1
|
Lancaster KE, Stockton M, Remch M, Wester CW, Nash D, Brazier E, Adedimeji A, Finlayson R, Freeman A, Hogan B, Kasozi C, Kwobah EK, Kulzer JL, Merati T, Tine J, Poda A, Succi R, Twizere C, Tlali M, Groote PV, Edelman EJ, Parcesepe AM. Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104309. [PMID: 38228025 PMCID: PMC10939808 DOI: 10.1016/j.drugpo.2023.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS In 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. RESULTS Sites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. CONCLUSIONS Availability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.
Collapse
Affiliation(s)
| | - Melissa Stockton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Remch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Denis Nash
- City University of New York (CUNY), New York, NY, USA
| | - Ellen Brazier
- City University of New York (CUNY), New York, NY, USA
| | | | | | - Aimee Freeman
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Breanna Hogan
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Judiacel Tine
- Centre Hospitalier National Universitaire de Fann, Dakar, Senagal
| | - Armel Poda
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Regina Succi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Christelle Twizere
- Centre National de Référence en Matière de VIH/SIDA au Burundi, Bujumbura, Burundi
| | - Mpho Tlali
- University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | | | | |
Collapse
|
2
|
Rivera Saldana CD, Abramovitz D, Beletsky L, Borquez A, Kiene S, Marquez LK, Patton T, Strathdee S, Zúñiga ML, Martin NK, Cepeda J. Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis. Addiction 2023; 118:1763-1774. [PMID: 37039246 PMCID: PMC10524658 DOI: 10.1111/add.16203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND AIMS Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. METHODS We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016-2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. RESULTS Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3-29.7/100py) in 2016 to 21.1/100py (UI = 15.0-29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0-27.8/100py) by 2026 and avert 186 (32-389) new infections, 76 (UI = 12-160) cases of cirrhosis and 32 (5-73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. CONCLUSIONS In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.
Collapse
Affiliation(s)
- Carlos D Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Susan Kiene
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Thomas Patton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Jones AA, Santos-Lozada AR. The Impact of Racism, Class, and Criminal Justice on Women's Distress and Health: A Reinforcing Cycle of Social Disadvantage. Am J Public Health 2023; 113:S13-S15. [PMID: 36696622 PMCID: PMC9877381 DOI: 10.2105/ajph.2022.307149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Abenaa A Jones
- The authors are with the Department of Human Development and Family Studies, Pennsylvania State University, University Park
| | - Alexis R Santos-Lozada
- The authors are with the Department of Human Development and Family Studies, Pennsylvania State University, University Park
| |
Collapse
|
4
|
Ford JA, Ortiz K, Schepis TS, McCabe SE. Types of criminal legal system exposure and polysubstance use: Prevalence and correlates among U.S. adults in the National Survey on Drug Use and Health, 2015-2019. Drug Alcohol Depend 2022; 237:109511. [PMID: 35752022 PMCID: PMC10862373 DOI: 10.1016/j.drugalcdep.2022.109511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Criminal legal system (CLS) exposed adults experience higher rates of substance use, substance use disorder (SUD), and overdose. As most CLS exposed adults are not incarcerated, it is important to focus on CLS exposure across the carceral continuum. METHODS This research used pooled data from adult respondents (N = 206,314) in the National Survey on Drug Use and Health (2015-2019). Survey weighted descriptive statistics and Poisson regression were used to estimate prevalence of polysubstance use (i.e., concurrent use) across CLS exposure types (i.e., arrest, probation, parole), identifying relevant correlates. RESULTS The prevalence of polysubstance use was higher among CLS exposed adults, and nearly two-thirds of CLS exposed adults who used multiple types of substances indicated having an SUD. Comparing CLS exposure types, polysubstance use was less likely among adults on probation (IRR=0.89, 95%CI=0.84,0.94) or parole (IRR=0.82, 95%CI=0.76,0.87) compared to those arrested. Polysubstance use was also more likely among adults on probation (IRR=1.09, 95%CI =1.01,1.17) compared to those on parole. While some characteristics (i.e., age, ethnicity, SUD) were consistently associated with polysubstance use across types of CLS exposure, other characteristics (i.e., sexual identity, marital status, suicidal ideation) were not. CONCLUSIONS There is heterogeneity in health risks as a function of CLS exposure type. Further research is needed to identify causal mechanisms and differences based on demographic characteristics. Given high levels of polysubstance use across CLS exposure types, a shift towards a more comprehensive approach in substance use epidemiology may facilitate building an evidence-base to maximize treatment related interventions to reduce polysubstance-involved overdoses.
Collapse
Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL, USA; Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Kasim Ortiz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Department of Sociology & Criminology, University of New Mexico, Albuquerque, NM, USA
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Gehring ND, Speed KA, Wild TC, Pauly B, Salvalaggio G, Hyshka E. Policy actor views on structural vulnerability in harm reduction and policymaking for illegal drugs: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103805. [PMID: 35907373 DOI: 10.1016/j.drugpo.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD. METHODS The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings. RESULTS The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. CONCLUSIONS Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.
Collapse
Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
| |
Collapse
|
6
|
Stanton MC, Ali SB, McCormick K. Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs. BMC Health Serv Res 2022; 22:913. [PMID: 35831861 PMCID: PMC9281157 DOI: 10.1186/s12913-022-08277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction. METHODS To examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction. RESULTS Drug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does. DISCUSSION This study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.
Collapse
Affiliation(s)
- Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Katie McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
| |
Collapse
|
7
|
Urbanik MM, Maier K, Greene C. A qualitative comparison of how people who use drugs’ perceptions and experiences of policing affect supervised consumption services access in two cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103671. [DOI: 10.1016/j.drugpo.2022.103671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
|
8
|
Acceptability of a HIV self-testing program among people who use illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
|
9
|
Surratt HL, Yeager HJ, Adu A, González EA, Nelson EO, Walker T. Pre-Exposure Prophylaxis Barriers, Facilitators and Unmet Need Among Rural People Who Inject Drugs: A Qualitative Examination of Syringe Service Program Client Perspectives. Front Psychiatry 2022; 13:905314. [PMID: 35706473 PMCID: PMC9189386 DOI: 10.3389/fpsyt.2022.905314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk for HIV infection, yet in rural areas PWID are understudied with respect to prevention strategies. Kentucky is notable for heavy rural HIV burden and increasing rates of new HIV diagnoses attributable to injection drug use. Despite high need and the strong evidence for Pre-Exposure Prophylaxis (PrEP) as a gold-standard biomedical HIV prevention tool, scale up has been limited among PWID in Kentucky and elsewhere. This paper explores individual, environmental, and structural barriers and facilitators of PrEP care from the perspective of PWID in rural Kentucky. METHODS Data are drawn from an ongoing NIH-funded study designed to adapt and integrate a PrEP initiation intervention for high-risk PWID at point of care in two rural syringe service programs (SSPs) in southeastern Kentucky. As part of this initiative, a qualitative study guided by PRISM (Practical, Robust, Implementation, and Sustainability Model) was undertaken to gather SSP client perspectives on intervention needs related to PrEP, competing needs related to substance use disorder, as well as tangible supports for and barriers to PrEP uptake. Recruitment and interviews were conducted during September-November 2021 with 26 SSP clients, 13 from each of the two SSP sites. A semi-structured guide explored injection behaviors, SSP use, knowledge of PrEP, perceived barriers to PrEP, as well as aspects of the risk environment (e.g., housing instability, community stigma) that may impact PrEP uptake. Interviews were digitally recorded, transcribed verbatim and verified by project staff. A detailed coding scheme was developed and applied by independent coders using NVivo. Coded transcripts were synthesized to identify salient themes in the data using the principles of thematic analysis All study procedures were approved by the University IRB. RESULTS Participants were 96% white, 42% female, with a median age of 41 years (range 21-62); all reported injection use within the past month. Overall, we found low PrEP awareness among this sample, yet interest in PrEP was high, with several indicating PrEP is urgently needed. Clients reported overwhelmingly positive experiences at the SSPs, considering them trusted and safe locations to receive health services, and were enthusiastic about the integration of co-located PrEP services. Lack of basic HIV and PrEP knowledge and health literacy were in evidence, which contributed to common misperceptions about personal risk for HIV. Situational risks related to substance use disorder, particularly in the context of withdrawal symptoms and craving, often lead to heightened HIV injection and sexual risk behaviors. Stigma related to substance use and HIV arose as a concern for PrEP uptake, with several participants reflecting that privacy issues would impact their preferences for education, prescribing and monitoring of PrEP. Noted tangible barriers included inconsistent access to phone service and transportation. Primary supports included high levels of insurance coverage, consistent pharmacy access, and histories with successful medication management for other health conditions. CONCLUSIONS Drawing on the critical perspectives of people with substance use disorder, our findings provide important and actionable information on individual and environmental barriers and facilitators of PrEP uptake among rural PWID at high risk for HIV infection. These data will drive the adaptation and implementation of a client-centered approach to integrated PrEP care within rurally located SSP settings to address unmet needs for PrEP care.
Collapse
Affiliation(s)
- Hilary L Surratt
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Hannah J Yeager
- Department of Anthropology, University of Rochester, Rochester, NY, United States
| | - Akosua Adu
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States
| | - Evelyn A González
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Elizabeth O Nelson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States
| | - Tamara Walker
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States
| |
Collapse
|
10
|
Wiessing L, Kalamara E, Stone J, Altan P, Van Baelen L, Fotiou A, Garcia D, Goulao J, Guarita B, Hope V, Jauffret-Roustide M, Jurgelaitienė L, Kåberg M, Kamarulzaman A, Lemsalu L, Kivite-Urtane A, Kolarić B, Montanari L, Rosińska M, Sava L, Horváth I, Seyler T, Sypsa V, Tarján A, Yiasemi I, Zimmermann R, Ferri M, Dolan K, Uusküla A, Vickerman P. Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 – is the precautionary principle applicable? Euro Surveill 2021; 26. [PMID: 34886941 PMCID: PMC8662800 DOI: 10.2807/1560-7917.es.2021.26.49.2002093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. Aim We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe. Methods Aggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR. Results Univariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe. Conclusion In univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).
Collapse
Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Eleni Kalamara
- EASO MTC Block A, Winemakers Wharf, Grand Harbour Valletta, Malta
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peyman Altan
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Luk Van Baelen
- Sciensano, Epidemiology and public health, Lifestyle and chronic diseases, Brussels, Belgium
| | - Anastasios Fotiou
- University Mental Health, Neurosciences, & Precision Medicine Research Institute, Athens, Greece
| | - D’Jamila Garcia
- NOVA FCSH – Universidade Nova de Lisboa, Lisbon, Portugal
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Joao Goulao
- General Director on Addictive Behaviours and Dependencies, Ministry of Health, Lisbon, Portugal
| | - Bruno Guarita
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Marie Jauffret-Roustide
- Santé Publique France, Saint-Maurice, France
- British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada
- Centre d’Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), Paris, France
- Baldy Center for Law and Social Policy, Buffalo University of Social Sciences, New York, United States
| | - Lina Jurgelaitienė
- Social Innovations and Science Centre, Vilnius, Lithuania
- Drug, Tobacco and Alcohol Control Department, Vilnius, Lithuania
| | - 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
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Liis Lemsalu
- Centre for Prevention of Drug Addiction and Infectious Diseases, National Institute for Health Development, Tallinn, Estonia
| | | | - Branko Kolarić
- Medical Faculty, University of Rijeka, Rijeka, Croatia
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Linda Montanari
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Magdalena Rosińska
- National Institute of Public Health NIH – National Research Institute, Warsaw, Poland
| | - Lavinius Sava
- National Antidrug Agency – Ministry of Internal Affairs, Bucharest, Romania
| | - Ilonka Horváth
- Gesundheit Österreich GmbH – Austrian National Public Health Institution, International Affairs and Consulting, Vienna, Austria
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Ioanna Yiasemi
- Monitoring Department, Cyprus National Addictions Authority, Nicosia, Cyprus
| | - Ruth Zimmermann
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, Sydney, Australia
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
11
|
Rivera Saldana CD, Beletsky L, Borquez A, Kiene SM, Strathdee SA, Zúñiga ML, Martin NK, Cepeda J. Impact of cumulative incarceration and the post-release period on syringe-sharing among people who inject drugs in Tijuana, Mexico: a longitudinal analysis. Addiction 2021; 116:2724-2733. [PMID: 33620749 PMCID: PMC8380753 DOI: 10.1111/add.15445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. DESIGN Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. SETTING Tijuana, Mexico. PARTICIPANTS Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. MEASUREMENTS Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. FINDINGS At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. CONCLUSIONS A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.
Collapse
Affiliation(s)
- Carlos D. Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| |
Collapse
|
12
|
Kavanagh MM, Agbla SC, Joy M, Aneja K, Pillinger M, Case A, Erondu NA, Erkkola T, Graeden E. Law, criminalisation and HIV in the world: have countries that criminalise achieved more or less successful pandemic response? BMJ Glob Health 2021; 6:bmjgh-2021-006315. [PMID: 34341021 PMCID: PMC8330576 DOI: 10.1136/bmjgh-2021-006315] [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] [Received: 05/14/2021] [Accepted: 07/14/2021] [Indexed: 11/04/2022] Open
Abstract
How do choices in criminal law and rights protections affect disease-fighting efforts? This long-standing question facing governments around the world is acute in the context of pandemics like HIV and COVID-19. The Global AIDS Strategy of the last 5 years sought to prevent mortality and HIV transmission in part through ensuring people living with HIV (PLHIV) knew their HIV status and could suppress the HIV virus through antiretroviral treatment. This article presents a cross-national ecological analysis of the relative success of national AIDS responses under this strategy, where laws were characterised by more or less criminalisation and with varying rights protections. In countries where same-sex sexual acts were criminalised, the portion of PLHIV who knew their HIV status was 11% lower and viral suppression levels 8% lower. Sex work criminalisation was associated with 10% lower knowledge of status and 6% lower viral suppression. Drug use criminalisation was associated with 14% lower levels of both. Criminalising all three of these areas was associated with approximately 18%-24% worse outcomes. Meanwhile, national laws on non-discrimination, independent human rights institutions and gender-based violence were associated with significantly higher knowledge of HIV status and higher viral suppression among PLHIV. Since most countries did not achieve 2020 HIV goals, this ecological evidence suggests that law reform may be an important tool in speeding momentum to halt the pandemic.
Collapse
Affiliation(s)
- Matthew M Kavanagh
- Department of International Health, Georgetown University, Washington, District of Columbia, USA .,O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, USA
| | - Schadrac C Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marissa Joy
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, USA
| | - Kashish Aneja
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, USA.,Society for Democratic Rights, New Delhi, India
| | - Mara Pillinger
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, USA
| | | | - Ngozi A Erondu
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia, USA
| | - Taavi Erkkola
- Strategic Information Department, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneve, Switzerland
| | - Ellie Graeden
- Talus Analytics, Boulder, Colorado, USA.,Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| |
Collapse
|
13
|
Beletsky L, Thumath M, Haley DF, Gonsalves G, Jordan A. HIV's Trajectory: Biomedical Triumph, Structural Failure. Am J Public Health 2021; 111:1258-1260. [PMID: 34111362 DOI: 10.2105/ajph.2021.306354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Leo Beletsky
- Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, and the Division of Infectious Disease and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA. Meaghan Thumath is with the School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, and the Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Danielle F. Haley is with School of Public Health, Boston University, Boston, MA. Gregg Gonsalves is with Yale School of Public Health, New Haven, CT. Ayana Jordan is with the Yale University School of Medicine, New Haven, CT
| | - Meaghan Thumath
- Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, and the Division of Infectious Disease and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA. Meaghan Thumath is with the School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, and the Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Danielle F. Haley is with School of Public Health, Boston University, Boston, MA. Gregg Gonsalves is with Yale School of Public Health, New Haven, CT. Ayana Jordan is with the Yale University School of Medicine, New Haven, CT
| | - Danielle F Haley
- Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, and the Division of Infectious Disease and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA. Meaghan Thumath is with the School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, and the Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Danielle F. Haley is with School of Public Health, Boston University, Boston, MA. Gregg Gonsalves is with Yale School of Public Health, New Haven, CT. Ayana Jordan is with the Yale University School of Medicine, New Haven, CT
| | - Gregg Gonsalves
- Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, and the Division of Infectious Disease and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA. Meaghan Thumath is with the School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, and the Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Danielle F. Haley is with School of Public Health, Boston University, Boston, MA. Gregg Gonsalves is with Yale School of Public Health, New Haven, CT. Ayana Jordan is with the Yale University School of Medicine, New Haven, CT
| | - Ayana Jordan
- Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, and the Division of Infectious Disease and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA. Meaghan Thumath is with the School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, and the Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Danielle F. Haley is with School of Public Health, Boston University, Boston, MA. Gregg Gonsalves is with Yale School of Public Health, New Haven, CT. Ayana Jordan is with the Yale University School of Medicine, New Haven, CT
| |
Collapse
|
14
|
Trappen SL, McLean KJ. Policing pain: A qualitative study of non-criminal justice approaches to managing opioid overdose during the COVID-19 pandemic. J Prev Interv Community 2021; 49:136-151. [PMID: 33998397 DOI: 10.1080/10852352.2021.1908206] [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: 10/21/2022]
Abstract
Opioid related drug overdose deaths are a leading cause of death and injury in the United States. While research demonstrates that where people live has a major impact on drug use and abuse, most work looks at social dynamics at the county level or under the rubric of the urban/rural divide. Only recently, scholarship has become attuned to the post-industrialized areas located on the fringes of urban cores. Data presented in here are from field research conducted in McKeesport, Pennsylvania, a small river town located east of Pittsburgh. Once a thriving industrial city, it is now deteriorated and has documented high levels of overdose experience. Preliminary results suggest that McKeesport residents, even before the emergence of SARS-CoV-2 (COVID-19), practice social and physical distancing as a way of life; data indicate how the pandemic potentially exacerbates the risk of accidental opioid overdose among a population defined by both geographic and social isolation.
Collapse
Affiliation(s)
- Sandra L Trappen
- Department of Criminal Justice, Penn State University, Greater Allegheny, McKeesport, PA, USA
| | - Katherine J McLean
- Department of Criminal Justice, Penn State University, Greater Allegheny, McKeesport, PA, USA
| |
Collapse
|
15
|
A Two-Year Outcome Evaluation of Government-Led Initiative to Upscale Hospital-based Hepatitis C Treatment Using a Standard Two-Drug Regimen in Malaysia. HEPATITIS MONTHLY 2021. [DOI: 10.5812/hepatmon.113226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Malaysia has been fully committed to the global endeavor to eliminate hepatitis C virus (HCV) infection by 2030. In early 2018, the Ministry of Health (MOH) embarked on a “one-size-fits-all strategy” by introducing generic versions of sofosbuvir and daclatasvir as the standard treatment for HCV infection in public hospitals nationwide. Objectives: To evaluate the outcomes of such an initiative in multiple aspects, including the number and characteristics of patients treated, the extent of evidence-based drug use, the treatment completion status, individual responses to treatment, common side effects of treatment, and its economic implications. Methods: The findings were generated from the data compiled by the MOH, capturing the information regarding the treatment provided to adult HCV-infected patients in 16 selected hospitals between April 2018 and March 2020, along with the drug costs incurred. Results: A total of 1,797 patients were treated, nearly four times more than the patients receiving interferon-based treatment across the country in the preceding two years. Approximately one-third of them had liver cirrhosis, and the main HCV genotypes were 3 (46.9%) and 1a (20.0%). Dosing, treatment duration and the addition of ribavirin to the treatment generally agreed with the recommendations of the MOH. More than 90% of the patients completed the treatment course, and a sustained virologic response (SVR) rate of 95.4% (95% CI: 94.2, 96.7%) was recorded in those with a known treatment outcome (n = 1,163). The SVR achievement did not vary across HCV genotypes and cirrhosis status, but those ≥ 50 years of age (adjusted OR: 2.13; 95% CI: 1.16, 3.92) were more likely to fail the treatment. Side effects were rare. Anemia and fatigue caused treatment discontinuation in only 0.3% of the patients. The total drug expenditure reached US$678,258.20, and the mean cost of a 12-week treatment course of sofosbuvir and daclatasvir (US$235.16) was lower than the cost expected by the MOH (US$300). Conclusions: The findings demonstrate a high degree of real-world effectiveness, safety, and affordability of the standard treatment, suggesting that such a government-led initiative was reasonable and timely and could be extended to include more public health institutions.
Collapse
|
16
|
Marotta PL, Gilbert L, Goddard-Eckrich D, Hunt T, Metsch L, Davis A, Feaster D, Wu E, El-Bassel N. A Dyadic Analysis of Criminal Justice Involvement and Sexual HIV Risk Behaviors Among Drug-Involved Men in Community Corrections and Their Intimate Partners in New York City: Implications for Prevention, Treatment and Policies. AIDS Behav 2021; 25:1047-1062. [PMID: 33057892 PMCID: PMC8570384 DOI: 10.1007/s10461-020-03019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 10/23/2022]
Abstract
People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.
Collapse
Affiliation(s)
- Phillip L Marotta
- Division of Prevention and Community Psychology, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, USA.
- The Consultation Center, Yale University, New Haven, CT, USA.
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Dawn Goddard-Eckrich
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Tim Hunt
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Lisa Metsch
- School of General Studies, Columbia University, New York City, NY, USA
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alissa Davis
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Daniel Feaster
- Department of Biostatistics, School of Public Health, University of Miami, Miami, FL, USA
| | - Elwin Wu
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| |
Collapse
|
17
|
Nguyen MXB, Chu AV, Powell BJ, Tran HV, Nguyen LH, Dao ATM, Pham MD, Vo SH, Bui NH, Dowdy DW, Latkin CA, Lancaster KE, Pence BW, Sripaipan T, Hoffman I, Miller WC, Go VF. Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial. Implement Sci 2020; 15:64. [PMID: 32771017 PMCID: PMC7414564 DOI: 10.1186/s13012-020-01020-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background People who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam. Methods Design: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs. Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months. Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm. Discussion Scaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation. Trial registration NCT03952520 on Clinialtrials.gov. Registered 16 May 2019.
Collapse
Affiliation(s)
- Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam.
| | - Anh V Chu
- University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ha V Tran
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.,University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Long H Nguyen
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - An T M Dao
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - Manh D Pham
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Son H Vo
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Ngoc H Bui
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Irving Hoffman
- Division of Infectious Diseases, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516, USA
| | - William C Miller
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Schneider KE, Park JN, Allen ST, Weir BW, Sherman SG. Knowledge of Good Samaritan Laws and Beliefs About Arrests Among Persons Who Inject Drugs a Year After Policy Change in Baltimore, Maryland. Public Health Rep 2020; 135:393-400. [PMID: 32264789 PMCID: PMC7238711 DOI: 10.1177/0033354920915439] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Delivering and receiving prompt medical care during an overdose are imperative to ensure survival. Good Samaritan laws encourage people to call 911 during an overdose by providing immunity from selected drug arrests (eg, low-level possession). However, it is unclear whether persons who inject drugs (PWID) are aware of and understand these laws and their implications. We examined awareness among PWID of the 2015 Good Samaritan law in Maryland and their beliefs about whether they could be arrested for calling 911 or having an overdose. METHODS We surveyed 298 PWID in Baltimore, Maryland. We estimated the proportion who knew what the Good Samaritan law addressed and who believed they could be arrested for calling 911 or overdosing. We used a multivariate model to assess the association between harm-reduction services and knowledge of the Good Samaritan law or beliefs about getting arrested for calling 911 or overdosing. RESULTS Of PWID, 56 of 298 (18.8%) knew what the Good Samaritan law addressed, 43 of 267 (16.1%) believed they could be arrested for calling 911, and 32 of 272 (11.8%) believed they could be arrested for having an overdose. After adjusting for demographic characteristics, accessing the syringe services program was associated with accurate knowledge and the belief that PWID could be arrested for calling 911; however, training in overdose reversal was not associated. CONCLUSIONS Most PWID were unaware of the Good Samaritan law; this lack of awareness is a barrier to preventing overdose deaths. Educating PWID about Good Samaritan laws is essential, and such education should include police to ensure that law enforcement is congruent with Good Samaritan laws and does not perpetuate mistrust between police and PWID.
Collapse
Affiliation(s)
- Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian W. Weir
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
20
|
Baker P, Beletsky L, Avalos L, Venegas C, Rivera C, Strathdee SA, Cepeda J. Policing Practices and Risk of HIV Infection Among People Who Inject Drugs. Epidemiol Rev 2020; 42:27-40. [PMID: 33184637 PMCID: PMC7879596 DOI: 10.1093/epirev/mxaa010] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 01/03/2023] Open
Abstract
Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.
Collapse
Affiliation(s)
- Pieter Baker
- Correspondence to Pieter Baker, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093 (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
21
|
Footer KHA, Park JN, Rouhani S, Galai N, Silberzahn BE, Huettner S, Allen ST, Sherman SG. The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City. PLoS One 2020; 15:e0227809. [PMID: 31978164 PMCID: PMC6980607 DOI: 10.1371/journal.pone.0227809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022] Open
Abstract
Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (β = 0.71, p = 0.037), in daily sex work (β = 1.32, p = 0.026), arrested in the past 12 months (β = 1.44, p<0.001) or injecting drugs in the past 3 months (β = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations’ health outcomes, including HIV risk.
Collapse
Affiliation(s)
- Katherine H. A. Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
- * E-mail:
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Bradley E. Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Steven Huettner
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| |
Collapse
|
22
|
Garcia RA, Kenyon KH, Brolan CE, Coughlin J, Guedes DD. Court as a health intervention to advance Canada's achievement of the sustainable development goals : a multi-pronged analysis of Vancouver's Downtown Community Court. Global Health 2019; 15:80. [PMID: 31847875 PMCID: PMC6918572 DOI: 10.1186/s12992-019-0511-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/21/2019] [Indexed: 12/04/2022] Open
Abstract
Background The increase in problematic substance use is a major problem in Canada and elsewhere, placing a heavy burden on health and justice system resources given a spike in drug-related offences. Thus, achievement of Sustainable Development Goal (SDG) Target 3.5 to ‘Strengthen the prevention and treatment of substance abuse’ is important for Canada’s overall realization of the SDGs, including SDG 3 (Good Health and Wellbeing). Since 2008, Vancouver’s Downtown Community Court (DCC) has pioneered an innovative partnership among the justice, health and social service systems to address individuals’ needs and circumstances leading to criminal behaviour. While researchers have examined the DCC’s impact on reducing recidivism, with Canada’s SDG health commitments in mind, we set out to examine the ways health and the social determinants of health (SDH) are engaged and framed externally with regard to DCC functioning, as well as internally by DCC actors. We employed a multi-pronged approach analyzing (1) publicly available DCC documents, (2) print media coverage, and (3) health-related discourse and references in DCC hearings. Results The documentary analysis showed that health and the SDH are framed by the DCC as instrumental for reducing drug-related offences and improving public safety. The observation data indicate that judges use health and SDH in providing context, understanding triggers for offences and offering rationale for sentencing and management plans that connect individuals to healthcare, social and cultural services. Conclusions Our study contributes new insights on the effectiveness of the DCC as a means to integrate justice, health and social services for improved health and community safety. The development of such community court interventions, and their impact on health and the SDH, should be reported on by Canada and other countries as a key contribution to SDG 3 achievement, as well as the fulfillment of other targets under the SDG framework that contain the SDH. Consideration should be given by Canada as to how to capture and integrate the important data generated by the DCC and other problem-solving courts into SDG reporting metrics. Certainly, the DCC advances the SDGs’ underlying Leave No One Behind principle in a high-income country context.
Collapse
Affiliation(s)
| | | | - Claire E Brolan
- Centre for Policy Futures, University of Queensland, Brisbane, Australia
| | | | | |
Collapse
|
23
|
How are transgender women acquiring HIV? Insights from phylogenetic transmission clusters in San Francisco. AIDS 2019; 33:2073-2079. [PMID: 31335804 DOI: 10.1097/qad.0000000000002318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We explored potential HIV transmission typologies that involve transgender women to obtain insights on sexual and needle-sharing networks as sources of HIV infection. DESIGN San Francisco residents diagnosed with HIV in care at public facilities who had available viral pol sequences from June 2001 to January 2016 were included in the analysis. METHODS Viral sequence data were matched to the San Francisco HIV/AIDS Case Registry to obtain demographic and risk classification information. Transmission clusters with at least two cases were identified by bootstrap values at least 90% and mean pairwise genetic distances 0.025 or less substitutions per site. RESULTS Transgender women represented 275 of 5200 patients; 86 were present in 70 clusters. Four typologies were hypothesized: first, transgender women in clusters with MSM; second, transgender women who inject drugs in clusters with cisgender women and men who inject drugs; third, multiple transgender women in clusters with one man; and fourth, multiple transgender women who do not inject drugs in clusters with men and cisgender women who inject drugs. CONCLUSION Transmission patterns of transgender women may stand apart from MSM epidemics. Transgender women clustered with people who inject drugs, and with men who have sex with transgender women and cisgender women. Aggregation of transgender women into the category of MSM may obscure understanding of how they acquire HIV and to whom they may transmit infection. Phylogenetic insights strengthen the case that HIV prevention programs for MSM may not be applicable to transgender women or their partners.
Collapse
|
24
|
Khorasheh T, Naraine R, Watson TM, Wright A, Kallio N, Strike C. A scoping review of harm reduction training for police officers. Drug Alcohol Rev 2019; 38:131-150. [PMID: 30785229 DOI: 10.1111/dar.12904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/20/2018] [Accepted: 01/01/2019] [Indexed: 01/18/2023]
Abstract
ISSUES Preventable overdose deaths, especially due to opioids, have increasingly been reported worldwide. Expansion of life-saving harm reduction services is underway with increasing public support in some jurisdictions. However, such services often fall short of reaching people who use drugs (PWUD), in part, due to law enforcement practices that are aligned with punitive drug laws and incongruent with harm reduction principles. One suggested strategy to facilitate police understanding and uptake of practices that are more congruent with harm reduction is to provide police with relevant training. APPROACH This scoping review synthesises English-language peer-reviewed and grey literature on harm reduction training programs for police. KEY FINDINGS We reviewed 31 sources and found that most trainings covered topics related to harm reduction objectives, overdose recognition and response, occupational safety and policing practices. Information was often presented via single-session, 1-hour long, slide-assisted presentations that were integrated into in-service trainings. Inconsistent throughout the literature was the career stage or position/rank of training audience (e.g. cadets, senior officers, street-level officers), when and how much training should be provided, and the occupational background of the training facilitator. IMPLICATIONS The available literature contains significant gaps pertaining to descriptions of training development, design and content specific to facilitating positive police-PWUD interactions, and formal evaluations. These gaps limit our understanding of what well-designed trainings may look like, if and how training alters policing practices, and to what extent training completion may lead to improved outcomes. CONCLUSION Greater research and formal evaluations of harm reduction training for police is recommended.
Collapse
Affiliation(s)
- Triti Khorasheh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Renuka Naraine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amy Wright
- The Works, Toronto Public Health, Toronto, Canada
| | - Natalie Kallio
- keepSIX Supervised Consumption Services, South Riverdale Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
Culbert GJ, Waluyo A, Wang M, Putri TA, Bazazi AR, Altice FL. Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety. AIDS Behav 2019; 23:2048-2058. [PMID: 30465106 DOI: 10.1007/s10461-018-2344-6] [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: 01/02/2023]
Abstract
With adequate support, people with HIV (PWH) may achieve high levels of adherence to antiretroviral therapy (ART) during incarceration. We examined factors associated with ART utilization and adherence among incarcerated PWH (N = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2-24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2-12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7-6.2, p < 0.001), and perceived need for medical treatment (aOR = 1.6, 95% CI 1.1-2.5, p = 0.011), and negatively associated with chance locus of control (aOR = 0.3, 95% CI 0.1-0.7, p = 0.013). Most participants utilizing ART (74.5%) reported less than "perfect" ART adherence. ART adherence was independently associated with perceived personal safety (β = 0.21, 95% CI 0.01-0.40, p = 0.032) and methadone utilization (β = 0.84, 95% CI 0.10-1.67, p = 0.047). PWH receiving methadone had a sixfold higher adjusted odds of being highly-adherent to ART (aOR = 6.3, 95% CI 1.1-35.7, p = 0.036). Interventions that increase methadone utilization and personal safety may improve ART adherence among incarcerated PWH.
Collapse
Affiliation(s)
- Gabriel J Culbert
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave. Rm. 910, Chicago, IL, USA.
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
| | - Agung Waluyo
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Melinda Wang
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Tissa Aulia Putri
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Alexander R Bazazi
- Department of Psychiatry, San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
26
|
Mittal ML, Artamonova I, Baker P, Strathdee SA, Cepeda J, Bañuelos A, Morales M, Arredondo J, Rocha-Jimenez T, Clairgue E, Bustamante E, Patiño E, Gaines T, Beletsky L. Improving police conceptual knowledge of Mexico's law on cannabis possession: Findings from an assessment of a police education program. Am J Addict 2019; 27:608-611. [PMID: 30516331 DOI: 10.1111/ajad.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/06/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Policing practices do not reflect recent decriminalization of drug possession in Mexico. We assessed knowledge of cannabis law as part of a police education program (PEP) post-drug law reform in Tijuana. METHODS Officers took pre-/post-PEP surveys; random subsample (n = 759) received follow-up assessments. Longitudinal logistic regression (pre-, post-, 3-months post-PEP) measured knowledge of cannabis law. RESULTS PEP increased conceptual knowledge of cannabis law from baseline to post-training (AOR = 56.1, CI: 41.0-76.8) and 3 months post-PEP (AOR = 11.3, CI: 9.0-14.2). CONCLUSION AND SCIENTIFIC SIGNIFICANCE PEPs improve police knowledge of cannabis law. Reforms should be bundled with PEPs to improve policy implementation. (Am J Addict 2018;XX:XX-XX).
Collapse
Affiliation(s)
- Maria L Mittal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla.,School of Medicine, Universidad Xochicalco, Tijuana, Mexico
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla.,Graduate School of Public Health, San Diego State University, San Diego, California
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Mario Morales
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla.,Graduate School of Public Health, San Diego State University, San Diego, California
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | | | - Efrain Patiño
- School of Medicine, Universidad Xochicalco, Tijuana, Mexico.,Public Safety Support Department, Dirección Municipal de Salud, Tijuana, Mexico
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla.,School of Law and Bouvé College of Health Sciences, Northeastern University, Massachusetts
| |
Collapse
|
27
|
LaMonaca K, Dumchev K, Dvoriak S, Azbel L, Morozova O, Altice FL. HIV, Drug Injection, and Harm Reduction Trends in Eastern Europe and Central Asia: Implications for International and Domestic Policy. Curr Psychiatry Rep 2019; 21:47. [PMID: 31161306 PMCID: PMC6685549 DOI: 10.1007/s11920-019-1038-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Scaling up evidence-based HIV prevention strategies like opioid agonist therapies (OAT), syringe services programs (SSPs), and antiretroviral therapy (ART) to mitigate the harms of drug injection is crucial within Eastern Europe and Central Asia (EECA), the only region globally where HIV incidence and mortality are increasing. RECENT FINDINGS Though the proportion of new HIV cases directly attributable to drug injection has recently declined, it remains a critical driver of HIV, especially to sexual partners. Concurrently, scale-up of OAT, SSPs, and ART has remained low, contributing to a volatile HIV epidemic among people who inject drugs (PWID). Despite evidence that drug injection contributes to an evolving HIV epidemic in EECA, coverage of evidence-based harm reduction programs remains substantially below needed targets. Due to a combination of punitive drug laws, ideological resistance to OAT among clinicians and policymakers, and inadequate domestic and international funding, limited progress has been observed in increasing the availability of these programs.
Collapse
Affiliation(s)
- Katherine LaMonaca
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street Suite 323, New Haven, CT, 06510, USA
| | | | - Sergii Dvoriak
- Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine
| | - Lyuba Azbel
- London School of Hygiene & Tropical Medicine, London, UK
| | - Olga Morozova
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street Suite 323, New Haven, CT, 06510, USA.
| |
Collapse
|
28
|
Arredondo J, Beletsky L, Baker P, Abramovitz D, Artamonova I, Clairgue E, Morales M, Mittal ML, Rocha-Jimenez T, Kerr T, Banuelos A, Strathdee SA, Cepeda J. Interactive Versus Video-Based Training of Police to Communicate Syringe Legality to People Who Inject Drugs: The SHIELD Study, Mexico, 2015-2016. Am J Public Health 2019; 109:921-926. [PMID: 30998406 PMCID: PMC6507990 DOI: 10.2105/ajph.2019.305030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To assess how instructional techniques affect officers' intent to communicate syringe legality during searches in Tijuana, Mexico, where pervasive syringe confiscation potentiates risk of HIV and HCV among people who inject drugs (PWID) and of occupational needle-stick injury among police. Methods. Using the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model, Tijuana police underwent training to encourage communication of syringe possession legality to PWID. Trainees received either passive video or interactive role-play exercise on safer search techniques. We used logistic regression to assess the training's impact on self-reported intent to communicate syringe legality by training type and gender. Results. Officers (n = 1749) were mostly men (86%) assigned to patrol (84%). After the training, intent to communicate the law improved markedly: from 20% to 39% (video group) and 20% to 58% (interactive group). Gender and training type significantly predicted intent to communicate syringe legality. Male and female officers' adjusted odds ratios in the interactive group were 5.37 (95% confidence interval [CI] = 4.56, 6.33) and 9.16 (95% CI = 5.88, 14.28), respectively, after the training. Conclusions. To more effectively persuade police to endorse harm reduction and occupational safety practices, police trainings should include interactive elements.
Collapse
Affiliation(s)
- Jaime Arredondo
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Leo Beletsky
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Pieter Baker
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Daniela Abramovitz
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Irina Artamonova
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Erika Clairgue
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Mario Morales
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Maria Luisa Mittal
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Teresita Rocha-Jimenez
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Thomas Kerr
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Arnulfo Banuelos
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Steffanie A Strathdee
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Javier Cepeda
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| |
Collapse
|
29
|
Thi Thanh Huong N, Thi Hau N, Van Chau N, Trung Tan L, Thi Minh Tam N, Gray R, O’Connell KA, Neukom J. Perceived barriers and facilitators to uptake of HIV testing services among people who inject drugs in Vietnam. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1448473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ngo Thi Thanh Huong
- Population Services International (PSI)/Vietnam, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội, Vietnam
| | - Nguyen Thi Hau
- Community Peer Researcher, Hai Bà Trưng, Hà Nội, Vietnam
| | | | - Le Trung Tan
- Community Peer Researcher, Phu Luong, Thai Nguyen, Vietnam
| | - Nguyen Thi Minh Tam
- Vietnam Authority of HIV/AIDS Control, Ministry of Health Head, Dept. of Health Organisation and Management, Hanoi Medical University, Hanoi, Vietnam
| | - Rob Gray
- Independent Consultants, Population Services International, Washington DC, USA
| | | | - Josselyn Neukom
- Population Services International (PSI)/Vietnam, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội, Vietnam
| |
Collapse
|
30
|
Owczarzak J, Phillips SD, Cho W. 'Pure' drug users, commercial sex workers and 'ordinary girls': gendered narratives of HIV risk and prevention in post-Soviet Ukraine. CULTURE, HEALTH & SEXUALITY 2018; 20:1171-1184. [PMID: 29417879 PMCID: PMC6082725 DOI: 10.1080/13691058.2017.1421708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
International best practices call for a gender-responsive approach to HIV prevention for women, including those who use drugs and those who engage in sex work. This paper draws on multiple qualitative data sources collected over five years in Ukraine to explore the notions of gender, women and family that buttress HIV-related programmes for women. Our analysis reveals that service providers often cast women as hapless victims of unfortunate family circumstances and troubled personal relationships that produce sudden poverty, or social strivers who seek access to wealth and privilege at the expense of their health. Women are portrayed as most vulnerable to HIV when they lack a male 'protector'. We argue that the programmes constituted around these stereotypes of women and their vulnerabilities reflect new forms of institutional power that deflect attention away from gendered socio-economic processes that contribute to women's HIV vulnerability, including job insecurity and unemployment, workplace discrimination, unreliable social benefits and power imbalances within their relationships. We explore how to transform HIV prevention efforts to better address the causes of women's increased vulnerability to HIV in Ukraine and in Eastern Europe more generally.
Collapse
Affiliation(s)
- Jill Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, USA
| | | | - Woojeong Cho
- Department of Anthropology, Indiana University, Bloomington, USA
| |
Collapse
|
31
|
Morales M, Rafful C, Gaines TL, Cepeda JA, Abramovitz D, Artamonova I, Baker P, Clairgue E, Mittal ML, Rocha-Jimenez T, Arredondo J, Kerr T, Bañuelos A, Strathdee SA, Beletsky L. Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:36. [PMID: 30219105 PMCID: PMC6139125 DOI: 10.1186/s12914-018-0175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/29/2018] [Indexed: 12/04/2022]
Abstract
Background Mexican law permits syringe purchase and possession without prescription. Nonetheless, people who inject drugs (PWID) frequently report arrest for syringe possession. Extrajudicial arrests not only violate human rights, but also significantly increase the risk of blood-borne infection transmission and other health harms among PWID and police personnel. To better understand how police practices contribute to the PWID risk environment, prior research has primarily examined drug user perspectives and experiences. This study focuses on municipal police officers (MPOs) in Tijuana, Mexico to identify factors associated with self-reported arrests for syringe possession. Methods Participants were active police officers aged ≥18 years, who completed a self-administered questionnaire on knowledge, attitudes and behaviors related to occupational safety, drug laws, and harm reduction strategies. Univariable and multivariable logistic regression was used to identify correlates of recent syringe possession arrest. Results Among 1044 MPOs, nearly half (47.9%) reported always/sometimes making arrests for syringe possession (previous 6mo). Factors independently associated with more frequent arrest included being male (Adjusted Odds Ratio [AOR] = 1.62; 95% Confidence Interval [95% CI] =1.04–2.52; working in a district along Tijuana River Canal (where PWID congregate) (AOR = 2.85; 95%CI = 2.16–3.77); having recently experienced a physical altercation with PWID (AOR = 2.83; 95% CI = 2.15–3.74); and having recently referred PWID to social and health services (AOR = 1.97; 95% CI = 1.48–2.61). Conversely, odds were significantly lower among officers reporting knowing that syringe possession is legal (AOR = 0.61; 95% CI = 0.46–0.82). Conclusions Police and related criminal justice stakeholders (e.g., municipal judges, prosecutors) play a key role in shaping PWID risk environment. Findings highlight the urgent need for structural interventions to reduce extra-judicial syringe possession arrests. Police training, increasing gender and other forms of diversity, and policy reforms at various governmental and institutional levels are necessary to reduce police occupational risks, improve knowledge of drug laws, and facilitate harm reduction strategies that promote human rights and community health.
Collapse
Affiliation(s)
- Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, 22110, Tijuana, Baja California, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Thomas Kerr
- Center of Excellence in HIV/AIDS, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, 2141 Blvd Cuauhtémoc Sur y Río Suchiate, 22015, Tijuana, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA. .,Health in Justice Action Lab, School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, 02115, USA.
| |
Collapse
|
32
|
Borquez A, Beletsky L, Nosyk B, Strathdee SA, Madrazo A, Abramovitz D, Rafful C, Morales M, Cepeda J, Panagiotoglou D, Krebs E, Vickerman P, Claude Boily M, Thomson N, Martin NK. The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study. Lancet Public Health 2018; 3:e429-e437. [PMID: 30122559 PMCID: PMC6211569 DOI: 10.1016/s2468-2667(18)30097-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND As countries embark on public health-oriented drug law reform, health impact evaluations are needed. In 2012, Mexico mandated the narcomenudeo reform, which depenalised the possession of small amounts of drugs and instituted drug treatment instead of incarceration. We investigated the past and future effect of this drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico. METHODS In this epidemic modelling study, we used data from the El Cuete IV cohort study to develop a deterministic model of injecting and sexual HIV transmission in people who inject drugs in Tijuana between 2012 and 2030. The population was stratified by sex, incarceration status, syringe confiscation by the police, HIV stage, and exposure to drug treatment or rehabilitation (either opioid agonist treatment or compulsory drug abstinence programmes). We modelled the effect of these exposures on HIV risk in people who inject drugs, estimating the effect of observed and potential future reform enforcement levels. FINDINGS In 2011, prior to the narcomenudeo reform, 547 (75%) of 733 people who inject drugs in the El Cuete cohort reported having ever been incarcerated, on average five times since starting injecting. Modelling estimated the limited reform implementation averted 2% (95% CI 0·2-3·0) of new HIV infections in people who inject drugs between 2012 and 2017. If implementation reduced incarceration in people who inject drugs by 80% from 2018 onward, 9% (95% CI 4-16) of new HIV infections between 2018 and 2030 could be averted, with 21% (10-33) averted if people who inject drugs were referred to opioid agonist treatment instead of being incarcerated. Referral to compulsory drug abstinence programmes instead of prison could have a lower or potentially negative impact with -2% (95% CI -23 to 9) infections averted. INTERPRETATION Mexican drug law reform has had a negligible effect on the HIV epidemic among people who inject drugs in Tijuana. However, appropriate implementation could markedly reduce HIV incidence if linked to opioid agonist treatment. Unfortunately, compulsory drug abstinence programmes are the main type of drug rehabilitation available and their expansion could potentially increase HIV transmission. FUNDING National Institute on Drug Abuse, UC San Diego Center for AIDS Research.
Collapse
Affiliation(s)
- Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA.
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Alejandro Madrazo
- Drug Policy Program, Centro de Investigación y Docencia Económicas, Sede Región Centro, Aguascalientes, Mexico
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Mario Morales
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; School of Social Work, San Diego State University, CA, USA
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | | | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Marie Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Nicholas Thomson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
33
|
Zule WA, Latypov A, Otiashvili D, Bangel S, Bobashev GV. Feasibility of needle and syringe programs in Tajikistan distributing low dead space needles. Harm Reduct J 2018; 15:44. [PMID: 30170604 PMCID: PMC6119303 DOI: 10.1186/s12954-018-0249-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background In 2012, the World Health Organization recommended that needle and syringe programs offer their clients low dead space insulin syringes with permanently attached needles. However, in many countries, these syringes are not acceptable to a majority of people who inject drugs. This study assessed the feasibility of working with needle and syringe programs to implement the WHO recommendation using low dead space detachable needles. The study also assessed the acceptability of the needles. Methods Two needle and syringe programs in Tajikistan—one in Kulob and one in Khudjand—received 25,000 low dead space detachable needles each. The programs distributed low dead space detachable needles and a marketing flyer that emphasized the relative advantages of the needles. Each program also enrolled 100 participants, and each participant completed a baseline interview and a 2-month follow-up interview. Results At follow-up, 100% of participants reported trying the low dead space detachable needles, and 96% reported that they liked using the needles. Both needle and syringe programs distributed all their needles within the first 60 days of the project indicating use of the needles, even among clients who did not participate in the study. Conclusions This project demonstrates that it is feasible for needle and syringe programs to offer and promote low dead space needles to their clients. The findings indicate that low dead space needles are acceptable to needle and syringe program clients in these Tajikistan cities. To reduce HIV and hepatitis C virus transmission, needle and syringe programs should offer low dead space needles, low dead space insulin syringes in addition to standard needles, and syringes to their clients.
Collapse
Affiliation(s)
- William A Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 2709-2194, USA.
| | - Alisher Latypov
- Global Health Research Center of Central Asia, Columbia University, New York, NY, USA
| | - David Otiashvili
- Addiction Research Center - Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia
| | - Steffani Bangel
- Institute of Women and Ethnic Studies, 365 Canal St #1550, New Orleans, LA, 70130, USA
| | - Georgiy V Bobashev
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 2709-2194, USA
| |
Collapse
|
34
|
Beletsky L, Baker P, Arredondo J, Emuka A, Goodman-Meza D, Medina-Mora ME, Werb D, Davidson P, Amon JJ, Strathdee S, Magis-Rodriguez C. The global health and equity imperative for safe consumption facilities. Lancet 2018; 392:553-554. [PMID: 30152386 DOI: 10.1016/s0140-6736(18)31469-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA; School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ashley Emuka
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Dan Werb
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Joseph J Amon
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | | |
Collapse
|
35
|
Bundy JD, Bazzano LA, Xie D, Cohan J, Dolata J, Fink JC, Hsu CY, Jamerson K, Lash J, Makos G, Steigerwalt S, Wang X, Mills KT, Chen J, He J. Self-Reported Tobacco, Alcohol, and Illicit Drug Use and Progression of Chronic Kidney Disease. Clin J Am Soc Nephrol 2018; 13:993-1001. [PMID: 29880471 PMCID: PMC6032576 DOI: 10.2215/cjn.11121017] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/05/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies suggest that tobacco, alcohol, and illicit drug use is associated with CKD. We examined the associations of substance use with CKD progression and all-cause mortality among patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Renal Insufficiency Cohort Study is a prospective, longitudinal cohort study among 3939 participants with CKD in the United States. Self-reported tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug (cocaine, heroin, or methamphetamine) use were obtained at baseline and annual follow-up visits. CKD progression was defined as incident ESKD or halving of eGFR. Substance use was modeled as the cumulative average exposure to capture both recent and long-term use in multivariable time-dependent Cox regression. RESULTS Over a median 5.5-year follow-up, 1287 participants developed CKD progression, and 1001 died. Baseline proportions of tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug use were 13%, 20%, 33%, and 12%, respectively. Compared with nonsmoking throughout follow-up, multivariable-adjusted hazard ratios for persistent tobacco smoking were 1.02 (95% confidence interval, 0.86 to 1.21) for CKD progression and 1.86 (95% confidence interval, 1.54 to 2.24) for all-cause mortality. Compared with nondrinking throughout follow-up, multivariable-adjusted hazard ratios for persistent alcohol drinking were 1.06 (95% confidence interval, 0.88 to 1.29) for CKD progression and 0.73 (95% confidence interval, 0.58 to 0.91) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent marijuana use were 0.94 (95% confidence interval, 0.82 to 1.07) for CKD progression and 1.11 (95% confidence interval, 0.96 to 1.30) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent hard illicit drug use were 1.25 (95% confidence interval, 1.00 to 1.55) for CKD progression and 1.41 (95% confidence interval, 1.10 to 1.81) for all-cause mortality. CONCLUSIONS Hard illicit drug use is associated with higher risk of CKD progression and all-cause mortality, tobacco smoking is associated with higher risk of all-cause mortality, and alcohol drinking is associated with lower risk of all-cause mortality among patients with CKD.
Collapse
Affiliation(s)
- Joshua D. Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Dawei Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Janet Cohan
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Jacqueline Dolata
- Division of Nephrology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey C. Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chi-yuan Hsu
- Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Kenneth Jamerson
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - James Lash
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Gail Makos
- Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan; and
| | - Susan Steigerwalt
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Xue Wang
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine T. Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - the CRIC Study Investigators
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Medicine, University of Illinois, Chicago, Illinois
- Division of Nephrology, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Division of Nephrology, University of California San Francisco, San Francisco, California
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan; and
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan
| |
Collapse
|
36
|
Paquette CE, Pollini RA. Injection drug use, HIV/HCV, and related services in nonurban areas of the United States: A systematic review. Drug Alcohol Depend 2018; 188:239-250. [PMID: 29787966 PMCID: PMC5999584 DOI: 10.1016/j.drugalcdep.2018.03.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Injection drug use (IDU) in nonurban areas of the United States is a growing public health concern, but there has been no comprehensive assessment of existing research on injection-related HIV and hepatitis C (HCV) in nonurban communities. We conducted a systematic review to assess the current literature and identify knowledge gaps. METHODS We systematically searched six databases for relevant articles published between January 1990 and June 2016 and screened, extracted, and analyzed the resulting data. Studies were included if they reported original findings from the nonurban U.S. related to 1) IDU and its role in HIV/HCV transmission, and/or 2) HIV/HCV services for people who inject drugs (PWID). RESULTS Of 2330 studies, 34 from 24 unique research projects in 17 states met inclusion criteria. Despite increasing HCV and high vulnerability to injection-related HIV outbreaks in nonurban areas, only three studies since 2010 recruited and tested PWID for HIV/HCV. Twelve reported on sharing injection equipment but used varying definitions of sharing, and only eight examined correlates of injection risk. Nine studies on syringe access suggest limited access through syringe exchange programs and pharmacies. Only two studies addressed HCV testing, none addressed HIV testing, and three examined behavioral or other interventions. CONCLUSIONS Despite growing concern regarding nonurban IDU there are few studies of HIV/HCV and related services for PWID, and the existing literature covers a very limited geographical area. Current research provides minimal insights into any unique factors that influence injection risk and HIV/HCV service provision and utilization among nonurban PWID.
Collapse
Affiliation(s)
- Catherine E Paquette
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Beltsville, MD, 20705, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, United States
| | - Robin A Pollini
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Beltsville, MD, 20705, United States; Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University, 3606 Collins Ferry Road, Suite 201, Morgantown, WV, 26505, United States.
| |
Collapse
|
37
|
Rafful C, Melo J, Medina-Mora ME, Rangel G, Sun X, Jain S, Werb D. Cross-border migration and initiation of others into drug injecting in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S277-S284. [PMID: 29168262 PMCID: PMC5940504 DOI: 10.1111/dar.12630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Efforts to prevent injection drug use (IDU) are increasingly focusing on the role that people who inject drugs (PWID) play in facilitating the entry of others into this behaviour. This is particularly relevant in settings experiencing high levels of IDU, such as Mexico's northern border region, where cross-border migration, particularly through forced deportation, has been found to increase a range of health and social harms related to injecting. DESIGN AND METHODS PWID enrolled in a prospective cohort study in Tijuana, Mexico, since 2011 were interviewed semi-annually, which solicited responses on their experiences initiating others into injecting. Univariate and multivariable logistic regression analyses were conducted at the Preventing Injection by Modifying Existing Responses (PRIMER) baseline, with the dependent variable defined as reporting ever initiating others into injection. The primary independent variable was lifetime deportation from the USA to Mexico. RESULTS Among 532 participants, 14% (n = 76) reported initiating others into injecting, the majority of participants reporting initiating acquaintances (74%, n = 56). In multivariable analyses, initiating others into injecting was independently associated with reporting living in the USA for 1-5 years [adjusted odds ratio (AOR) = 2.42; 95% confidence interval (CI) 1.22-4.79, P = 0.01], and methamphetamine and heroin injection combined (AOR = 3.67; 95% CI 1.11-12.17, P = 0.03). Deportation was not independently associated with initiating others into injecting. DISCUSSION AND CONCLUSIONS The impact of migration needs to be considered within binational programming seeking to prevent the expansion of epidemics of injecting and HIV transmission among mobile populations residing in the Mexico-USA border region.
Collapse
Affiliation(s)
- Claudia Rafful
- Division of Global Public Health, University of California San Diego, San Diego, USA
- San Diego State University, San Diego, USA
| | - Jason Melo
- Division of Global Public Health, University of California San Diego, San Diego, USA
| | | | - Gudelia Rangel
- Secretariat of Health, Mexico City, Mexico
- Mexico-United States Border Health Commission, Tijuana, Mexico
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, Biostatistics Research Center, University of California San Diego, San Diego, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, Biostatistics Research Center, University of California San Diego, San Diego, USA
| | - Dan Werb
- Division of Global Public Health, University of California San Diego, San Diego, USA
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| |
Collapse
|
38
|
Dawson L, Strathdee SA, London AJ, Lancaster KE, Klitzman R, Hoffman I, Rose S, Sugarman J. Addressing ethical challenges in HIV prevention research with people who inject drugs. JOURNAL OF MEDICAL ETHICS 2018; 44:149-158. [PMID: 27114469 PMCID: PMC6367727 DOI: 10.1136/medethics-2015-102895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 05/15/2023]
Abstract
Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.
Collapse
Affiliation(s)
- Liza Dawson
- Division of AIDS, NIH/NIAID, Bethesda, Maryland, USA
| | | | | | | | | | - Irving Hoffman
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott Rose
- Family Health International, Durham, North Carolina, USA
| | | |
Collapse
|
39
|
Racial Inequities in HIV Prevalence and Composition of Risk Networks Among People Who Inject Drugs in HIV Prevention Trial Network 037. J Acquir Immune Defic Syndr 2018; 76:394-401. [PMID: 28816720 DOI: 10.1097/qai.0000000000001521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV prevention interventions in the United States have failed to eliminate racial inequities. Here, we evaluate factors associated with racial inequities in HIV prevalence among people who inject drugs using HIV Prevention Trial Network 037 data. METHODS We measured racial homophily (ie, all members share the same race), being in an HIV+ network (network with ≥1 HIV+ member), and drug and sex risk behaviors. A 2-level logistic regression with a random intercept evaluated the association between being in an HIV+ network and race adjusting for individual-level and network-level factors. RESULTS Data from 232 index participants and 464 network members were included in the analysis. Racial homophily was high among blacks (79%) and whites (70%); 27% of all-black, 14% of all-white, and 23% of racially mixed networks included HIV+ members. Sex risk was similar across networks, but needle sharing was significantly lower in all-black (23%) compared with all-white (48%) and racially mixed (46%) networks. All-black [adjusted odds ratio (AOR), 3.6; 95% confidence interval (CI), 1.4 to 9.5] and racially mixed (AOR, 2.0; 95% CI: 1.1 to 3.7) networks were more likely to include HIV+ network members; other factors associated with being in HIV+ network included homelessness (AOR, 2.0; 95% CI, 1.2 to 3.2), recent incarceration (AOR, 0.4; 95% CI, 0.2 to 0.7), and cocaine injection (AOR, 1.7; 95% CI, 1.0 to 2.7). Risk behaviors were not associated with being in an HIV+ network. CONCLUSION Despite having lower drug risk behavior, all-black networks disproportionately included HIV+ members. HIV prevention interventions for people who inject drugs need to go beyond individual risk and consider the composition of risk networks.
Collapse
|
40
|
Marotta P, El-Bassel N, Terlikbayeva A, Mergenova G, Primbetova S, Wu E, Gilbert L. Sexual Risks and Policing among Male Migrant and Non-migrant Market Vendors in Central Asia. J Urban Health 2018; 95:116-128. [PMID: 28681341 PMCID: PMC5862692 DOI: 10.1007/s11524-017-0171-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The following study examined associations between sexual risk behaviors and policing among external migrant, internal migrant, and non-migrant male market workers in Almaty, Kazakhstan. Negative binomial regression and logistic regressions examined associations between sexual risk behaviors and policing (questioning by market officials and migration police, and arrest) for 1342 external, internal, and non-migrant workers recruited using respondent-driven sampling (RDS). Incidence rate ratios (IRR) and adjusted odds ratios (OR) were stratified by migration status. External migrants were more likely than non-migrants to experience questioning by market officials (IRR = 2.07, p<0.01), migration police (IRR = 3.60, p<0.001), and arrest (OR = 5.32, p<0.001). When stratified by migration status, being under the influence of drugs or alcohol (IRR = 3.04, p<0.01) and sex with men (IRR = 2.71, p<0.05) were associated with being questioned or harassed by market police among external migrants. External migrant who reported having more than one sex partner while traveling were also more likely to report being arrested than external migrants (OR = 3.92, p<0.05). Meeting HIV prevention needs of labor migrants demands acknowledging the role of policing and allocating sufficient resources to support the implementation of HIV prevention programs in these settings.
Collapse
Affiliation(s)
- Phillip Marotta
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Nabila El-Bassel
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | | | - Gaukhar Mergenova
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | | | - Elwin Wu
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Louisa Gilbert
- Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| |
Collapse
|
41
|
Marotta PL, McCullagh CA. A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013. Eur J Epidemiol 2017; 33:679-688. [PMID: 29234968 DOI: 10.1007/s10654-017-0342-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022]
Abstract
Data at the individual-level provide evidence that opioid substitution treatment (OST) programs protect against mortality for opioid dependent populations. Prior research has not examined the merits of national implementation of opioid substitution programs for reducing mortality at the country-level. This study elucidates longitudinal associations between country-level implementation of opioid substitution treatment programs on mortality rates of drug related deaths (DRD) from 1995 to 2013 in 30 European nations. Cases of DRD were measured using National Definitions for each country from official sources of data. Preliminary analysis of dispersion of cases of DRD using means and variances justified use of the negative binomial regression model with a population offset. Year and country-level fixed effects negative binomial regression models investigated the association between years of implementation of methadone maintenance therapy (MMT), OST in prison, and high dose buprenorphine treatment (HDBT) implementation and mortality rates from drug related deaths after adjusting for unemployment rates, heroin seizures and per capita expenditures on health. Beta coefficients were converted to Incidence Rate Ratios (IRR) and standard errors bootstrapped using non-parametric methods to adjust for bias (SDbs). The mean mortality rate of DRD was 1.81 from 1995 to 2013. In adjusted models, each additional year of MMT (IRR = .61, SD = .04, p < .001; SDbs = .08, p < .001), prison OST (IRR = .90, SD = .01, p < .001; SDbs = .02, p < .001), and HDBT (IRR = .09, SD = .02, p < .001; SDbs = .02, p < .01) was significantly associated with lower rates of DRDs after adjusting for country and year fixed effects. Implementation of OST programs in the general population and in prison settings may have protected against mortality from drug use at the country-level in Europe from 1995 to 2013.
Collapse
Affiliation(s)
- Phillip L Marotta
- School of Social Work, New York, NY, USA.
- Columbia University, New York, NY, USA.
| | | |
Collapse
|
42
|
Marotta P. Assessing Spatial Relationships between Race, Inequality, Crime, and Gonorrhea and Chlamydia in the United States. J Urban Health 2017; 94:683-698. [PMID: 28831708 PMCID: PMC5610128 DOI: 10.1007/s11524-017-0179-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Incidence rates of chlamydia and gonorrhea reached unprecedented levels in 2015 and are concentrated in southern counties of the USA. Using incidence data from the Center for Disease Control, Moran's I analyses assessed the data for statistically significant clusters of chlamydia and gonorrhea at the county level in 46 states of the USA. Lagrange multiplier diagnostics justified selection of the spatial Durbin regression model for chlamydia and the spatial error model for gonorrhea. Rates of chlamydia (Moran's I = .37, p < .001) and gonorrhea (Moran's I = .38, p < .001) were highly clustered particularly in the southern region of the USA. Logged percent in poverty (B = .49, p < .001 and B = .48, p < .001) and racial composition of African-Americans (B = .16, p < .001 and B = .40, p < .001); Native Americans (B = .12, p < .001 and B = .20, p < .001); and Asians (B = .14, p < .001 and B = .09, p < .001) were significantly associated with greater rates of chlamydia and gonorrhea, respectively, after accounting for spatial dependence in the data. Logged rates of rates violent crimes were associated with chlamydia (B = .053, p < .001) and gonorrhea (B = .10, p < .001). Logged rates of drug crimes (.052, p < .001) were only associated with chlamydia. Metropolitan census designation was associated with logged rates of chlamydia (B = .12, p < .001) and gonorrhea (B = .24, p < .001). Spatial heterogeneity in the distribution of rates of chlamydia and gonorrhea provide important insights for strategic public health interventions in the USA and inform the allocation of limited resources for the prevention of chlamydia and gonorrhea.
Collapse
|
43
|
Tuot S, Ngin C, Pal K, Sou S, Sawez G, Morgan P, Srey M, Chan T, Chhoun P, Golichenko O, Choub SC, Yi S. How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study. Harm Reduct J 2017. [PMID: 28629463 PMCID: PMC5477156 DOI: 10.1186/s12954-017-0167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Harm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders. METHODS This qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns. RESULTS There was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD. CONCLUSIONS There is a lack of common understanding of the drug-related law and policy and their implications to harm reduction services among both law enforcement officers and PWID/PWUD. Thus, there is a need to mainstream and simplify the law and policy for better comprehension among these actors. To improve the quality and coverage of harm reduction interventions, the gap of understanding and enforcement of laws and policies should be narrowed, and coordination between the government and NGOs and other key stakeholders should be strengthened.
Collapse
Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Chanrith Ngin
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sochenda Sou
- Asia Actions for Harm Reduction, KHANA, Phnom Penh, Cambodia
| | - Ghazal Sawez
- Public Health Program, Touro University California, Vallejo, CA, 94592, USA
| | - Phylicia Morgan
- Public Health Program, Touro University California, Vallejo, CA, 94592, USA
| | - Mony Srey
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Tola Chan
- Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | | | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Public Health Program, Touro University California, Vallejo, CA, 94592, USA.
| |
Collapse
|
44
|
Health-damaging policing practices among persons who inject drugs in Mexico: Are deported migrants at greater risk? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:41-46. [PMID: 28601020 DOI: 10.1016/j.drugpo.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/12/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence-based public health and criminal justice policies aimed at addressing the structurally vulnerable population of persons who inject drugs (PWID) and who are involved in the immigrant enforcement and deportation system are lacking. Policing practices are critical structural determinants of HIV among PWID. PWID in Mexico who have been deported from the US are at elevated risk of HIV. METHODS From 2011 to 2013, 733 PWID were recruited to complete structured questionnaires, including past 6-month experiences with police. Eligible PWID were 18 years or older, had injected in the past month, and resided in Tijuana, Mexico with no intentions of moving. To determine if deportation status was associated with experiences of arrests and problematic policing practices, we conducted separate multivariate logistic regression models for independent policing variables. RESULTS In multivariate analyses, deportation status was independently associated with higher odds of being arrested (Adjusted Odds Ratio (AOR): 1.45; 95% Confidence Interval (CI): 1.02-2.05), being asked for a bribe (AOR: 1.39; 95% CI: 1.05-2.04), and being forced to leave a place of residence (AOR: 2.00; 95% CI: 1.08-3.70) in the past 6 months. CONCLUSION Results highlight a previously poorly understood elements of the US-deportation experience: migrants' experiences with law enforcement post-deportation and the role of deportation policies and practices as structural drivers of public health risk in destination countries. We provide policy recommendations for Mexico and the US based on our findings, which have potential application in other countries seeking to improve enforcement and related policing practices from a public health perspective.
Collapse
|
45
|
Vashishtha D, Mittal ML, Werb D. The North American opioid epidemic: current challenges and a call for treatment as prevention. Harm Reduct J 2017; 14:7. [PMID: 28494762 PMCID: PMC5427522 DOI: 10.1186/s12954-017-0135-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/19/2017] [Indexed: 12/01/2022] Open
Abstract
There is a need for creative, public health-oriented solutions to the increasingly intractable problems associated with the North American opioid epidemic. This epidemic is a fundamentally continental problem, as routes of migration, drug demand, and drug exchange link the USA with Mexico and Canada. The challenges faced throughout North America include entrenched prescribing practices of opioid medications, high costs and low availability of medication-assisted treatment (MAT), and policy approaches that present substantial barriers to care.We advocate for the scale up of a low-threshold treatment model for MAT that incorporates the best practices in addiction treatment. Such a model would remove barriers to care through widespread treatment availability and affordability and also a policy of decriminalization. Given that MAT reduces the frequency of drug injecting among opioid injectors, this treatment model should also be guided by an understanding of the socially communicable nature of injection drug use, such that increasing MAT availability may also prevent the spread of injecting practices to individuals at risk of transitions from non-injection to injection drug use. To that end, the "Treatment as Prevention" model employed to respond to the individual- and population-level risks for HIV/AIDS prevention could be adapted to efforts to halt the North American opioid epidemic.
Collapse
Affiliation(s)
- Devesh Vashishtha
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
| | - Maria Luisa Mittal
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA
- Facultad de Medicina, Universidad Xochicalco Campus Tijuana, RampaYumalinda 4850, Colonia Chapultepec Alamar C.P.22540, Tijuana, Baja California, México
| | - Daniel Werb
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
| |
Collapse
|
46
|
Syvertsen JL, Paquette CE, Pollini RA. Down in the valley: Trajectories of injection initiation among young injectors in California's Central Valley. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:41-49. [PMID: 28458170 DOI: 10.1016/j.drugpo.2017.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/31/2017] [Accepted: 03/13/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Injection drug use initiation represents a critical point of public health intervention, as injection increases risk for blood borne infections including Hepatitis C and HIV. In this paper, we explore pathways to injection initiation among youth (≤30) in the rural context of California's Central Valley, where rates of injection drug use are among the highest in the nation. METHODS We draw on semi-structured qualitative interviews with 20 young injectors to examine drug use histories, including the factors that participants associated with their transition to injection drug use. RESULTS The average age was 24.7 years (range: 20-30), 45% were female (n=9), and 30% were Latino (n=6). Participants described a variety of pathways to injection, culminating in a first injection that involved either opioids (n=12) or methamphetamine (n=8). Among the opioid group, the majority used prescription opioids before transitioning to injection, while a smaller number transitioned to opioid injection from non-opioid recreational drug use. Injectors who first used prescription opioids often described growing up in affluent suburban areas and transitioned to injection with peers, owing to a combination of factors related to individual tolerance, cost, and shifting drug markets. In contrast, methamphetamine initiates grew up in less affluent families with histories of substance use that exposed them to drugs at an early age. Methamphetamine users transitioned from smoking and snorting to injection, often with family members or intimate partners, within broader contexts of social disadvantage and stress. CONCLUSION While much of the focus on young injectors has centred on the current opioid epidemic, our data suggest a need to consider multiple pathways towards injection initiation of different drugs. Targeted interventions addressing the unique injection transition contexts of both opioids and methamphetamine are urgently needed in the Central Valley of California.
Collapse
Affiliation(s)
- Jennifer L Syvertsen
- The Ohio State University, Department of Anthropology, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210, USA
| | - Catherine E Paquette
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Beltsville, MD 20705, USA
| | - Robin A Pollini
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Beltsville, MD 20705, USA.
| |
Collapse
|
47
|
Wiessing L, Ferri M, Běláčková V, Carrieri P, Friedman SR, Folch C, Dolan K, Galvin B, Vickerman P, Lazarus JV, Mravčík V, Kretzschmar M, Sypsa V, Sarasa-Renedo A, Uusküla A, Paraskevis D, Mendão L, Rossi D, van Gelder N, Mitcheson L, Paoli L, Gomez CD, Milhet M, Dascalu N, Knight J, Hay G, Kalamara E, Simon R, Comiskey C, Rossi C, Griffiths P. Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study. Harm Reduct J 2017; 14:19. [PMID: 28431584 PMCID: PMC5401609 DOI: 10.1186/s12954-017-0141-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/04/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.
Collapse
Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Vendula Běláčková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Patrizia Carrieri
- Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
- ORS PACA, Marseille, France
| | - Samuel R. Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, New York, USA
| | - Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, The University of New South Wales (UNSW), Sydney, Australia
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jeffrey V. Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Barcelona Institute of Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Vana Sypsa
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Sarasa-Renedo
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Spanish Field Epidemiology Training Program (PEAC), National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Luis Mendão
- Group of Activists on Treatments (GAT), Lisbon, Portugal
| | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Nadine van Gelder
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Luke Mitcheson
- Alcohol, Drug, and Tobacco Division, Health and Wellbeing Directorate, Public Health England, London, UK
| | - Letizia Paoli
- Leuven Institute of Criminology (LINC), Faculty of Law, University of Leuven, Leuven, Belgium
- Centre for Global Governance Studies (GSS), Leuven, Belgium
| | - Cristina Diaz Gomez
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Maitena Milhet
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Nicoleta Dascalu
- The Romanian Association Against AIDS (ARAS), Bucharest, Romania
| | | | - Gordon Hay
- Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Eleni Kalamara
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Roland Simon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | | | - Carla Rossi
- Centro Studi Statistici e Sociali CE3S, Rome, Italy
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| |
Collapse
|
48
|
Guise A, Albers ER, Strathdee SA. 'PrEP is not ready for our community, and our community is not ready for PrEP': pre-exposure prophylaxis for HIV for people who inject drugs and limits to the HIV prevention response. Addiction 2017; 112:572-578. [PMID: 27273843 PMCID: PMC5145792 DOI: 10.1111/add.13437] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/16/2016] [Accepted: 04/19/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Pre-exposure prophylaxis for HIV, or 'PrEP', is the use of antiretroviral medicines by people who are HIV-negative to protect themselves against acquiring HIV. PrEP has shown efficacy for preventing HIV acquisition. Despite the potential, many concerns have been voiced by people who inject drugs (PWID) and their organizations. There is a need to engage with these views and ensure their integration in to policy and strategy. This paper presents PWID views on PrEP to foster the uptake of these opinions into scientific and policy debate around PrEP METHODS: Critical analysis of a report of a community consultation led by the International Network of People who Use Drugs (INPUD). RESULTS The INPUD report highlights enthusiasm from PWID for PrEP, but also three main concerns: the feasibility and ethics of PrEP, its potential use as a substitute for other harm reduction strategies and how a focus on PrEP heralds a re-medicalization of HIV. Each concern relates to evidenced gaps in essential services or opposition to harm reduction and PWID human rights. CONCLUSIONS People who use drugs have fundamental concerns about the potential impacts of pre-exposure prophylaxis for HIV which reflect a 'fault line' in HIV prevention: a predominance of biomedical approaches over community perspectives. Greater community engagement in HIV prevention strategy is needed, or we risk continuing to ignore the need for action on the underlying structural drivers and social context of the HIV epidemic.
Collapse
Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, 9500 Gilman Drive , La Jolla , 92093-0507, USA
| | - Eliot Ross Albers
- International Network of People who Use Drugs, Unit 2C05, South Bank Technopark, 90 London Road, London, SE1 6LN, United Kingdom
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, 9500 Gilman Drive , La Jolla , 92093-0507, USA
| |
Collapse
|
49
|
Davis C, Green T, Beletsky L. Action, Not Rhetoric, Needed to Reverse the Opioid Overdose Epidemic. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:20-23. [PMID: 28661292 DOI: 10.1177/1073110517703310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite shifts in rhetoric and some positive movement, Americans with the disease of addiction are still often stigmatized, criminalized, and denied access to evidencebased care. Dramatically reducing the number of lives unnecessarily lost to overdose requires an evidence-based, equity-focused, well-funded, and coordinated response. We present in this brief article evidence-based and promising practices for improving and refocusing the response to this simmering public health crisis. Topics covered include improving clinical decision-making, improving access to non-judgmental evidence-based treatment, investing in comprehensive public health approaches to problematic drug use, and changing the way law enforcement actors interact with people who use drugs.
Collapse
Affiliation(s)
- Corey Davis
- Corey Davis, J.D., M.S.P.H., is with the Network for Public Health Law and the Brody School of Medicine, East Carolina University. Traci Green, Ph.D., Ms.C., is with the Department of Emergency Medicine, Boston University School of Medicine and the Department of Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital. Leo Beletsky, J.D., M.P.H., is with the School of Law and College of Health Sciences, Northeastern University and the Division of Global Public Health, UC San Diego School of Medicine
| | - Traci Green
- Corey Davis, J.D., M.S.P.H., is with the Network for Public Health Law and the Brody School of Medicine, East Carolina University. Traci Green, Ph.D., Ms.C., is with the Department of Emergency Medicine, Boston University School of Medicine and the Department of Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital. Leo Beletsky, J.D., M.P.H., is with the School of Law and College of Health Sciences, Northeastern University and the Division of Global Public Health, UC San Diego School of Medicine
| | - Leo Beletsky
- Corey Davis, J.D., M.S.P.H., is with the Network for Public Health Law and the Brody School of Medicine, East Carolina University. Traci Green, Ph.D., Ms.C., is with the Department of Emergency Medicine, Boston University School of Medicine and the Department of Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital. Leo Beletsky, J.D., M.P.H., is with the School of Law and College of Health Sciences, Northeastern University and the Division of Global Public Health, UC San Diego School of Medicine
| |
Collapse
|
50
|
El-Bassel N, Marotta PL, Shaw SA, Chang M, Ma X, Goddard-Eckrich D, Hunt T, Johnson K, Goodwin S, Almonte M, Gilbert L. Women in community corrections in New York City: HIV infection and risks. Int J STD AIDS 2017; 28:160-169. [PMID: 26887890 PMCID: PMC5367917 DOI: 10.1177/0956462416633624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the incidence of HIV among women on probation, parole and alternatives to incarceration programs is significant to public health, drivers of this concentrated epidemic among women under community corrections remain understudied. This study examined prevalence of HIV and sexually transmitted infections and the associations between substance use, socio-demographic factors and the prevalence of biologically-confirmed HIV and other sexually transmitted infections among a sample of 337 substance-using women recruited from community correction sites in New York City. Prevalence of HIV was 13% and sexually transmitted infections was 26% ( Chlamydia, trachomatis and Neisseria gonorrhea). After adjusting for covariates, HIV-positive women were 1.42 times more likely to use crack/cocaine than HIV-negative women (95% CI = 1.05-1.92). HIV-positive women were 25% less likely than HIV-negative women to report any unprotected vaginal and anal sex with their main partner (95% CI = 0.57-0.99). They were 70% less likely than HIV-negative women to report unprotected vaginal sex with a non-paying casual partner (95% CI = 0.1-0.9) and 22% less likely to report unprotected vaginal sex across all partners (95% CI = 0.61-0.99). Community corrections settings may be optimal venues to launch HIV/sexually transmitted infections prevention that have potential to reach and engage an ever-growing number of substance-using women.
Collapse
Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Phillip L Marotta
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Stacey A Shaw
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Mingway Chang
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Xin Ma
- Social Intervention Group, Columbia University, New York, New York, USA
| | | | - Tim Hunt
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Karen Johnson
- Social Intervention Group, Columbia University, New York, New York, USA
| | - Sharun Goodwin
- The New York City Department of Probation, New York, New York, USA
| | - Maria Almonte
- Bronx Community Solutions, Center for Court Innovation, Bronx, New York, USA
| | - Louisa Gilbert
- Social Intervention Group, Columbia University, New York, New York, USA
| |
Collapse
|