Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

OBJECTIVES

This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections.

STUDY DESIGN

The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland.

METHODS

Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression.

RESULTS

Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043).

CONCLUSIONS

Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Objective

The aim of the study was to describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland.

Study design

This is a cross-sectional Unlinked Anonymous Monitoring (UAM) Survey of PWID.

Methods

People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease 2019 (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared with data from the 2019 UAM Survey, where possible.

Results

Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 than in 2019; cocaine injection in the preceding four weeks increased from 17% (242/1456) to 25% (33/130). One in five PWID (19%; 35/188) reported difficulties in accessing HIV and hepatitis testing, and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting.

Conclusions

Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services owing to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities.

How gastroenterologists inform patients of results after lower endoscopy

OBJECTIVE

Little is known about how gastroenterologists communicate endoscopic findings and biopsy results to their patients. We sought to determine the factors that may influence this behavior.

METHODS

A survey questionnaire was developed and mailed to the 80 members of the Delaware Valley Society for GI Endoscopy. Information was obtained on the demographic characteristics and responses to six case vignettes prepared to examine communication patterns. We determined possible influences of conscious sedation and the benignity or severity of findings on communication practices.

RESULTS

Sixty-one surveys (76%) were completed and analyzed. Endoscopists immediately inform patients of normal results. For abnormal results, 92% would immediately inform nonsedated patients versus 79% that would inform sedated patients (p < 0.008). Analysis of responses to the case vignettes indicated that 82% of endoscopists would immediately reassure the patient about a benign appearing (< 1 cm) polyp, but only 70% would do so for a polyp > 2 cm (p < 0.01). In contrast, when presented with a frank malignancy, 94% would inform the patient. Eighty-four percent of endoscopists would telephone results of a benign pathology report, but only 34% would telephone report a dysplastic lesion (p < 0.001). There was no correlation between the response rate and various demographic parameters such as physician age, type of, or length of time in practice.

CONCLUSIONS

Gastroenterologists usually report normal findings immediately, but are less likely to do so after use of sedation or encountering abnormal findings. Most of those surveyed would use the telephone to communicate abnormal findings.

A pilot study of cancer knowledge and screening behaviors of Vietnamese and Cambodian women

Breast and cervix cancer screening behaviors, while suboptimal in all Americans, are of particular concern in minority females. Little is known about cancer knowledge and screening behavior in Southeast Asian populations in the United States. We interviewed 38 Southeast Asian women of Cambodian or Vietnamese origin living in the Philadelphia, Pennsylvania, area. A telephone interview was conducted by bilingual/bicultural interviewers. Seventy-one percent (95% confidence interval [CI], 54% to 85%) of women in the study did not know what cancer was and 74% were unable to identify a cancer prevention strategy. Greater knowledge about cancer and identification of preventive measures were associated with employment outside the home, more years of education, and age, but not with length of time in the United States. Cancer education programs need to identify the patient's level of knowledge about cancer, elicit and respectfully address beliefs about causality and prevention, and ensure that health information is provided in a language understandable to the patient.

Setting the referral process in motion: a case study with teaching objectives

Pediatric collaboration with mental health professionals is necessary due to the high prevalence of behavioral and emotional disorders in this population. Clinicians frequently encounter parental resistance to acceptance and follow-through on recommended mental health services. In addition, physicians may have difficulty recognizing and referring psychosocial problems due to inadequate training or experience. The case presented of a 10-year-old girl with enuresis illustrates the process of referring a patient with a behavioral problem from a general pediatrician to a mental health specialist. The behavioral pediatrician plays a critical role in providing linkage between medical and psychosocial care.

Physician-patient power struggles: their role in noncompliance

Physicians have tended to label the patient who doesn't follow their advice as resistant and noncompliant. However, compliance studies have not identified the physician's sometimes unwitting complicity in the noncompliance. Some physician-patient partnerships are marked by an intensifying power struggle which may have more to do with the emotional needs of each party than with the specific content around which the struggle is focused. This article discusses how these power struggles can be activated and what the physician can do to defuse the struggle and work effectively with noncompliant patients.