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Treloar C, Hopwood M, Drysdale K, Lea T, Holt M, Dowsett GW, Aggleton P, Bryant J. Stigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103229. [PMID: 33774423 DOI: 10.1016/j.drugpo.2021.103229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Sevigny EL, Meylakhs P, Feizollahi MJ, Amini MR. Development of a global index measuring national policy commitments to HIV prevention and treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102877. [PMID: 32717705 DOI: 10.1016/j.drugpo.2020.102877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) around the world are disproportionately affected by the HIV epidemic. National policy responses to the epidemic heavily influence risk factors for HIV acquisition among this key group. Prior efforts to monitor national policy responses to HIV/AIDS among PWID were limited both in scope and coverage. In this paper we develop and validate the HIV-PWID Policy Index (HPPI) to benchmark and monitor national commitments to HIV prevention and treatment among PWID. METHODS Composite indicator was constructed employing fuzzy multilayer data envelopment analysis (FMLDEA). Model inputs based on data from 105 countries included 27 variables measured across six conceptual domains, including needle and syringe programs, opioid substitution treatment, testing and counseling, information and education, monitoring and evaluation, and legal and policy climate. RESULTS According to the HPPI, which ranges from 0 to 1, the top performing countries in policy commitments to HIV prevention and treatment among PWID were Spain (0.988), Switzerland (0.982), Luxembourg (0.970), Moldova (0.970), and Kyrgyzstan (0.945), whereas the poorest performing included Nicaragua (0.094), Japan, (0.094), Cape Verde (0.097), Syria (0.174), and Benin (0.185). Regionally, commitment to HIV services targeting PWID was highest among European countries (0.81) and lowest among African countries (0.50), with Oceania (0.76), Asia (0.66), and the Americas (0.56) in the mid-range. Subregional differences were even more prominent, with West and Central European nations (0.84) and Central American nations (0.22) earning the highest and lowest HPPI scores, respectively. CONCLUSIONS The HPPI documented substantial national and regional variation in policy responses to the HIV epidemic among PWID. Our analysis also revealed that many countries have limited HIV/AIDS data collection and monitoring capabilities. Continued enhancement and standardization of global HIV/AIDS monitoring efforts are therefore vital to articulated national and international benchmarking and performance assessment goals.
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Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Georgia State University, Atlanta, GA, USA.
| | - Peter Meylakhs
- Laboratory for Comparative Social Research, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | | | - Mohamad Reza Amini
- Systems Management, Management and Economic Department, Tarbiat Modares University, Tehran, Iran
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Mukherjee TI, Pillai V, Ali SH, Altice FL, Kamarulzaman A, Wickersham JA. Evaluation of a hepatitis C education intervention with clients enrolled in methadone maintenance and needle/syringe programs in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:144-152. [PMID: 28652072 DOI: 10.1016/j.drugpo.2017.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Approximately 40%-90% of people who inject drugs (PWID) in Malaysia have hepatitis C (HCV). PWID continue to be disproportionately affected by HCV due to their lack of knowledge, perceived risk and interest in HCV treatment. Education interventions may be an effective strategy for increasing HCV knowledge in PWID, and harm reduction services are uniquely positioned to implement and deploy such interventions. METHODS We recruited 176 clients from methadone maintenance treatment (MMT: N=110) and needle/syringe programs (NSP: N=66) between November 2015 and August 2016. After baseline knowledge assessments, clients participated in a standardized, 45-min HCV education program and completed post-intervention knowledge assessments to measure change in knowledge and treatment interest. RESULTS Participants were mostly male (96.3%), Malay (94.9%), and in their early 40s (mean=42.6years). Following the intervention, overall knowledge scores and treatment interest in MMT clients increased by 68% and 16%, respectively (p<0.001). In contrast, NSP clients showed no significant improvement in overall knowledge or treatment interest, and perceived greater treatment barriers. Multivariate linear regression to assess correlates of HCV knowledge post-intervention revealed that optimal dosage of MMT and having had an HIV test in the past year significantly increased HCV knowledge. Having received a hepatitis B vaccine, however, was not associated with increased HCV knowledge after participating in an education session. CONCLUSION Generally, HCV knowledge and screening is low among clients engaged in MMT and NSP services in Malaysia. Integrating a brief, but comprehensive HCV education session within harm reduction services may be a low-cost and effective strategy in improving overall HCV knowledge and risk behaviors in resource-limited settings. In order to be an effective public health approach, however, education interventions must be paired with strategies that improve social, economic and political outcomes for PWID. Doing so may reduce HCV disparities by increasing screening and treatment interest.
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Affiliation(s)
- Trena I Mukherjee
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Hafizah Ali
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, CT, USA
| | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Bahji A, Wood E, Ahamad K, Dong H, DeBeck K, Milloy MJ, Kerr T, Hayashi K. Increasing awareness about HIV prevention among young people who initiated injection drug use in a Canadian setting, 1988-2014. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1258-64. [PMID: 26514080 PMCID: PMC4666805 DOI: 10.1016/j.drugpo.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/25/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Globally, harm reduction interventions, including needle and syringe programs (NSPs), have been shown to reduce HIV risks among people who inject drugs (PWID). However, little is known about the impact of these efforts on the circumstances of first injection. Therefore, we sought to identify changes in the awareness about HIV prevention and syringe borrowing at the time of first injection drug use in Vancouver, Canada, during a period of NSP expansion. METHODS Data were drawn from prospective cohorts of PWID in Vancouver, who initiated injecting between 1988 and 2014. Multivariable regression was used to assess changes in the awareness about HIV and NSPs and syringe borrowing behaviour at first injection against calendar year of first injection. RESULTS Among 1044 participants (36.9% female), at the time of first injection 73.9% reported having known syringe sharing was an HIV risk, 54.1% reported having heard of NSPs, and 7.8% reported having borrowed a syringe used by others. In multivariable analyses, calendar year of first injection was independently and positively associated with awareness about HIV (adjusted prevalence ratio [APR]: 1.09; 95% confidence interval [CI]: 1.06, 1.11) and awareness about NSPs (APR: 1.18; 95% CI: 1.13, 1.24). While calendar year of first injection was significantly and negatively associated with syringe borrowing at first injection in bivariable analyses, the association did not remain significant in multivariable analyses (adjusted odds ratio: 0.90; 95% CI: 0.72, 1.14). CONCLUSIONS We found that awareness about HIV and NSPs at first injection have increased over time amongst PWID in this setting. However, declining trends in syringe borrowing at first injection were not determined after adjustment for socio-demographic characteristics. This suggests that HIV prevention efforts may have contributed to increased awareness about HIV prevention, but further research is needed to identify sub-populations at heightened risk of HIV at first injection.
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Affiliation(s)
- Anees Bahji
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Evan Wood
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Keith Ahamad
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3; Family and Community Medicine, Providence Health Care, 1190 Hornby Street, Vancouver, BC, Canada V6Z 2K5
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Public Policy, Simon Fraser University, 3271-515 West Hastings Street, Vancouver, BC, Canada V6B 5K3
| | - M-J Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kanna Hayashi
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
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Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2015; 35:477-83. [PMID: 26369759 DOI: 10.1111/dar.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Gay and other homosexually active men (hereafter 'gay men') are at elevated risk of becoming infected with hepatitis C virus (HCV) via injecting drug use and sexual risk practices. This paper aimed to measure HCV knowledge among gay men in Australia and whether knowledge differed according to HCV risk. DESIGN AND METHODS In 2013, a cross-sectional, online survey of 405 Australian gay men explored the social aspects of HCV. Bivariate and multivariate linear regressions were used to examine factors associated with higher HCV knowledge. RESULTS The mean age of respondents was 39.2 years (SD = 13.3), and most men (75.3%) were born in Australia. According to self-report, 32.1% were HIV-positive, 3.0% were HCV-positive and 8.9% were HIV/HCV co-infected. The mean number of correct HCV knowledge items was 8.2 (SD = 3.9; range 0-15). In a multivariate analysis, higher HCV knowledge was associated with higher educational attainment, being HCV-positive, being HIV-positive and injecting drug use. DISCUSSION AND CONCLUSIONS HCV knowledge among gay men was moderately good, although knowledge of testing, treatment and natural history of HCV was generally quite poor. Encouragingly, higher knowledge was reported among men at highest HCV risk. Viral hepatitis and HIV organisations, together with general practitioners and other health services, should continue to target gay men at a high risk of acquiring HCV with education and health promotion. [Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2016;35:477-483].
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
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Chen JS. Education as networking: Rethinking the success of the harm reduction policy of Taiwan. Health (London) 2014; 19:280-93. [PMID: 25139870 DOI: 10.1177/1363459314545697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The harm reduction policy of Taiwan has been considered a success. However, the HIV incidence among injection drug users declined before the nationwide needle and syringe program and drug substitution treatments were implemented. Thus, other factors in the policy might have contributed to its success. Some authors have suggested that education may have played a pivotal part. In this research, the purported significance of education in the success of the policy is conceptualized by reviewing the studies on harm reduction in Taiwan and reflecting upon my own fieldwork. Moreover, relevant literature is used as reference to reformulate this notion of education. This article shows that harm reduction education may be conducted in numerous forms, most of which are non-formal, improvisational, and contingent. Non-governmental organizations may play a role, but more actors, strategies, infrastructures, and interactions should be considered. This article draws from actor-network theory and refines the current thesis that attributes the policy success to education by utilizing three reflections, namely, appreciating materiality and spatiality, recognizing covert actors in the networking, and treating education as an outcome rather than a means. In conclusion, looking at education as a form of networking offers theoretical insight that increases understanding of its participants, mechanisms, processes, and permutations.
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Newland J, Treloar C. Peer education for people who inject drugs in New South Wales: Advantages, unanticipated benefits and challenges. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2012.761951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
AIM To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs. DESIGN We employed a qualitative life history design. SETTING Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes. PARTICIPANTS The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6-33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23-53). MEASUREMENTS Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically. FINDINGS Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice. CONCLUSIONS Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages.
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Affiliation(s)
- Magdalena Harris
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK.
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Ritter A, Cameron J. A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2009; 25:611-24. [PMID: 17132577 DOI: 10.1080/09595230600944529] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions.
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Affiliation(s)
- Alison Ritter
- Australian National University, Canberra, Australian Capital Territory, Australia.
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Ma YH, Ding SQ, Wang C. Vulnerability to HIV infection and related health risk behaviors of the out of school adolescents migrated with their parents to Beijing. BIOMEDICAL AND ENVIRONMENTAL SCIENCES : BES 2008; 21:404-410. [PMID: 19133614 DOI: 10.1016/s0895-3988(08)60061-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore the vulnerability to HIV infection and related risk behaviors of the out-of-school adolescents who migrated with their parents from rural areas to cities. METHODS From September to October 2005, 260 out-of-school adolescents aged 14-20 years were interviewed through a questionnaire. RESULTS Out-of-school adolescents lacked HIV/AIDS knowledge and related life skills, and their psychosocial competency was relatively low. The interviewed adolescents were open in their sexuality, showing a low rate of condom use. Their attitudes towards people living with HIV/AIDS and HIV/AIDS prevention competency were positively correlated with family well-being, harmonious relations between their parents, a stable job, knowledge, life skill, and psychosocial competency for emotion control and empathy. CONCLUSION Out-of-school adolescents are highly vulnerable to HIV/AIDS infection and transmission. Practical and feasible health and life skill education and psychosocial competency are the keys to effective HIV/AIDS prevention among out-of-school adolescent migrants.
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Affiliation(s)
- Ying-Hua Ma
- Institute of Child and Adolescent Health, Peking University, Beijing 100083, China.
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Donoghoe MC, Verster A, Pervilhac C, Williams P. Setting targets for universal access to HIV prevention, treatment and care for injecting drug users (IDUs): towards consensus and improved guidance. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19 Suppl 1:S5-14. [PMID: 18243681 DOI: 10.1016/j.drugpo.2007.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 11/27/2007] [Accepted: 12/03/2007] [Indexed: 11/16/2022]
Abstract
Scaling-up access to HIV/AIDS prevention, treatment and care for injecting drug users (IDUs) has been frustrated by the lack of a framework, indicators and agreed targets for interventions specifically targeting IDUs. Major progress in this regard has been achieved with the recent development of a joint Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users and related technical consultations. This guide provides technical guidance to countries on setting ambitious, but achievable national targets for scaling-up towards universal access (UA). The guide has been developed as a collaboration between the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Office on Drugs and Drugs (UNODC), the World Health Organization (WHO) and with national and international expertise and builds on previous UNAIDS guidelines. The guide serves to provide more consistent methods of measuring and comparing countries' progress towards universal access and offers consensus as to which interventions should be included in a comprehensive package. It provides guidance on defining and estimating denominator populations and proposes a set of indicators to measure coverage, as well as indicative targets or benchmarks against which to measure progress towards UA. The guide moves on from a narrow focus on coverage that neglects other important aspects of access, namely availability and quality of interventions. Finally, the guide encourages country involvement in, and ownership of, what are sometimes perceived as politically motivated coverage targets. Technical consultations, with country experts using the guide to set national targets, suggested a tendency for targets to be proposed that are achievable but fall short of what is required to achieve universal access and have a real impact on HIV/AIDS epidemics. Consensus and improved guidance on achieving universal access needs to be supported by political will, good leadership and, in some countries, remedies to inadequacies in health systems.
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Affiliation(s)
- Martin C Donoghoe
- World Health Organization Regional Office for Europe, Copenhagen DK-2100, Denmark.
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Dhand A. The roles performed by peer educators during outreach among heroin addicts in India: Ethnographic insights. Soc Sci Med 2006; 63:2674-85. [PMID: 16908091 DOI: 10.1016/j.socscimed.2006.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Indexed: 10/24/2022]
Abstract
Peer-based outreach is a popular strategy in which former or current drug addicts are employed as peer educators to contact and educate out-of-treatment addicts. This study examines the interaction patterns that occur during outreach with particular regard to the roles that peer educators perform. Using ethnographic methods, it reports findings from a group of 'peer educators' and 'clients' from Yamuna Bazaar, New Delhi. In this context, peer educators assumed three roles that were co-constructed with clients: 'counsellor', 'doctor', and 'role model'. Analysis of these role-plays revealed three significant patterns. First, the performances involved a hierarchical structuring with the peer educator in an authority position in nearly all interactions. Second, the role-plays were fluid and evolving with peer educators often transitioning across roles during the same interaction. Lastly, role performances appeared to have an underlying role replication mechanism in which roles were learned by first playing the subordinate role (e.g. 'patient') and then performing the dominant role (e.g. 'doctor') with another peer (e.g. new 'patient'). These findings provide insight into issues of empowerment, peer relationship dynamics, and social diffusion processes among drug-using communities, and peer-based situations more generally.
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Affiliation(s)
- Amar Dhand
- Department of Educational Studies, University of Oxford, Oxford, UK.
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