual violence (7%). In an adjusted analysis, female participants reported higher experiences of sexual violence (prevalence ratio [PR] = 2.46; 95% confidence interval [CI] 1.62, 3.74; p < 0.001) compared to male participants. In adjusted analysis, coastal residents had a higher experience of overall violence (PR = 1.48; 95% CI 1.27, 1.72; p < 0.001) than those living in Nairobi. This regional effect was relatively stronger among the female respondents (pinteraction = 0.025). Participants' sex modified the association between region and experiencing violence after adjusting potential confounding factors. CONCLUSIONS The study reveals the prevalence of violence among PWID and identifies high-risk sub-groups, including women, specifically for sexual violence, and coastal residents. Tailored interventions addressing their unique needs are essential. A holistic approach that combines violence prevention and response, comprehensive harm reduction, healthcare access, and community support is crucial to address the complex issue of drug use and HIV burden among PWID in Kenya for improved health outcomes.
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Affiliation(s)
| | | | - Loice W Mbogo
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | - Betsy Sambai
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | | | | | | | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Esther Gitau
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Sarah Masyuko
- University of Washington, Seattle, WA, USA
- National AIDS and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya
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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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Obidoa C, Thompson PO, Thitsa M, Martin CF, Katner H. Socio-ecologic Correlates of HIV/AIDS-Related Sexual Risk Behavior of African American Emerging Adults. AIDS Behav 2023; 27:3392-3400. [PMID: 37027071 DOI: 10.1007/s10461-023-04055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
There is growing evidence showing that patterns of individual sexual risk behaviors are insufficient in explaining the disproportionate HIV/AIDS burden borne by African Americans. Instead, dynamic features of social, economic, political, and geographic contexts play a more determining role. However, not enough studies have examined the impact of multi-level factors including neighborhood-level influences on HIV/AIDS sexual risk among African American emerging adults using a socio-ecologic perspective. Anchored on the socio-ecologic framework, this study examines the collective role of relevant socio-ecologic determinants of sexual risk-taking among African American emerging adults. Results from both bivariate and multivariate analyses revealed that individual and neighborhood-level variables were significantly associated with sexual risk in our study population partially confirming the hypothesis of the study. Male gender, educational attainment, and neighborhood social disorder were the strongest predictors of sexual risk. Our findings contribute to the vast literature on sexual risk behavior patterns of young adults, and increasing evidence demonstrating the role of contextual factors as stronger predictors of sexual risk and HIV infection among at-risk youth. Our findings, however, underscore the need for further research on the pathways of HIV socio-behavioral vulnerability in this demographic group.
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Affiliation(s)
- Chinekwu Obidoa
- Department of International & Global Studies, Mercer University, 1501 Mercer University Drive, Macon, GA, 31207, USA.
| | - Peter Onah Thompson
- Department of Government & Justice Studies, Appalachian State University, 350K Anne Belk Hall, Boone, USA
| | - Makhin Thitsa
- Department of Electrical & Computer Engineering, Mercer University, 1501 Mercer University Drive, Macon, GA, 31207, USA
| | - Clyde F Martin
- Paul Whitfield Horn Professor Emeritus, Texas Tech University, Lubbock, USA
| | - Harold Katner
- Division of Infectious Diseases, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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Brothers TD, Bonn M, Lewer D, Comeau E, Kim I, Webster D, Hayward A, Harris M. Social and structural determinants of injection drug use-associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis. Addiction 2023; 118:1853-1877. [PMID: 37170877 DOI: 10.1111/add.16257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND AIMS Injection drug use-associated bacterial and fungal infections are increasingly common, and social contexts shape individuals' injecting practices and treatment experiences. We sought to synthesize qualitative studies of social-structural factors influencing incidence and treatment of injecting-related infections. METHODS We searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1 January 2000 to 18 February 2021. Informed by Rhodes' 'risk environment' framework, we performed thematic synthesis in three stages: (1) line-by-line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher-order analytical themes. RESULTS We screened 4841 abstracts and included 26 qualitative studies on experiences of injecting-related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro-environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health-care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted-injecting and sharing sterile equipment; and (6) self-care, including vein health and self-treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission). CONCLUSIONS Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health-care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community.
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Affiliation(s)
- Thomas D Brothers
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Matthew Bonn
- Canadian Association of People who Use Drugs (CAPUD), Dartmouth, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Emilie Comeau
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Inhwa Kim
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Duncan Webster
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Infectious Diseases, Saint John Regional Hospital, Saint John, Canada
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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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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Wise A, Kianian B, Chang HH, Linton S, Wolfe ME, Smith J, Tempalski B, Des Jarlais D, Ross Z, Semaan S, Wejnert C, Sionean C, Cooper HL. Socioeconomic and racial/ethnic spatial polarization and incarceration among people who inject drugs in 19 US metropolitan areas, 2015. SSM Popul Health 2023; 23:101486. [PMID: 37635990 PMCID: PMC10448199 DOI: 10.1016/j.ssmph.2023.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/01/2022] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
The purpose of this study is to test, for the first time, the association between spatial social polarization and incarceration among people who inject drugs (PWID) in 19 large U.S. metropolitan statistical areas (MSAs) in 2015. PWID were recruited from MSAs for the Centers for Disease Control and Prevention's 2015 National HIV Behavioral Surveillance. Administrative data were used to describe the ZIP-code areas, counties, and MSAs where PWID lived. We operationalized spatial polarization using the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and household income at the ZIP-code level. We tested the association between spatial polarization and odds of past-year arrest and detainment using multilevel multivariable models. We found 37% of the sample reported being incarcerated in the past year. Report of past-year incarceration varied by race/ethnicity: 45% of non-Hispanic white PWID reported past-year incarceration, as did 25% of non-Hispanic Black PWID, and 43% of Hispanic/Latino PWID (N = 9047). Adjusted odds ratios suggest that Black PWID living in ZIP-code areas with a higher ICE score, meaning more white and affluent, had higher odds of past-year incarceration, compared to white PWID. In previous research, incarceration has been found to be associated with HIV acquisition and can deter PWID from engaging in harm reduction activities.
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Affiliation(s)
- Akilah Wise
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Behzad Kianian
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Howard H. Chang
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Sabriya Linton
- 615 Wolfe Street, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. Wolfe
- 1518 Clifton Road, School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Barbara Tempalski
- 71 W. 23rd Street, Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, 10010, USA
| | - Don Des Jarlais
- 708 Broadway, College of Global Public Health, New York University, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Cyprian Wejnert
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Catlainn Sionean
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Hannah L.F. Cooper
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - for the NHBS Study Group
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- 615 Wolfe Street, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 1518 Clifton Road, School of Nursing, Emory University, Atlanta, GA, USA
- 71 W. 23rd Street, Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, 10010, USA
- 708 Broadway, College of Global Public Health, New York University, New York, NY, 10003, USA
- ZevRoss Spatial Analysis, New York, NY, USA
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
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11
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Zaccheo SK, Marrone G, Pandey LR, Deuba K. The impact of border crossing and imprisonment on injection practices and risk of HIV and hepatitis C infection among men who inject drugs in Nepal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104145. [PMID: 37549595 DOI: 10.1016/j.drugpo.2023.104145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In Nepal, personal drug use is criminalized and among people who inject drugs (PWID), the majority of whom are men, movement across the border with India for drug procurement and use is common. Using a risk environment approach, this study examined associations between border crossing and imprisonment with respect to HIV, HCV and injection risk behavior among men who inject drugs in Nepal. METHODS This cross-sectional study analyzed data from 1345 participants from 14 districts across Nepal. Explanatory variables were prior imprisonment and past-month border crossing to procure or use drugs. We used multivariable logistic regression to evaluate associations between these variables and HIV, HCV, HIV/HCV co-infection and past-month injection risk behavior among PWID. RESULTS Over half of participants reported prior imprisonment (34.6% prior to past year, 21.6% within past year) and Indo-Nepal border crossing in the past year to use or buy drugs (31.2% sometimes, 20.8% often); over one quarter of participants (29.6%) reported both. Imprisonment prior to the past year was associated with higher odds of all outcome variables: HIV (adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI) 1.29-4.59), HCV (aOR 1.51, 95% CI 1.08-2.09), HIV/HCV co-infection (aOR 3.12, 95% CI 1.58-6.14) and injection risk behavior (aOR 1.64, 95% CI 1.20-2.25). Past-year border crossing to procure or use drugs was associated with HCV (aOR 2.06, 95% CI 1.42-2.98) and injection risk behavior (aOR 1.47, 95% CI 1.04-2.10), with larger effect sizes among PWID who reported both border crossing as well as history of imprisonment. CONCLUSION Imprisonment and border crossing were associated with injection risk behavior and disease outcomes. These findings indicate a need to implement cross-border disease surveillance and harm reduction initiatives in the Indo-Nepal border region and in Nepali prisons.
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Affiliation(s)
- Sonia K Zaccheo
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Lok Raj Pandey
- National Centre for AIDS and STD Control (NCASC), Ministry of Health and Population, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; National Centre for AIDS and STD Control (NCASC), Global Fund Programs, Kathmandu, Nepal.
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12
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Lechuga J, Ramos R, Dickson-Gomez J, Beachy S, Perez G, Nevola O, Varela A, Ramos ME, Sauceda J, Ludwig-Barrron N, Salazar J. Institutional violence from police militarization and drug cartel wars as a 'Big Event' and its influence on drug use harms and HIV risk in people who inject drugs on the U.S.-Mexico border. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104125. [PMID: 37499305 DOI: 10.1016/j.drugpo.2023.104125] [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: 01/14/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Globally, the US-Mexico Border is one of the largest drug trafficking regions, with Ciudad Juarez (CJ) and El Paso (EP) making up the second-largest border crossing in the world. Border communities are places where the risk of drug use harm and infectious diseases such as HIV are augmented due to the confluence of factors operating across the physical, social, economic and policy environment. Although the two cities are economically, culturally, and socially intertwined, each has distinct criminal justice systems and policy practices aimed at curtailing substance use. Between 2008 and 2011, the CJ/EP region experienced an unprecedented level of violence that stemmed from the intersection of police militarization and drug cartel wars, which profoundly shaped every aspect of life. Little research has documented the impact of drug cartel wars on the drug use and health harms of people who inject drugs (PWID) living in CJ and EP. The purpose of the study is to understand the effect that the drug cartel war had on the drug use harms and HIV risk of PWID. METHODS We conducted 40 in-depth interviews with people who inject drugs who resided in CJ or EP and had used heroin or crack cocaine in the last 30 days, and asked how police militarization and drug cartel war affected their daily lives. The risk environment framework informed the analysis and interpretation of findings. RESULTS Findings indicated that the risk environment was profoundly altered as PWID residing in CJ experienced profound changes in their daily lives that promoted engagement in behaviors that increased drug use and health harms including HIV risk, exacerbated trauma, and prevented use of substance use treatment and harm reduction services. The risk environment was also altered in EP, where PWID experienced drug supply shortages, violent policing practices, and reduced availability of harm reduction services. Findings underscore the permeability of risk environments across geographical borders. CONCLUSION The intersection of law enforcement militarization and drug cartel wars can be conceptualized as a 'big event' because it disrupts the drug market economy, leads to drug shortages, promotes entrance into the drug market economy by people who use drugs, reshapes drug use sites, and constrains the provision of harm reduction services. The stability of the harm reduction system in CJ was negatively impacted and limited the ability of individuals to reduce harm. Our findings show that drug cartel wars render the CJ/EP region extremely susceptible to drug use and health harms, while also creating vulnerability by severely restricting its ability to respond. Traditional recommendations to intervene to limit the impact of risk environments on the drug use harms of PWID need to be reconsidered in the context of drug cartel wars.
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Affiliation(s)
- Julia Lechuga
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States.
| | - Rebeca Ramos
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - Sara Beachy
- Lehigh University, Bethlehem PA, United States
| | - Gilberto Perez
- Texas State Health Department, Houston, TX, United States
| | | | - Alan Varela
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - John Sauceda
- The University of California San Francisco, San Francisco, CA, United States
| | | | - Jorge Salazar
- The University of California San Francisco, San Francisco, CA, United States
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13
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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14
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Rosen JG, Toomre T, To C, Olatunde PF, Cooper L, Glick JL, Park JN. Communicative appeals and messaging frames in visual media for HIV pre-exposure prophylaxis promotion to cisgender and transgender women. CULTURE, HEALTH & SEXUALITY 2023; 25:1007-1023. [PMID: 36074902 PMCID: PMC9992445 DOI: 10.1080/13691058.2022.2116111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Women in the USA represent 15% of new HIV diagnoses but only 5% of pre-exposure prophylaxis (PrEP) users. We sought to characterise communicative appeals and messaging frames used in US visual media to cultivate PrEP demand among cisgender and transgender women using content analysis methodology. We catalogued and coded media items (images and videos) from US PrEP marketing campaigns featuring women. Production and content characteristics were abstracted, and communicative appeals from media items were qualitatively coded in duplicate. We then descriptively summarised production and content characteristics and identified discrete subgroups of media items, clustering around specific messaging frames, through qualitative thematic analysis. Racial/ethnic minorities and sexual/gender minority women were heavily featured, and numerous media items leveraged cognitive and social communicative appeals to promote PrEP. We identified three unique messaging frames emerging from coded media items, portraying PrEP as: (1) necessary prevention (protection frame), (2) a desirable yet accessible commodity (aspiration frame), and (3) a conduit to sexual autonomy (empowerment frame). To effectively communicate PrEP information and promote PrEP to women, PrEP marketing should leverage alternative appeals (subjective norms, self-efficacy), address anticipated barriers to uptake (stigma, cost, medication interactions), and deconstruct misconceptions of PrEP use(rs).
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Teagan Toomre
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C To
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Praise F. Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center for Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
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15
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Lechuga J, Ramos R, Ludwig-Barron N, Perez G, Ramos ME, Ferreira-Pinto JB, Cordero JI, Sauceda J, Salazar J. Social and environmental determinants influencing injection drug use and HIV risk among two sister cities on the US-Mexico border: a comparative cross-sectional study, 2016-2018. Harm Reduct J 2023; 20:84. [PMID: 37400843 PMCID: PMC10318714 DOI: 10.1186/s12954-023-00802-0] [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: 10/04/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023] Open
Abstract
The economic, social, cultural and political milieus that influence injection drug-related HIV risk behaviors along the US-Mexico border in the previous decade have been studied comparing cities on an East-West axis. In an effort to inform interventions targeting factors beyond the individual level, we used a cross-sectional study design comparing people who inject drugs during 2016-2018, living on a North-South axis, in two cities-Ciudad Juárez, Chihuahua, Mexico and El Paso, Texas, USA-situated at the midpoint of the 2000 US-Mexico borderland stretch. We conceptualize injection drug use and its antecedents and consequences as influenced by factors operating at various levels of influence. Results of analysis comparing samples recruited from each border city indicated significant differences in demographic, socioeconomic, micro- and macro-level factors that affect risk. Similarities emerged in individual-level risk behaviors and some dynamics of risk at the drug use site most frequented to use drugs. In addition, analyses testing associations across samples indicated that different contextual factors such as characteristics of the drug use sites influenced syringe sharing. In this article, we reflect on the potential tailored interventions needed to target the context of HIV transmission risk among people who use drugs and reside in binational environment.
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Affiliation(s)
- Julia Lechuga
- College of Health Sciences, The University of Texas at El Paso, El Paso, USA.
| | - Rebeca Ramos
- College of Health Sciences, The University of Texas at El Paso, El Paso, USA
| | | | | | | | | | - Jacquelin I Cordero
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, USA
| | - John Sauceda
- Texas State Health Department in Houston, Houston, USA
| | - Jorge Salazar
- Texas State Health Department in Houston, Houston, USA
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THIMM‐KAISER MARCO, BENZEKRI ADAM, GUILAMO‐RAMOS VINCENT. Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation. Milbank Q 2023; 101:486-526. [PMID: 37062954 PMCID: PMC10262397 DOI: 10.1111/1468-0009.12642] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Policy Points A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research-to-practice translation gap and missed opportunity for advancing health equity. CONTEXT The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence. METHODS We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms. FINDINGS We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity. CONCLUSIONS Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer-reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence-based and targeted policy and programming. Such tools designed to close the research-to-practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.
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Affiliation(s)
- MARCO THIMM‐KAISER
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
| | - ADAM BENZEKRI
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
| | - VINCENT GUILAMO‐RAMOS
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
- School of Medicine, Duke University
- Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services
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17
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Sypsa V, Roussos S, Tsirogianni E, Tsiara C, Paraskeva D, Chrysanthidis T, Chatzidimitriou D, Papadimitriou E, Paraskevis D, Goulis I, Kalamitsis G, Hatzakis A. A new outbreak of HIV infection among people who inject drugs during the COVID-19 pandemic in Greece. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104073. [PMID: 37263112 DOI: 10.1016/j.drugpo.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multiple HIV outbreaks have been recorded among people who inject drugs (PWID) since 2010. During an intervention for PWID in 2019-2021 in Thessaloniki, Greece, an increasing number of HIV cases was documented. Here, we provide an analysis of this new outbreak. METHODS ALEXANDROS was a community-based program and participation included interviewing, rapid HIV/HCV tests, counselling and linkage to care. PWID were recruited through Respondent-Driven Sampling (RDS) in five sampling rounds. Crude and RDS-weighted HIV prevalence estimates were obtained. HIV incidence was estimated from data on 380 initially seronegative PWID with at least two tests. Multivariable Cox proportional hazards model was used to assess risk factors for HIV seroconversion. RESULTS In total, 1,101 PWID were recruited. At first participation, 53.7% were current PWID, 20.1% homeless, 20.3% on opioid substitution treatment and 4.8% had received syringes in the past 12 months. HIV prevalence (95% CI) was 7.0% (5.6-8.7%) and an increasing trend was observed over 2019-2021 (p = 0.002). Two-thirds of the cases (67.5%) were new diagnoses. HIV incidence was 7.0 new infections/100 person-years (95% CI:4.8-10.2). Homelessness in the past 12 months (HR:2.68; 95% CI:1.24-5.81) and receptive syringe sharing (HR:3.86; 95% CI:1.75-8.51) were independently associated with increased risk of seroconversion. By the end of the program, 67.3% of the newly diagnosed cases initiated antiretroviral treatment. CONCLUSIONS A new HIV outbreak among PWID was documented in Greece during the COVID-19 pandemic with homelessness and syringe sharing being associated with increased risk of HIV acquisition. Peer-driven programs targeting the population of high-risk underserved PWID can be used to early identify emerging outbreaks and to improve linkage to HIV care.
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Affiliation(s)
- Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrossini Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Greek Organisation Against Drugs (OKANA), Athens, Greece
| | - Chrissa Tsiara
- Hellenic National Public Health Organization, Marousi, Greece
| | | | - Theofilos Chrysanthidis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evaggelia Papadimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted Diseases and Emerging Diseases, Athens, Greece
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18
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Dahlby L, Boyd J, Knight R, Philbin M, Small W, Kerr T, McNeil R. The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study. AIDS Care 2023; 35:480-487. [PMID: 35698454 PMCID: PMC9930182 DOI: 10.1080/09540121.2022.2085868] [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: 01/15/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Street-involved youth who use drugs (YWUD) face an elevated risk of HIV acquisition and represent a key population for HIV prevention initiatives, including pre-exposure prophylaxis (PrEP). However, little is known regarding the acceptability and feasibility of PrEP uptake and adherence among this multiply-marginalized population. Semi-structured qualitative interviews were conducted with 24 street-involved YWUD (ages 17-24) to examine their perspectives toward PrEP; youth were recruited through a longitudinal prospective cohort study in Vancouver, Canada. Youth reported high levels of ambivalence toward PrEP despite engagement in HIV-related risk behaviors. This ambivalence was driven by misperceptions regarding HIV transmission, including stigmatizing associations between HIV transmission and personal hygiene. Such misperceptions led participants to enact strategies that were ineffective in preventing HIV transmission. Participants contested their inclusion as a "key population" for PrEP, which limited their enthusiasm for PrEP uptake and adherence. Participants also highlighted that wider social-structural inequities (e.g., housing vulnerability, poverty) that produced HIV-related risks were likely to undermine sustained PrEP use. Findings demonstrate the need for tailored implementation strategies to increase PrEP acceptability, including targeted education and anti-stigma interventions to increase awareness about HIV transmission. Interventions should also target structural inequities in order to fully address HIV risk and PrEP ambivalence.
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Affiliation(s)
- Lucia Dahlby
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Morgan Philbin
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Yale School of Medicine (Internal Medicine), 367 Cedar St, New Haven, CT, 06510
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Lin Q, Rojas Aguilera JA, Williams LD, Mackesy-Amiti ME, Latkin C, Pineros J, Kolak M, Boodram B. Social-spatial network structures among young urban and suburban persons who inject drugs in a large metropolitan area. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.21.23286255. [PMID: 36865191 PMCID: PMC9980242 DOI: 10.1101/2023.02.21.23286255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background It is estimated that there are 1.5% US adult population who inject drugs in 2018, with young adults aged 18-39 showing the highest prevalence. PWID are at a high risk of many blood-borne infections. Recent studies have highlight the importance of employing the syndemic approach to study opioid misuse, overdose, HCV and HIV, along with the social and environmental contexts where these interrelated epidemics occur in already marginalized communities. Social interactions and spatial contexts are important structural factors that are understudied. Methods Egocentric injection network and geographic activity spaces for young (aged 18-30) PWID and their injection, sexual, and social support network members (i.e., where reside, inject drugs, purchase drugs, and meet sex partners) were examined using baseline data from an ongoing longitudinal study (n=258). Participants were stratified based on the location of all place(s) of residence in the past year i.e., urban, suburban, and transient (both urban and suburban) to i) elucidate geospatial concentration of risk activities within multi-dimensional risk environments based on kernel density estimates; and ii) examine spatialized social networks for each residential group. Results Participants were mostly non-Hispanic white (59%); 42% were urban residents, 28% suburban, and 30% transient. We identified a spatial area with concentrated risky activities for each residence group on the West side of Chicago where a large outdoor drug market area is located. The urban group (80%) reported a smaller concentrated area (14 census tracts) compared to the transient (93%) and suburban (91%) with 30 and 51 tracts, respectively. Compared to other areas in Chicago, the identified area had significantly higher neighborhood disadvantages (e.g., higher poverty rate, p <0.001). Significant ( p <0.01 for all) differences were observed in social network structures: suburban had the most homogenous network in terms of age and residence, transient participants had the largest network (degree) and more non-redundant connections. Conclusion We identified concentrated risk activity spaces among PWID from urban, suburban, and transient groups in a large outdoor urban drug market area, which highlights the need for considering the role of risk spaces and social networks in addressing the syndemics in PWID populations.
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20
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Sauceda JA, Lechuga J, Ramos ME, Puentes J, Ludwig-Barron N, Salazar J, Christopoulos KA, Johnson MO, Gomez D, Covarrubias R, Hernandez J, Montelongo D, Ortiz A, Rojas J, Ramos L, Avila I, Gwadz MV, Neilands TB. A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol. BMC Public Health 2023; 23:307. [PMID: 36765309 PMCID: PMC9921633 DOI: 10.1186/s12889-023-15172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.
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Affiliation(s)
- John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA.
| | - Julia Lechuga
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Maria Elena Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Jorge Puentes
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Natasha Ludwig-Barron
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - Jorge Salazar
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - David Gomez
- Centro de Integración Juvenil (CIJ), Cuidad Juárez, Blvd Ing Bernardo Norzagaray, 32130, Cazatecas, Chihuahua, México
| | - Rogelio Covarrubias
- Centro Ambulatorio para la prevención y Atención de SIDA y de las Enfermedades de Transmisión Sexual (CAPASITS), Cuidad Juárez, Avenue Paseo Triunfo de la Republica 3530, 32330, Partido Escobedo, Chihuahua, México
| | - Joselyn Hernandez
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - David Montelongo
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Alejandro Ortiz
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Julian Rojas
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Luisa Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Itzia Avila
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Marya V Gwadz
- Silver School of Social Work, New York University, 1 Washington Square N, 10003, New York, NY, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
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21
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Walters SM, Frank D, Felsher M, Jaiswal J, Fletcher S, Bennett AS, Friedman SR, Ouellet LJ, Ompad DC, Jenkins W, Pho MT. How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103930. [PMID: 36641816 PMCID: PMC9974910 DOI: 10.1016/j.drugpo.2022.103930] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois. METHODS Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses. RESULTS We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care. CONCLUSION The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.
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Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States.
| | - David Frank
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States
| | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, United States
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL, United States
| | - Scott Fletcher
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States; College of Population Health, Thomas Jefferson University, United States; Department of Health Science, University of Alabama, Tuscaloosa, AL, United States; Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, United States; Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States; Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, United States; Department of Medicine, University of Chicago, Chicago, IL, United States; The Community Action Place, Murphysboro, IL, United States
| | - Alex S Bennett
- Center for Drug Use and HIV/HCV Research, New York, NY, United States; Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
| | - Samuel R Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, United States
| | - Lawrence J Ouellet
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, United States
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, United States
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22
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Aroke H, Buchanan A, Katenka N, Crawford FW, Lee T, Halloran ME, Latkin C. Evaluating the Mediating Role of Recall of Intervention Knowledge in the Relationship Between a Peer-Driven Intervention and HIV Risk Behaviors Among People Who Inject Drugs. AIDS Behav 2023; 27:578-590. [PMID: 35932359 PMCID: PMC10408304 DOI: 10.1007/s10461-022-03792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/01/2022]
Abstract
Peer-driven interventions can be effective in reducing HIV injection risk behaviors among people who inject drugs (PWID). We employed a causal mediation framework to examine the mediating role of recall of intervention knowledge in the relationship between a peer-driven intervention and subsequent self-reported HIV injection-related risk behavior among PWID in the HIV Prevention Trials Network (HPTN) 037 study. For each intervention network, the index participant received training at baseline to become a peer educator, while non-index participants and all participants in the control networks received only HIV testing and counseling; recall of intervention knowledge was measured at the 6-month visit for each participant, and each participant was followed to ascertain HIV injection-related risk behaviors at the 12-month visit. We used inverse probability weighting to fit marginal structural models to estimate the total effect (TE) and controlled direct effect (CDE) of the intervention on the outcome. The proportion eliminated (PE) by intervening to remove mediation by the recall of intervention knowledge was computed. There were 385 participants (47% in intervention networks) included in the analysis. The TE and CDE risk ratios for the intervention were 0.47 [95% confidence interval (CI): 0.28, 0.78] and 0.73 (95% CI: 0.26, 2.06) and the PE was 49%. Compared to participants in the control networks, the peer-driven intervention reduced the risk of HIV injection-related risk behavior by 53%. The mediating role of recall of intervention knowledge accounted for less than 50% of the total effect of the intervention, suggesting that other potential causal pathways between the intervention and the outcome, such as motivation and skill, self-efficacy, social norms and behavior modeling, should be considered in future studies.
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Affiliation(s)
- Hilary Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
- Department of Computer Science and Statistics, College of Arts & Science, University of Rhode Island, Kingston, RI, 02281, USA
| | - Natallia Katenka
- Department of Computer Science and Statistics, College of Arts & Science, University of Rhode Island, Kingston, RI, 02281, USA
| | - Forrest W Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, 06510, USA
- Department of Statistics & Data Science, Yale University, New Haven, CT, 06510, USA
- Department of Ecology & Evolutionary Biology, Yale University, New Haven, CT, 06510, USA
- Yale School of Management, Yale University, New Haven, CT, 06510, USA
| | - TingFang Lee
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seatle, WA, 98109, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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23
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Gheibi Z, Fararouei M, Afrashteh S, Akbari M, Afsar Kazerooni P, Shokoohi M. Pattern of contributing behaviors and their determinants among people living with HIV in Iran: A 30-year nationwide study. Front Public Health 2023; 11:1038489. [PMID: 36908430 PMCID: PMC9998994 DOI: 10.3389/fpubh.2023.1038489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction A major shift in the routes of HIV transmission seams to be taking place in Iran. Our study aimed to investigate the 30-year trend of major HIV related behaviors in Iran. Methods The national HIV/AIDS registry database (from September 1986 to July 2016 with data on 32,168 people newly diagnosed with HIV) was used to study the 30 years trend and demographic determinants of major HIV related behaviors. Results The highest rate of drug injection (DI) among people living with HIV (PLHIV) was reported during 1996 to 1999 (p-for trend < 0.001) while the highest rate of sexual activity by minorities or hard to reach groups was during 2004 to 2011 (p-for trend < 0.001). Among males, drug injection was directly associated with being single (ORsingle/married = 1.34), being unemployed (ORunemployed/employed = 1.94) and having lower level of education (OR<highschool/≥highschool = 2.21). Regarding females, drug injection was associated with being housewife (ORhousewife/employed = 1.35) and lower level of education (OR<highschool/≥highschool = 1.85). In females, condomless sexual contact was more common among those younger (OR20-29/<20 = 6.15), and married (ORmarried/single = 7.76). However, among males those being single (ORmarried/single = 0.82), being more educated (OR≥highschool/<highschool = 1.24), and being unemployed (ORunemployed/employed = 1.53) reported more sexual activity by minoritised or hard to reach groups. Discussion The pattern of major HIV related behaviors among Iranian males and females have been rapidly changing and people living with HIV (PLHIV) are being diagnosed at a younger age. Health education to younger individuals is an essential HIV controlling strategy among Iranian population. Implementation of surveys in hidden and hard-to-reach populations is also recommended.
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Affiliation(s)
- Zahra Gheibi
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mojtaba Akbari
- Department of Epidemiology and Statistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mostafa Shokoohi
- HIV and Sexually Transmitted Infections Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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24
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Springfield O, Brouwer KC, Avila-Rios S, Morales-Miranda S, Mehta SR. Molecular epidemiology of HIV-1 among adult female sex workers at the Guatemala-Mexico border. Glob Public Health 2023; 18:2278873. [PMID: 37944916 PMCID: PMC10808948 DOI: 10.1080/17441692.2023.2278873] [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: 04/07/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
ABSTRACTSex workers have been demonstrated to have increased vulnerabilities to HIV and a high population prevalence of the disease. Despite their increased risk, sex workers have been underrepresented in molecular epidemiology studies assessing HIV in Mesoamerica. This study aims to describe the sociodemographic characteristics and phylogenetic profile of HIV-1 within a cohort of HIV-positive female sex workers (FSW) situated at the Guatemala-Mexico border. HIV viral sequences were collected from a cohort of FSW ≥18 years of age from San Marcos, Guatemala (n = 6) and compared to viral sequences collected as part of the Mesoamerican Drug Resistance Monitoring Programme to assess HIV viral diversity in Mexico and Guatemala (n = 3956). All of the FSW sampled were determined to have genetically unrelated HIV infections, suggesting multiple introductions of the virus and/or the potential existence of populations not captured by current surveillance efforts. Many reported numerous vulnerabilities that may have heightened their risk of acquiring and transmitting HIV through sex work activities. Our phylogenetic analysis indicated that national surveillance programmes may not fully capture the viral diversity among FSW and their clients within this region. Additional research is needed to fully capture HIV diversity and transmission in Mesoamerica, especially in the Guatemala-Mexico border region.
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Affiliation(s)
- Olivia Springfield
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kimberly C. Brouwer
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Santiago Avila-Rios
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Sonia Morales-Miranda
- Consorcio de Investigación sobre VIH SIDA TB Consorcio de Investigación en Salud, Cuernavaca, Morelos, México
| | - Sanjay R. Mehta
- University of California San Diego School of Medicine, La Jolla, California, USA
- San Diego Veterans Affairs Medical Center, San Diego, California, USA
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25
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Buhendwa M, Sliep Y, Mchunu GG, Nxumalo CT. Exploring the Influence of Social Capital on HIV Prevention with Migrants from the Democratic Republic of Congo (DRC) Living in Durban, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:618. [PMID: 36612938 PMCID: PMC9819981 DOI: 10.3390/ijerph20010618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Background: Research shows a growing attentiveness to the role of social and environmental influences on HIV risk behaviours. Moreover, the understanding of HIV risk behaviours has moved from an earlier consideration of individual risk, to ecological models, with the understanding that behaviours are rooted in the economic, environmental and social structure. Aim: To explore how social capital, specifically on a social bonding level, operates as a risk or protective factor for the spread of HIV among French-speaking migrants from the Democratic Republic of Congo (DRC), living in Durban, South Africa. Methods: A qualitative approach using a case study design was used to conduct the study. Data were collected through focus group discussions and individual in-depth interviews from a purposive sample of French-speaking migrants from DRC, living in Durban, South Africa. Ethical approval to conduct the study was obtained from the University of KwaZulu-Natal's Human and Social Science Research Ethics' Committee. Data were analysed thematically using Creswell's steps of data analysis. Results: This study found that social capital can act as both a protective factor in certain circumstances, and a risk factor in others. Trust, norms, reciprocity and social networks are complex elements in the refugee community and are influenced by a myriad of factors including the past and present stressors that are prevalent within this community. Conclusions: The findings confirm the complexity of issues related to HIV prevention which necessitate policy and practice interventions to mitigate consequences that may result from the higher risks of HIV transmission in this community.
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Affiliation(s)
- Mulumeoderhwa Buhendwa
- Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban 4000, South Africa
| | - Yvonne Sliep
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Durban 4140, South Africa
| | - Gugu Gladness Mchunu
- Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban 4000, South Africa
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26
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Schmidt CN, Puffer ES, Broverman S, Warren V, Green EP. Is social-ecological risk associated with individual HIV risk beliefs and behaviours?: An analysis of Kenyan adolescents' local communities and activity spaces. Glob Public Health 2022; 17:3670-3685. [PMID: 34236940 PMCID: PMC8741821 DOI: 10.1080/17441692.2021.1951801] [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: 12/27/2020] [Accepted: 06/14/2021] [Indexed: 02/06/2023]
Abstract
The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal (e.g. neighbourhood) level. Working with 218 adolescents and their parents/guardians in rural western Kenya, we combined participatory mapping activities with satellite imagery to identify adolescent activity spaces and create a novel measure of social-ecological risks. We then examined the associations between social-ecological risk and individual HIV risk beliefs and behaviours. We found support for the conjecture that social-ecological risks may be associated with individual beliefs and behaviours. As social-ecological risk increased for a sample of Kenyan adolescents, so did their reports of riskier sex beliefs and behaviours, as well as unsupervised outings at night. This study reinforces calls for disease prevention approaches that go beyond emphasising individual behaviour change.
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Affiliation(s)
| | - Eve S. Puffer
- Department of Psychiatry, Duke University, Durham, USA
- Department of Global Health, Duke University
| | - Sherryl Broverman
- Department of Global Health, Duke University
- Department of Biology, Duke University, Durham, USA
| | | | - Eric P. Green
- Department of Psychiatry, Duke University, Durham, USA
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27
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Mancera BM, Provencio-Vasquez E, Loza O, De Santis JP. Impulsivity, Sexual Compulsivity, and Sexual Risk Behaviors among Hispanic Men Who Have Sex with Men in a US-Mexico Border City. Issues Ment Health Nurs 2022; 43:1107-1113. [PMID: 36368928 DOI: 10.1080/01612840.2022.2134530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hispanic men who have sex with men (HMSM) experience HIV risk-related and mental health disparities. The relationship of mental health (i.e., depressive symptoms and anxiety) on sexual risk behaviors of HMSM has been reported. However, little is known about the influence of impulsivity and compulsivity on sexual risk behaviors. A cross-sectional study explored these factors among 150 HMSM in the El Paso, Texas area utilizing standardized measures, in a cross-sectional study. Regression analysis determined the influence of sexual impulsivity and compulsivity, and demographic variables on sexual risk behaviors, indicating interventions should target these behaviors to mitigate sexual risk among HMSM.
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Affiliation(s)
- Bibiana M Mancera
- Director of Community Engagement, Border Biomedical Research Center (BBRC), University of Texas at El Paso, El Paso, TX, USA
| | | | - Oralia Loza
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Joseph P De Santis
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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28
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Rier DA. Responsibility in Medical Sociology: A Second, Reflexive Look. THE AMERICAN SOCIOLOGIST 2022; 53:663-684. [PMID: 36246580 PMCID: PMC9540162 DOI: 10.1007/s12108-022-09549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Personal responsibility has emerged as an important element in many countries' public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such "responsibilization" as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual's perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.
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Affiliation(s)
- David A. Rier
- Department of Sociology & Anthropology, Bar-Ilan University, 5290002 Ramat-Gan, Israel
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29
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Duncan E, Shufelt S, Barranco M, Udo T. Acceptability of supervised injection facilities among persons who inject drugs in upstate New York. Harm Reduct J 2022; 19:87. [PMID: 35907854 PMCID: PMC9338679 DOI: 10.1186/s12954-022-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supervised injection facilities (SIFs) provide spaces where persons who inject drugs (PWID) can inject under medical supervision and access harm reduction services. Though SIFs are not currently sanctioned in most of the US, such facilities are being considered for approval in several Upstate New York communities. No data exist from PWID in Upstate New York, and little from outside major US urban centers, on willingness to use SIFs and associated factors. METHODS This analysis included 285 PWID (mean age = 38.7; 57.7% male; 72.3% non-Hispanic white) recruited for a study on hepatitis C prevalence among PWID in Upstate New York, where participants were recruited from syringe exchange programs (n = 80) and able to refer other PWID from their injection networks (n = 223). Participants completed an electronic questionnaire that included a brief description of SIFs and assessed willingness to use SIFs. We compared sociodemographic characteristics, drug use/harm reduction history, healthcare experience, and stigma between participants who were willing vs. unwilling to use such programs. RESULTS Overall, 67.4% were willing to use SIFs, 18.3% unwilling, and 14.4% unsure. Among those reporting being willing or unwilling, we found higher willingness among those who were currently homeless (91.8% vs. 74.6%; p = 0.004), who had interacted with police in the past 12 months (85.7% vs. 74.5%; p = 0.04), and who were refused service within a healthcare setting (100% vs. 77.1%; p = 0.03). CONCLUSION Our results support SIF acceptability in several Upstate New York PWID communities, particularly among those reporting feelings of marginalization. A large proportion reported being unsure about usage of SIFs, suggesting room for educating PWID on the potential benefits of this service. Our results support SIF acceptability in Upstate New York and may inform programming for underserved PWID, should SIFs become available.
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Affiliation(s)
- Eliana Duncan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.
| | - Sarah Shufelt
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Meredith Barranco
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.,Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
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30
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O’Brien S, Jaramillo MM, Roberts B, Platt L. Determinants of health among people who use illicit drugs in the conflict-affected countries of Afghanistan, Colombia and Myanmar: a systematic review of epidemiological evidence. Confl Health 2022; 16:39. [PMID: 35799203 PMCID: PMC9264525 DOI: 10.1186/s13031-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan, Colombia and Myanmar are the world's leading heroin and cocaine producers and have also experienced prolonged periods of armed conflict. The link between armed conflict and drug markets is well established but how conflict impacts on the health and social determinants of people who use drugs is less clear. The aim was to investigate health outcomes and associated factors among people who use illicit drugs in Afghanistan, Colombia and Myanmar. METHODS We conducted a systematic review searching Medline, EMBASE, PsychINFO and Global Health databases using terms relating to Afghanistan, Colombia and Myanmar; illicit drug use (all modes of drug administration); health and influencing factors. Quality assessment was assessed with the Newcastle-Ottawa-Scale and papers were analysed narratively. RESULTS 35 studies were included in Afghanistan (n = 15), Colombia (n = 9) and Myanmar (n = 11). Health outcomes focused predominantly on HIV, Hepatitis C (HCV), Hepatitis B and sexually transmitted infections (STIs), with one study looking at human rights violations (defined as maltreatment, abuse and gender inequality). Drug use was predominantly injection of heroin, often alongside use of amphetamines (Myanmar), cocaine and cocaine-based derivatives (Colombia). Only one study measured the effect of a period of conflict suggesting this was linked to increased reporting of symptoms of STIs and sharing of needles/syringes among people who inject drugs. Findings show high levels of external and internal migration, alongside low-income and unemployment across the samples. External displacement was linked to injecting drugs and reduced access to needle/syringe programmes in Afghanistan, while initiation into injecting abroad was associated with increased risk of HCV infection. Few studies focused on gender-based differences or recruited women. Living in more impoverished rural areas was associated with increased risk of HIV infection. CONCLUSIONS More research is needed to understand the impact of armed-conflict and drug production on the health of people who use drugs. The immediate scale-up of harm reduction services in these countries is imperative to minimize transmission of HIV/HCV and address harms associated with amphetamine use and other linked health and social care needs that people who use drugs may face.
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Affiliation(s)
- Sally O’Brien
- grid.8991.90000 0004 0425 469XFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Margarita Marin Jaramillo
- grid.10689.360000 0001 0286 3748Observatorio de Restitución Y Regulación de los Derechos de Propiedad Agraria, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bayard Roberts
- grid.8991.90000 0004 0425 469XFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Birch R, Jollimore J, Howard T, Lal A, Cui Z, Rich AJ, Lachowsky N, Moore DM, Hogg RS, Roth EA. Hosts as Gatekeepers for North American Gay and Bisexual Men's Private Group Sex Parties. JOURNAL OF HOMOSEXUALITY 2022; 69:1398-1413. [PMID: 33989132 DOI: 10.1080/00918369.2021.1913919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gay and bisexual men's (GBM) group sex parties are considered HIV risk environments due to their association with concurrent sexual partners, condomless anal sex, and polysubstance use. The possibility of group sex party hosts acting as gatekeepers to minimize risks has been suggested, but remains understudied. We analyzed qualitative data from 20 in-depth interviews with North American GBM who recently attended private group sex parties to determine if hosts' actions constitute harm reduction strategies. Results showed hosts acting as gatekeepers before parties by establishing and disseminating themes and rules, screening applicants, and selecting guests. During parties hosts enforced rules and rejected uninvited guests. By their actions, hosts established a more controlled environment compared to public sex-on-premises bathhouses, and facilitated boundary play, the paradoxical behavior of simultaneously desiring risk and safety, previously noted for GBM circuit parties. Results suggest initiating education programs focusing on private group sex party hosts as gatekeepers.
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Affiliation(s)
- Robert Birch
- Social Dimensions of Health, University of Victoria, Victoria, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, British Columbia, Canada
| | - Terry Howard
- Community-Based Researcher with Lived Experience of HIV, Co-Chair of Momentum Community Engagement Committee, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Ashleigh J Rich
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Public Health and Social Policy, Victoria, British Columbia
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric Abella Roth
- Centre for Addiction Research of British Columbia, Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
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Rasikh AS. Factors Associated with HIV Risk and Vulnerability Among Injecting Drug Users in Afghanistan: A Narrative Review. HIV AIDS (Auckl) 2022; 14:331-339. [PMID: 35911789 PMCID: PMC9329675 DOI: 10.2147/hiv.s366970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
The number of human immunodeficiency virus (HIV) cases in Afghanistan is increasing mainly associated with injecting drug use (IDU). This study aimed to explore the risk and vulnerability factors associated with HIV infection among injecting drug users (IDUs) in Afghanistan in order to contribute to improving the response and reversing the concentrated HIV epidemic among this group. A narrative review of the literature was conducted to reach the objective. The modified social ecological model was used as conceptual framework for analysis of the HIV risk and vulnerability factors among IDUs at five levels. At the “individual level”, the injecting risk behaviors among IDUs such as sharing the injecting equipment and their sexual risk behaviors like unprotected sexual contact with multiple partners identified as immediate factors that put them at risk of HIV infection. At the “network level”, lack of HIV knowledge and low uptake of the harm reduction services were identified as the factors that increase their vulnerability. At the “community level”, massive drug production and easy access to illicit drugs, armed conflicts, massive internal and external migration, unemployment and poverty, high stigma and discrimination against IDUs, unsafe injecting locations such as under the bridges; and at the “public policy level”, punitive drug laws, and weak national political response to HIV and IDU were identified as determinants that add to the IDUs vulnerability to HIV. At the “stage of epidemic level”, the concentrated HIV epidemic among IDUs in the country poses a potential risk to uninfected IDUs and beyond. In conclusion, the IDUs in Afghanistan are highly at risk and vulnerable to HIV. An informed and multisectoral response is required to control the epidemic. A rapid expansion of the harm reduction interventions is urgently needed.
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Affiliation(s)
- Ahmad Shekaib Rasikh
- Department of Infectious Diseases, Kabul University of Medical Sciences, Kabul, Afghanistan
- KIT Health (Royal Tropical Institute), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Correspondence: Ahmad Shekaib Rasikh, Tel +93791906514, Email
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Calderón-Villarreal A, Terry B, Friedman J, González-Olachea SA, Chavez A, Díaz López M, Pacheco Bufanda L, Martinez C, Medina Ponce SE, Cázares-Adame R, Rochin Bochm PF, Kayser G, Strathdee SA, Muñoz Meléndez G, Holmes SM, Bojorquez I, Los Huertos M, Bourgois P. Deported, homeless, and into the canal: Environmental structural violence in the binational Tijuana River. Soc Sci Med 2022; 305:115044. [PMID: 35633600 PMCID: PMC9585906 DOI: 10.1016/j.socscimed.2022.115044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Abstract
Introduction: The US deports more Mexicans to Tijuana than any other borderland city. Returning involuntarily as members of a stigmatized underclass, many find themselves homeless and de-facto stateless. Subject to routinized police victimization, many take refuge in the Tijuana River Canal (El Bordo). Previous reports suggest Tijuana River water may be contaminated but prior studies have not accessed the health effects or contamination of the water closest to the river residents. Methods: A binational, transdisciplinary team undertook a socio-environmental, mixed methods assessment to simultaneously characterize Tijuana River water quality with chemical testing, assess the frequency of El Bordo residents’ water-related diseases, and trace water contacts with epidemiological survey methods (n = 85 adults, 18+) in 2019, and ethnographic methods in 2019–2021. Our analysis brings the structural violence framework into conversation with an environmental injustice perspective to documented how social forces drive poor health outcomes enacted through the environment. Results: The Tijuana River water most proximate to its human inhabitants fails numerous water-quality standards, posing acute health risks. Escherichia coli values were ∼40,000 times the Mexican regulatory standard for directly contacted water. Skin infections (47%), dehydration (40%) and diarrhea (28%) were commonly reported among El Bordo residents. Residents are aware the water is contaminated and strive to minimize harm to their health by differentially using local water sources. Their numerous survival constraints, however, are exacerbated by routine police violence which propels residents and other people who inject drugs into involuntary contact with contaminated water. Discussion: Human rights to drinking water, sanitation and hygiene are routinely violated among El Bordo in-habitants. This is exacerbated by violent policing practices that force unhoused deportees to seek refuge in waterways, and drive water contacts. Furthermore, US-Mexico ‘free-trade’ agreements drive rapid growth in Tijuana, restrict Mexican environmental regulation enforcement, and drive underinvestment in sewage systems and infrastructure.
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Affiliation(s)
- Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California, San Diego (UCSD), San Diego, CA, USA; Graduate School of Public Health, San Diego State University (SDSU), San Diego, CA, USA.
| | - Brendan Terry
- Pomona College, Claremont, CA, USA; Epigenetics Programme, Babraham Institute, Cambridge, UK.
| | - Joseph Friedman
- University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | | | | | | | | | - Carlos Martinez
- University of California, Berkeley (UC Berkeley), Berkeley, CA, USA; University of California, San Francisco (UCSF), San Francisco, USA.
| | | | | | | | - Georgia Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, CA, USA.
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UCSD, San Diego, CA, USA.
| | | | | | - Ietza Bojorquez
- El Colegio de La Frontera Norte (El COLEF), Tijuana, Mexico.
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Visualizing the Knowledge Base and Research Hotspot of Public Health Emergency Management: A Science Mapping Analysis-Based Study. SUSTAINABILITY 2022. [DOI: 10.3390/su14127389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.
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Gore DJ, Schueler K, Ramani S, Uvin A, Phillips G, McNulty M, Fujimoto K, Schneider J. HIV Response Interventions that Integrate HIV Molecular Cluster and Social Network Analysis: A Systematic Review. AIDS Behav 2022; 26:1750-1792. [PMID: 34779940 PMCID: PMC9842229 DOI: 10.1007/s10461-021-03525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/19/2023]
Abstract
Due to improved efficiency and reduced cost of viral sequencing, molecular cluster analysis can be feasibly utilized alongside existing human immunodeficiency virus (HIV) prevention strategies. The goal of this paper is to elucidate how HIV molecular cluster and social network analyses are being integrated to implement HIV response interventions. We searched PubMed, Scopus, PsycINFO, and Cochrane Library databases for studies incorporating both HIV molecular cluster and social network data. We identified 32 articles that combined analyses of HIV molecular sequences and social or sexual networks. All studies were descriptive. Six studies described network interventions informed by molecular and social data but did not fully evaluate their efficacy. There is no current standard for incorporating molecular and social network analyses to inform interventions or data demonstrating its utility. More research must be conducted to delineate benefits and best practices for leveraging molecular data for network-based interventions.
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Affiliation(s)
- Daniel J Gore
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kellie Schueler
- Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA, USA
| | - Santhoshini Ramani
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Arno Uvin
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Moira McNulty
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Ghiabi M. Critique of everyday narco-capitalism. THIRD WORLD QUARTERLY 2022; 43:2557-2576. [PMID: 36505031 PMCID: PMC7613901 DOI: 10.1080/01436597.2022.2053776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/14/2022] [Accepted: 03/04/2022] [Indexed: 06/17/2023]
Abstract
Capitalism is not only an economic mode of production; it is also a form of life. This also applies to a historical type of capitalism, which is the capitalism founded on (illicit) drugs - in other words: narco-capitalism. The article discusses how capitalism alters life at the nexus of drug production, trade and consumption through a study of drug heartlands in Colombia, Afghanistan and Myanmar. What forms of life emerge under narco-capitalism? And how do people seek change and express agency in the exploitative conditions governed by narco-capital? To do so, the article proceeds through the following sections: first, it elucidates its definition of the 'everyday' as a conceptual and methodological scheme to understand capitalist forms of life. Then it uses material collected from people's everyday encounter with narco-capitalism in Afghanistan, Myanmar and Colombia to discuss mystification, predation and alienation. The article explores how capitalism produces forms of life that make use of drugs and narco-capital to dispossess and alienate collectivities. Finally, the article argues that to move beyond this alienating condition, drug wars and/or development are not a solution, because drugs are not the problem. Instead, it is people's organisation and world-building in dialectical mode to capitalist forms of life that can transform everyday life beyond predation and alienation.
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Affiliation(s)
- Maziyar Ghiabi
- College of Social Sciences and International Studies, University of Exeter, Exeter, UK
- Development Studies, School of Oriental and African Studies (SOA S), University of London, London, UK
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37
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McNeil R, Fleming T, Mayer S, Barker A, Mansoor M, Betsos A, Austin T, Parusel S, Ivsins A, Boyd J. Implementation of Safe Supply Alternatives During Intersecting COVID-19 and Overdose Health Emergencies in British Columbia, Canada, 2021. Am J Public Health 2022; 112:S151-S158. [PMID: 35262376 PMCID: PMC8965179 DOI: 10.2105/ajph.2021.306692] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To explore the implementation and effectiveness of the British Columbia, Canada, risk mitigation guidelines among people who use drugs, focusing on how experiences with the illicit drug supply shaped motivations to seek prescription alternatives and the subsequent impacts on overdose vulnerability. Methods. From February to July 2021, we conducted qualitative interviews with 40 people who use drugs in British Columbia, Canada, and who accessed prescription opioids or stimulants under the risk mitigation guidelines. Results. COVID-19 disrupted British Columbia's illicit drug market. Concerns about overdose because of drug supply changes, and deepening socioeconomic marginalization, motivated participants to access no-cost prescription alternatives. Reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market while allowing greater agency over drug use. Because prescriptions were primarily intended to manage withdrawal, participants supplemented with illicit drugs to experience enjoyment and manage pain. Conclusions. Providing prescription alternatives to illicit drugs is a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply, yet further optimizations are needed. (Am J Public Health. 2022;112(S2):S151-S158. https://doi.org/10.2105/AJPH.2021.306692).
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Affiliation(s)
- Ryan McNeil
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Taylor Fleming
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Samara Mayer
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Allison Barker
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Manal Mansoor
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Alex Betsos
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Tamar Austin
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Sylvia Parusel
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Andrew Ivsins
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Jade Boyd
- All authors are with the British Columbia Centre on Substance Use, Vancouver. Ryan McNeil is also with the Yale School of Medicine, Yale University, New Haven, CT. Jade Boyd is also with the Division of Social Medicine, University of British Columbia, Vancouver. Ryan McNeil is also a Guest Editor of this supplement issue
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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Holeksa J. Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city. Harm Reduct J 2022; 19:23. [PMID: 35246162 PMCID: PMC8894830 DOI: 10.1186/s12954-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. Methods Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. Results Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. Conclusion Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Citadellsvägen 7, 211 18, Malmö, Sweden.
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Rudolph AE. Integrating a web-based survey application into Qualtrics to collect risk location data for HIV prevention research. AIDS Care 2022; 34:397-403. [PMID: 34839777 PMCID: PMC9016781 DOI: 10.1080/09540121.2021.2008860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA
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Snodgrass JG, Lacy MG, Cole SW. Internet gaming, embodied distress, and psychosocial well-being: A syndemic-syndaimonic continuum. Soc Sci Med 2022; 295:112728. [PMID: 31879045 PMCID: PMC7289667 DOI: 10.1016/j.socscimed.2019.112728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/28/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023]
Abstract
We examine internet gaming-related suffering as a novel syndemic most prevalent among contemporary emerging adults. Synthetic analysis of our prior research on internet gaming and health affirms how social factors and mental and physical wellness mutually condition each other in this online play context. Employing biocultural anthropological mixed methods, we focus on statistical interactions between intensive gaming and social well-being in relation to genomic markers of immune function. We show that among gamers with low social well-being, intensive game play is associated with compromised immunity markers, but among those with robust social connection, that same play correlates with decreased activation of stress-related immunity activation. The apparently beneficial interaction of higher social well-being and intensive game play resonates with an emerging body of research showing how positive practices-in this case, engaged and pleasurable videogame play-can increase resilience to the negative linked psychological and genomic responses to precarity. Based on these findings, we argue, in relation to gaming behaviors, a syndemics analysis could usefully be expanded by attending to both sides of the synergistic interaction between two social conditions: not just exacerbation of dysfunction in relation to their combined effect, but also non-additive enhancement of health that may stem from such combinations. We draw on literature emphasizing the relevance to health of "eudaimonic" well-being-psychosocial processes that transcend immediate self-gratification and involve the pursuit of meaningful and pro-social goals. On that basis, we propose the term "syndaimonics" to capture synergies between social context and mental flourishing, which, in this context and presumably others, can illuminate sources of health resilience and overall improved psychosocial wellbeing.
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Affiliation(s)
- Jeffrey G. Snodgrass
- Department of Anthropology, Colorado State University, Fort Collins, CO, 80523-1787, USA,Corresponding author. (J.G. Snodgrass)
| | - Michael G. Lacy
- Department of Sociology, Colorado State University, Fort Collins, CO, 80523-1784, USA
| | - Steven W. Cole
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA, 90095, USA,Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, CA, 90095, USA
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42
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Quinn KG. The relationship between syndemics and intersectionality: A response to the commentary by Sangaramoorthy and Benton. Soc Sci Med 2022; 295:113784. [PMID: 33678479 PMCID: PMC8410884 DOI: 10.1016/j.socscimed.2021.113784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
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43
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Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J 2022; 19:1. [PMID: 34996466 PMCID: PMC8742380 DOI: 10.1186/s12954-021-00569-2] [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] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.
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Affiliation(s)
- Monica Fadanelli
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - April M Ballard
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Umed Ibragimov
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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44
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Medeiros P. Mapping HIV-related services for women in Eastern Canada: A qualitative study. WOMEN'S HEALTH 2022; 18:17455057221092264. [PMID: 35435076 PMCID: PMC9019332 DOI: 10.1177/17455057221092264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: Geographic health disparities have been well described in parts of Canada; however, little is known about the experiences of women living with HIV in the Maritime Provinces. This article focuses on the complex health system women living with HIV navigate geographically to access care in New Brunswick and Nova Scotia, Canada. Method: This study includes interviews with 10 women living with HIV and 39 community-based workers whose organizations provide services to this group of women in New Brunswick and Nova Scotia. Purposive sampling was used to recruit both women living with HIV and community workers. Interviews were recorded and transcribed into a Microsoft word document. Transcripts were imported into NVivo 11 for thematic analyses and used to map the services women with HIV were accessing in their communities in ArcGIS 10.2 for Windows. Results: The study found that there are a number of barriers women with HIV face in the Maritime Provinces, including the low number of specialist physicians, long travel distances to major urban centers for care, and the loss of HIV-specific supports and resources. In response to these difficulties, community-based organizations are leading efforts in their communities to increase outreach programs and the number of available peer workers to improve the health outcomes of women living with HIV. Furthermore, it showed that women living with HIV and community workers were interested in creating a women-centered HIV care system in the Maritime Provinces, but were uncertain how to move forward with this initiative. Conclusion: There is a need for women-centered HIV services. This study proposes streamlining the healthcare pathway and decreasing obstacles to increase women’s access to care in the Maritime Provinces.
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Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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45
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Abstract
In this article, we address the nature of syndemics and whether, as some have asserted, these epidemiological phenomena are global configurations. Our argument that syndemics are not global rests on recognition that they are composed of social/environment contexts, disease clusters, demographics, and biologies that vary across locations. These points are illustrated with the cases of syndemics involving COVID-19, diabetes mellitus, and HIV/AIDS. We draw on theoretical discourse from epidemiology, biology, and anthropology to present what we believe is a more accurate framework for thinking about syndemics with shared elements.
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Affiliation(s)
- Merrill Singer
- Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | - Nicola Bulled
- InCHIP, University of Connecticut, Storrs, Connecticut, USA
| | - Thomas Leatherman
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
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46
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Mezaache S, Briand-Madrid L, Laporte V, Rojas Castro D, Carrieri P, Roux P. A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users. Int J Prison Health 2021; 18:417-428. [PMID: 34928106 DOI: 10.1108/ijph-06-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE People who inject drugs (PWID) face multiple health problems, including infectious diseases and drug overdoses. Applying syndemic and risk environment frameworks, this paper aims to examine the co-occurrence and clustering of drug-related harms and their association with incarceration experience with or without in-prison drug injection. DESIGN/METHODOLOGY/APPROACH The authors used data from a cross-sectional survey conducted in 2015 among 557 active opioid injectors. Self-reported data were collected through face-to-face or online questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections and overdoses, and built an index variable by summing the number of harm categories experienced, yielding a score from 0 to 3. Association between incarceration experience and co-occurrence of harms was modelled using a multinomial logistic regression. FINDINGS Of the 557 participants, 30% reported lifetime experience of drug-related viral infection, 46% bacterial infection and 22% drug overdose. Multinomial logistic models showed that those who injected drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03-5.36) and three (aOR = 9.72, 95% CI: 3.23-29.22) harm categories than those who had never been incarcerated. They were also more likely to report three harm categories than formerly incarcerated respondents who did not inject drugs in prison (aOR = 5.14, 95% CI: 1.71-15.48). ORIGINALITY/VALUE This study provides insights of the syndemic nature of drug-related harms and highlights that drug injection during incarceration is associated with co-occurring harms. Public health interventions and policy changes are needed to limit the deleterious impact of prison on PWID.
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Affiliation(s)
- Salim Mezaache
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Laélia Briand-Madrid
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Daniela Rojas Castro
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France and Coalition PLUS, Pantin, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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47
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Affiliation(s)
- Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, D.C., USA.
| | - Timothy Newfield
- Department of History, Georgetown University, Washington, D.C., USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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48
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Shaw SY, Ireland L, McClarty LM, Loeppky C, Bullard J, Van Caeseele P, Keynan Y, Kasper K, Moses S, Blanchard JF, Becker ML. Healthcare utilization among persons living with HIV in Manitoba, Canada, prior to HIV diagnosis: A case-control analysis. Int J STD AIDS 2021; 33:265-274. [PMID: 34894866 DOI: 10.1177/09564624211051615] [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: 11/16/2022]
Abstract
BACKGROUND Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls. METHODS Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported. RESULTS A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with "blood disorders" (AOR: 4.2, 95% CI: 2.0-9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6-3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4-3.6). CONCLUSION Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.
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Affiliation(s)
- Souradet Y Shaw
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Laurie Ireland
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
| | - Leigh M McClarty
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carla Loeppky
- Manitoba Health, Seniors, and Active Living, Winnipeg, MB, Canada.,Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
| | - Ken Kasper
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James F Blanchard
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
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49
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Stopka TJ, Jacque E, Kelley J, Emond L, Vigroux K, Palacios WR. Examining the spatial risk environment tied to the opioid crisis through a unique public health, EMS, and academic research collaborative: Lowell, Massachusetts, 2008–2018. Prev Med Rep 2021; 24:101591. [PMID: 34976650 PMCID: PMC8683861 DOI: 10.1016/j.pmedr.2021.101591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/20/2022] Open
Abstract
Between 2015 and 2018, Lowell Massachusetts experienced outbreaks in opioid overdoses, HIV, and hepatitis C virus infections (HCV) among people who inject drugs. Through an innovative collaboration between emergency medical services (EMS), public health, and academic partners, we assessed the geographic distribution of opioid-related risks to inform intervention efforts. We analyzed data from three unique data sources for publicly discarded syringes, opioid-related incidents (ORIs), and fatal opioid overdoses in Lowell between 2008 and 2018. We assessed the risk environment over time using a geographic information system to identify and characterize hotspots and noted parallel trends within the syringe discard and ORI data. We identified two notable increases in ORIs per day: the first occurring between 2008 and 2010 (from 0.3 to 0.5), and the second between 2011 and 2014 (from 0.9 to 1.3), following the introduction of fentanyl within local drug markets. We also identified seasonal patterns in the syringe discard, ORI, and overdose data. Through our spatial analyses, we identified significant clusters of discarded syringes, ORIs, and fatal overdoses (p < 0.05), and neighborhoods where high densities of these outcomes overlapped. We found that areas with the highest densities shifted over time, expanding beyond the epicenter of the Downtown neighborhood. Data sharing and analyses among EMS, public health, and academic partners can foster better assessments of local risk environments. Our work, along with new public health efforts in Lowell, led to a city-funded position to improve pick-up and proper disposal of publicly discarded syringes, and better targeted harm reduction services.
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Affiliation(s)
- Thomas J. Stopka
- Dept. of Public Health and Community Medicine, Tufts University School of Medicine, United States
- Corresponding author at: Department of Public Health and Community Medicine, Clinical and Translational Science Institute, Tufts University School of Medicine, 136 Harrison Avenue, MV244 Boston, MA 02111, United States.
| | - Erin Jacque
- Dept. of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Jon Kelley
- Trinity Emergency Medical Services, United States
| | | | | | - Wilson R. Palacios
- School of Criminology & Justice Studies, University of Massachusetts, Lowell, United States
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50
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Chayama KL, Ng C, Small W, Ivsins A, McNeil R. "It's a burden, it's a nuisance. I wish I didn't have these other ailments": a qualitative exploration of comorbidities management among older people living with HIV who use drugs in Vancouver, British Columbia. J Int AIDS Soc 2021; 24:e25785. [PMID: 34636148 PMCID: PMC8505831 DOI: 10.1002/jia2.25785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction People living with HIV (PLHIV) who use illicit drugs (other than or in addition to cannabis) are living longer due to antiretroviral therapy (ART). Older PLHIV who use drugs have an increased risk for comorbidities, and managing multiple health conditions is a growing concern among this population. However, in‐depth understandings of the lived realities and complexities of living with HIV alongside comorbidities among older PLHIV who use drugs remain limited. We sought to explore how older PLHIV who use drugs manage their comorbid conditions in a setting with universal ART access. Methods Between January 2019 and March 2020, semi‐structured, in‐depth interviews were conducted in Vancouver, Canada with 42 older PLHIV who use drugs and were living with at least one comorbidity. All participants were currently on ART, and had initiated treatment at least 2 years prior to the interviews. Data were analysed using inductive and deductive approaches. Results Several themes were identified through this analysis. First, comorbidities were perceived as more urgent health concerns and prioritized over HIV. Second, stigma and discrimination hindered access to care for comorbidities. Third, the concurrent management of HIV and comorbidities was often challenging due to unmanaged or poorly managed comorbidities. Fourth, the potential impact of ART on the development of comorbidities was a source of concern and frustration. Finally, integrated treatment approaches facilitated engagement with HIV and comorbidities care. Conclusions Our findings underscore the need for HIV care to shift from a primary focus on managing HIV to an integrated, patient‐centred approach that addresses both HIV and non‐HIV‐related health needs, as well as an equitable and non‐judgemental delivery of such care for an ageing population of PLHIV who use drugs.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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