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Association of skin infections with sharing of injection drug preparation equipment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103198. [PMID: 33744668 PMCID: PMC8373634 DOI: 10.1016/j.drugpo.2021.103198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may serve as bacterial niduses for skin and soft tissue infections (SSTI). Given the rising rates of SSTI in PWID, we investigated the association of needle and IDPE sharing on incidence of SSTI in a cohort of PWID. METHODS Inpatient PWID (N = 252) were recruited to a randomized controlled trial of an intervention aimed at reducing infections. The primary outcome was self-reported incidence of SSTI one-year post-hospitalization. In this secondary analysis, we assessed two variables: 1) sharing of IDPE alone, 2) sharing needles with or without IDPE, and compared these groups separately to persons who reported no sharing of needles or IDPE via a mixed-effects negative binomial regression model to estimate the effect of baseline sharing behavior on SSTI during follow-up via incidence rate ratios (IRR). RESULTS Participant characteristics: 38 years [mean], 58% male, 60% White, 90% primarily injected opioids, 1.58 (± 2.35) mean SSTI in the year prior to baseline. In terms of sharing behavior, 29% didn't share needles or IDPE, 13% shared IDPE only, and 58% shared needles with or without IDPE three months prior to baseline. After adjusting for co-variables, PWID who shared IDPE alone had a 2.2 fold higher IRR of SSTI (95%CI 1.27; 3.85, p = 0.005) and PWID who shared needles with or without IDPE had a 3.31 fold higher IRR of SSTI (95%CI 2.04; 5.37, p < 0.001), compared to those who did not share any equipment. The number of SSTI at baseline was associated with an IRR of 1.20 of SSTI during follow-up (95%CI 1.09; 1.32, p < 0.001). CONCLUSIONS In this cohort of hospitalized PWID, we found a significant association between baseline sharing of IDPE alone and of sharing of needles with or without IDPE with one-year incidence of SSTI.
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Ibragimov U, Cooper KE, Batty E, Ballard AM, Fadanelli M, Gross SB, Klein EM, Lockard S, Young AM, Cooper HLF. Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky. Harm Reduct J 2021; 18:68. [PMID: 34193165 PMCID: PMC8244225 DOI: 10.1186/s12954-021-00518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS Stigma, a feature of IREF's meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID's individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS Features of the social and healthcare environments operating at the meso-level, as well as PWID's individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.
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Affiliation(s)
| | | | - Evan Batty
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - April M Ballard
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Monica Fadanelli
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Skylar B Gross
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Emma M Klein
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Scott Lockard
- Kentucky River District Health Department, Hazard, KY, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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Wakeman B, Kremer M, Schulkin J. The application of harm reduction to methamphetamine use during pregnancy: a call to arms. Am J Obstet Gynecol MFM 2021; 3:100418. [PMID: 34102337 DOI: 10.1016/j.ajogmf.2021.100418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
Compared with opioid use disorder, methamphetamine use is a public health crisis that has limited evidence-based pharmacologic interventions for long-term treatment. The prevalence of methamphetamine use during pregnancy is growing and contributes to adverse maternal and neonatal outcomes. Because of widespread stigma and social complexities associated with methamphetamine use during pregnancy, these patients often experience limited prenatal care, further contributing to poor outcomes. In public health circles, harm reduction describes a framework for conceptualizing substance use by championing health promotion and the safest use of substances, as opposed to the unachievable goal of abstinence. There is limited evidence supporting the application of harm reduction in this population. We call for action and research to investigate how the progressive concept of harm reduction might be applied to mitigate adverse outcomes for obstetrical patients who use methamphetamine.
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Affiliation(s)
- Brooke Wakeman
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
| | - Mallory Kremer
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
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Meyers SA, Earnshaw VA, D’Ambrosio B, Courchesne N, Werb D, Smith LR. The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature. Drug Alcohol Depend 2021; 223:108706. [PMID: 33901753 PMCID: PMC8168566 DOI: 10.1016/j.drugalcdep.2021.108706] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use-related stigma is a significant barrier to care among persons who use drugs (PWUD). Less is known regarding how intersectional identities, like gender, shape experiences of substance use-related stigma. We sought to answer the following question: Do men or women PWUD experience more drug use stigma? METHODS Data were drawn from a systematic review of the global, peer-reviewed scientific literature on substance use-related stigma conducted through 2017 and guided by the Stigma and Substance Use Process Model and PRISMA guidelines. Articles were included in the present analysis if they either qualitatively illustrated themes related to the gendered nature of drug use-related stigma, or quantitatively tested the moderating effect of gender on drug use-related stigma. RESULTS Of the 75 studies included, 40 (53 %) were quantitative and 35 (47 %) were qualitative. Of the quantitative articles, 22 (55 %) found no association between gender and drug use-related stigma, 4 (10 %) identified women who use drugs (WWUD) were more stigmatized, and 2 (5 %) determined men who use drugs (MWUD) were more stigmatized. In contrast, nearly all (34; 97 %) of the qualitative articles demonstrated WWUD experienced greater levels of drug use-related stigma. CONCLUSION The quantitative literature is equivocal regarding the influence of gender on drug use-related stigma, but the qualitative literature more clearly demonstrates WWUD experience greater levels of stigma. The use of validated drug use-related stigma measures and the tailoring of stigma scales to WWUD are needed to understand the role of stigma in heightening the disproportionate harms experienced by WWUD.
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Affiliation(s)
- S. A. Meyers
- Department of Psychology, San Diego State University, 5500
Campanile Drive, San Diego, CA 92182, USA,Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
| | - V. A. Earnshaw
- Human Development and Family Sciences, University of Delaware,
Newark, DE, 19716, USA
| | - B. D’Ambrosio
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,School of Social Work, College of Health and Human Services,
San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N. Courchesne
- Department of Psychiatry, University of California San Diego,
9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. Werb
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,Centre for Urban Health Solutions, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - L. R. Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA
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Qin Y, Price C, Rutledge R, Puglisi L, Madden LM, Meyer JP. Women's Decision-Making about PrEP for HIV Prevention in Drug Treatment Contexts. J Int Assoc Provid AIDS Care 2021; 19:2325958219900091. [PMID: 31918605 PMCID: PMC7099671 DOI: 10.1177/2325958219900091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite pre-exposure prophylaxis’s (PrEP) efficacy for HIV prevention, uptake has been
low among women with substance use disorders (SUDs) and attributed to women’s lack of
awareness. In semistructured interviews with 20 women with SUD and 15 key stakeholders at
drug treatment centers, we assessed PrEP awareness and health-related decision-making.
Women often misestimated their own HIV risk and were not aware of PrEP as a personally
relevant option. Although women possessed key decision-making skills, behavior was
ultimately shaped by their level of motivation to engage in HIV prevention. Motivation was
challenged by competing priorities, minimization of perceived risk, and anticipated
stigma. Providers were familiar but lacked experience with PrEP and were concerned about
women’s abilities to action plan in early recovery. HIV prevention for women with SUD
should focus on immediately intervenable targets such as making PrEP meaningful to women
and pursuing long-term systemic changes in policy and culture. Efforts can be facilitated
by partnering with drug treatment centers to reach women and implement PrEP
interventions.
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Affiliation(s)
- Yilu Qin
- Internal Medicine Primary Care Residency Program, HIV Training Track, Yale School of Medicine, New Haven, CT, USA
| | - Carolina Price
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Ronnye Rutledge
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa Puglisi
- Department of Medicine, Section of General Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,APT Foundation Inc, New Haven, CT, USA
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
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HIV incidence and associated risk factors in female spouses of men who inject drugs in Pakistan. Harm Reduct J 2021; 18:51. [PMID: 33964932 PMCID: PMC8106847 DOI: 10.1186/s12954-021-00497-1] [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: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence. We investigated HIV prevalence and incidence among female spouses of MWID registered at Nai Zindagi Trust (NZT), Pakistan, between 2012 and 2019. Methods NZT registration and service provision data for female spouses who participated in HIV testing and counselling calculated HIV prevalence and incidence using the person years (PY) method. Cox proportional hazards models identified factors associated with incident infection. Results Overall HIV prevalence among female spouses of MWID was 8.5%. Among 3478 HIV-negative female spouses, 109 incident infections were observed, yielding an incidence rate of 1.5/100PY (95% CI 1.2–1.8). Independent predictors of incident infection were registration in Punjab province (AHR 1.73 95% CI 1.13–2.68, p = 0.012) and 1–5 years of education (AHR 1.89 95% CI 1.22–2.93, p = 0.004). Knowledge of HIV at registration was protective against infection (AHR 0.51, 95% CI 0.26–0.99, p = 0.047), along with a MWID spouse who had initiated antiretroviral therapy (ART) (AHR 0.25, 95% CI 0.16–0.38, p < 0.001), while incident infection was inversely associated with number of children (≥ 5 children AHR 0.44 95% CI 0.22–0.88, p = 0.022). Conclusions Additional efforts are needed to reduce HIV transmission among female spouses of MWID, including targeted provision of HIV education and access to HIV screening. Interventions that target MWID are also required, including evidence-based drug treatment and access to ART, including support to maximize adherence. Finally, consideration should be given to making HIV pre-exposure prophylaxis available to female spouses at high risk of HIV transmission, particularly young women and those whose husbands are not receiving, or have difficulty adhering to, ART.
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Tsybina P, Kassir S, Clark M, Skinner S. Hospital admissions and mortality due to complications of injection drug use in two hospitals in Regina, Canada: retrospective chart review. Harm Reduct J 2021; 18:44. [PMID: 33882950 PMCID: PMC8061207 DOI: 10.1186/s12954-021-00492-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infectious complications of injection drug use (IDU) often require lengthy inpatient treatment. Our objective was to identify the number of admissions related to IDU in Regina, Canada, as well as describe patient demographics and comorbidities, yearly mortality, readmission rate, and cumulative cost of these hospitalizations between January 1 and December 31, 2018. Additionally, we sought to identify factors that increased risk of death or readmission. METHODS This study is a retrospective chart review conducted at the two hospitals in Regina. Eligible study cases were identified by querying the discharge database for predetermined International Classification of Diseases code combinations. Electronic medical records were reviewed to assess whether each admission met inclusion criteria, and hospitalization and patient data were subsequently extracted for all included admissions. Mortality data were gleaned from hospital and Ministry of Health databases. Data were analyzed using Excel and IBM SPSS Statistics to identify common comorbidities, admission diagnoses, and costs, as well as to compare patients with a single admission during the study period to those with multiple admissions. Logistic regression analysis was used to identify the relationship between individual variables and in- and out-of-hospital annual mortality. RESULTS One hundred and forty-nine admissions were included, with 102 unique patients identified. Common comorbidities included hepatitis C (47%), human immunodeficiency virus (HIV) (25%), and comorbid psychiatric disorders (19%). In 23% of all admissions, patients left hospital prior to treatment completion, and 27% of patients experienced multiple admissions. Female patients and those with chronic pain were more likely to be readmitted (p = 0.024 and p = 0.029, respectively). Patients admitted with infective endocarditis were more likely to die during hospitalization (p = 0.0001). The overall mortality was 15% in our cohort. The estimated cumulative cost of inpatient treatment of complications of IDU in Regina was $3.7 million CAD in 2018. CONCLUSION Patients with history of IDU and hospital admission experience high mortality rates in Regina, a city with paucity of inpatient supports for persons who use injection drugs. Needle syringe programs, opioid agonist therapy, and safe consumption sites have been shown to improve outcomes as well as reduce healthcare costs for this patient population. We will use our findings to advocate for increased access to these harm reduction strategies in Regina, particularly for inpatients.
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Affiliation(s)
- Polina Tsybina
- College of Medicine, Regina General Hospital, University of Saskatchewan, 1440 14th Avenue, Regina, SK, S4P 0W5, Canada.
| | - Sandy Kassir
- Research Department, Saskatchewan Health Authority, Regina, Canada
| | - Megan Clark
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Stuart Skinner
- Department of Medicine, University of Saskatchewan, Regina, Canada
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Viera A, Gotham H, Cheng AL, Carlson K, Witt J. Barriers and Challenges to Making Referrals for Treatment and Services for Opioid Misuse in Family Planning Settings. J Womens Health (Larchmt) 2021; 31:38-46. [PMID: 33844948 DOI: 10.1089/jwh.2020.8761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In this opioid overdose epidemic, women are an overlooked group seeing increasing rates of overdose death. Implementation challenges have prevented evidence-based interventions from effectively reaching women who misuse opioids, with gaps in access to effective treatment and services. Family planning clinics could serve as important points of contact for referral to needed treatments and services. The study explores how family planning staff knowledge and attitudes related to opioid misuse serve as potential barriers and challenges in making referrals for evidence-based services and treatments. Methods: In 2018, we conducted a national online survey of family planning staff, assessing knowledge and attitudes of treatments and services for opioid misuse. Results: A total of 691 family planning staff completed the survey. Most respondents agreed that opioid misuse was a major problem in their community (86.0%) and identified challenges in responding to it, including a lack of treatment access (70.3%), the absence of in-house behavioral health staff (67.2%), and unfamiliarity with local treatment providers (54.1%). Respondents reported low levels of acceptability for syringe services programs (46.0%), medications such as methadone and buprenorphine (55.4%), and naloxone to reverse opioid overdose (60.1%). Controlling for other factors, race/ethnicity, urbanicity, workplace role, and substance use training were associated with differences in acceptability. Conclusions: Family planning settings could play a critical role in connecting women who misuse opioids to treatment and services. Strategies are needed to increase the acceptability of evidence-based interventions and the feasibility of having family planning staff play a linkage role.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA.,Yale University Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Heather Gotham
- Department of Psychiatry and Behavioral Sciences, Center for Behavioral Health Services and Implementation Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Jacki Witt
- School of Nursing and Health Studies, University of Missouri Kansas City, Kansas City, Missouri, USA
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Canfield M, Norton S, Downs J, Gilchrist G. Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records. J Subst Abuse Treat 2021; 127:108365. [PMID: 34134870 DOI: 10.1016/j.jsat.2021.108365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. METHOD The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370). RESULTS The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children. CONCLUSION The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.
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Affiliation(s)
- Martha Canfield
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Bardwell G, Austin T, Maher L, Boyd J. Hoots and harm reduction: a qualitative study identifying gaps in overdose prevention among women who smoke drugs. Harm Reduct J 2021; 18:29. [PMID: 33678163 PMCID: PMC7937364 DOI: 10.1186/s12954-021-00479-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This study examines women's experiences smoking illicit drugs during an overdose epidemic, including their utilization of a women-only supervised inhalation site. METHODS Qualitative research methods included on-site ethnographic observation and semi-structured interviews with 32 participants purposively recruited from the women-only site. Data were coded and analyzed using NVivo 12 and thematic analysis was informed by gendered and socio-structural understandings of violence. RESULTS Participants had preferences for smoking drugs and these were shaped by their limited income, inability to inject, and perceptions of overdose risk. Participants expressed the need for services that attend to women's specific experiences of gendered, race-based, and structural violence faced within and outside mixed-gender social service settings. Results indicate a need for sanctioned spaces that recognize polysubstance use and drug smoking, accommodated by the women-only SCS. The smoking environment further fostered a sociability where participants could engage in perceived harm reduction through sharing drugs with other women/those in need and were able to respond in the event of an overdose. CONCLUSIONS Findings demonstrate the ways in which gendered social and structural environments shape women's daily experiences using drugs and the need for culturally appropriate interventions that recognize diverse modes of consumption while attending to overdose and violence. Women-only smoking spaces can provide temporary reprieve from some socio-structural harms and build collective capacity to practice harm reduction strategies, including overdose prevention. Women-specific SCS with attention to polysubstance use are needed as well as continued efforts to address the socio-structural harms experienced by women who smoke illicit drugs.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Tamar Austin
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Lisa Maher
- Faculty of Medicine, Kirby Institute for Infection and Immunity, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Reducing HIV Risk Behaviors Among Black Women Living With and Without HIV/AIDS in the U.S.: A Systematic Review. AIDS Behav 2021; 25:732-747. [PMID: 32918639 DOI: 10.1007/s10461-020-03029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
This systematic review provides an examination of the status of HIV/AIDS prevention interventions for Black, heterosexual women in the U.S. from 2012 to 2019. Using PRISMA guidelines, 28 interventions were identified. Over half of the interventions were: conducted in the southern region of the U.S.; evaluated using a randomized controlled trial; focused on adults; used a group-based intervention delivery; were behaviorally focused and theoretically driven. None included biomedical strategies of PrEP, nPEP, and TasP. Few interventions included adolescent or aging Black women; none included their sex/romantic partners. Future studies dedicated to addressing the specific needs of subpopulations of Black, heterosexual women may provide opportunities to expand and/or tailor current and future HIV/AIDS prevention interventions, including offering participants with options to choose which, and the level of involvement, of their sex/romantic partner(s) in their sexual health decision-making. While strides to improve HIV prevention efforts with Black, heterosexual women have occurred, more is needed.
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Semá Baltazar C, Kellogg TA, Boothe M, Loarec A, de Abreu E, Condula M, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs: Results from the implementation of the first drop-in-center in Mozambique. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103095. [PMID: 33429163 DOI: 10.1016/j.drugpo.2020.103095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates. METHODS We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD. RESULTS A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9). CONCLUSION This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anne Loarec
- Médecins Sans Frontières, Maputo, Mozambique
| | | | | | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco (UCSF), USA; School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia
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Geddes L, Iversen J, Wand H, Esmaeili A, Tsui J, Hellard M, Dore G, Grebely J, Dietze P, Bruneau J, Prins M, Morris MD, Shoukry NH, Lloyd AR, Kim AY, Lauer G, Cox AL, Page K, Maher L. Sex Discrepancies in the Protective Effect of Opioid Agonist Therapy on Incident Hepatitis C Infection. Clin Infect Dis 2021; 70:123-131. [PMID: 30816419 DOI: 10.1093/cid/ciz162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. METHODS Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses. RESULTS Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .001). CONCLUSIONS Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.
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Affiliation(s)
- Louise Geddes
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Jenny Iversen
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Aryan Esmaeili
- Clinical Research Education, Icahn School of Medicine at Mount Sinai, New York
| | - Judith Tsui
- University of Washington School of Medicine, Seattle
| | | | - Gregory Dore
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Victoria, Australia
| | - Julie Bruneau
- Le Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec, Canada
| | - Maria Prins
- Cluster Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.,Amsterdam University Medical Center, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, The Netherlands
| | | | - Naglaa H Shoukry
- Le Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec, Canada
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales Sydney, Australia
| | | | - Georg Lauer
- Harvard Medical School, Boston, Massachusetts
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Albuquerque
| | - Lisa Maher
- Kirby Institute, University of New South Wales Sydney, Australia
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Meyer J, Price C, Tracey D, Sharpless L, Song Y, Madden L, Elwyn G, Altice F. Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders. Patient Prefer Adherence 2021; 15:1913-1927. [PMID: 34511887 PMCID: PMC8420782 DOI: 10.2147/ppa.s315543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
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Affiliation(s)
- Jaimie Meyer
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- Correspondence: Jaimie Meyer Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USATel +203 737 6233Fax +203 737 4051 Email
| | - Carolina Price
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | | | - Yue Song
- Yale School of Public Health, New Haven, CT, USA
- Oregon Health Sciences University, Portland, OR, USA
| | - Lynn Madden
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- Scientific Institute for Quality of Healthcare, University Nijmegen Medical Centre, Nijmegen, Netherlands
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Frederick Altice
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Motavalli D, Taylor JL, Childs E, Valente PK, Salhaney P, Olson J, Biancarelli DL, Edeza A, Earlywine JJ, Marshall BDL, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "Health Is on the Back Burner:" Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs. J Gen Intern Med 2021; 36:129-137. [PMID: 32918199 PMCID: PMC7858998 DOI: 10.1007/s11606-020-06201-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The estimated 2.2 million people who inject drugs (PWID) in the USA experience significant gaps in preventive healthcare and a high burden of infectious, psychiatric, and other chronic diseases. Many PWID rely on emergency medical services, which are costly and not designed to deliver preventive services, manage chronic conditions, or address social needs. OBJECTIVE The objective of this study was to explore barriers and facilitators to primary care utilization from the perspectives of PWID in New England, a region highly affected by the overdose crisis. DESIGN Participants completed semi-structured qualitative interviews exploring substance use and healthcare utilization patterns. PARTICIPANTS We recruited 78 PWID through community-based organizations (e.g., syringe service programs) in 16 urban and non-urban communities throughout Massachusetts and Rhode Island. APPROACH Thematic analysis identified barriers and facilitators to primary care utilization at the individual, interpersonal, and systemic levels. KEY RESULTS Among 78 PWID, 48 described recent primary care experiences; 33 had positive experiences and 15 described negative experiences involving discrimination or mistrust. Individual-level barriers to primary care utilization included perceived lack of need and competing priorities (e.g., avoiding opioid withdrawal, securing shelter beds). Interpersonal-level barriers included stigma and perceived low quality of care for PWID. Systemic-level barriers included difficulty navigating healthcare systems, inadequate transportation, long wait times, and frequent provider turnover. Participants with positive primary care experiences explained how appointment reminders, flexible hours, addiction medicine-trained providers, case management services, and transportation support facilitated primary care utilization and satisfaction. CONCLUSIONS Findings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes.
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Affiliation(s)
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Ellen Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Peter Salhaney
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Jennifer Olson
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Joel J Earlywine
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, 02118, USA.
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Karlsson N, Kåberg M, Berglund T, Hammarberg A, Widman L, Ekström AM. A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103059. [PMID: 33360734 DOI: 10.1016/j.drugpo.2020.103059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Needle exchange programs (NEP) are important in reducing risk behaviours among people who inject drugs (PWID), also exposed to HIV and hepatitis C (HCV) through injecting drug use (IDU). Women (WWID) compared to men who inject drugs (MWID), are particularly vulnerable with complex needs, however less is known about their risk determinants and NEP outcomes. METHODS In an open prospective NEP cohort, 697 WWID and 2122 MWID were followed, 2013-2018. Self-reported socio/drug-related determinants for receptive injection (needle/syringe and paraphernalia) and sexual risk behaviours at enrolment, lost to follow-up (LTFU) and probability of retention, were assessed for both groups. Multivariable logistic regression (adjusted odds ratios, aOR) for enrolment and Poisson regression (adjusted incidence rate ratios, aIRR) for LTFU, were used. Cumulative NEP-retention probability was analysed using a six- and 12-month scenario. RESULTS At NEP enrolment, injection risk behaviours among WWID were associated with: younger age; homelessness; amphetamine-IDU; non-participation in opioid substitution therapy (OST); history of custody and among MWID: lower education level; cohabitation; homelessness, being a tenant; amphetamine-IDU; non-participation in OST; history of being sectioned, HIV-negative and HCV-positive. Condomless sex among WWID was associated with: younger age; lower education-level; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; being HIV-negative and HCV-positive and among MWID: younger age; married; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; history of custody, prison and being HIV-negative. WWID had higher NEP-retention levels compared to MWID over time. Being LTFU among WWID was associated with being HIV-negative and reporting injection risk behaviours and among MWID, younger age, non-participation in OST, being HIV-negative and having protected sex. CONCLUSIONS Despite better NEP compliance among WWID, high injection and sexual risk behaviours in both gender-subgroups, especially in intimate relationships, suggests ongoing HCV and HIV-infection risks. Subgroup-variation in the NEP continuum of care warrants more gender-disaggregated research and tailoring gender-sensitive services may improve prevention, health and retention outcomes.
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Affiliation(s)
- Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden.
| | - Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Torsten Berglund
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden
| | - Anders Hammarberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Linnea Widman
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Jain JP, Strathdee SA, West BS, Gonzalez-Zuniga P, Rangel G, Pitpitan EV. Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico. Drug Alcohol Rev 2020; 39:898-907. [PMID: 32794626 PMCID: PMC7959186 DOI: 10.1111/dar.13134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS HIV and hepatitis C virus transmission among people who inject drugs (PWID) is fuelled by personal and environmental factors that vary by sex. We studied PWID in Mexico to identify sex differences in multilevel determinants of injection risk. DESIGN AND METHODS From 2011 to 2013, 734 PWID (female: 277, male: 457) were enrolled into an observational cohort study in Tijuana. Participants completed interviews on injection and sexual risks. Utilising baseline data, we conducted multiple generalised linear models stratified by sex to identify factors associated with injection risk scores (e.g. frequency of injection risk behaviours). RESULTS For both sexes, difficult access to sterile syringes was associated with elevated injection risk (b = 1.24, 95% confidence interval [CI] 1.16-1.33), using syringes from a safe source (e.g. needle exchange programs) was associated with lower injection risk (b = 0.87, 95% CI 0.82-0.94), and for every one-unit increase in safe injection self-efficacy we observed a 20% decrease in injection risk (b = 0.80, 95% CI 0.76-0.84). Females had a higher safe injection self-efficacy score compared to males (median 2.83, interquartile range 2.2-3 vs. median 2.83, interquartile range 2-3; P = 0.01). Among females, incarceration (b = 1.22, 95% CI 1.09-1.36) and police confiscation of syringes in the past 6 months (b = 1.16, 95% CI 1.01-1.33) were associated with elevated injection risk. Among males, sex work (b = 1.16, 95% CI 1.04-1.30) and polysubstance use in the past 6 months (b = 1.22, 95% CI 1.13-1.31) were associated with elevated injection risk. DISCUSSION AND CONCLUSIONS Interventions to reduce HIV and hepatitis C virus transmission among PWID in Tijuana should be sex-specific and consider multilevel determinants of injection risk to create safer drug use environments.
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Affiliation(s)
- Jennifer P Jain
- School of Medicine, University of California, San Diego, San Diego, USA
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Brooke S West
- School of Social Work, Columbia University, New York, USA
| | | | - Gudelia Rangel
- United States-Mexico Border Health Commission and El Colegio de la Frontera Norte, Tijuana, Mexico
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Värmå Falk M, Strömdahl S, Ekström AM, Kåberg M, Karlsson N, Dahlborn H, Hammarberg A. A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs. Harm Reduct J 2020; 17:84. [PMID: 33092595 PMCID: PMC7579804 DOI: 10.1186/s12954-020-00425-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting HIV and hepatitis C (HCV). Compared to men, WWID are also less present in harm reduction programs such as needle exchange programs (NEP). The aim of this study is to investigate reasons for, and barriers to, participation in NEP among WWID in Sweden, and to identify measures that could be taken to strengthen the program and increase participation among WWID. METHOD In-depth interviews (IDIs) were conducted with 20 WWID who had participated in the Stockholm NEP for at least six months and was over 18 years old. IDIs were audio recorded and transcribed et verbatim. Qualitative content analysis was used to identify themes. RESULTS The need for sterile injection equipment was identified as the main driver to join and remain in the NEP program. Continuous participation in the NEP was further driven by easy access to a multitude of health-related services. The most valued service was the sexual and reproductive health services (SRHR), allowing participants to access contraceptives, cervical cancer screening and sexually transmitted infections testing (STI-testing). NEP staffs' respectful treatment of participants further contributed to program participation. However, participants also expressed a number of concerns around NEP participation, which created barriers to joining. These included losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area and fear of receiving positive HIV/HCV test results. Practical barriers included limited opening hours and travel distance to the NEP. To strengthen the program, most participants requested additional SRHR services. Most participants also proposed some form of "women only" access to the NEP, to strengthen the feeling of the NEP as a safe space. CONCLUSION This study identified factors that may increase uptake of NEP among WWID. Additional SRHR services and "women only" access are recommended to be implemented and evaluated as part of NEP. These findings may inform and improve the current scale-up of NEPs in Sweden to ensure equal access to services.
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Affiliation(s)
- Malin Värmå Falk
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - Susanne Strömdahl
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Helena Dahlborn
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Shirley-Beavan S, Roig A, Burke-Shyne N, Daniels C, Csak R. Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barcelona, Spain. Harm Reduct J 2020; 17:78. [PMID: 33076931 PMCID: PMC7574529 DOI: 10.1186/s12954-020-00429-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that are available suggest that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; and a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life changing and life affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.
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Affiliation(s)
| | - Aura Roig
- Metzineres. Environments of Shelter for Womxn Who Use Drugs Surviving Violence, c/o ICEERS, Carrer de Sepúlveda, 65, Oficina 2, 08015, Barcelona, Spain
| | | | - Colleen Daniels
- Harm Reduction International, 61 Mansell Street, London, E1 8AN, UK
| | - Robert Csak
- Harm Reduction International, 61 Mansell Street, London, E1 8AN, UK
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El-Bassel N, Norcini Pala A, Mukherjee TI, McCrimmon T, Mergenova G, Terlikbayeva A, Primbetova S, Witte SS. Association of Violence Against Female Sex Workers Who Use Drugs With Nonfatal Drug Overdose in Kazakhstan. JAMA Netw Open 2020; 3:e2020802. [PMID: 33044551 PMCID: PMC7550967 DOI: 10.1001/jamanetworkopen.2020.20802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Female sex workers (FSWs) who use drugs face increased risk of intimate partner violence (IPV) and nonpartner violence (NPV). The association between violence and drug overdose is unknown. OBJECTIVE To examine the association between IPV, NPV, and nonfatal drug overdose among FSWs who use drugs in Kazakhstan. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 400 adult FSWs in Kazakhstan who reported illicit drug use in the past year, exchanged sex for money or drugs, and reported having unprotected sex in the past 90 days. Baseline data were collected from February 2015 to May 2017 from Project Nova, an HIV prevention study among FSWs who use drugs in Kazakhstan. Data analysis was conducted from April 2019 to March 2020. EXPOSURES Lifetime and recent (past 90 day) experiences of physical, sexual, and psychological IPV and NPV using the Revised Conflict Tactics Scale. Subtypes of violence were identified using exploratory factor analysis. MAIN OUTCOMES AND MEASURES Lifetime and recent incidence of nonfatal overdose; sociodemographic characteristics as well as lifetime and recent sex work and drug use behaviors were also collected. RESULTS The 400 participants had a mean (SD) age of 34.1 (8.4) years. Most experienced food insecurity (358 [89.5%]) and homelessness (232 [58.0%]) in the past 90 days; one-third (130 [32.5%]) reported a history of incarceration. Most (359 [89.7%]) experienced some form of violence; 150 (37.5%) reported a lifetime nonfatal overdose, of whom 27 (18.0%) reported nonfatal overdose in the past 90 days. Lifetime severe physical violence (adjusted odds ratio [aOR], 1.27; 95% CI, 1.02-1.59; P = .03), engagement in sex work for more than 10 years (aOR, 2.54; 95% CI, 1.50-4.28; P < .001), and a history of incarceration (aOR, 4.34; 95% CI, 2.58-7.32; P < .001) were associated with greater odds of nonfatal overdose. Engaging in sex work for more than 10 years (aOR, 3.97; 95% CI, 1.36-11.61; P = .01) and a history of incarceration (aOR, 3.63; 95% CI, 1.39-9.48; P = .008) were associated with greater odds of recent nonfatal overdose. CONCLUSIONS AND RELEVANCE In this study, violence against FSWs who use drugs in Kazakhstan was associated with increased odds of nonfatal overdose. Harm reduction programs for women should consider including services to address gender-based violence and the needs of women after incarceration.
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Affiliation(s)
- Nabila El-Bassel
- Columbia University School of Social Work, Columbia University, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Andrea Norcini Pala
- Columbia University School of Social Work, Columbia University, New York, New York
| | - Trena I. Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tara McCrimmon
- Columbia University School of Social Work, Columbia University, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | | | - Susan S. Witte
- Columbia University School of Social Work, Columbia University, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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71
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Meyers SA, Smith LR, Luisa Mittal M, Strathdee SA, Garfein RS, Guise A, Werb D, Rafful C. The role of gender and power dynamics in injection initiation events within intimate partnerships in the US-Mexico border region. CULTURE, HEALTH & SEXUALITY 2020; 22:1080-1095. [PMID: 31625809 PMCID: PMC7771651 DOI: 10.1080/13691058.2019.1651903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Women's initiation into injection drug use often establishes a pattern of risk following first injection. This study explored sources of gendered power dynamics in injection initiation experiences for people who inject drugs. A qualitative subsample from two prospective community-recruited cohorts of people who inject drugs in San Diego and Tijuana provided data on the contexts surrounding injection initiation processes. Intimate partnerships were identified in initiation; sub-themes were identified drawing on three concepts within the theory of gender and power. With reference to sexual division of labour, men were often responsible for access to resources in partnerships across both contexts, although there were limited accounts of women obtaining those resources. Extending the structure of power, women in San Diego reported that initiation events involving an intimate partner occurred from a position of vulnerability but expressed greater agency when providing initiation assistance. With regard to structure of cathexis, social norms proscribing injection initiation among women exist, particularly in Tijuana. Gendered power dynamics are a multifaceted component of injection initiation events, especially for women in intimate partnerships. These results stress the need for nuance in understanding the intersection of risk, gender and harm reduction within injection initiation events across socio-cultural contexts.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Facultad de Medicina, Universidad Xochicalco, Tijuana, Baja California, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andy Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Addison House, Guy's Hospital, King's College London, London, UK
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Claudia Rafful
- Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Center for Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
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72
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Hatashita H, Cooper C. An evaluation of knowledge and concerns in women of child-bearing potential living with chronic hepatitis C infection. CANADIAN LIVER JOURNAL 2020; 3:294-299. [DOI: 10.3138/canlivj-2019-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022]
Abstract
Background: There is little research focused on women living with the hepatitis C virus (HCV). We evaluated the knowledge, opinions, and concerns of women living with HCV of child-bearing potential. We specifically focused on pregnancy-related and child rearing issues. Methods: Fifteen women aged 29 to 45 seen at The Ottawa Hospital Viral Hepatitis Program between July 2017 and June 2018 consented and completed a questionnaire. Eighty percent were born in Canada. The average duration of infection was 7.2 years. Results: The majority (67%–93%) of respondents reported health concerns, fear of stigma, and shame related to their HCV diagnoses. Most (80%) feared transmitting HCV to their partner. Women are more willing to seek a partner and/or have children if they are cured of HCV. HCV-specific knowledge—as it pertains to transmission risk and direct-acting antiviral (DAA) safety during pregnancy and child rearing—was suboptimal and did not correlate with education level. All participants expressed a high degree of desire to receive DAA therapy. Conclusions: Better strategies to increase HCV-specific knowledge in women of child-bearing potential are required. Efforts to increase screening and treatment access in this population are warranted.
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Affiliation(s)
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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73
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Karamouzian M, Nasirian M, Ghaffari Hoseini S, Mirzazadeh A. HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1923-1937. [PMID: 31701288 DOI: 10.1007/s10508-019-01574-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23% (95% confidence interval [CI] 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran.
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Affiliation(s)
- Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maryam Nasirian
- Biostatistics and Epidemiology Department, and Infectious Diseases and Tropical Medicine Research Center, School of Public Health, Isfahan University of Medical Sciences, Hezarjarib Blvd., Isfahan, 8174673461, Iran.
| | - Shervin Ghaffari Hoseini
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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74
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Understanding the Family Planning Needs of Female Participants in a Syringe Exchange Program: A Needs Assessment and Pilot Project. J Addict Med 2020; 13:366-371. [PMID: 31589180 DOI: 10.1097/adm.0000000000000508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the reproductive health needs of women who inject drugs (WWID) and are participants in a syringe exchange program (SEP) in Hawaii. Our secondary objective was to develop and pilot services in response to those needs. METHODS We conducted a reproductive health needs-assessment of women participating in the SEP. We also documented the perspectives and recommendations of key informants who work closely with women in this program. This needs-assessment informed a pilot contraceptive project at the SEP. RESULTS We received surveys from 50 syringe exchange participants and hosted 1 focus group with 6 participants. We completed 8 key informant interviews. The majority of survey respondents indicated that they did not want to become pregnant in the next year, but most were not using a reliable method of contraception. Additionally, for most respondents, prevention of pregnancy was a lower priority than other health and wellness needs. Focus group participants and key informants emphasized the importance of developing a network of accessible providers to address reproductive health needs, and also the importance of using the principles of trauma-informed care when developing a service. We developed a pilot program to offer contraceptive injections at the syringe exchange program. In the first 6 months of offering the service, 1 participant elected to use the injection. CONCLUSIONS WWID participating in this SEP may not prioritize their family planning needs when other health and safety needs are unmet. A pilot program to offer contraceptive injections at SEP had almost zero uptake.
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75
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Meyers SA, Smith LR, Werb D. Preventing transitions into injection drug use: A call for gender-responsive upstream prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102836. [PMID: 32679459 DOI: 10.1016/j.drugpo.2020.102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 01/30/2023]
Abstract
In 2017, there were large increases (260-500%) in overdose deaths among women in the United States across age groups (30-64 years and 55-64 years). In addition, U.S. women who inject drugs (WWID) are at increased risk for substance use-related disease transmission, bacterial infections, as well as sexual and physical violence compared to men who inject drugs. Relatedly, women face unique access barriers to substance use-related services, such as stigma and low coverage of gender-specific drug use-related services. Despite these heightened risks experienced by WWID, interventions specifically tailored to preventing women from transitioning into injection drug use have not been developed to date. As such, we advocate for the development of gender-responsive programs to prevent injection drug use initiation. This is critical to ensuring a comprehensive approach to preventing injection drug use initiation among those populations at highest risk of injection-related morbidity and mortality.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1T8, Canada.
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76
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Bach P, Hayashi K, Milloy MJ, Nosova E, Kerr T, Wood E, Fairbairn N. Characterising the increasing prevalence of crystal methamphetamine use in Vancouver, Canada, from 2006-2017: A gender-based analysis. Drug Alcohol Rev 2020; 39:932-940. [PMID: 32666650 DOI: 10.1111/dar.13126] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/06/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Methamphetamine use is increasing in North America and is associated with numerous negative health effects and social harms. As drug-related harms are often gendered, this study sought to examine the differential impacts of gender on the trends, risk factors and health implications of crystal methamphetamine use among a Canadian cohort of people with high rates of injection polysubstance use. METHODS Data were collected from two prospective cohorts of people who inject drugs in Vancouver, Canada. We examined trends in reported crystal methamphetamine use from 2006-2017 using the Cochrane-Armitage test for trend. We used multivariable generalised estimating equations, stratified by gender, to determine independent risk factors and health outcomes associated with crystal methamphetamine use. RESULTS In total, 1984 participants were included in the study, including 694 (35%) women. The prevalence of reported crystal methamphetamine use within the previous 6 months rose from 19% in 2006 to 36% in 2017, with a rise seen in both genders (P < 0.001). Reported crystal methamphetamine use was associated with numerous risk behaviours and drug-related harms in both genders, and in women it was associated with an increase in experiences of sexual violence (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.27). CONCLUSIONS These findings demonstrate the rising prevalence of reported crystal methamphetamine use in Vancouver in a cohort with high rates of polysubstance use. This work highlights drug and sex-related risk behaviours associated with crystal methamphetamine use for both genders, and underscores the need to develop strategies to address the growing use of crystal methamphetamine.
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Affiliation(s)
- Paxton Bach
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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77
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Fleming T, Valleriani J, Ng C, Maher L, Small W, McNeil R. Acceptability of a hypothetical preventative HIV vaccine among people who use drugs in Vancouver, Canada. BMC Public Health 2020; 20:1081. [PMID: 32646390 PMCID: PMC7350753 DOI: 10.1186/s12889-020-09202-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). METHODS We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Vancouver, Canada. Participants were recruited from an ongoing prospective cohort of HIV-negative PWUD. Data were coded using NVivo, and analyzed thematically. RESULTS Acceptability was framed by practical considerations such as cost and side effects, and was influenced by broader trust of government bodies and health care professionals. While an HIV vaccine was perceived as an important prevention tool, willingness to be vaccinated was low. Results suggest that future vaccine implementation must consider how to minimize the burden an HIV vaccine may place on PWUD. Centering the role of health care providers in information dissemination and delivery may assist with uptake. CONCLUSIONS Our findings suggest improvements in care and improved patient-provider relationships would increase the acceptability of a potential HIV vaccine among this population.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Valleriani
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- National Institute for Cannabis Health and Education, Toronto, ON, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Burnet Institute, Melbourne, VIC, Australia
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
- Program in Addiction Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA.
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78
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Ely GE, Linn BK, Staton M, Hales TW, Agbemenu K, Maguin E. Contraceptive use in Appalachian women who use drugs and were recruited from rural jails. SOCIAL WORK IN HEALTH CARE 2020; 59:365-386. [PMID: 32614736 PMCID: PMC7337968 DOI: 10.1080/00981389.2020.1769249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
This study describes a secondary data analysis of contraceptive use across the lifetime and within the six months prior to incarceration in a sample of 400 currently incarcerated women recruited from rural, Appalachian jails, who were using drugs prior to incarceration. Phase 1 (baseline) data from an NIH funded study were used to examine rates of contraceptive use, reasons for nonuse of condoms, and correlates of condom use. Results indicate that the majority (96.5%) of respondents reported lifetime use of contraceptives, and most (70.5%) had a history of using multiple methods, with male condoms, oral contraceptive pills, and contraceptive injections being the most commonly used methods. Almost 69% of respondents reported nonuse of contraceptives within the last six months, despite high rates of involvement in risky, intimate male partnerships prior to incarceration. Contraceptive use was found to be historically acceptable in this sample, in stark contrast to rates of use within the last six months prior to incarceration, suggesting that reproductive justice-informed, social work interventions to help improve current contraceptive use are warranted as a harm-reduction approach.
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Affiliation(s)
- Gretchen E Ely
- School of Social Work, University at Buffalo, The State University of New York , Buffalo, NY, USA
| | - Braden K Linn
- Clinical and Research Institute on Addictions, University at Buffalo , Buffalo, NY, USA
| | - Michele Staton
- College of Medicine, Department of Behavioral Sciences, University of Kentucky , Lexington, KY, USA
| | - Travis W Hales
- School of Social Work, University at North Carolina-Charlotte , Charlotte, NC, USA
| | | | - Eugene Maguin
- Department of Psychology, University at Buffalo , Buffalo, NY, USA
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Lewer D, Hope VD, Harris M, Kelleher M, Jewell A, Pritchard M, Strang J, Morley KI. Incidence and treatment costs of severe bacterial infections among people who inject heroin: A cohort study in South London, England. Drug Alcohol Depend 2020; 212:108057. [PMID: 32422537 PMCID: PMC7301433 DOI: 10.1016/j.drugalcdep.2020.108057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections. METHODS For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions. RESULTS During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69-77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32-1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million. CONCLUSIONS People who inject heroin have extreme and long-term risk of severe bacterial infections.
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Affiliation(s)
- Dan Lewer
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK.
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, 3rd Floor, Exchange Station, Tithebarn Street, Liverpool L2 2QP, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Michael Kelleher
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Amelia Jewell
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, Level 3, 207 Bouverie Street, The University of Melbourne Victoria 3010 Australia; RAND Europe, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK
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80
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Li L, Lin C, Liang LJ, Pham QL, Feng N, Nguyen AT. HCV infection status and care seeking among people living with HIV who use drugs in Vietnam. AIDS Care 2020; 32:83-90. [PMID: 32297556 DOI: 10.1080/09540121.2020.1739209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
HCV co-infection is widespread among people living with HIV who use drugs (PLHWUD). However, HCV testing was inconsistently implemented among PLHWUD. The low infection awareness and mental health challenges together impede PLHWUD's treatment-seeking. The study used baseline data of a randomized controlled trial conducted in Vietnam. HCV infection status was collected through self-report and medical record review. A linear mixed-effects regression model was used to examine the relationships between PLHWUD's perceived barriers to seeking healthcare, their depressive symptoms, and the consistencies in HCV status reports. Among the 181 PLHWUD in the study, one-third (64; 35.4%) had inconsistent self-reports and medical records of HIV infection status. The agreement between the two records was fair (Kappa statistics = 0.43). PLHWUD with consistent HCV infection confirmed by both medical records and self-reports perceived lower levels of healthcare-seeking barriers than those with discrepant HCV reports (estimated difference = -1.59, SE = 0.71, P = 0.027). Depressive symptoms were significantly correlated with healthcare-seeking barriers among those with discrepant HCV results (estimate = 0.17, SE = 0.06, P = 0.007). There is an urgent need to extend HCV screening efforts and increase HCV awareness among PLHWUD. Explicit HCV result notification and integrated mental health support are recommended to facilitate patients' access to needed care.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior - Center for Community Health, the University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior - Center for Community Health, the University of California, Los Angeles, CA, USA
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior - Center for Community Health, the University of California, Los Angeles, CA, USA
| | - Quang Loc Pham
- Semel Institute for Neuroscience and Human Behavior - Center for Community Health, the University of California, Los Angeles, CA, USA
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior - Center for Community Health, the University of California, Los Angeles, CA, USA
| | - Anh Tuan Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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81
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Mandel E, E Kendall C, Mason K, Guyton M, Lettner B, Broad J, Altenberg J, Donelle J, Powis J. Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto. CANADIAN LIVER JOURNAL 2020. [DOI: 10.3138/canlivj-2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The majority of new hepatitis C (HCV) cases occur among people who inject drugs. In recent years, multidisciplinary models of HCV treatment have emerged that demonstrate successful treatment outcomes for this population, as well as broad positive individual- and system-level impacts. Our objective was to evaluate changes in health care use among a cohort of people living with HCV before and after engagement with one such program. Methods: Program data were uniquely linked to provincial health administrative databases. Rates of emergency department (ED) visits and hospital admissions of clients from 2011 through 2015 ( N = 103) were evaluated using linkages with administrative data for the 2 years before and after program initiation. Data were evaluated using negative binomial regression models with a covariance structure to account for within-individual correlations. Results: Of participants, 72.8% were men (mean age 47 years), and 38% experienced high rates of physical and mental health comorbidity (Aggregated Diagnosis Group score ≥10). Female clients had significantly fewer ED visits 2 years after program initiation (5.04 versus 3.12; risk ratio [RR] 0.61 [95% CI 0.44% to 0.86%]). ED visits for infectious diseases and soft tissue injury were significantly lower for the cohort overall (RRs 0.58 0.51 [95% CIs 0.35% to 0.95% and 0.29% to 0.90%], respectively). Conclusion: Co-locating HCV treatment within comprehensive primary care and harm reduction services appears to have benefits beyond HCV, including a reduction in ED visits among women and a decrease in ED visits for soft tissue infections for all participants.
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Affiliation(s)
- Erin Mandel
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jennifer Broad
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Ontario
- Michael Garron Hospital, Toronto, Ontario
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82
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Mandel E, E Kendall C, Mason K, Guyton M, Lettner B, Broad J, Altenberg J, Donelle J, Powis J. Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto. CANADIAN LIVER JOURNAL 2020; 3:203-211. [DOI: 10.3138/canlivj.2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/14/2019] [Indexed: 11/20/2022]
Abstract
Background: The majority of new hepatitis C (HCV) cases occur among people who inject drugs. In recent years, multidisciplinary models of HCV treatment have emerged that demonstrate successful treatment outcomes for this population, as well as broad positive individual- and system-level impacts. Our objective was to evaluate changes in health care use among a cohort of people living with HCV before and after engagement with one such program. Methods: Program data were uniquely linked to provincial health administrative databases. Rates of emergency department (ED) visits and hospital admissions of clients from 2011 through 2015 ( N = 103) were evaluated using linkages with administrative data for the 2 years before and after program initiation. Data were evaluated using negative binomial regression models with a covariance structure to account for within-individual correlations. Results: Of participants, 72.8% were men (mean age 47 years), and 38% experienced high rates of physical and mental health comorbidity (Aggregated Diagnosis Group score ≥10). Female clients had significantly fewer ED visits 2 years after program initiation (5.04 versus 3.12; risk ratio [RR] 0.61 [95% CI 0.44% to 0.86%]). ED visits for infectious diseases and soft tissue injury were significantly lower for the cohort overall (RRs 0.58 0.51 [95% CIs 0.35% to 0.95% and 0.29% to 0.90%], respectively). Conclusion: Co-locating HCV treatment within comprehensive primary care and harm reduction services appears to have benefits beyond HCV, including a reduction in ED visits among women and a decrease in ED visits for soft tissue infections for all participants.
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Affiliation(s)
- Erin Mandel
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jennifer Broad
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Ontario
- Michael Garron Hospital, Toronto, Ontario
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83
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Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, McNeil R. "Bed Bugs and Beyond": An ethnographic analysis of North America's first women-only supervised drug consumption site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102733. [PMID: 32247720 DOI: 10.1016/j.drugpo.2020.102733] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically 'gender-neutral', thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some women's access. Such dynamics highlight the significance of North America's first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores women's lived experiences of this unique harm reduction intervention. METHODS Ethnographic research was conducted from May 2017 to June 2018 to explore women's experiences with SisterSpace in Vancouver's Downtown Eastside, an epicenter of Canada's overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. FINDINGS The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as 'deviant' and 'victims', enabling knowledge-sharing of experiences through a gendered lens. CONCLUSION SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.
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Affiliation(s)
- 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, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Jennifer Lavalley
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sandra Czechaczek
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Thomas Kerr
- 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, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, 2052, Australia and Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Ryan McNeil
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA; General Internal Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA
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84
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Platt L, Harris M, Sweeney S. Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs. Addiction 2020; 115:714-715. [PMID: 31953895 DOI: 10.1111/add.14918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Magdalena Harris
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sedona Sweeney
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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85
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Valencia J, Alvaro-Meca A, Troya J, Gutiérrez J, Ramón C, Rodríguez A, Vázquez-Morón S, Resino S, Moreno S, Ryan P. Gender-based vulnerability in women who inject drugs in a harm reduction setting. PLoS One 2020; 15:e0230886. [PMID: 32226042 PMCID: PMC7105126 DOI: 10.1371/journal.pone.0230886] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background and aims In comparison with men, women who use drugs (WWUD) have considerably more frequent and intense experiences with interpersonal violence, sexual abuse and trauma. The aim of this study was to identify issues related to gender-based vulnerability in a group of WWUD attended in a harm reduction facility in Madrid, Spain. Material and methods A cross-sectional study was conducted during a screening of blood borne infections. We included WWUD (smoked or injected heroin/cocaine) who were actively screened for HIV, HBV and HCV in a harm reduction setting in Madrid (Spain) from January to December 2017. WWUD were interviewed for gender-based abuse or violence using a face-to-face questionnaire by a trained interviewer. Aspects related to their social-epidemiological condition and gender-based vulnerability were collected. Results We included 109 women who were actively using drugs. The median age was 39 (IQR 35–47) years, 84.4% were Spanish born, 22.9% were homeless, 43 (41.7%) had ever used injected drugs, 29 (26.6%) were currently using injected drugs, and 27.1% had mental health disorders. Aspects related to gender-based vulnerability were collected. Among those surveyed, they reported having ever suffered emotional or psychological damage (88%), having experienced at least one incident of serious physical injury by a male partner (71%), and having ever suffered sexual abuse (49%). In addition, 28% had ever exchanged sex for money/drugs. When compared to women that did not use injecting drugs, those who injected drugs had more frequently exchanged sex for money/drugs (55% vs 21%, p = 0.003). Conclusions A high proportion of WWUD suffer psychological or physical violence by partners denoting gender-based vulnerability. Interventions in harm reduction settings with a multidisciplinary and gender-based approach should be implemented.
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Affiliation(s)
- Jorge Valencia
- Harm Reduction Unit “SMASD”; Subdirección General de Adicciones; SERMAS, Madrid, Spain
- Non-Governmental Organization “Madrid Positivo”, Madrid, Spain
- * E-mail:
| | - Alejandro Alvaro-Meca
- Unit of Preventive Medicine and Public Health, Rey Juan Carlos University, Alcorcon, Madrid, Spain
| | - Jesús Troya
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jorge Gutiérrez
- Non-Governmental Organization “Madrid Positivo”, Madrid, Spain
| | - Cristina Ramón
- Non-Governmental Organization “Madrid Positivo”, Madrid, Spain
| | | | - Sonia Vázquez-Morón
- Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Salvador Resino
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, University of Alcalá de Henares, Madrid, Spain
| | - Pablo Ryan
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Complutense de Madrid University (UCM), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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86
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Collins AB, Boyd J, Czechaczek S, Hayashi K, McNeil R. (Re)shaping the self: An ethnographic study of the embodied and spatial practices of women who use drugs. Health Place 2020; 63:102327. [PMID: 32224291 DOI: 10.1016/j.healthplace.2020.102327] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
While gendered experiences of drug use have been well-established, understanding how women resist structures that constrain their agency is important for mitigating drug-related harms, especially as overdose has become North America's leading cause of accidental death. Drawing on the intersectional risk environments of WWUD, this ethnographic study examined how gendered expectations of women's drug use, appearance, and comportment influenced vulnerability to overdose within the context of a fentanyl-driven overdose crisis. This community-engaged ethnography, conducted in Vancouver, Canada from May 2017 to December 2018, included in-depth interviews with 35 marginally-housed WWUD (transgender-inclusive) and approximately 100 h of fieldwork in single room accommodation (SRA) housing and an established street-based drug scene. Data were analyzed thematically with attention to embodiment, agency, and intersectionality. Findings highlight how gendered expectations and normative violence impacted women's use of space, both in the drug scene and SRAs. To resist efforts to 'discipline' their bodies, participants engaged in situated gender performances. Physical appearance was also deemed critical to managing drug use disclosure. Participants adopted gendered embodied practices, including altered consumption methods or injecting in less visible areas, to conceal their use from peers and at times, their partners. To resist harms associated with involuntary disclosure, participants often used alone in SRAs or in public spaces. While such practices allowed women to exert agency within constraining systems, they concurrently heightened overdose risk. Findings demonstrate how women engaged in everyday acts of resistance through embodied drug use practices, which increased their agency but elevated overdose risk. Implementing gender-specific programs that increase bodily agency and control (e.g. low-threshold services for personal care, women-focused harm reduction support) are needed to reduce risk of overdose for WWUD.
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Affiliation(s)
- Alexandra B Collins
- School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, United States.
| | - 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
| | - Sandra Czechaczek
- British Columbia Centre on Substance Use, 400 - 1045, Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400 - 1045, Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888, University Drive, Burnaby, BC V5A 1S6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400 - 1045, Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, United States; Program in Addiction Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, United States
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87
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Factors Associated With the Use of Supervised Consumption Facilities Among Women Who Inject Drugs in a Canadian Setting. J Addict Med 2020; 14:e226-e232. [PMID: 32142059 DOI: 10.1097/adm.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Supervised consumption facilities (SCFs) are evidence-based harm reduction interventions that have been shown to reduce the risk of social and health-related harms associated with injection drug use. Previous qualitative studies have highlighted important motivations for SCF use among women who use drugs. However, factors associated with SCF use among women have not previously been evaluated. METHODS Data were obtained from 2 longitudinal community-recruited cohorts of people who use drugs in Vancouver, Canada between 2003 and 2017. Multivariable generalized estimating equations were used to calculate the odds of SCF use associated with social and structural risk factors for drug-related harm among women who reported injection drug use in the preceding 6-months. RESULTS A total of 795 participants were included in the study, contributing to 6302 interviews, with 602 participants (76%) reporting SCF use in at least one interview. Multivariable analysis demonstrated daily heroin and crystal methamphetamine injection (Adjusted Odds Ratio [AOR] = 1.32 and 1.65, respectively), injecting in public (AOR = 1.77), binge injection (AOR = 1.22) and lack of housing (AOR = 1.74) to be associated with SCF use. CONCLUSIONS The current study demonstrates higher intensity patterns of drug use, including daily heroin and crystal methamphetamine injection, injecting in public and binge injection, as well as homelessness to be associated with SCF use among women. Future research should identify barriers to SCF use among women to minimize the risk of overdose and other drug-related harms.
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88
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Kåberg M, Karlsson N, Discacciati A, Widgren K, Weiland O, Ekström AM, Hammarberg A. Significant decrease in injection risk behaviours among participants in a needle exchange programme. Infect Dis (Lond) 2020; 52:336-346. [PMID: 32072841 DOI: 10.1080/23744235.2020.1727002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and aims: Sharing of unsterile injection equipment contributes to transmission of hepatitis C virus (HCV), HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) but is largely preventable through needle exchange programmes (NEP). Sweden has been one of the last countries in Europe to scale up access to NEP for PWID, who consequently have high prevalence rates of HCV and HIV. The aim of the study was to investigate demographic and drug-related determinants of injection risk behaviours, sharing of needle/syringe and paraphernalia, and patterns of change over time in subgroups of PWID participating in the Stockholm NEP.Methods: The Stockholm NEP started in 2013 as the first formal NEP in the region. A total of 2860 PWID were included in this prospective open cohort study. The association between demographic and drug-related determinants and injection risk behaviours were analysed at baseline and followed up at 6, 12, 24, 36 and 48 months post-enrolment.Results: The following factors were associated with high levels of injection risk behaviours at inclusion: female gender, homelessness, low education level, younger age, amphetamine use, not in opioid substitution therapy (OST), being HIV negative and being HCV positive. We found an overall significant decrease in injection risk behaviours over time among participants. Not previously investigated in depth, we found that subgroups of participants varied in degrees of injection risk behaviour reduction over time and that women decreased injection risk behaviours faster than men. Enrolment in OST, HIV positive and age <25 years at inclusion were not associated with a decrease in injection risk behaviours over time.Conclusions: In this prospective cohort study over 4 years, we found that NEP participation was associated with a significant decrease in injection risk behaviours.
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Affiliation(s)
- Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Widgren
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ola Weiland
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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89
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Lancaster KE, Cooper HLF, Browning CR, Malvestutto CD, Bridges JFP, Young AM. Syringe Service Program Utilization, Barriers, and Preferences for Design in Rural Appalachia: Differences between Men and Women Who Inject Drugs. Subst Use Misuse 2020; 55:2268-2277. [PMID: 32748730 PMCID: PMC7584727 DOI: 10.1080/10826084.2020.1800741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Carlos D Malvestutto
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - John F P Bridges
- Departments of Biomedical Informatics and Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
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90
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Women's utilization of housing-based overdose prevention sites in Vancouver, Canada: An ethnographic study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102641. [PMID: 31887644 DOI: 10.1016/j.drugpo.2019.102641] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In response to a fentanyl-driven overdose crisis, low-threshold supervised consumption sites, termed overdose prevention sites (OPS), have been rapidly implemented in Vancouver, Canada. Since approximately 88% of fatal overdoses in the province occur indoors, OPS have been integrated into select non-profit-operated single room accommodations (SRA) housing. We examined the social-structural features of these housing-based OPS (HOPS) on women's overdose risk. METHODS Ethnographic research was conducted from May 2017 to December 2018 in Vancouver. Data included 35 in-depth interviews with women who use drugs living in SRAs and approximately 100 h of observational fieldwork in SRAs and surrounding areas. Data were analyzed using an intersectional risk environment approach, with attention to equity and violence. FINDINGS Findings demonstrate that the social and structural environments of HOPS created barriers for women to access these interventions, resulting in an increased overdose risk. Primary barriers included uncertainty as to who else was accessing HOPS, rules prohibiting smoking, and a lack of trust in staff's abilities to effectively respond to an overdose. Most participants considered HOPS to be unsafe environments, and expressed fear of violence from residents and/or guests. The perceived risk of violence was informed by previous experiences of assault and the witnessing of violence. Many participants thus consumed drugs alone in their rooms to better control their safety, despite heightened overdose risk. Further, most participants did not perceive themselves to be at risk of an overdose due to drug use practices and tolerance levels, and viewed using alone as a safer option than HOPS. CONCLUSION Findings highlight how the low-barrier design and operation of HOPS can undermine women's engagement with HOPS. Overdose prevention strategies in SRAs should also include gender-specific models (e.g. women-only HOPS, women peer workers) to help mitigate barriers to these services within the context of the current overdose crisis.
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91
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Goldenberg S, Watt S, Braschel M, Hayashi K, Moreheart S, Shannon K. Police-related barriers to harm reduction linked to non-fatal overdose amongst sex workers who use drugs: Results of a community-based cohort in Metro Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102618. [PMID: 31838244 DOI: 10.1016/j.drugpo.2019.102618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND High rates of overdose and overdose-related mortality in North America represent a pressing health and social concern. Women sex workers face severe health and social inequities, which have been linked to structural factors including negative police interactions; however, little is known regarding the burden of overdose or how policing impacts overdose risk amongst sex workers who use drugs. Given this, we aimed to explore the independent effects of experiencing police-related barriers to harm reduction on non-fatal overdose amongst women sex workers who use drugs in Metro Vancouver, Canada over a 7.5-year period. METHODS Data were drawn from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women sex workers in Metro Vancouver, from 2010 to 2017. Using multivariate logistic regression with generalized estimating equations (GEE), we used a confounder modeling approach to identify the independent effect of experiencing police-related barriers to harm reduction strategies on non-fatal overdose amongst sex workers using drugs within the last six months at each study visit. RESULTS Amongst 624 participants, 7.7% overdosed within the last six months at baseline and 27.6% overdosed during the study period, contributing 287 non-fatal overdose events over the 7.5-year period. 68.6% reported police-related barriers to harm reduction strategies during the study. In a multivariate confounder model, exposure to police-related barriers to harm reduction strategies [AOR: 2.15, CI: 1.60-2.90] was independently associated with higher odds of non-fatal overdose after adjustment for key confounders. CONCLUSIONS Our findings suggest that in the context of the current overdose crisis, adversarial policing practices may undermine access to lifesaving overdose prevention services and exacerbate overdose risks for marginalized women. Findings underscore the urgent need to scale-up access and remove barriers to progressive harm reduction strategies for women sex workers.
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Affiliation(s)
- Shira Goldenberg
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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92
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Prangnell A, Imtiaz S, Karamouzian M, Hayashi K. Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies. Drug Alcohol Rev 2019; 39:71-82. [PMID: 31758602 DOI: 10.1111/dar.13001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/29/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022]
Abstract
ISSUES Childhood abuse is a public health challenge with lifelong impacts, including future drug use. However, previous research has been mixed regarding impacts on injection drug use. This systematic review examines the impact of childhood abuse (sexual, physical and emotional) on adult injection drug use. APPROACH We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and grey literature to identify relevant studies from database inception to 26 September 2018. Studies were eligible if: (i) they were empirical original research published in English; (ii) considered childhood abuse as potential risk factors for lifetime history of injection drug use; and (iii) included adult participants. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. KEY FINDINGS Of the 1994 articles screened, 17 studies met the inclusion criteria. Most studies were conducted in the USA and utilised cross-sectional research designs. All of the 17 studies measured sexual abuse, six studies measured physical abuse and three studies measured emotional abuse; most (N = 11) of which reported a statistically significant and positive association between at least one sub-scale of childhood abuse and injection drug use. IMPLICATIONS Our findings highlight the need for devising interventions to reduce the harms associated with childhood abuse. CONCLUSIONS The evidence base suggests a significant positive association between experiences of childhood physical abuse and elevated risks of injection drug initiation with mixed results for sexual and emotional abuse.
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Affiliation(s)
- Amy Prangnell
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sameer Imtiaz
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada.,HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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93
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Latent Classes of Sexual Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Among Women Who Inject Drugs Across 20 US Cities. J Acquir Immune Defic Syndr 2019; 79:305-314. [PMID: 30044301 DOI: 10.1097/qai.0000000000001816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Monitoring the effects of HIV prevention efforts among persons who inject drugs is key to informing prevention programs and policy. METHODS Data for this study came from the 2012 National HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities. The present analyses include those who identified as female, ever had sex with a man, and were at risk of HIV infection (did not report a previous positive HIV test result) (n = 2624). We conducted latent class analysis to identify sexual risk classes, and modeled associations with engagement in HIV prevention services and HIV test results. RESULTS We identified 6 classes of sexual risk behavior: (1) low risk, (2) monogamous, (3) casual partner, (4) multiple partners, (5) exchange sex, and (6) exchange plus main partner. The class distribution was similar across the mainland regions. Bisexual orientation and homelessness were significant predictors of higher-risk class. HIV prevalence and participation in behavioral interventions did not vary significantly by risk class, while obtaining and using free condoms did. Independent of risk class, women in cities in the South were significantly less likely to use free condoms, and HIV prevalence was higher among non-Hispanic black women and women aged 40-49 years. CONCLUSIONS Bisexual orientation and homelessness were predictors of higher risk. Condom distribution programs reached fewer women in cities in the South. Race and age disparities in HIV-positive rates persisted after adjusting for sexual risk class.
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94
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Kamel-Khodabandeh A, Mirzaee M, Jahani Y, Sharifi H. Sex under Influence of Drugs: A Nationwide Survey among Iranian Female Sex Workers. ADDICTION & HEALTH 2019; 10:205-215. [PMID: 31263519 PMCID: PMC6593167 DOI: 10.22122/ahj.v10i4.566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Due to the high level of sexual relationships, prostitute women are faced with many dangers, including acquired immune deficiency syndrome (AIDS), sexually transmitted infections (STIs), fertility problems, drug use, etc. In this regard, addict prostitute women are exposed to more risks because drug use is considered as an outstanding factor in those associated with transmission of AIDS and being in an insecure sexual relationship. The purpose of this study was to find out the variables influential on the level of drug use, before or during sexual relationship. Methods In 2010, 625 prostitute women were selected by multistage sampling from 21 centers out of 12 provinces. Then, we used a standard questionnaire for gathering data by a face-to-face interview. The multilevel ordinal logistic regression in survey model was used to find out the relationship between variables and the level of drug use before or during sexual relationship. Findings The number of monetary customers at the last working day [adjusted odds ratio (AOR): 1.87, 95% confidence interval (CI): 1.50-2.32] and having sexual relationship during the past month with monetary customers (AOR: 4.77, 95% CI: 2.61-8.70) were significantly related to the level of drug use before or during sexual relationship in the past month. Conclusion Since the level of drug use before or during sexual relationship was higher in women who had more daily sexual relationships, these women are exposed to the consequences of drug use; thus, identifying the status of this group of women is important to plan for future injuries.
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Affiliation(s)
- Atiyeh Kamel-Khodabandeh
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghaddameh Mirzaee
- Associate Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Associate Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- Associate Professor, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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95
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Le LVN, O’Connor S, Tran TH, Maher L, Kaldor J, Sabin K, Tran HV, Tran QD, Ho VAT, Nguyen TA. High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use. Western Pac Surveill Response J 2019; 10:9-18. [PMID: 32110460 PMCID: PMC7024697 DOI: 10.5365/wpsar.2019.10.1.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The World Health Organization's guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. METHODS We surveyed 1886 women aged ≥ 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. RESULTS Across these provinces, high prevalence of HCV exposure (8.8-30.4%) and active infection (3.6-22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8-37.9), injection drug use (aOR = 23.3; 95% CI: 13.1-41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4-4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2-3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8-39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8-5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2-4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3-3.7) were independently associated with HCV exposure. DISCUSSION FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.
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Affiliation(s)
- Linh-Vi N Le
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | - Siobhan O’Connor
- United States Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Tram Hong Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | - John Kaldor
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | | | | | - Quang Dai Tran
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Van Anh Thi Ho
- United States Centers for Disease Control and Prevention, Hanoi, Viet Nam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
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96
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Collins AB, Bardwell G, McNeil R, Boyd J. Gender and the overdose crisis in North America: Moving past gender-neutral approaches in the public health response. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 69:43-45. [PMID: 31078907 PMCID: PMC10894462 DOI: 10.1016/j.drugpo.2019.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/05/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 12A9, Canada.
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 12A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 12A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 12A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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97
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Lower HCV treatment uptake in women who have received opioid agonist therapy before and during the DAA era: The ANRS FANTASIO project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:61-68. [PMID: 31129024 DOI: 10.1016/j.drugpo.2019.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the era of direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection, HCV treatment uptake remains insufficiently documented in key populations such as people with opioid dependence. Access to opioid agonist therapy (OAT) is facilitated in France through delivery in primary care, and individuals with opioid dependence can be identified as those receiving OAT. Women with opioid dependence are especially vulnerable because of associated sex-related stigma, discrimination, and marginalization, all of which negatively interfere with access to HCV prevention and care. This study, based on data collected between 2012 and 2016 in France, aimed to assess whether (i) chronically HCV-infected women with opioid dependence had lower rates of HCV treatment uptake than their male counterparts during the same period (i.e., study period), and (ii) the advent of DAA resulted in increased treatment uptake rates in these women. METHODS Individuals with opioid dependence were identified as those receiving OAT at least once during the study period. Analyses were based on exhaustive anonymous care delivery data from the French national healthcare reimbursement database. We used multinomial logistic regression to estimate sex-based disparities in HCV treatment uptake (DAA or pegylated-interferon (Peg-IFN)-based treatment versus no treatment) while accounting for potential confounders. RESULTS The study sample comprised 27,127 individuals, including 5640 (20.8%) women. Median [interquartile range] age was 45 [40-49] years. Between 2012 and 2016, 70.9 (women: 77.2; men: 69.3), 17.3 (14.2; 18.2) and 11.7% (8.6%; 12.5%) of the study sample received, respectively, no HCV treatment, DAA and Peg-IFN-based treatment only. After multiple adjustment for potential confounders, women were 41% (adjusted odds-ratio (AOR) [95% confidence interval (CI]): 0.59[0.53-0.65]) and 28% (0.72[0.66-0.78]) less likely than men to have had Peg-IFN-based and DAA treatment, respectively. CONCLUSION Despite increased HCV treatment uptake in women with opioid dependence in the DAA era, rates remain lower than for men. In the coming years, access to DAA treatment will continue to increase in France thanks to a forthcoming simplified model of HCV care which includes primary care as an entry point. Nevertheless, a greater understanding of sex-specific barriers to HCV care and the implementation of appropriate sex-specific measures remain a priority.
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98
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Meyer JP, Isaacs K, El-Shahawy O, Burlew AK, Wechsberg W. Research on women with substance use disorders: Reviewing progress and developing a research and implementation roadmap. Drug Alcohol Depend 2019; 197:158-163. [PMID: 30826625 PMCID: PMC6440852 DOI: 10.1016/j.drugalcdep.2019.01.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Research on women with substance use disorders has expanded, yet knowledge and implementation gaps remain. METHODS Drawing from topics discussed at the 2017 meeting of InWomen's in Montreal, Canada, this article reviews key progress in research on substance use among women, adolescents, and families to delineate priorities for the next generation of research. RESULTS The field has seen significant accomplishments in multiple domains, including the management of pregnant women with substance use and comorbid psychiatric disorders, caring for neonates in opioid withdrawal, greater inclusion of and treatment options for LGBTQ + communities, gendered instrumentation, and gender-focused HIV interventions for adolescent girls and women. Women who use alcohol and other drugs often experience other comorbid medical conditions (chronic Hepatitis C and HIV), contextual confounders (intimate partner violence exposure, homelessness, trauma), and social expectations (e.g., as caretakers) that must be addressed as part of integrated care to effectively treat women's substance use issues. Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. Few dedicated and gender-focused funding opportunities exist and research has been siloed, limiting the potential for collaborations or interdisciplinary cross-talk. CONCLUSION Given renewed attention to substance use in the context of the burgeoning opioid epidemic and shifts in global politics that affect women's substance use, the field requires a strategic rethink to invigorate a pipeline of future research and researchers.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Krystyna Isaacs
- Benten Technologies, 13996 Parkeast Circle, Chantilly, VA, 20151, USA.
| | - Omar El-Shahawy
- New York University School of Medicine, Department of Population Health, 550 First Avenue, New York, NY, 10016, USA.
| | - A Kathleen Burlew
- University of Cincinnati, Department of Psychology, ML 0376, 4150 Edwards One Center, Cincinnati, OH, 45221, USA.
| | - Wendee Wechsberg
- RTI International, Research Triangle Park, 3040 E Cornwallis Rd, Durham, NC, 27709, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA; North Carolina State University, Raleigh, NC, 27695, USA; Duke University School of Medicine, Durham, NC, 27710, USA.
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99
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Boyd J, Collins AB, Mayer S, Maher L, Kerr T, McNeil R. Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada. Addiction 2018; 113:2261-2270. [PMID: 30211453 PMCID: PMC6400212 DOI: 10.1111/add.14417] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/06/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS North America's overdose epidemic is increasingly driven by fentanyl and fentanyl-adulterated drugs. Supervised consumption sites, including low-threshold models (termed overdose prevention sites; OPS), are now being debated in the United States and implemented in Canada. Despite evidence that gendered and racialized violence shape access to harm reduction among women who use drugs (WWUD), this has not been examined in relation to OPS and amid the overdose epidemic. This study explores how overlapping epidemics of overdose and gendered and racialized violence in Vancouver's Downtown Eastside, one of North America's overdose epicenters, impacts how marginalized WWUD experience OPS. DESIGN Qualitative analysis using rapid ethnographic fieldwork. Data collection included 185 hours of naturalistic observation and in-depth interviews; data were analyzed thematically using NVivo. SETTING Vancouver, Canada. PARTICIPANTS Thirty-five WWUD recruited from three OPS. MEASUREMENTS Participants' experiences of OPS and the public health emergency. FINDINGS The rapid onset and severity of intoxication associated with the use of fentanyl-adulterated drugs in less regulated drug use settings not only amplified WWUD's vulnerability to overdose death but also violence. Participants characterized OPS as safer spaces to consume drugs in contrast to less regulated settings, and accommodation of assisted injections and injecting partnerships was critical to increasing OPS access among WWUD. Peer-administered injections disrupted gendered power relations to allow women increased control over their drug use; however, participants indicated that OPS were also gendered and racialized spaces that jeopardized some women's access. CONCLUSION Although women who use drugs in Vancouver, Canada appear to feel that overdose prevention sites address forms of everyday violence made worse by the overdose epidemic, these sites remain 'masculine spaces' that can jeopardize women's access.
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Affiliation(s)
- Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra B Collins
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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100
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Bajis S, Maher L, Treloar C, Hajarizadeh B, Lamoury FMJ, Mowat Y, Schulz M, Marshall AD, Cunningham EB, Cock V, Ezard N, Gorton C, Hayllar J, Smith J, Whelan M, Martinello M, Applegate TL, Dore GJ, Grebely J. Acceptability and preferences of point-of-care finger-stick whole-blood and venepuncture hepatitis C virus testing among people who inject drugs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:23-30. [PMID: 30388566 DOI: 10.1016/j.drugpo.2018.08.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Uptake of hepatitis C virus (HCV) testing remains inadequate globally. Simplified point-of-care tests should enhance HCV diagnosis and elimination. We aimed to assess the acceptability of finger-stick and venepuncture HCV RNA testing among people who inject drugs (PWID). METHODS Participants were enrolled in an observational cohort study with recruitment at 13 sites between June 2016 and February 2018. Capillary whole-blood collected by finger-stick and plasma collected by venepuncture were performed for Xpert® HCV viral load testing. Participants completed a questionnaire on acceptability of, and preferences for, blood collection methods. RESULTS Among 565 participants (mean age, 44 years; 69% male), 64% reported injecting drugs in the last month, and 63% were receiving opioid substitution treatment. Eighty three percent reported that finger-stick testing was very acceptable. Overall, 65% of participants preferred finger-stick over venepuncture testing, with 61% of these preferring to receive results in 60 min. The most common reason for preferring finger-stick over venepuncture testing was it was quick (62%) followed by venous access difficulties (21%). The main reasons for preferring venepuncture over finger-stick testing were that it was quick (61%) and accurate (29%). Females were more likely to prefer finger-stick testing than males (adjusted OR 1.96; 95% CI 1.30, 2.99; p = 0.002). Among people with recent (previous month) injecting drug use, Aboriginal and/or Torres Strait Islander people were less likely than non-Aboriginal people to prefer finger-stick testing (adjusted OR 0.57; 95% CI 0.34, 0.9; p = 0.033). CONCLUSIONS Finger-stick whole-blood collection is acceptable to people who inject drugs, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; The Burnet Institute, Melbourne, Victoria, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | | | - Yasmin Mowat
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Marcel Schulz
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Evan B Cunningham
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide, South Australia, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Carla Gorton
- Cairns Sexual Health Service, Cairns, Queensland, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Michelle Whelan
- Campbelltown Drug Health Services, Sydney, New South Wales, Australia
| | | | - Tanya L Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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