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Wise A, Kianian B, Chang H, Linton S, Wolfe ME, Smith J, Tempalski B, Des Jarlais D, Ross Z, Semaan S, Wejnert C, Broz D, Cooper H. Place-Based Correlates of Exchange Sex Among People Who Inject Drugs in 19 U.S. Metropolitan Areas, 2012. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2897-2909. [PMID: 33796991 DOI: 10.1007/s10508-020-01883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
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Affiliation(s)
- Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA.
| | - Behzad Kianian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E Wolfe
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY, USA
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Health System, New York, NY, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA
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Lazarus JV, Pericàs JM, Picchio C, Cernosa J, Hoekstra M, Luhmann N, Maticic M, Read P, Robinson EM, Dillon JF. We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade. J Intern Med 2019; 286:503-525. [PMID: 31472002 DOI: 10.1111/joim.12972] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Globally, some 71 million people are chronically infected with hepatitis C virus (HCV). Marginalized populations, particularly people who inject drugs (PWID), have low testing, linkage to care and treatment rates for HCV. Several models of care (MoCs) and service delivery interventions have the potential to improve outcomes across the HCV cascade of care, but much of the relevant research was carried out when interferon-based treatment was the standard of care. Often it was not practical to scale-up these earlier models and interventions because the clinical care needs of patients taking interferon-based regimens imposed too much of a financial and human resource burden on health systems. Despite the adoption of highly effective, all-oral direct-acting antiviral (DAA) therapies in recent years, approaches to HCV testing and treatment have evolved slowly and often remain rooted in earlier paradigms. The effectiveness of DAAs allows for simpler approaches and has encouraged countries where the drugs are widely available to set their sights on the ambitious World Health Organization (WHO) HCV elimination targets. Since a large proportion of chronically HCV-infected people are not currently accessing treatment, there is an urgent need to identify and implement existing simplified MoCs that speak to specific populations' needs. This article aims to: (i) review the evidence on MoCs for HCV; and (ii) distil the findings into recommendations for how stakeholders can simplify the path taken by chronically HCV-infected individuals from testing to cure and subsequent care and monitoring.
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Affiliation(s)
- J V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J M Pericàs
- Infectious Diseases and Clinical Microbiology Territorial Direction, Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Biomedical Research Institute Dr Pifarré Foundation, Lleida, Spain
| | - C Picchio
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J Cernosa
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Hoekstra
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - N Luhmann
- Médecins du Monde France, Paris, France
| | - M Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - P Read
- Kirketon Road Centre, Sydney, NSW, Australia
| | - E M Robinson
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
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Cloud DH, Ibragimov U, Prood N, Young AM, Cooper HLF. Rural risk environments for hepatitis c among young adults in appalachian kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:47-54. [PMID: 31113713 DOI: 10.1016/j.drugpo.2019.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/25/2019] [Accepted: 05/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rural Kentucky is an epicenter of hepatitis C(HCV), especially among young adults who inject drugs. While the Risk Environment Framework (REF) has been used widely to study and address socio-ecological determinants of infectious disease among people who inject drugs (PWID), it has been almost exclusively applied to urban environments. Applying REF to rural environments can enhance our understanding of the drivers of HCV epidemics in these hard-hit areas, and inform the creation and implementation of harm reduction interventions in this local context. METHODS Participants were recruited between March and August 2017 via community-based outreach methods (e.g., cookouts, flyers) and peer referral. Individuals who met eligibility criteria (aged 18-35, recently used prescription opioids and/or heroin to get high, lived in one of the 5 target counties) participated indepth, semi-structured interviews. The interview guide was informed by the REF, and covered HCV-related risk behaviors and environmental features that shaped vulnerability to engaging in these behaviors. Interviews were transcribed and analyzed using constructivist grounded-theory methods. RESULTS Participants (N=19) described multiple intersecting risk environment features that shaped vulnerability to HCV transmission. Economic decline generated intergenerational poverty, dwindling employment prospects, and diminished social enrichment opportunities that collectively contributed to substance misuse and risky injection practices. Geographic isolation, lack of collective knowledge about HCV transmission risks, scarce harm reduction services, familial poverty, and fear of law enforcement interacted to increase the odds of people injecting in "trap houses" (akin to shooting galleries) or secluded areas, spaces in which they rushed to inject and shared injection equipment. Pervasive stigma was a structural barrier to adopting, expanding, and using harm reduction services. CONCLUSION This exploratory study identified features of rural risk environments that may contribute to significant HCV burdens in Appalachian Kentucky. Findings signal the importance of expanding proven harm reduction strategies and anti-stigma interventions tailored to rural contexts.
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Affiliation(s)
- David H Cloud
- Emory University, Rollins School of Public Health, United States.
| | | | - Nadya Prood
- Emory University, Rollins School of Public Health, United States
| | - April M Young
- University of Kentucky College of Public Health, United States
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Tempalski B, Cooper HLF, Kelley ME, Linton SL, Wolfe ME, Chen YT, Ross Z, Des Jarlais DC, Friedman SR, Williams LD, Semaan S, DiNenno E, Wejnert C, Broz D, Paz-Bailey G. Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas. AIDS Behav 2019; 23:318-335. [PMID: 29971735 PMCID: PMC6318077 DOI: 10.1007/s10461-018-2217-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC's 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sabriya L Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY, 14850, USA
| | - Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, Suite 530, New York, NY, 10006, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
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Milburn NG, Hamilton AB, Lopez S, Wyatt GE. Mentoring the next generation of behavioral health scientists to promote health equity. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2019; 89:369-377. [PMID: 31070422 PMCID: PMC7577403 DOI: 10.1037/ort0000415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health inequities and disparities among various racial/ethnic minority, sexual minority, and rural populations are the focus of increasing national efforts. Three health problems disproportionately affecting these populations-HIV/AIDS, substance abuse, and trauma-deserve particular attention because of their harmful effects on health across the life span. To address these problems, our training program, the UCLA HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), mentors and trains early career behavioral health scientists to conduct research using scientifically sound, culturally collaborative, and population-centered approaches. HA-STTP has been highly successful in training a diverse, productive, nationwide group of scholars. The program provides 2 years of training and mentorship to 20 (5 per year over 4 years) scholars. It is unique in its attention to traumatic stress as a form of dysregulation, particularly as experienced by underserved populations. Furthermore, our training program embraces a uniquely comprehensive, culturally grounded understanding of traumatic stress and its implications for substance abuse and HIV. HA-STTP advances scholars' knowledge of the interconnections among substance abuse, HIV/AIDS, traumatic stress, and health disparities, particularly in underrepresented populations; provides intensive mentorship to support scholars' research interests and career trajectories; capitalizes on a multidisciplinary, multiracial/ethnic network of expert faculty; and evaluates the program's impact on scholars' knowledge and productivity. By fostering the growth of scholars committed to conducting research with underrepresented populations that are disproportionately affected by HIV/AIDS, substance abuse, and traumatic stress, this program enhances nationwide efforts to diminish the prevalence of these problems and improve health and quality of life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Semel Institute for Neuroscience & Human Behavior, University of California
| | - Alison B Hamilton
- Department of Psychiatry and Biobhavioral Sciences, University of California, Los Angeles
| | - Susana Lopez
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, University of California
| | - Gail E Wyatt
- Department of Psychiatry and Biobhavioral Sciences, University of California, Los Angeles
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Zhang X, Pérez-Stable EJ, Bourne PE, Peprah E, Duru OK, Breen N, Berrigan D, Wood F, Jackson JS, Wong DWS, Denny J. Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century. Ethn Dis 2017; 27:95-106. [PMID: 28439179 DOI: 10.18865/ed.27.2.95] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.
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Affiliation(s)
- Xinzhi Zhang
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | | | - Nancy Breen
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | - James S Jackson
- College of Literature, Science and the Arts, University of Michigan
| | - David W S Wong
- Department of Geography and GeoInformation Science, College of Science, George Mason University
| | - Joshua Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center
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