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Guure C, Dery S, Baptista da Silva C, Asamoah-Adu C, Ayisi-Addo S, Diaba K, Loglo MG, Mohammed A, Sarpong YA, Hanu S, Torpey K. Situational assessment and epidemiology of HIV, HBV and HCV among people who use and inject drugs in Ghana. PLoS One 2024; 19:e0305923. [PMID: 39186757 PMCID: PMC11346957 DOI: 10.1371/journal.pone.0305923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/06/2024] [Indexed: 08/28/2024] Open
Abstract
INTRODUCTION People who inject drugs (PWID) and people who use drugs (PWUD) are an important population group that remain under-served in Ghana. Though PWID and PWUD are among the key populations most-at-risk to acquire sexually transmitted or blood-borne diseases, they are among those with the least access to human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses' prevention, care and treatment services in Ghana due to lack of data on them. We provide a rapid assessment of the PWUD and PWID situation in Ghana. METHODS This rapid cross-sectional design undertook consultative meetings between the study team and relevant stakeholders, including Civil Society Organizations (CSO) working with PWUD/PWID. The assessment considered a representative sample of PWID and PWUD. It was conducted in four (4) selected regions of Ghana (Greater Accra, Ashanti, Western, and Northern). Overall, 323 participants were interviewed using respondent-driven sampling (RDS) approach. Information obtained from participants were demographics, HIV risk behaviors, human immunodeficiency (HIV) and sexually transmitted infections (STI)-related knowledge HIV/HCV/HBV screening, attitude, and practices among others. Analyses were conducted using Stata version 17 and RDSAT version 7.1.46 software. FINDINGS Drug use was found to be more prevalent among the youth with a median age of 37 years. Majority of the respondents were males (86%). About 28% of the female respondents identified themselves as sex workers, while about 74% have been involved in transactional sex. The median age at which respondents started using and injecting drugs was 20 and 22 years respectively. Majority (68%) of the respondents consume drugs through smoking, with 20% through snorting, inhaling or swallowing and 12% through injection. The drug mostly used among the respondents was heroin (52%). The most commonly injected drug was cocaine (55%). About 64.7% of respondents reported mixing two or more drugs. HIV prevalence among respondents was 2.5%, 12.3% among women and 17.7% among women engaged in sex work, highlighting the overlap vulnerability. The prevalence of hepatitis C was 6.0%, and Hepatitis B was 4.5%. Access to care is limited, with 63% of the respondents never been tested for HIV. CONCLUSION These rapid assessment findings reveal the challenging conditions for people who use and inject drugs coupled with a relatively high prevalence of HIV and Hepatitis C compared to the general population. However, it also reveals that Ghana has a window of opportunity to prevent an exponential spread of HIV and Hepatitis in this population. Therefore, there is the need to implement prevention and treatment programs for HIV and hepatitis among people who use and inject drugs including essential strategies for an enabling environment in Ghana.
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Affiliation(s)
- Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | | | | | | | - Kofi Diaba
- West Africa Program to Combat AIDS, Accra, Ghana
| | | | - Adamu Mohammed
- West Africa Behavioural Health Addictions and Recovery Management, Accra, Ghana
| | | | | | - Kwasi Torpey
- Department of Population Family and Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
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Pedro M, Seanna P, Honoria G, Renee H, Chunki F, Ben E. HCV prevalence and phylogenetic characteristics in a cross-sectional, community study of young people who inject drugs in New York City: Opportunity for and threats to HCV elimination. Health Sci Rep 2024; 7:e2211. [PMID: 38957862 PMCID: PMC11217018 DOI: 10.1002/hsr2.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
Background and Aims In the United States, the opioid epidemic has led many young people who use opioids to initiate injection drug use, putting them at risk for hepatitis C virus (HCV) infection. However, community surveys to monitor HCV prevalence among young people who inject drugs (YPWID) are rare. Methods As part of Staying Safe (Ssafe), a trial to evaluate an HCV-prevention intervention, a community-recruited sample of 439 young people who use opioids (ages 18-30) in New York City (NYC) were screened from 2018 to 2021. Screening procedures included a brief verbal questionnaire, a visual check for injection marks, onsite urine drug testing, rapid HCV antibody (Ab) testing, and dried blood spot (DBS) collection. DBS specimens were sent to a laboratory for HCV RNA testing and phylogenetic analysis to identify genetic linkages among HCV RNA-positive specimens. Multivariable logistic regression was used to assess associations between HCV status (Ab and RNA) and demographics and drug use patterns. Results Among the 330 participants who reported injecting drugs (past 6 months), 33% (n = 110) tested HCV Ab-positive, 58% of whom (n = 64) had HCV RNA-positive DBS specimens, indicating active infection. In multivariable analysis, visible injection marks (AOR = 3.02; p < 0.001), older age (AOR = 1.38; p < 0.05), and female gender (AOR = 1.69; p = 0.052) were associated with HCV Ab-positive status. Visible injection marks were also associated with HCV RNA-positive status (AOR = 5.24; p < 0.01). Twenty-five percent of RNA-positive specimens (14/57) were genetically linked. Conclusion The relatively low prevalence of active infection suggests the potential impact of treatment-as-prevention in reducing HCV prevalence among YPWID. Targeted community serosurveys could help identify actively infected YPWID for treatment, thereby reducing HCV incidence and future transmissions.
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Affiliation(s)
| | - Pratt Seanna
- CUNY Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
| | - Guarino Honoria
- CUNY Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
| | - Hallack Renee
- NYS Department of HealthWadsworth CenterAlbanyNew YorkUSA
| | - Fong Chunki
- CUNY Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
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Valerio H, Alavi M, Marshall AD, Hajarizadeh B, Amin J, Law M, Tillakeratne S, George J, Degenhardt L, Grebely J, Matthews GV, Dore GJ. Factors associated with hepatitis C treatment uptake among females of childbearing age in New South Wales, Australia: A population-based study. Drug Alcohol Rev 2024; 43:1080-1092. [PMID: 37254644 DOI: 10.1111/dar.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/15/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Females of childbearing age with hepatitis C virus (HCV) face increased marginalisation with intersecting, sex-specific barriers to direct acting antiviral (DAA) therapy. We assessed the factors associated with uptake of DAA therapy among females of childbearing age, including those with evidence of recent drug dependence. METHODS HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, perinatal, HIV notifications, deaths and prescription databases. Recent drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT occurring in the DAA era (2016-2018). Logistic regression was used to analyse factors associated with DAA uptake among females of childbearing age (18-44), including those with recent drug dependence. RESULTS Among 57,467 people with evidence of chronic HCV in the DAA era (2016-2018), 20,161 (35%) were female, including 33% (n = 6563/20,161) of childbearing age (18-44). Among all females of childbearing age (n = 6563) and those with evidence of recent drug dependence (n = 2278/6563, 35%), DAA uptake was lower among those who had given birth in the DAA era (vs. no birth record, all females of childbearing age; aOR: 0.74, 95% CI 0.61, 0.89; those with recent drug dependence; aOR 0.69, 95% CI 0.51, 0.93) and Aboriginal and Torres Strait Islander peoples (all females of childbearing age; aOR 0.81, 95% CI 0.71, 0.93; those with recent drug dependence aOR 0.75, 95% CI 0.62, 0.90). CONCLUSION Females of childbearing age should be considered a key population for DAA therapy. Enhancing antenatal and postnatal HCV care may be critical in the pursuit towards elimination.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Health Systems and Population Sciences, Macquarie University, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024; 43:1071-1079. [PMID: 38271084 DOI: 10.1111/dar.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Stoicescu C, Medley B, Wu E, El-Bassel N, Tanjung P, Gilbert L. Synergistic effects of exposure to multiple types of violence on non-fatal drug overdose among women who inject drugs in Indonesia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104486. [PMID: 38885596 DOI: 10.1016/j.drugpo.2024.104486] [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: 03/11/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND While research has demonstrated associations between experiencing violence from intimate and non-intimate partners and non-fatal drug overdose among women who inject drugs, existing studies focus predominantly on the Global North and are analytically limited. Guided by syndemics theory, this study examined whether different forms of gender-based violence exert independent and interactive effects on non-fatal drug overdose among women who inject drugs in Indonesia. METHODS We recruited 731 cisgender adult women who injected drugs in the preceding year via respondent-driven sampling. We used multivariate logistic regressions to examine associations between self-reported intimate partner violence (IPV), police sexual violence, and police extortion, and non-fatal drug overdose, with covariance adjustment for factors drawn from the risk environment. We tested for interaction effects among violence measures by calculating metrics for attributable proportion (AP), relative excess risk due to interaction (RERI), and synergy index (S). RESULTS Experiencing IPV (AOR 2.5; 95 % CI 1.2, 5.1; p = 0.012), police extortion (AOR 2.2; 95 % CI 1.5, 3.2; p ≤ 0.001), and police sexual violence (AOR 3.7; 95 % CI 1.5, 9.4; p = 0.005) each independently predicted non-fatal overdose, after adjusting for potential confounders. A significant positive interaction was detected between IPV and police sexual violence on drug overdose (AP=0.6, p = 0.001; S = 3.8, p = 0.015) such that the joint effect of these two forms of violence was associated with a nearly fourfold increase in non-fatal overdose risk compared to the main effects of each violence exposure. CONCLUSION This is the first study to show that concurrent IPV and police sexual violence exert an amplifying effect on non-fatal overdose beyond the additive effects of each exposure. Supporting the value of gender-responsive harm reduction services that integrate violence and overdose responses, results suggest that eliminating one form of violence when multiple forms of GBV are present could magnify the expected reduction in overdose.
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Affiliation(s)
- Claudia Stoicescu
- Public Health and Preventive Medicine, Monash University, Green Office 9 Building, Jl. BSD Green Office Park, BSD City, Banten 15345, Indonesia; Centre for Criminology, University of Oxford, St Cross Building, St Cross Road, Oxford OX1 3UL, United Kingdom.
| | - Bethany Medley
- School of Social Work, Columbia University, 116th and Broadway, New York, NY 10027, United States
| | - Elwin Wu
- School of Social Work, Columbia University, 116th and Broadway, New York, NY 10027, United States
| | - Nabila El-Bassel
- School of Social Work, Columbia University, 116th and Broadway, New York, NY 10027, United States
| | - Putri Tanjung
- Women and Harm Reduction International Network, online, Jakarta, Indonesia
| | - Louisa Gilbert
- School of Social Work, Columbia University, 116th and Broadway, New York, NY 10027, United States
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Broady TR, Valerio H, Alavi M, Wheeler A, Silk D, Martinello M, Conway A, Milat A, Dunlop A, Murray C, Henderson C, Amin J, Read P, Marks P, Degenhardt L, Stevens A, Prain B, Hayllar J, Reid D, Montebello M, Wade A, Christmass M, Cock V, Dore GJ, Treloar C, Grebely J. Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104468. [PMID: 38795465 DOI: 10.1016/j.drugpo.2024.104468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Heather Valerio
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Anna Conway
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Camperdown, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Murray
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | | | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annabelle Stevens
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Bianca Prain
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Mark Montebello
- North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexandra Wade
- Mid North Coast Local Health District, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Walker JG, Elmes J, Grenfell P, Eastham J, Hill K, Stuart R, Boily MC, Platt L, Vickerman P. The impact of policing and homelessness on violence experienced by women who sell sex in London: a modelling study. Sci Rep 2024; 14:8191. [PMID: 38589373 PMCID: PMC11002010 DOI: 10.1038/s41598-023-44663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/11/2023] [Indexed: 04/10/2024] Open
Abstract
Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88-4.43) or displaced (4.79, 1.99-12.11), or of experiencing displacement if homeless (3.60, 1.59-8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53-81%). The effects are non-linear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5-10.3%) or 6.7% (3.7-10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1-11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4-6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9-19.6%) in combination. Violence reduces by 26.5% (22.6-28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.
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Affiliation(s)
- Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kathleen Hill
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Anwar I, Faye A, Pereira Gonçalves J, Briand Madrid L, Maradan G, Lalanne L, Jauffret-Roustide M, Auriacombe M, Roux P. Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort. Int J Womens Health 2024; 16:451-462. [PMID: 38495429 PMCID: PMC10944247 DOI: 10.2147/ijwh.s448147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/25/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. Methods We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Results Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Conclusion Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.
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Affiliation(s)
- Ilhame Anwar
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Aissatou Faye
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Jessica Pereira Gonçalves
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 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
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France
| | - Marie Jauffret-Roustide
- CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
- British Columbia Center on Substance Use, Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, NY, USA
| | - Marc Auriacombe
- Univ. Bordeaux, Bordeaux, France
- Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux, France
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
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Barré T, Bourlière M, Parlati L, Ramier C, Marcellin F, Protopopescu C, Di Beo V, Cagnot C, Dorival C, Nicol J, Zoulim F, Carrat F, Carrieri P. Hepatitis C virus cure from direct-acting antivirals and mortality: Are people with and without a history of injection drug use in the same boat? (ANRS CO22 Hepather cohort). Drug Alcohol Rev 2024; 43:718-731. [PMID: 38133601 DOI: 10.1111/dar.13802] [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: 07/10/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The risk of mortality in people with a history of injection drug use (PHID) is high, as is the prevalence of hepatitis C virus (HCV) infection. Although direct-acting antivirals (DAA) are effective in this population in terms of sustained virological response, it is not known whether PHID benefit as much as people with no history of injection drug use from DAA-related HCV cure in terms of reduced all-cause mortality. METHODS Using Cox proportional hazards models based on the ANRS CO22 Hepather cohort data (n = 9735), we identified factors associated with all-cause mortality among HCV-infected people. We tested for interaction effects between drug injection status, HCV cure and other explanatory variables. RESULTS DAA-related HCV cure was associated with a 66% (adjusted hazard ratio [95% confidence interval]: 0.34 [0.29-0.39]) lower risk of all-cause mortality, irrespective of drug injection status. Detrimental effects of unhealthy alcohol use on mortality were identified in PHID only. DISCUSSION AND CONCLUSIONS DAA-related HCV cure led to comparable benefits in terms of reduced mortality in PHID and people with no history of injection drug use. Policies and strategies to enhance DAA uptake among PHID are needed to lower mortality in this population. Clinical trial registration details: ClinicalTrials.gov: NCT01953458.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Marc Bourlière
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
- Département d'hépatologie et gastroentérologie, Hôpital Saint Joseph, Marseille, France
| | - Lucia Parlati
- Université de Paris Cité; Institut National de la Santé et de la Recherche Médicale; Assistance Publique-Hôpitaux de Paris, Département d'Hépatologie/Addictologie, Hôpital Cochin, Paris, France
| | - Clémence Ramier
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Vincent Di Beo
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Carole Cagnot
- ANRS | Emerging Infectious Diseases, Department of Clinical Research, Paris, France
| | - Celine Dorival
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Jérôme Nicol
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Fabien Zoulim
- Institut National de la Santé et de la Recherche Médicale U1052, Centre National de la Recherche Scientifique, Unités Mixtes de Recherche-5286, Cancer Research Center of Lyon, Lyon, France
- University of Lyon, Université Claude-Bernard, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Unité de Santé Publique, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrizia Carrieri
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
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10
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Walker S, Curtis M, Kirwan A, Thatcher R, Dietze P. "No-one just does drugs during business hours!": evaluation of a 24/7 primary needle and syringe program in St Kilda, Australia. Harm Reduct J 2024; 21:51. [PMID: 38402389 PMCID: PMC10894474 DOI: 10.1186/s12954-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Primary needle and syringe programs (NSPs) have been integral for the prevention of blood-borne virus (BBV) transmission among people who inject drugs. Despite this, many people who inject drugs face barriers accessing these services, particularly after-hours when most services are closed. To our knowledge, the St Kilda NSP, in Melbourne, Victoria, is the only primary NSP providing 24/7 dedicated stand-alone face-to-face services for people who inject drugs in Australia. We conducted an evaluation of the St Kilda NSP to assess its role and effectiveness in meeting client needs. METHODS Mixed research methods were used to conduct the evaluation. We analysed four quantitative data sets including the Victorian Needle and Syringe Program Information System data; NSP 'snapshot' survey data; and St Kilda NSP records of after-hours contacts and naloxone training events. Qualitative interviews were conducted with 20 purposively selected NSP clients, which were focused on individual needs, expectations and experiences accessing the service. Interviews were audio recorded and transcribed, and data were analysed thematically. A convergent research design was used to merge the five data sets. RESULTS St Kilda NSP had 39,898 service contacts in 2018; 72% of contacts occurred outside business hours. Similarly, of 1,185,000 sterile needles and syringes dispatched, 71% were distributed outside business hours. Participants described valuing the after-hours service because drug use patterns did not always align with standard NSP opening hours and after-hours access afforded anonymity when collecting injecting equipment. Narratives highlighted several additional benefits of the 24/7 service, including: access to safer sex equipment; material support; naloxone training; referrals to specialist services; face-to-face emotional and social support from a non-judging worker; and for women involved in sex work in particular, being able to seek refuge when feeling unsafe on the streets. CONCLUSIONS Our study provides evidence of the social and health benefits (beyond that of preventing BBV transmission) that can be gained through the provision of 24/7 primary NSP services. Findings support the need for the establishment of after-hours primary NSPs in other areas of Australia where active street-based drug markets operate outside business hours and concentrated numbers of people who inject drugs live and spend time.
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Affiliation(s)
- Shelley Walker
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
- Burnet Institute, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Michael Curtis
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Amy Kirwan
- Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Thatcher
- Access Health & 24/7 Needle and Syringe Program, Alcohol, Drugs and Other Addictions Stream, Victoria Social Mission Department, The Salvation Army Australian Territory, Melbourne, Victoria, Australia
| | - Paul Dietze
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
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11
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Harris MTH, Laks J, Hurstak E, Jain JP, Lambert AM, Maschke AD, Bagley SM, Farley J, Coffin PO, McMahan VM, Barrett C, Walley AY, Gunn CM. "If you're strung out and female, they will take advantage of you": A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209190. [PMID: 37866442 PMCID: PMC11040599 DOI: 10.1016/j.josat.2023.209190] [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: 01/18/2023] [Revised: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant disparities in substance use severity and treatment persist among women who use drugs compared to men. Thus, we explored how identifying as a woman was related to drug use and treatment experiences. METHODS The study recruited participants for a qualitative interview study in Boston and San Francisco from January-November 2020. Self-identified women, age ≥ 18 years, with nonprescribed opioid use in the past 14 days were eligible for inclusion. The study team developed deductive codes based on intersectionality theory and inductive codes generated from transcript review, and identified themes using grounded content analysis. RESULTS The study enrolled thirty-six participants. The median age was 46; 58 % were White, 16 % were Black, 14 % were Hispanic, and 39 % were unstably housed. Other drug use was common with 81 % reporting benzodiazepine, 50 % cocaine, and 31 % meth/amphetamine use respectively. We found that gender (i.e., identifying as a woman) intersected with drug use and sex work practices and exacerbated experiences of marginalization. Violence was ubiquitous in drug use environments. Some women reported experiences of gender-based violence in substance use service settings that perpetuated cycles of trauma and reinforced barriers to care. Substance use services that were women-led, safe, and responsive to women's needs were valued and sought after. CONCLUSION Women reported a cycle of trauma and drug use exacerbated by oppression in substance use services settings. In addition to increasing access to gender-responsive care, our study highlights the need for greater research and examination of practices within substance use service settings that may be contributing to gender-based violence.
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Affiliation(s)
- Miriam T H Harris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jordana Laks
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Emily Hurstak
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jennifer P Jain
- School of Nursing and Department of Community Health Systems at the University of California, San Francisco, CA 94143, USA.
| | - Audrey M Lambert
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Ariel D Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
| | - John Farley
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Phillip O Coffin
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Cynthia Barrett
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA 02118, USA.
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12
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Requena MB, Protopopescu C, Stewart AC, van Santen DK, Klein MB, Jarrin I, Berenguer J, Wittkop L, Salmon D, Rauch A, Prins M, van der Valk M, Sacks-Davis R, Hellard ME, Carrieri P, Lacombe K. All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104311. [PMID: 38184902 DOI: 10.1016/j.drugpo.2023.104311] [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: 07/10/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Among people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants. METHODS We included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability. RESULTS Of the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72-1.91]). Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3-2.6] vs. 0.8/100 PY [95 % CI = 0.7-0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0-1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15-2.61]). CONCLUSION Post-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era.
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Affiliation(s)
- Maria-Bernarda Requena
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, iPLESP, Paris, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Ashleigh C Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marina B Klein
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain; Infectious Diseases. Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Linda Wittkop
- Université de Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, U1219, CIC-EC 1401, Bordeaux, France; Inria équipe SISTM, Talence, France; CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, AI&II, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, AI&II, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Karine Lacombe
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, iPLESP, Paris, France; AP-HP, Department of Infectious Diseases, Saint-Antoine Hospital, Paris, France
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13
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Mathias H, Foster LA, Rushton A. Programs and practices that support pregnant people who use drugs' access to sexual and reproductive health care in Canada: a scoping review. BMC Pregnancy Childbirth 2024; 24:72. [PMID: 38254076 PMCID: PMC10804510 DOI: 10.1186/s12884-023-06225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD's access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. METHODS A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016-2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD's access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. RESULTS A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic 'wrap-around services.' Several programs delivered these services on-site or as 'drop-in' programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. CONCLUSIONS Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/5y64j .
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Lesley Ann Foster
- Department of Cultural Studies, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Ashleigh Rushton
- Faculty of Health Sciences, The University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C, V2R 0N3, Canada
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McCrary LM, Cox ME, Roberts KE, Knittel AK, Jordan RA, Proescholdbell SK, Schranz AJ. Endocarditis, drug use and biological sex: A statewide analysis comparing sex differences in drug use-associated infective endocarditis with other drug-related harms. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104280. [PMID: 38103457 PMCID: PMC10843756 DOI: 10.1016/j.drugpo.2023.104280] [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: 07/21/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Hospitalizations for drug use-associated infective endocarditis (DUA-IE) have risen sharply across the United States over the past decade. The sex composition of DUA-IE remains less clear, and studies have indicated a possible shift to more females. We aimed to compare more recent statewide hospitalization rates for DUA-IE in females versus males and contextualize them among other drug-related harms in North Carolina (NC). METHODS This study was a retrospective analysis using public health datasets of all NC hospital discharges for infective endocarditis from 2016 to 2020. Drug use-related hospitalizations were identified using ICD-10-CM codes. Discharge rates by year and sex for DUA-IE and non-DUA-IE were calculated and compared to fatal overdoses and acute hepatitis C (HCV). Temporal, demographic, and pregnancy trends were also assessed. RESULTS Hospitalizations rates for DUA-IE were 9.7 per 100,000 over the five-year period, and 1.2 times higher among females than males. Females composed 57% of DUA-IE hospitalizations over the period. Conversely, fatal overdose, acute HCV, and non-DUA-IE hospitalization rates were higher among males. Age, county of residence, and pregnancy status did not explain the higher DUA-IE among females. CONCLUSION Females now comprise the majority of DUA-IE hospitalizations in NC, unlike other drug-related harms. No clear demographic or geographic associations were found, and further research is needed to explain this phenomenon. Preventing invasive infections among females who inject drugs should be prioritized.
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Affiliation(s)
- L Madeline McCrary
- Washington University School of Medicine in St. Louis, Department of Medicine, 4523 Clayton Ave MSC 8051-0043-15, St. Louis, MO 63110
| | - Mary E Cox
- North Carolina Department of Health and Human Services, Division of Public Health, 2001 Mail Service Center, Raleigh, NC 27699, USA
| | - Kate E Roberts
- Bryn Mawr College, Graduate School of Social Work and Social Research, 300 Airdale Rd, Bryn Mawr, PA 19010, USA
| | - Andrea K Knittel
- University of North Carolina, Department of Obstetrics and Gynecology, 3009 Old Clinic Building, CB #7570, Chapel Hill, NC 27599, USA
| | - Robyn A Jordan
- University of North Carolina, Department of Psychiatry, 1101 Weaver Dairy Rd Ste 102, Chapel Hill 27514, USA
| | - Scott K Proescholdbell
- North Carolina Department of Health and Human Services, Division of Public Health, 2001 Mail Service Center, Raleigh, NC 27699, USA
| | - Asher J Schranz
- University of North Carolina, Department of Medicine, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599, USA.
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15
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Emanuel E, Slater L, Croxford S, Edmundson C, Ibitoye A, Njoroge J, Ijaz S, Hope V, Platt L, Phipps E, Desai M. Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey. Public Health 2023; 225:79-86. [PMID: 37922590 DOI: 10.1016/j.puhe.2023.09.024] [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: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
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.
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Affiliation(s)
- E Emanuel
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - L Slater
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom.
| | - S Croxford
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - A Ibitoye
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - J Njoroge
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Ijaz
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V Hope
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; Liverpool John Moores University, Liverpool, United Kingdom
| | - L Platt
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E Phipps
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Desai
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
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Wiginton JM, Booth R, Smith LR, Shakya S, da Silva CE, Patterson TL, Pitpitan EV. Effects of a social network intervention on HIV seroconversion among people who inject drugs in Ukraine: moderation by network gender composition. Harm Reduct J 2023; 20:165. [PMID: 37940947 PMCID: PMC10631017 DOI: 10.1186/s12954-023-00899-3] [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: 03/31/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Women who inject drugs in Ukraine are disproportionately burdened by HIV. To help address the needs of this population, a greater understanding of how interventions may uniquely benefit women who inject drugs is needed. METHODS Data come from a randomized controlled trial of a social network intervention targeting people who inject drugs in Ukraine (N = 1195). Indexes, plus two of their injection network members, received HIV testing and counseling (control arm) or HIV testing and counseling plus a social network intervention (intervention arm), in which indexes were trained to influence network members' risk behaviors. We used Cox regressions with interaction terms to assess differences in time to HIV seroconversion between arms by network gender composition and gender of the index. For significant interaction terms, we calculated simple effects, generated survival functions using Kaplan-Meier methods, and compared survival curves using log-rank tests. RESULTS At 12 months, there were 45 seroconversions among women (40.0 [28.3, 51.7] per 100 person years) and 111 among men (28.4 [23.1, 33.6] per 100 person years) in the control arm; there were 27 seroconversions among women (17.1 [10.7, 23.6] per 100 person years) and 77 among men (18.7 [14.5, 22.9] per 100 person years) in the intervention arm. Network gender composition (but not gender of the index) moderated the intervention effect on HIV incidence (p < 0.05). Specifically, the intervention appeared to be even more protective against HIV acquisition as female gender composition increased. In the intervention arm, the HIV seroconversion hazard rate was 44% lower with 1 network female; 61% lower with 2 network females; and 72% lower with 3 network females. CONCLUSIONS A greater number of women in an injection network, coupled with the provision of risk-reduction strategies, is associated with HIV risk-mitigation, though the mechanisms through which this occurs remain unclear. Findings can support new research and practice directions that prioritize women who inject drugs and more thoughtfully support their health and wellbeing.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
- School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado School of Medicine, Denver, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Sajina Shakya
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, USA
- School of Public Health, San Diego State University, San Diego, USA
| | - Thomas L Patterson
- Departments of Psychiatry, University of California San Diego, San Diego, USA
| | - Eileen V Pitpitan
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA.
- School of Social Work, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
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17
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Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
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Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
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18
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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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19
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Jones AA, Schneider KE, Falade-Nwulia O, Sterner G, Tobin K, Latkin CA. Social Networks, Stigma, and Hepatitis C Care Among Women Who Inject Drugs: Findings from A Community Recruited Sample. J Psychoactive Drugs 2023; 55:464-470. [PMID: 36453686 PMCID: PMC10232671 DOI: 10.1080/02791072.2022.2129886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 12/05/2022]
Abstract
This study explores the role of perceived HCV stigma and social networks on HCV care among people who inject drugs (PWID) of both sexes, and solely among women who inject drugs (WWID). Data were from 269 HCV positive PWID, community-recruited through street-based outreach in Baltimore, MD. We defined HCV stigma based on participants' perceptions of treatment by others and their need to conceal their HCV status. Among WWID, HCV stigma was linked with decreased odds of undergoing liver disease staging (aOR = 0.33, 95% CI: 0.13,0.85) or to have attempted to get the HCV cure (aOR = 0.39, CI: 0.16,0.97), these associations were not evident in the overall sample with both sexes. Social network characteristics were significant correlates of HCV care in the overall sample, and these associations were stronger among WWID. WWID with more HCV positive social network members had higher odds of an HCV-related healthcare visit in the prior 12 months (aOR = 4.28, CI: 1.29,14.17) and to have undergone liver disease staging (aOR = 2.85, CI: 1.01,8.05). WWID with more social network members aware of the HCV cure were more likely to report an attempt at obtaining the HCV cure (aOR = 5.25, CI: 1.85,14.89). Our results suggest complexity in the role of social networks and stigma on HCV care.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, Pennsylvania State University, PA, USA
- Consortium on Substance Use and Addiction, the Pennsylvania State University, PA, USA
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - G Sterner
- Consortium on Substance Use and Addiction, the Pennsylvania State University, PA, USA
- Department of Criminal Justice, Pennsylvania State University, PA, USA
| | - K Tobin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
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20
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Schwarz C, Schubert R, Schwarz M, Schütz A, Jenke A, Bauer D, Steinwender B, Gutic E, Reiberger T, Haltmayer H, Gschwantler M. CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers. J Virus Erad 2023; 9:100338. [PMID: 37663576 PMCID: PMC10474458 DOI: 10.1016/j.jve.2023.100338] [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: 03/01/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT). Methods OAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed. Results 4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred. Conclusion Providing integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.
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Affiliation(s)
- Caroline Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Raphael Schubert
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Anika Jenke
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - David Bauer
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | | | - Enisa Gutic
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
| | - Thomas Reiberger
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Gschwantler
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
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21
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Jones AA, Schneider KE, Tobin KE, O'Sullivan D, Latkin CA. Daily opioid and stimulant co-use and nonfatal overdoses in the context of social disadvantage: Findings on marginalized populations. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:208986. [PMID: 36822268 PMCID: PMC10313799 DOI: 10.1016/j.josat.2023.208986] [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: 06/18/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Opioids and stimulants are increasingly implicated in overdose deaths, particularly among minoritized groups. We examined daily opioid and cocaine co-use, nonfatal overdoses, and naloxone carrying among minoritized people who inject drugs (PWID). METHODS The study derived data from 499 PWID in Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Participants reported overdoses; sociodemographic characteristics; and use of nonmedical prescription opioids, heroin, cocaine, and naloxone. RESULTS Among the participants, the mean age was 46, 34 % were female, 64 % self-identified as Black, and 53 % experienced recent homelessness. Black PWID, compared to White PWID, were as likely to use opioids and cocaine daily but were 61 % less likely to have naloxone. After controlling for sociodemographic characteristics, women (aOR:1.88, 95%CI: 1.14, 3.11), persons experiencing homelessness (aOR:3.07, 95%CI: 1.79, 5.24), and those who experienced a recent overdose (aOR:2.14, 95%CI: 1.29, 3.58) were significantly more likely to use opioids and any form of cocaine every day. In a subanalysis of only female PWID, females engaged in sex work (aOR:2.27, 95%CI: 1.02, 5.07) and females experiencing recent homelessness (aOR:5.82, 95%CI: 2.50, 13.52) were significantly more likely to use opioids and cocaine daily. Furthermore, females (aOR:1.69, 95%CI:1.03, 2.77), persons experiencing homelessness (aOR:1.94, 95%CI:1.16, 3.24), and those with higher educational attainment (aOR:2.06, 95%CI:1.09, 3.91) were more likely to often/always carry naloxone, while Black PWID were less likely to have naloxone (aOR:0.39, 95%CI:0.22, 0.69). CONCLUSIONS These findings highlight the need for targeted naloxone distribution and other harm-reduction interventions among minoritized groups in urban areas.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, USA.
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - K E Tobin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
| | - D O'Sullivan
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, USA
| | - C A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, USA
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22
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Mayer S, Boyd J, Fairbairn N, Chapman J, Brohman I, Jenkins E, McNeil R. Women's experiences in injectable opioid agonist treatment programs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104054. [PMID: 37192557 PMCID: PMC10330495 DOI: 10.1016/j.drugpo.2023.104054] [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: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT. METHODS Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes. RESULTS Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment. CONCLUSION This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.
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Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 717 East Hastings St. 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
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 717 East Hastings St. 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
| | - Jules Chapman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Isabella Brohman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall. Vancouver, BC V6T 2B5, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 717 East Hastings St. 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; Internal Medicine, Yale School of Medicine, New Haven, 06510, United States; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, 06510, United States; Department of Anthropology, Yale University, New Haven, 06510, United States.
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23
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Levander XA, Carmody T, Cook RR, Potter JS, Trivedi MH, Korthuis PT, Shoptaw S. A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial. Addiction 2023; 118:1320-1328. [PMID: 36864016 PMCID: PMC10330044 DOI: 10.1111/add.16163] [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: 09/05/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND AND AIMS Socio-cultural (gender) and biological (sex)-based differences contribute to psychostimulant susceptibility, potentially affecting treatment responsiveness among women with methamphetamine use disorder (MUD). The aims were to measure (i) how women with MUD independently and compared with men respond to treatment versus placebo and (ii) among women, how the hormonal method of contraception (HMC) affects treatment responsiveness. DESIGN This was a secondary analysis of ADAPT-2, a randomized, double-blind, placebo-controlled, multicenter, two-stage sequential parallel comparison design trial. SETTING United States. PARTICIPANTS This study comprised 126 women (403 total participants); average age = 40.1 years (standard deviation = 9.6) with moderate to severe MUD. INTERVENTIONS Interventions were combination intramuscular naltrexone (380 mg/3 weeks) and oral bupropion (450 mg daily) versus placebo. MEASUREMENTS Treatment response was measured using a minimum of three of four negative methamphetamine urine drug tests during the last 2 weeks of each stage; treatment effect was the difference between weighted treatment responses of each stage. FINDINGS At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days, P = 0.050, difference = -7.7, 95% confidence interval (CI) = -15.0 to -0.3] and more women than men had anxiety (59.5 versus 47.6%, P = 0.027, difference = 11.9%, 95% CI = 1.5 to 22.3%). Of 113 (89.7%) women capable of pregnancy, 31 (27.4%) used HMC. In Stage 1 29% and Stage 2 5.6% of women on treatment had a response compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males (P < 0.001); with no between-gender treatment effect (0.144 females versus 0.100 males; P = 0.363, difference = 0.044, 95% CI = -0.050 to 0.137). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none; P = 0.769, difference = 0.028, 95% CI -0.157 to 0.212). CONCLUSIONS Women with methamphetamine use disorder receiving combined intramuscular naltrexone and oral bupropion treatment achieve greater treatment response than placebo. Treatment effect does not differ by HMC.
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Affiliation(s)
- Ximena A. Levander
- Oregon Health and Science University, Department of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Portland, OR, USA
| | - Thomas Carmody
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan R. Cook
- Oregon Health and Science University, Department of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Portland, OR, USA
| | - Jennifer S. Potter
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Philip Todd Korthuis
- Oregon Health and Science University, Department of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Portland, OR, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Cooper L, Rosen JG, Zhang L, Pelaez D, Olatunde PF, Owczarzak J, Park JN, Glick JL. Exploring the impact of the COVID-19 pandemic on healthcare and substance use service access among women who inject drugs: a qualitative study. Harm Reduct J 2023; 20:71. [PMID: 37296423 PMCID: PMC10251329 DOI: 10.1186/s12954-023-00793-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare and substance use services engagement, including primary and mental health services as well as residential and outpatient drug treatment. Women who inject drugs (WWID) face known barriers to healthcare and substance use service engagement, which pre-date the COVID-19 pandemic. The impact of COVID-19 on WWID's engagement with healthcare and substance use services, however, remains understudied. METHODS To explore the impact of the COVID-19 pandemic on service-seeking and utilization, we conducted in-depth interviews with 27 cisgender WWID in Baltimore, Maryland, in April-September 2021. Iterative, team-based thematic analysis of interview transcripts identified disruptions and adaptations to healthcare and substance use services during the COVID-19 pandemic. RESULTS The COVID-19 pandemic disrupted service engagement for WWID through service closures, pandemic safety measures restricting in-person service provision, and concerns related to contracting COVID-19 at service sites. However, participants also described various service adaptations, including telehealth, multi-month prescriptions, and expanded service delivery modalities (e.g., mobile and home delivery of harm reduction services), which overwhelmingly increased service engagement. CONCLUSION To build upon service adaptations occurring during the pandemic and maximize expanded access for WWID, it is vital for healthcare and substance use service providers to continue prioritizing expansion of service delivery modality options, like telehealth and the provision of existing harm reduction services through alternative platforms (e.g., mobile services), that facilitate care continuity and increase coverage.
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Affiliation(s)
- Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Oakland, USA
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, 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
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Ju Nyeong Park
- 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
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
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Artenie A, Stone J, Fraser H, Stewart D, Arum C, Lim AG, McNaughton AL, Trickey A, Ward Z, Abramovitz D, Alary M, Astemborski J, Bruneau J, Clipman SJ, Coffin CS, Croxford S, DeBeck K, Emanuel E, Hayashi K, Hermez JG, Low-Beer D, Luhmann N, Macphail G, Maher L, Palmateer NE, Patel EU, Sacks-Davis R, Van Den Boom W, van Santen DK, Walker JG, Hickman M, Vickerman P. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:533-552. [PMID: 36996853 PMCID: PMC10817215 DOI: 10.1016/s2468-1253(23)00018-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. FINDINGS Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. INTERPRETATION Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. FUNDING Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.
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Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Daniel Stewart
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK
| | - Chiedozie Arum
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Anna L McNaughton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie Bruneau
- Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada
| | - Steven J Clipman
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla S Coffin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sara Croxford
- Public Health and Clinical Directorate, UK Health Security Agency, London, UK
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada
| | - Eva Emanuel
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Daniel Low-Beer
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Gisela Macphail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Piatkowski T, Robertson J, Lamon S, Dunn M. Gendered perspectives on women's anabolic-androgenic steroid (AAS) usage practices. Harm Reduct J 2023; 20:56. [PMID: 37098574 PMCID: PMC10127974 DOI: 10.1186/s12954-023-00786-x] [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: 06/23/2022] [Accepted: 04/19/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The masculinizing effects from anabolic-androgenic steroid (AAS) appear to be different between men and women, leading to calls for more gender-specific information regarding women and AAS use. This study sought to gather perspectives from both men and women on the unique challenges surrounding women's use of AAS, irrespective of their personal use. Secondly, the study interrogated how women's AAS practices differ from those of men specifically. METHODS The data presented in this paper come from a subsample of participants who participated in a larger study investigating women and performance and image enhancing drug (PIED) use in Australia. Participants were included in the current analysis if they were: (i) males or females who competed with or coached female strength athletes using AAS and (ii) female and male strength athletes who used AAS. The final sample comprised 21 participants of which there was a proportion of males (n = 7) and females (n = 7) using AAS. RESULTS Women's choices in AAS selection were predominantly around oral compounds (e.g. Oxandrolone) as well as other PIEDs (e.g. Clenbuterol). Some women report the use of injectable AAS represents a change in the profile of the typical female user as it reportedly comes alongside drastic physical and psychological changes. CONCLUSIONS The unique challenges facing women who use AAS are largely isolation and stigma, with little evidence-based practice or education being available to them online or through peer-groups. Future work may consider piloting harm reduction strategies that may be co-designed with this group.
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Affiliation(s)
- Tim Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Jonathan Robertson
- Deakin Business School, Deakin University, Melbourne, VIC, Australia
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
| | - Severine Lamon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Matthew Dunn
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia.
- School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, VIC, 3220, Australia.
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27
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Austin T, Lavalley J, Parusel S, Collins AB, Olding M, Boyd J. Women who use drugs: engagement in practices of harm reduction care. Harm Reduct J 2023; 20:49. [PMID: 37055805 PMCID: PMC10100181 DOI: 10.1186/s12954-023-00775-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Harm reduction services that employ or are operated by people who use drugs are an effective means of mitigating overdose risks and other drug-related harms. However, stereotypes portraying people who use criminalized drugs as incapable caregivers persist. This is especially true for women who use drugs, and to a greater extent racialized women, who are characterized as having diverged from traditional ideals of womanhood as a result of drug-user stigma and the intersections of gender- and class-based and racist stereotypes. In an effort to identify and understand how women who use drugs practise care through harm reduction, we explored the experiences of women accessing a low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive) in Vancouver, Canada. METHODS Data were drawn from research conducted from May 2017 to June 2018 exploring women's experiences accessing the supervised consumption site during an overdose crisis. Data included forty-five semistructured interviews with women recruited from the site, analysed thematically to explore practices of care through harm reduction. FINDINGS Participants reported engaging in both formal and informal care. Acts of care included interventions that both aligned with and deviated from conventional understandings of care practices, including overdose reversal and education, overdose supervision/care, and assisted injection. CONCLUSION The boundary between formal and informal harm reduction care is fluid. Women who use drugs engage in harm reduction across these borders with acts of care that align with or fill the gaps in current harm reduction services in order to meet the needs of drug-using communities, challenging negative stereotypes of women who use drugs. However, these caregiving practices can increase risks to care providers' physical, mental, and emotional health and wellness. Increased financial, social, and institutional supports, including safer supply, assisted injection, and community resources, are needed to better support women as they continue to engage in harm reduction care.
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Affiliation(s)
- Tamar Austin
- Birth Place Lab, UBC Midwifery, Faculty of Medicine, University Boulevard, Vancouver, BC, 3302-5950, Canada
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lavalley
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Parusel
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michelle Olding
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Burrard Street, Vancouver, BC, 608-1081, Canada.
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28
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Levander XA, Foot CA, Magnusson SL, Cook RR, Ezell JM, Feinberg J, Go VF, Lancaster KE, Salisbury-Afshar E, Smith GS, Westergaard RP, Young AM, Tsui JI, Korthuis PT. Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey. J Gen Intern Med 2023; 38:98-106. [PMID: 35731368 PMCID: PMC9849531 DOI: 10.1007/s11606-022-07558-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/30/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services. OBJECTIVE We determined contraceptive use prevalence among WWUD in rural communities then compared estimates to women from similar rural areas. We investigated characteristics of those using contraceptives, and associations between contraceptive use and SUD treatment, healthcare utilization, and substance use. DESIGN Rural Opioids Initiative (ROI) - cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020); National Survey on Family Growth (NSFG) - nationally-representative U.S. household reproductive health survey (2017-2019). PARTICIPANTS Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use; fecundity determined by self-reported survey responses. MAIN MEASURES Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. KEY RESULTS Of 855 women in the ROI, 36.8% (95% CI 33.7-40.1, unweighted) and 38.6% (95% CI 30.7-47.2, weighted) reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use (aOR 1.50 [95% CI 1.08-2.06]). There was a positive association between contraception use and recent medications for opioid use disorder (aOR 1.34 [95% CI 0.95-1.88]) and prior 6-month primary care utilization (aOR 1.32 [95% CI 0.96-1.82]) that did not meet the threshold for statistical significance. CONCLUSION WWUD in rural areas reported low contraceptive use; those who recently received SUD treatment had greater odds of contraceptive use. Improvements are needed in expanding reproductive and preventive health within SUD treatment and primary care services in rural communities.
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Affiliation(s)
- Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Canyon A Foot
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Ryan R Cook
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jerel M Ezell
- Africana Studies and Research Center, Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Department of Medicine Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | - Vivian F Go
- Department of Health Behavior, School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | | | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Ryan P Westergaard
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - April M Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - P Todd Korthuis
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Romo E, Rudolph AE, Stopka TJ, Wang B, Jesdale BM, Friedmann PD. HCV serostatus and injection sharing practices among those who obtain syringes from pharmacies and directly and indirectly from syringe services programs in rural New England. Addict Sci Clin Pract 2023; 18:2. [PMID: 36597153 PMCID: PMC9809047 DOI: 10.1186/s13722-022-00358-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Among people who inject drugs (PWID), obtaining syringes via syringe services programs (SSPs) and pharmacies reduces injection sharing practices associated with hepatitis C virus (HCV). Whether indirect use of SSPs via secondary exchange confers a similar benefit remains unknown, particularly in rural settings. We compared HCV serostatus and injection sharing practices by primary syringe source among a sample of rural PWID. METHODS Data are from a cross-sectional study of adults who use drugs recruited from eleven rural counties in New Hampshire, Vermont, and Massachusetts using respondent-driven sampling (2018-2019). Study staff performed HCV antibody testing. An audio computer-assisted self-interview assessed sociodemographic characteristics, past 30-day injection practices, and past 30-day primary syringe source. Primary syringe source was classified as direct SSP, pharmacy, indirect SSP (secondary exchange), or "other" (friend/acquaintance, street seller, partner/relative, found them). Mixed effects modified Poisson models assessed the association of primary syringe source with HCV seroprevalence and injection sharing practices. RESULTS Among 397 PWID, the most common primary syringe source was "other" (33%), then pharmacies (27%), SSPs (22%), and secondary exchange (18%). In multivariable models, compared with those obtaining most syringes from "other" sources, those obtaining most syringes from pharmacies had a lower HCV seroprevalence [adjusted prevalence ratio (APR):0.85, 95% confidence interval (CI) 0.73-0.9985]; however, the upper bound of the 95% CI was close to 1.0. Compared with those obtaining most syringes from other sources, PWID obtaining most syringes directly from SSPs or pharmacies were less likely to report borrowing used syringes [APR(SSP):0.60, 95% CI 0.43-0.85 and APR(Pharmacies):0.70, 95% CI 0.52-0.93], borrowing used injection equipment [APR(SSP):0.59, 95% CI 0.50-0.69 and APR (Pharmacies):0.81, 95% CI 0.68-0.98], and backloading [APR(SSP):0.65, 95% CI 0.48-0.88 and APR(Pharmacies):0.78, 95% CI 0.67-0.91]. Potential inverse associations between obtaining most syringes via secondary exchange and injection sharing practices did not reach the threshold for statistical significance. CONCLUSIONS PWID in rural New England largely relied on informal syringe sources (i.e., secondary exchange or sources besides SSPs/pharmacies). Those obtaining most syringes from an SSP or pharmacy were less likely to share injection equipment/syringes and had a lower HCV seroprevalence, which suggests using these sources reduces the risk of new HCV infections or serves as proxy for past injection behavior.
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Affiliation(s)
- Eric Romo
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Abby E. Rudolph
- grid.264727.20000 0001 2248 3398Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA USA
| | - Thomas J. Stopka
- grid.67033.310000 0000 8934 4045Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Bo Wang
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Bill M. Jesdale
- grid.168645.80000 0001 0742 0364Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Peter D. Friedmann
- grid.266683.f0000 0001 2166 5835Office of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA USA
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30
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Armoon B, Fleury MJ, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Emergency Department Use, Hospitalization, and Their Sociodemographic Determinants among Patients with Substance-Related Disorders: A Worldwide Systematic Review and Meta-Analysis. Subst Use Misuse 2023; 58:331-345. [PMID: 36592043 DOI: 10.1080/10826084.2022.2161313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32-2.83; hospitalization: OR = 1.53, 95%CI = 1.36-1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13-1.59; hospitalization: OR = 1.42, 95%CI = 1.20-1.69). Being female (OR = 1.24, 95%CI = 1.14-1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24-3.21) and tobacco (OR = 1.25, 95%CI = 1.11-1.42), having HIV (OR = 1.70, 95%CI = 1.47-1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27-2.85) and injury (OR = 2.62, 95%CI = 1.08-6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08-1.81) and using cocaine (OR = 1.60, 95%CI = 1.32-1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Giang HT, Duc NQ, Khue PM, Quillet C, Oanh KTH, Thanh NTT, Vallo R, Feelemyer J, Vinh VH, Rapoud D, Michel L, Laureillard D, Moles JP, Jarlais DD, Nagot N, Huong DT. Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam. AIDS Behav 2022; 27:1989-1997. [PMID: 36441408 PMCID: PMC10149475 DOI: 10.1007/s10461-022-03932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
We examined gender differences among people who inject drug (PWID) in Hai Phong, Vietnam in term of blood-borne infections, risk behaviors, and access to care. Using respondent-driven-sampling surveys, we recruited 3146 PWID from 2016 to 2018. Inclusion criteria included a positive urine test for heroin and recent injection marks. There were 155 female PWID (4,9%), including 82 at RDS-2016, 32 at RDS-2017 and 38 at RDS-2018. The age mean was 36.3 ± 7.2 years. The majority of female PWID had less than high school education (90.9%) and were unemployed (51.3%). There was no difference in the proportion of HIV and HCV positive by gender. However, women had several significant differences in risk behaviors than men in multivariable logistic regression. Being a woman was independently associated with being unemployed, being a sex worker, having unstable housing, having uses drugs for less than 5 years, more use of methamphetamine, having a partner who ever injected drugs, and less access to methadone treatment. Interventions targeting female PWID are needed, possibly through community organizations and peer educators.
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Affiliation(s)
- Hoang Thi Giang
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam.
| | - Nguyen Quang Duc
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Pham Minh Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Catherine Quillet
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | | | - Roselyne Vallo
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Vu Hai Vinh
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Delphine Rapoud
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Center, CESP/Inserm 1018, French Red Cross, Paris, France
| | - Didier Laureillard
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Jean Pierre Moles
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Nicolas Nagot
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
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Lancaster KE, Endres-Dighe S, Sucaldito AD, Piscalko H, Madhu A, Kiriazova T, Batchelder AW. Measuring and Addressing Stigma Within HIV Interventions for People Who Use Drugs: a Scoping Review of Recent Research. Curr HIV/AIDS Rep 2022; 19:301-311. [PMID: 36048310 PMCID: PMC10546998 DOI: 10.1007/s11904-022-00619-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Persistent stigma remains a crucial barrier to HIV prevention and treatment services among people who use drugs (PWUD), particularly for those living with or at-risk for HIV. This scoping review examines the current state of science with regard to approaches for measuring and addressing stigma within HIV interventions among PWUD. RECENT FINDINGS Sixteen studies fit the inclusion criteria for this review. Half the studies originated within the USA, and the remaining represented four different regions. Within these studies, stigma was measured using various quantitative, qualitative, and mixed methods. The studies primarily focused on HIV stigma, including value-based judgments, anticipated stigma, and perceived stigma domains. Information-based and skills building approaches at the individual level were the most common for the stigma reduction interventions. Adoption of systematic evaluations is needed for measuring stigma, including intersectional stigma, within HIV interventions among PWUD. Future studies should focus on developing multilevel intersectional stigma reduction interventions for PWUD with and at-risk for HIV globally.
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Affiliation(s)
| | | | - Ana D Sucaldito
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Hannah Piscalko
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Aarti Madhu
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Prevalence and factors associated with hospitalisation for bacterial skin infections among people who inject drugs: The ETHOS Engage Study. Drug Alcohol Depend 2022; 237:109543. [PMID: 35772249 DOI: 10.1016/j.drugalcdep.2022.109543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed to determine the prevalence of hospitalisation for SSTIs among PWID, and identify similarities and differences in factors associated with hospitalisation for SSTIs versus non-bacterial harms related to injecting drug use. METHODS We performed cross-sectional analyses of baseline data from an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Logistic regression models were used to identify factors associated with self-reported hospitalisation for (1) SSTIs (abscess and/or cellulitis), and (2) non-bacterial harms related to injecting drug use (e.g., non-fatal overdose; hereafter referred to as non-bacterial harms), both together and separately. RESULTS 1851 participants who injected drugs in the previous six months were enrolled (67% male; 85% injected in the past month; 42% receiving opioid agonist treatment [OAT]). In the previous year, 40% (n = 737) had been hospitalised for drug-related causes: 20% (n = 377) and 29% (n = 528) of participants were admitted to hospital for an SSTI and non-bacterial harm, respectively. Participants who were female (adjusted odds ratio [aOR]: 1.53, 95% CI: 1.19-1.97) or homeless (aOR: 1.59, 95% CI: 1.16-2.19) were more likely to be hospitalised for an SSTI, but not a non-bacterial harm. Both types of hospitalisation were more likely among people recently released from prison. CONCLUSIONS Hospitalisation for SSTIs is common among PWID. Community-based interventions to prevent SSTIs and subsequent hospitalisation among PWID will require targeting of at-risk groups, including women, people experiencing homelessness, and incarcerated people upon prison release.
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Goodman-Meza D, Arredondo J, Slim S, Angulo L, Gonzalez-Nieto P, Loera A, Shoptaw S, Cambou MC, Pitpitan EV. Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: A pilot study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103745. [PMID: 35636071 PMCID: PMC9924820 DOI: 10.1016/j.drugpo.2022.103745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fentanyl has led to an increased number of overdose deaths in North America. Testing substances for fentanyl may be a harm reduction strategy to prevent overdose. Little is known about behavior change after fentanyl testing and the attitudes around fentanyl knowledge and testing along the US-Mexico border in the context of a safe consumption site. METHODS This was a pilot quantitative and qualitative study with 30 women who use drugs at an unsanctioned safe consumption site in Mexicali, Mexico. Women participated in a quantitative survey, a semi-structured interview, and fentanyl testing of substances. Injection behavior was observed after fentanyl testing results were provided. Qualitative data were collected to explore the meanings participants attributed to fentanyl and fentanyl testing. RESULTS Half of the substances tested positive for fentanyl (n=15, 50%), and all of them were in samples of black tar heroin. Among those participants who tested positive for fentanyl, 7 (47%) subsequently used less of the intended substance, 1 did not use the intended substance, and 7 (47%) did not change their behavior (i.e., used as originally intended). In qualitative interviews, a predominant theme was a description of fentanyl as dangerous and deadly and fentanyl testing as being helpful for modifying drug use behaviors. However, participants recognized that there could be no change in behavior following a positive fentanyl test in the context of not being able to find substances free of fentanyl. CONCLUSION We observed mixed results related to behavior change after women's intended substance for use tested positive for fentanyl. Fentanyl testing was acceptable to women, but behavior change was hampered by the inability to find substances free of fentanyl. Further research is needed to maximize the potential of fentanyl testing as a harm reduction tool especially in the context of a changing drug supply.
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Affiliation(s)
- David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México; School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Alejandra Loera
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
| | - Steve Shoptaw
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Mary C Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Eileen V Pitpitan
- School of Social Work, San Diego State University, Hepner Hall room 119 5500 Campanile Drive, San Diego, CA, 92182, USA
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Barré T, Sogni P, Zaegel-Faucher O, Wittkop L, Marcellin F, Carrieri P, Gervais A, Levier A, Rosenthal E, Salmon-Céron D, Protopopescu C. Cannabis Use as a Protective Factor Against Overweight in HIV-Hepatitis C Virus Co-Infected People (ANRS CO13 HEPAVIH Cohort). AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:272-290. [PMID: 35994579 DOI: 10.1521/aeap.2022.34.4.272] [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: 06/15/2023]
Abstract
Overweight is increasingly prevalent in people living with HIV (PLWH), and is a high risk factor for metabolic disorders in this population. PLWH co-infected with hepatitis C virus (HCV) have a higher risk of metabolic disorders than their mono-infected counterparts. The putative relationship between cannabis use and body weight found in the general population has never been documented in HIV-HCV co-infected people. We tested whether cannabis use is associated with body mass index (BMI), overweight, and underweight in HCV co-infected PLWH (N = 992). Mixed-effects linear and logistic regression models were used to study the association between cannabis use and the three outcomes over time. After multivariable adjustment, cannabis use was inversely associated with BMI. Cannabis use was associated with a lower and higher risk of overweight and underweight, respectively. Cannabis use should be assessed and taken into account in the clinical management of the HIV-HCV co-infected population.
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Affiliation(s)
- Tangui Barré
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Philippe Sogni
- Université Paris Descartes, Paris, France, INSERM U1223, Institut Pasteur, Paris, France, and Service d'Hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, France
| | - Olivia Zaegel-Faucher
- Clinical Immuno-Hematology Department, Aix-Marseille University, and Sainte-Marguerite University Hospital, Marseille, France
| | - Linda Wittkop
- ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Université de Bordeaux, Bordeaux, France, and Service D'information Médicale, CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Fabienne Marcellin
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Patrizia Carrieri
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Axel Levier
- ANRS I Emerging Infectious Diseases, Department of Clinical Research, Paris, France
| | - Eric Rosenthal
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
- ANRS I Emerging Infectious Diseases, Department of Clinical Research, Paris, France
- Université Côte d'Azur, Nice, France
| | - Dominique Salmon-Céron
- Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France, and Université Paris Descartes, Paris, France
| | - Camelia Protopopescu
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), and Institut Sciences de la Santé Publique d'Aix-Marseille (ISSPAM), Marseille, France
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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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Falade-Nwulia O, Felsher M, Kidorf M, Tobin K, Yang C, Latkin C. The impact of social network dynamics on engagement in drug use reduction programs among men and women who use drugs. J Subst Abuse Treat 2022; 137:108713. [PMID: 34969578 PMCID: PMC9086095 DOI: 10.1016/j.jsat.2021.108713] [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: 07/19/2021] [Revised: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cross-sectional studies have shown strong relationships between social network characteristics and substance use disorder (SUD) treatment engagement. The current study examined associations between longitudinal changes in egocentric social networks of male and female people who use drugs (PWUD) and engagement in drug use reduction programs, broadly defined as either formal SUD treatment or self-help groups. METHOD Using data from an HIV prevention and care study in Baltimore, MD, this study categorized PWUD into those who engaged and did not engage in any drug use reduction programs over two follow-ups during a one-year observation window. The study used multivariate logistic generalized estimating equations (GEE) to examine associations between network composition and stability measures and drug use reduction program engagement, stratified by gender. RESULTS Of the 176 subjects participating in drug use reduction programs at baseline, 56.3% remained engaged at one year. Among both male and female respondents, higher turnover into non-kin networks was associated with increased odds of engagement in drug use reduction programs (AOR 1.4; 95% CI: 1.1-1.9, AOR 1.3; 95% CI: 1.0-1.8, respectively). For males, retention of intimate partner networks was associated with increased odds of program engagement (AOR 2.9; 95% CI: 1.1-7.6); for females, higher turnover into kin networks was associated with decreased odds of engagement (AOR 0.8; 95% CI: 0.5-1.0). CONCLUSION Evaluation of associations between social network characteristics and drug use reduction program engagement appears to benefit from longitudinal analyses that are stratified by gender. Efforts to improve retention in formal SUD treatment or self-help groups might consider intervening through social networks, perhaps by increasing overall levels of social support.
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Affiliation(s)
| | - Marisa Felsher
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Karin Tobin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Setting foot in private spaces: extending the hepatitis C cascade of care to automatic needle/syringe dispensing machines, a mixed methods study. Harm Reduct J 2022; 19:56. [PMID: 35643528 PMCID: PMC9148492 DOI: 10.1186/s12954-022-00640-6] [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: 03/16/2022] [Accepted: 05/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Global commitment to achieving hepatitis C virus (HCV) elimination has enhanced efforts in improving access to direct-acting antiviral (DAA) treatments for people who inject drugs (PWID). Scale-up of efforts to engage hard-to-reach groups of PWID in HCV testing and treatment is crucial to success. Automatic needle/syringe dispensing machines (ADMs) have been used internationally to distribute sterile injecting equipment. ADMs are a unique harm reduction service, affording maximum anonymity to service users. This paper explores the feasibility and acceptability of extending the HCV cascade of care to sites where ADMs are located.
Methods The ADM users into Treatment (ADMiT) study was undertaken in a metropolitan region in Sydney, Australia. This mixed methods study involved analysis of closed-circuit television footage, ethnographic methods (fieldwork observation and in-depth interviews) and structured surveys. Researchers and peers conducted fieldwork and data collection over 10 weeks at one ADM site, including offering access to HCV testing and treatment. Results Findings from 10 weeks of fieldwork observations, 70 survey participants and 15 interviews highlighted that there is scope for engaging with this population at the time they use the ADM, and enhanced linkage to HCV testing and treatment may be warranted. Most survey participants reported prior HCV testing, 61% in the last 12 months and 38% had received HCV treatment. However, fieldwork revealed that most people observed using the ADM were not willing to engage with the researchers. Field work data and interviews suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. Discussion Enhanced linkage to HCV testing and treatment for people who use ADMs may be warranted. However, data suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. The current study raises important public health questions about the need to ensure interventions reflect the needs of affected communities, including their right to remain anonymous.
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Xavier J, Greer A, Pauly B, Loyal J, Mamdani Z, Ackermann E, Barbic S, Buxton JA. "There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103714. [PMID: 35561485 DOI: 10.1016/j.drugpo.2022.103714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession. METHODS We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews. RESULTS We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities. CONCLUSION Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.
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Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University,8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bernadette Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Victoria, BC V8P 5C2, Canada
| | - Jackson Loyal
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Zahra Mamdani
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Emma Ackermann
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada; British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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Larney S, Madden A, Marshall AD, Martin NK, Treloar C. A gender lens is needed in hepatitis C elimination research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103654. [PMID: 35306279 DOI: 10.1016/j.drugpo.2022.103654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/18/2023]
Abstract
The World Health Organisation has established a goal of eliminating the hepatitis C virus (HCV) as a public health threat by 2030. Considerable effort is being directed towards research to support and enhance HCV treatment uptake among people who inject drugs, but there is a distinct lack of attention given to gender in this work. We argue that a gender lens is needed to make visible the limitations of current HCV elimination research, and support the development of innovative, inclusive approaches to HCV treatment. Partnerships between researchers and people who inject drugs are essential in this work, particularly in the development and evaluation of programs by and for women who inject drugs. Failure to acknowledge the gendered dimensions of HCV elimination risks entrenching gender disparities in access to treatment and cure.
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Affiliation(s)
- Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada.
| | - Annie Madden
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Alison D Marshall
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA; School of Population Health Sciences, University of Bristol, UK
| | - Carla Treloar
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Social Policy Research Centre, UNSW Sydney, Australia
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41
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Boyd J, Maher L, Austin T, Lavalley J, Kerr T, McNeil R. Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting. Am J Public Health 2022; 112:S191-S198. [PMID: 35349325 PMCID: PMC8965171 DOI: 10.2105/ajph.2022.306776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence. Results. Participants' substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants. Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women's overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent-child relationships. (Am J Public Health. 2022;112(S2):S191-S198. https://doi.org/10.2105/AJPH.2022.306776).
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Affiliation(s)
- Jade Boyd
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Lisa Maher
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Tamar Austin
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Jennifer Lavalley
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Thomas Kerr
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Ryan McNeil
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
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42
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Meyers-Pantele SA, Jain S, Sun X, Marks C, DeBeck K, Hayashi K, Strathdee SA, Werb D. Gender and the first-time provision of injection initiation assistance among people who inject drugs across two distinct North American contexts: Tijuana, Mexico and Vancouver, Canada. Drug Alcohol Rev 2022; 41:686-696. [PMID: 34636100 PMCID: PMC8930605 DOI: 10.1111/dar.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Injection drug use initiation is commonly facilitated by other people who inject drugs (PWID). We investigated how the gender of PWID influences their risk of providing initiation assistance to others across two distinct geo-cultural settings. METHODS Data were drawn from two prospective cohorts in Tijuana, Mexico and Vancouver, Canada which conducted semi-annual interviews within the PReventing Injecting by Modifying Existing Responses (PRIMER) study. Participants consisted of PWID who had reported never providing injection initiation assistance at baseline. We then conducted site-specific discrete-time survival analyses assessing the relationship between gender and other relevant covariates (e.g. age and past 6-month sex work) on the risk of the first reported instance of providing initiation assistance. RESULTS Of 1988 PWID (Tijuana: n = 596; Vancouver: n = 1392), 256 (43%) and 511 (36.7%) participants were women, and 42 (1.7%) and 78 (1.6%) reported recent injection initiation assistance across a median of three and two follow-up visits, respectively. Women had a lower risk of providing injection initiation assistance for the first time in Tijuana (adjusted hazard ratio = 0.52, 95% confidence interval 0.27-0.99), but not in Vancouver. Gendered pathways, like sex work, were associated with providing initiation assistance for the first time in Vancouver (adjusted hazard ratio = 1.97, 95% confidence interval 1.08-3.61). DISCUSSION AND CONCLUSIONS Women in Tijuana, but not Vancouver, were less likely to provide first-time initiation assistance among PWID. These results can inform gender- and site-specific prevention efforts aimed at reducing transitions into drug injecting across geographic contexts.
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Affiliation(s)
- Stephanie A. Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, USA,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,School of Public Health, University of Nevada, Reno, USA
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, Canada
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43
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Matheson C, Bon L, Bowman L, Hannah A, MacLeod K. Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031840. [PMID: 35162860 PMCID: PMC8835263 DOI: 10.3390/ijerph19031840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/03/2022]
Abstract
Against a backdrop of high levels of drug related harms in Scotland, this research aimed to inform training development to aid the upskilling of the workforce to support people who use drugs and are involved in transactional sex. Sixteen qualitative interviews were conducted with participants recruited across four health board areas and a range of services covering sexual health and/or harm reduction. Interviews explored initiation, frequency, and the nature of transactional sex; drug use, and experience of services. A thematic analysis was undertaken. Vulnerability was a key emerging theme when discussing drug use, sexual behavior, and service use. Vulnerability increased risk of a range of harms from sexual assault to injecting harms and overdose. Participants were often, but not always, introduced to drugs and transactional sex by someone who had power over them or was more experienced in drug use and/or sex. High risk drug use was evident in terms of polydrug use, consuming large quantities of drugs, sharing crack pipes/injecting equipment. There is a need for information and services to reduce the risk of harm from drugs, sexual violence, and unprotected sex as well as non-judgmental, trauma aware services. The workforce needs to be skilled to recognize and manage these potentially complex syndemics.
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Affiliation(s)
- Catriona Matheson
- Independent Research Consultant, Aberdeen AB10 6RT, UK
- Correspondence:
| | - Lesley Bon
- Scottish Drugs Forum, Glasgow G1 3LN, UK; (L.B.); (L.B.); (A.H.); (K.M.)
| | - Louise Bowman
- Scottish Drugs Forum, Glasgow G1 3LN, UK; (L.B.); (L.B.); (A.H.); (K.M.)
| | - Adrienne Hannah
- Scottish Drugs Forum, Glasgow G1 3LN, UK; (L.B.); (L.B.); (A.H.); (K.M.)
| | - Katy MacLeod
- Scottish Drugs Forum, Glasgow G1 3LN, UK; (L.B.); (L.B.); (A.H.); (K.M.)
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Collins AB, McNeil R, Czechaczek S, Boyd J. " That's what I'm supposed to do at work": Gendered labor, self-care, and overdose risk among women who use drugs in Vancouver, Canada. CRITICAL PUBLIC HEALTH 2022; 32:382-391. [PMID: 35812810 PMCID: PMC9268005 DOI: 10.1080/09581596.2020.1844151] [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: 01/03/2023]
Abstract
Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside - one of Canada's overdose epicenters - this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations.
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Affiliation(s)
- Alexandra B. Collins
- School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States
| | - Ryan McNeil
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States, General Internal Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States
| | - Sandra Czechaczek
- 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, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
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45
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Guy D, Doran J, White TM, van Selm L, Noori T, Lazarus JV. The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review. Front Psychiatry 2022; 13:951682. [PMID: 36090369 PMCID: PMC9459118 DOI: 10.3389/fpsyt.2022.951682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION People who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population. METHODS We systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review. RESULTS Our search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers. CONCLUSIONS To improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.
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Affiliation(s)
- Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,National Infection Service, UK Health Security Agency, London, United Kingdom.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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46
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Chueng TA, Tookes HE, McLaughlin M, Arcaro-Vinas AM, Serota DP, Bartholomew TS. Injection and Sexual Behavior Profiles among People Who Inject Drugs in Miami, Florida. Subst Use Misuse 2022; 57:1374-1382. [PMID: 35686722 PMCID: PMC9413019 DOI: 10.1080/10826084.2022.2083171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The dynamics of injection drug use and higher-risk sexual practices compound the risk of HIV and HCV acquisition. Published literature on people who inject drugs (PWID) has examined risk of infection assuming homogeneity of cohort behavior. Categorizing subgroups by injection and sexual risk can inform a more equitable approach to how syringe services programs (SSPs) adapt harm reduction resources and implementation of evidence-based interventions. We explored injection and sexual risk profiles among PWID to determine significant predictors of class membership. METHODS Data were collected from 1,272 participants at an SSP in Miami-Dade County. Latent Class Analysis (LCA) examined how 10 injection/sexual behavior indicators cluster together to create profiles. Model fit statistics and multivariable multinomial latent class regression identified the optimal class structure and significant predictors of class membership. We assessed SSP visits, naloxone access, HIV/HCV testing and prevalence, and incidence of self-reported wounds. RESULTS Three distinct profiles of injection/sexual risk were determined: Low Injection/High Sexual (LIHS) (9.4%); High Injection/Moderate Sexual (HIMS) (18.9%); and Low Injection/Low Sexual (LILS) (71.7%). Participants reporting gay/bisexual orientation and methamphetamine injection more likely belonged to the LIHS class. LIHS class members had higher prevalence of HIV, while those of HIMS reported increased hepatitis C prevalence. Compared to members of LILS, those of HIMS more likely experienced unstable housing, gay/bisexual orientation, heroin or speedball injection, and identifying as women. HIMS cohort members had more SSP visits, naloxone accessed, and higher wound incidence than those of LILS. CONCLUSIONS Understanding PWID subgroups amplifies the importance of implementing evidencebased interventions such as PrEP for those engaging in highest risk behavior, with focused interventions of antiretroviral management and access to condoms for members of the LIHS class and HCV screening with wound care for those belonging to HIMS.
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Affiliation(s)
- Teresa A Chueng
- Department of Infectious Diseases, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hansel E Tookes
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan McLaughlin
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - David P Serota
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Hayes BT, Favaro J, Coello D, Behrends CN, Jakubowski A, Fox AD. Participants of a mail delivery syringe services program are underserved by other safe sources for sterile injection supplies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103474. [PMID: 34619446 PMCID: PMC8755579 DOI: 10.1016/j.drugpo.2021.103474] [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: 07/15/2021] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND In the United States, accessing sterile injection supplies remains challenging for many people who inject drugs (PWID). Although women are less likely to inject drugs than men, women who do inject are disproportionately affected by IDU-related complications. Needle Exchange Technology (NEXT), the first formal online accessed mail delivery syringe services program (SSP) in the US, may overcome access barriers. We evaluated whether NEXT was reaching women participants and people without access to other safe sources of sterile injection supplies. METHODS This cross-sectional study examined NEXT participants who enrolled in the mail-delivery SSP from February 2018 through March 2021. All NEXT participants completed an online questionnaire during enrollment, which included sociodemographic and clinical characteristics and injection-related risk factors (including prior sources of sterile injection supplies). Multivariable logistic regression (MVR) was used to examine associations between gender and prior use of safe sources of injection supplies (i.e., SSPs or pharmacies). RESULTS 1,032 participants received injection supplies. Median age was 34 and participants were mostly cis-gendered women (55%) and white (93%). 34% reported infection with HCV; women were more likely to report HCV infection than men (38% vs 28%; p < 0.01). 68% of participants acquired injection supplies from less safe sources. Few participants exclusively used safe sources for injection supplies (26%). In adjusted MVR analysis, women participants had significantly lower odds than men of having exclusively used safe sources for injection supplies (adjusted OR 0.71, 95% CI 0.52, 0.98). CONCLUSION Our findings suggest that NEXT services are utilized by women and people without prior access to sterile injection supplies. Women participants were less likely than men to have exclusively used safe sources for sterile injection supplies. Future research should explore women's preference for mail-delivery over in-person SSPs and determine whether online accessed mail delivery services can reach other underserved populations of PWID.
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Affiliation(s)
- Benjamin T Hayes
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA,Corresponding author at: Montefiore Medical
Center, 3300 Kossuth Ave., Bronx, NY, 10467 United States. Tel.: +1
718-920-7102; fax: +1 718-561-5165.
| | | | | | | | - Andrea Jakubowski
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA
| | - Aaron D. Fox
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA
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Dhiman RK, Grover GS, Premkumar M, Roy A, Taneja S, Duseja A, Arora S. Outcomes of Real-World Integrated HCV Microelimination for People Who Inject Drugs: An expansion of the Punjab Model. EClinicalMedicine 2021; 41:101148. [PMID: 34712928 PMCID: PMC8529203 DOI: 10.1016/j.eclinm.2021.101148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of chronic hepatitis C (CHC) in People Who Inject Drugs (PWID) is 8-10% as compared to 3·6% in the general population in Punjab, India. We assessed the real-world efficacy and safety of free-of-charge generic direct-acting antivirals (DAAs), sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir)±ribavirin in the microelimination of CHC in PWID in a public health setting. METHODS An integrated care team at 25 sites provided algorithm based DAAs treatment to PWID supervised by telemedicine clinics between 18th June 2016 and 31st July 2019. The primary endpoint was sustained virological response at 12 weeks (SVR-12); the secondary endpoints were treatment completion, adherence, safety, and adverse events. ClinicalTrials.gov number: NCT01110447. FINDINGS We enrolled 3477 PWID (87·2% men; mean age 33·6±12·5 years; 83·8% rural; 6·8% compensated cirrhosis). While 2280 (65·5%) patients completed treatment, 1978 patients completed 12 weeks of follow up for SVR-12. SVR-12 was achieved in 91·1% of patients per protocol, 49.5% as per intention to treat (ITT) and 90·1% in a modified ITT analysis. Of 546 (15·7%) patients with treatment interruptions, 99 (19·7%) could be traced to test for SVR-12 with a cure rate of 77·8%. There were no major adverse events or consequent treatment discontinuation. INTERPRETATION Integrated care of PWID with CHC with DAAs is safe and effective. Measures for reducing treatment interruptions will further improve outcomes. FUNDING The Government of the state of Punjab, India under the Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF) project, funds the project.
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Key Words
- ALT, alanine aminotransferase
- CHC, chronic hepatitis C
- CI, confidence interval
- DAAs, direct-acting antiviral agents
- DCV, Daclatasvir
- DH, District Hospital
- ECHO, Extension for Community healthcare Outcome
- G, Genotype
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV
- HCV, hepatitis C virus
- IDU, injection drug use
- INASL, Indian National Association for study of the Liver
- India
- LDV, ledipasvir
- MMPHCRF, Mukh Mantri Punjab Hepatitis C Relief Fund
- NVHCP, National Viral Hepatitis Control Programme
- OST, opioid substitution therapy peg-interferon
- PWID, People Who Inject Drugs
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained virologic response
- VEL, Velpatasvir
- hepatitis C virus
- injection drug use
- microelimination
- people who inject drugs
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Affiliation(s)
- Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
- Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India
- Technical Resource Group - National Viral Hepatitis Control Program (NVHCP), Government of India, India
- Injection Safety Project, Punjab Government, Punjab, India
| | | | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Roy
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjeev Arora
- ECHO Institute University of New Mexico, USA, New Mexico, United States
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Rivera Saldana CD, Beletsky L, Borquez A, Kiene SM, Strathdee SA, Zúñiga ML, Martin NK, Cepeda J. Impact of cumulative incarceration and the post-release period on syringe-sharing among people who inject drugs in Tijuana, Mexico: a longitudinal analysis. Addiction 2021; 116:2724-2733. [PMID: 33620749 PMCID: PMC8380753 DOI: 10.1111/add.15445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. DESIGN Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. SETTING Tijuana, Mexico. PARTICIPANTS Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. MEASUREMENTS Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. FINDINGS At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. CONCLUSIONS A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.
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Affiliation(s)
- Carlos D. Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
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McQuade M, Reddy N, Barbour K, Owens L. Integrating reproductive health care into substance use disorder services. Int Rev Psychiatry 2021; 33:572-578. [PMID: 33974476 DOI: 10.1080/09540261.2021.1904845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who use drugs face layered stigma and barriers to accessing reproductive health care services. At the same time, they have unique needs for compassionate, trauma-informed, low-barrier reproductive health care. We review the literature on collocated reproductive health care and substance use treatment services in this population and advocate for expansion of reproductive health care services at sites providing care for substance use disorder. Through this review article, we outline the evidence for and best practices in collocating reproductive health care within substance use disorder services.
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Affiliation(s)
- Miriam McQuade
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Neha Reddy
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kyle Barbour
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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