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Eger WH, Bazzi AR, Valasek CJ, Vera CF, Harvey-Vera A, Artamonova I, Rangel MG, Strathdee SA, Pines HA. Long-acting Injectable PrEP Interest and General PrEP Awareness among People who Inject Drugs in the San Diego-Tijuana Border Metroplex. AIDS Behav 2024; 28:1650-1661. [PMID: 38319461 DOI: 10.1007/s10461-024-04285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) could help overcome multilevel challenges to HIV prevention for people who inject drugs (PWID), including those in the binational San Diego-Tijuana metroplex. Yet, general PrEP awareness and interest in LAI-PrEP remain underexplored among PWID. From 2020 to 2021, 562 HIV-negative PWID in San Diego and Tijuana completed surveys assessing general PrEP awareness and interest in oral and LAI-PrEP. Modified Poisson regression examined factors associated with general PrEP awareness. Multinomial logistic regression assessed factors associated with interest in both oral and LAI-PrEP, oral PrEP only, LAI-PrEP only, or neither. General PrEP awareness was low (18%) and associated with experiencing unsheltered homelessness (adjusted prevalence ratio [APR] = 1.50, 95% confidence interval [CI]: 0.96-2.33), past 6-month fentanyl injection (APR = 1.53, 95% CI: 1.04-2.25), and transactional sex (APR = 1.71, 95% CI: 1.06-2.76). Interest in oral PrEP only was most common (44%), followed by LAI-PrEP only (25%) and neither (16%). Compared to the odds of being interested in LAI-PrEP only, the odds of being interested in oral PrEP only were lower among those who were stopped by police (AOR = 0.38, 95% CI: 0.22-0.65), reported past 6-month fentanyl injection (AOR = 0.33, 95% CI: 0.20-0.56), polydrug use (AOR = 0.48, 95% CI: 0.27-0.86), injecting multiple times daily (AOR = 0.26, 95% CI: 0.14-0.46), receptive syringe use (AOR = 0.30, 95% CI: 0.19-0.49), and higher perceived HIV risk (AOR = 0.24, 95% CI: 0.15-0.39). Interest in LAI-PrEP was more common among PWID reporting social and structural factors that could interfere with oral PrEP adherence, suggesting LAI-PrEP implementation could increase PrEP coverage among those most vulnerable to HIV.
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Affiliation(s)
- William H Eger
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Chad J Valasek
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Irina Artamonova
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - M Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | | | - Heather A Pines
- School of Medicine, University of California, San Diego, La Jolla, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
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Hatch MA, Laschober TC, Paschen-Wolff M, Ertl MM, Nelson CM, Wright L, Lancaster C, Feaster DJ, Forrest D, Hankey C, Monger M, Fegley JP, Irving R, Young C, Rose J, Spector A, Dresser L, Moran L, Jelstrom E, Tross S. PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high. Drug Alcohol Depend 2024; 257:111133. [PMID: 38447393 PMCID: PMC11131129 DOI: 10.1016/j.drugalcdep.2024.111133] [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: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence. METHODS HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models. RESULTS Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex. CONCLUSIONS PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.
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Affiliation(s)
- Mary A Hatch
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA.
| | - Tanja C Laschober
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Margaret Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa M Ertl
- University of Minnesota-Twin Cities, Department of Psychology, Minneapolis, MN 55455, USA
| | - C Mindy Nelson
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - Lynette Wright
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Chloe Lancaster
- University of South Florida, Department of Leadership, Policy, and Lifelong Learning, Tampa, FL 33620, USA
| | - Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - David Forrest
- University of Miami, Department of Anthropology, Coral Gables, FL, USA
| | - Colby Hankey
- Aspire Health Partners, HIV Services, Orlando, FL 32804, USA
| | - Mauda Monger
- My Brother's Keeper, 710 Avignon Dr, Ridgeland, MS 39157, USA
| | - Joshua P Fegley
- CrescentCare, 330 Tulane Ave, 1st Floor, New Orleans, LA 70119, USA
| | - Rhonda Irving
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Cynthia Young
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Juliana Rose
- Gateway Community Services, Research Department, Jacksonville, FL, USA
| | - Anya Spector
- Stella and Charles Guttman Community College, City University of New York, New York, NY, USA
| | | | - Landhing Moran
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
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3
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Suprasert B, Tate M, Reagan D, Ruiz R, Gao K, McNaughton K, Miller K, Marr A, Taylor KD, Wilson EC, McFarland W. Continuing Low Awareness and Use of Pre-exposure Prophylaxis (PrEP) for HIV among People Who Inject Drugs (PWID), San Francisco, 2022. AIDS Behav 2024:10.1007/s10461-024-04308-z. [PMID: 38526638 DOI: 10.1007/s10461-024-04308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
Clinical trials provide evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition including through sharing of injection equipment among people who inject drugs (PWID). However, uptake among many populations at risk for HIV has been slow, particularly among PWID. We examined data from the National HIV Behavioral Surveillance (NHBS) from San Francisco in 2022 to measure PrEP uptake and identify factors associated with PrEP awareness among PWID. Of 479 PWID with HIV-negative or unknown HIV status, 54.9% were aware of PrEP, 5.9% had discussed PrEP with a healthcare provider, and 1.5% had used PrEP in the past year. Lack of PrEP awareness was associated with being age 50 years and older (adjusted odds ratio [aOR] 0.40, 95% CI 0.27-0.60), being men who have sex with women (vs. men who have sex with men, aOR 0.47, 95% CI 0.24-0.92), having a disability (aOR 0.58, 95% CI 0.35-0.95), using heroin as their most frequently injected drug (aOR 0.51, 95% CI, 0.34-0.78), not having tested for HIV, HCV, or an STD in the past year (aOR 0.43, 95% CI 0.28-0.64), and not having access to new sterile needles in the past year (aOR 0.28, 95%CI 0.08-1.00). We found negligible change in the awareness and uptake of PrEP among PWID since previously measured in NHBS in 2018. Low PrEP use among PWID may be addressed by increasing provider discussion of PrEP with their PWID patients and clients during routine care, expanding testing for injection-related infections among PWID, and integrating PrEP access into harm reduction programs.
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Affiliation(s)
- Bow Suprasert
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA.
| | - Moranda Tate
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Danyion Reagan
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Raul Ruiz
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Katherine Gao
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Katherine McNaughton
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Kassandra Miller
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
| | - Alexander Marr
- Institute of Global Health Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kelly D Taylor
- Institute of Global Health Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Erin C Wilson
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Willi McFarland
- Department of Public Health, Center for Public Health Research, San Francisco, CA, 94102-6033, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Boudewyns V, Uhrig JD, Williams PA, Anderson SKE, Stryker JE. Message Framing Strategies to Promote the Uptake of PrEP: Results from Formative Research with Diverse Adult Populations in the United States. AIDS Behav 2024; 28:535-546. [PMID: 38151665 DOI: 10.1007/s10461-023-04242-6] [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] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.
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Affiliation(s)
- Vanessa Boudewyns
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA.
| | - Jennifer D Uhrig
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Pamela A Williams
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jo Ellen Stryker
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional Stigma as a Fundamental Cause of Health Disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. STIGMA AND HEALTH 2023; 8:325-343. [PMID: 37744082 PMCID: PMC10516303 DOI: 10.1037/sah0000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, NY
- Center for Drug Use and HIV/HCV Research, New York, NY
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Bruce Link
- Department of Sociology, University of California Riverside, Riverside, CA
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Rosen JG, Zhang L, Pelaez D, Park JN, Glick JL. A Capacity-Strengthening Intervention to Support HIV Pre-exposure Prophylaxis (PrEP) Awareness-Building and Promotion by Frontline Harm Reduction Workers in Baltimore, Maryland: A Mixed Methods Evaluation. AIDS Behav 2023; 27:2440-2453. [PMID: 36596866 PMCID: PMC9810241 DOI: 10.1007/s10461-022-03971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention tool among people who inject drugs (PWID). We developed and piloted an intervention to bolster PrEP promotion competencies among frontline harm reduction workers (FHRW) serving PWID clients in Baltimore, Maryland. Between December 2021 and February 2022, we developed and facilitated four trainings, which included didactic and practice-based/role-playing components, with 37 FHRW from four organizations. FHRW completed three structured surveys (pretest, posttest, 6-week posttest) and in-depth interviews (n = 14) to measure changes in PrEP promotion competencies attributable to training participation. PrEP knowledge and self-efficacy increased significantly (p < 0.001) from pretest to posttest, sustained through 6-week posttest. The proportion of FHRW discussing PrEP with clients doubled during the evaluation period (30-67%, p = 0.006). Feeling empowered to discuss PrEP and provision of population-tailored PrEP information were facilitators of PrEP promotion, while limited client interaction frequency/duration, privacy/confidentiality concerns, and anticipated PrEP stigma by clients inhibited PrEP promotion. Our capacity-strengthening intervention successfully increased PrEP knowledge, self-efficacy, and promotion among FHRW, affirming the adaptability and feasibility of integrating our training toolkit into FHRW practice across implementation settings.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Shaw G, Schaefer R, Schmidt HMA, Madden A, Chang J, Mozalevskis A, Msimanga-Radebe B, Mangadan Konath N, Verster A, Baggaley R, Rodolph M, Macdonald V. Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery. Harm Reduct J 2023; 20:16. [PMID: 36782321 PMCID: PMC9924874 DOI: 10.1186/s12954-023-00729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. METHODS Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. RESULTS PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. CONCLUSIONS This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.
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Affiliation(s)
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Heather-Marie A Schmidt
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland ,UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Annie Madden
- International Network of People who Use Drugs, London, UK
| | - Judy Chang
- International Network of People who Use Drugs, London, UK
| | - Antons Mozalevskis
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | | | | | - Annette Verster
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Rachel Baggaley
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Michelle Rodolph
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Virginia Macdonald
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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9
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Walters SM, Felsher M, Frank D, Jaiswal J, Townsend T, Muncan B, Bennett AS, Friedman SR, Jenkins W, Pho MT, Fletcher S, Ompad DC. I Don't Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1648. [PMID: 36674402 PMCID: PMC9864395 DOI: 10.3390/ijerph20021648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. METHODS Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. RESULTS Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. CONCLUSIONS People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
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Affiliation(s)
- Suzan M. Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
| | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - David Frank
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Tarlise Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Brandon Muncan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Samuel R. Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL 62702, USA
| | - Mai T. Pho
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | - Danielle C. Ompad
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
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10
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King AR, Shah S, Randall LA, Frew PM, Spaulding A, Holloway IW. Acceptability of injectable pre-exposure prophylaxis among people who inject drugs in three urban U.S. settings. BMC Infect Dis 2022; 22:737. [PMID: 36104676 PMCID: PMC9473463 DOI: 10.1186/s12879-022-07572-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Outbreaks of new HIV transmission among people who inject drugs (PWID) are a major public health concern. Oral daily PrEP, has been identified as a critical addition to the biomedical toolkit for this population. However, limited research on the acceptability of long-acting injectable PrEP has been conducted with this population. Methods We conducted a cross sectional multi-site survey with 1127 participants from May 2019–February 2020 to assess the acceptability of novel PrEP regimens. We computed bivariate and multivariable logistic regressions to evaluate correlates of the outcome variable: acceptability of 3-month injectable-PrEP. SAS v.9.4 was used to conduct statistical analysis. Results Limited knowledge of or use of PrEP, past or present, was evident within the sample. Injection drug use in the past six months was significantly associated with LA injectable PrEP acceptability, with the odds of acceptability being 1.885 (CI: 1.376, 2.582) times greater than those who did not inject drugs. After adjusting for confounders, injection drug use was significantly associated with the outcome, such that the odds of acceptability of LA injectable PrEP were 1.705 (CI: 1.198, 2.427) times greater among PWID compared to those who did not inject drugs (p < 0.03). The results demonstrate acceptability (38.2%) in a durable (3-month) injectable PrEP modality among participants who also identified as PWID. Conclusions PrEP promotion efforts among PWID to increase access to long-acting injectable PrEP are necessary. Through efforts to increase acceptance and regular use of long-acting injectable PrEP, public health strategies may be able to effectively lessen chances of future HIV outbreaks among PWID.
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Viera A, van den Berg JJ, Sosnowy CD, Mehta NA, Edelman EJ, Kershaw T, Chan PA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake Among Men Who have Sex with Men Who Use Stimulants: A Qualitative Study. AIDS Behav 2022; 26:3016-3028. [PMID: 35303188 PMCID: PMC9378498 DOI: 10.1007/s10461-022-03633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
The HIV epidemic disproportionately impacts men who have sex with men (MSM), particularly those who use stimulants. We explored barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake among this population. From June 2018 through February 2019, we conducted semi-structured interviews in Providence, Rhode Island, and New Haven, Connecticut, with 21 MSM who reported recent (past six months) stimulant use. We identified individual, interpersonal, and structural barriers to PrEP, including: (1) high awareness but mixed knowledge of PrEP, resulting in concerns about side effects and drug interactions; (2) interest that was partly determined by substance use and perceived HIV risk; (3) fragmented and constrained social networks not conducive to disseminating PrEP information; and (4) PrEP access, such as insurance coverage and cost. Our findings suggest potential approaches to increase PrEP uptake in this group, including promotion through mainstream and social media, clarifying misinformation, and facilitating increased access through structural interventions.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA.
| | - Jacob J van den Berg
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, 02903, Providence, RI, USA
- Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, 02906, Providence, RI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA
| | - Collette D Sosnowy
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
| | - Nikita A Mehta
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
| | - E Jennifer Edelman
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar St, 06510, New Haven, CT, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
| | - Philip A Chan
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, 02903, Providence, RI, USA
- Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, 02906, Providence, RI, USA
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12
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Marshall AD, Martinello M, Treloar C, Matthews GV. Perceptions of hepatitis C treatment and reinfection risk among HIV-positive men who have sex with men and engage in high risk behaviours for hepatitis C transmission: The CEASE qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103828. [PMID: 35994937 DOI: 10.1016/j.drugpo.2022.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Globally, treatment uptake for hepatitis C virus (HCV) infection among HIV-HCV coinfected men who have sex with men (MSM) has substantially increased since the advent of interferon-free direct-acting antivirals (DAA). However, HIV-positive MSM who engage in high risk behaviours are at an increased risk of HCV reinfection post-treatment. The aim of this study was to investigate perceptions of HCV diagnosis, treatment and reinfection risk among HCV-HIV coinfected MSM who engage in drug use and/or high risk sexual behavior in Sydney, Australia. METHODS Participants were recruited from the Control and Elimination within AuStralia of HEpatitis C from people living with HIV (CEASE) cohort (n=402) who reported engaging in drug use and/or high risk sexual behavior for transmission of HCV infection. Participants were interviewed about their perceptions of HCV diagnosis, treatment, and reinfection risk. Interview data were transcribed, coded, and analyzed thematically. RESULTS Of 33 participants interviewed (mean age 49 years), many participants were 'shocked' by their HCV diagnosis. Participants who believed they acquired HCV infection through sexual exposure felt it was important that their healthcare practitioner agreed with their perspective to mitigate stigmatizing experiences. Overall, participants expressed high satisfaction with their treatment experience due to long-standing therapeutic relationships with their HIV physician. Many participants expressed knowledge of how to prevent HCV reinfection from injection drug use, yet other than condom usage, most were unsure how to reduce high risk sexual activity with such discussions occurring less frequently with healthcare practitioners. CONCLUSION Findings indicate that MSM who engage in drug use and high risk sexual activity would benefit from additional education on reducing reinfection risk through sexual activity and services to reduce substance use, if requested.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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13
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Walters SM, Bolinski RS, Almirol E, Grundy S, Fletcher S, Schneider J, Friedman SR, Ouellet LJ, Ompad DC, Jenkins W, Pho MT. Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis. Addict Sci Clin Pract 2022; 17:24. [PMID: 35468860 PMCID: PMC9037978 DOI: 10.1186/s13722-022-00303-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. METHODS The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. RESULTS Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. CONCLUSION The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.
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Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | - Rebecca S Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stacy Grundy
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | | | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel R Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Lawrence J Ouellet
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
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14
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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15
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Bolinski RS, Walters S, Salisbury-Afshar E, Ouellet LJ, Jenkins WD, Almirol E, Van Ham B, Fletcher S, Johnson C, Schneider JA, Ompad D, Pho MT. The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2230. [PMID: 35206421 PMCID: PMC8872091 DOI: 10.3390/ijerph19042230] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. METHODS We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. RESULTS Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated "beans" and "buttons". Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. CONCLUSIONS The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
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Affiliation(s)
- Rebecca S. Bolinski
- Department of Sociology, Southern Illinois University, 475 Clocktower Drive, Room 323A, Carbondale, IL 62901, USA
| | - Suzan Walters
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Lawrence J. Ouellet
- Division of Epidemiology and Biostatistics/COIP (MC 923), School of Public Health, University of Illinois Chicago, 1603 W. Taylor, Chicago, IL 60607, USA;
| | - Wiley D. Jenkins
- Epidemiology and Biostatistics, Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA;
| | - Brent Van Ham
- Center for Rural Health and Social Service Development, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA;
| | - Scott Fletcher
- The Community Action Place, Inc., 1400 N. Wood Road Suite 7, Murphysboro, IL 62966, USA;
| | - Christian Johnson
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - John A. Schneider
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - Danielle Ompad
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Mai T. Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
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16
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Cantu C, Surita K, Buendia J. Factors that Increase Risk of an HIV Diagnosis Following a Diagnosis of Syphilis: A Population-Based Analysis of Texas Men. AIDS Behav 2022; 26:2574-2580. [PMID: 35107661 DOI: 10.1007/s10461-022-03593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/01/2022]
Abstract
Studies have consistently shown that diagnosis of a syphilis infection increases the risk of human immunodeficiency virus (HIV) infection. This study examines patterns in HIV incidence among men following a Primary and Secondary (P&S) syphilis diagnosis. P&S syphilis cases among men reported to the Texas Department of State Health Services between January 2010 and June 2018 were linked to the Enhanced HIV/AIDS Reporting System. Risk factors for HIV diagnosis were identified using univariate and multivariate extended Cox proportional hazards models. The 9113 men with syphilis without a concurrent or prior HIV diagnosis contributed a cumulative 35,674 person-years with a mean follow-up time of 3.9 years. The multivariate model showed that among men with a P&S syphilis diagnosis, age, race/ethnicity, transmission risk, comorbid STDs, subsequent STDs, and syphilis diagnosing facility were independently associated with a new HIV diagnosis. The results highlight disparities in HIV diagnoses, despite current prevention recommendations. Reducing these disparities will require multi-level, comprehensive interventions that are appropriate for the diverse populations around the state.
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17
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Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention. AIDS Behav 2021; 25:3987-3999. [PMID: 34138377 PMCID: PMC8210500 DOI: 10.1007/s10461-021-03353-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) uptake among women in the United States has been low. To increase uptake, we developed a peer outreach and navigation PrEP intervention. Semi-structured qualitative interviews with 32 cisgender women and 3 transgender women were conducted to assess the intervention. We used a thematic approach to identify barriers to, and facilitators of the intervention. Facilitators included interest in PrEP, offer of health and social services, the intervention’s women-focused approach, and peer outreach and navigation. Barriers were perceived HIV risk, concerns about medication side effects or interactions, housing insecurity and travel, co-occurring health-related conditions, and caregiving responsibilities. We recommend that future interventions consider packaging PrEP in local community settings, such as syringe exchange programs; include services such as food and housing assistance; use peers to recruit and educate women; integrate a culturally appropriate women’s focus; and consider providing same-day PrEP.
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18
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Harris MTH, Bagley SM, Maschke A, Schoenberger SF, Sampath S, Walley AY, Gunn CM. Competing risks of women and men who use fentanyl: "The number one thing I worry about would be my safety and number two would be overdose". J Subst Abuse Treat 2021; 125:108313. [PMID: 34016300 PMCID: PMC8140193 DOI: 10.1016/j.jsat.2021.108313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/16/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard public health approaches to risk communication do not address the gendered dynamics of drug use. The aim of this study was to explore perceptions of fentanyl-related risks among women and men to inform future risk communication approaches. METHODS We conducted a qualitative study, purposively sampling English-speaking women and men, aged 18-25 or 35+ years, with past 12-month illicitly manufactured fentanyl use. In-depth individual interviews explored experiences of women and men related to overdose and fentanyl use. We conducted a grounded content analysis examining specific codes related to overdose and other health or social risks attributed to drug use. Using a constant comparison technique, we explored commonalities and differences in themes between women and men. RESULTS The study enrolled twenty-one participants, 10 women and 11 men. All participants had personal overdose experiences. Both women and men described overdosing as a "chronic" condition and expressed de-sensitization to the risk of overdose. Women and men described other risks around health, safety, and state services that often superseded their fear of overdose. Women feared physical and sexual violence and prioritized caring for children and maintaining relations with child protective services, while men feared violence arising from obtaining and using street drugs and incarceration. Only women reported that fear of violence prevented their utilization of harm reduction services. CONCLUSIONS Experiences with overdose and risk communication among people who use fentanyl-containing opioids varied by gender. The development of gender-responsive programs that address targeted concerns may be an avenue to enhance engagement with harm reduction and treatment services and create safe spaces for women not currently accessing available services.
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Affiliation(s)
- Miriam T H Harris
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Sarah M Bagley
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Boston University School of Medicine, Department of Pediatrics, Division of General Academic Pediatrics, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Ariel Maschke
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America.
| | - Samantha F Schoenberger
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Spoorthi Sampath
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America.
| | - Alexander Y Walley
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Christine M Gunn
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany Street, Boston, MA 02118, United States of America.
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19
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Ezell JM, Ompad DC, Walters S. How urban and rural built environments influence the health attitudes and behaviors of people who use drugs. Health Place 2021; 69:102578. [PMID: 33964805 DOI: 10.1016/j.healthplace.2021.102578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of "stigma zoning," defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA; Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
| | - Danielle C Ompad
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, USA; Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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20
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Muncan B, Jordan AE, Perlman DC, Frank D, Ompad DC, Walters SM. Acceptability and Effectiveness of Hepatitis C Care at Syringe Service Programs for People Who Inject Drugs in New York City. Subst Use Misuse 2021; 56:728-737. [PMID: 33682610 PMCID: PMC8514132 DOI: 10.1080/10826084.2021.1892142] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs.
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Affiliation(s)
- Brandon Muncan
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Ashly E. Jordan
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - David C. Perlman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Frank
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan M. Walters
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
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21
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Felsher M, Ziegler E, Amico KR, Carrico A, Coleman J, Roth AM. "PrEP just isn't my priority": Adherence challenges among women who inject drugs participating in a pre-exposure prophylaxis (PrEP) demonstration project in Philadelphia, PA USA. Soc Sci Med 2021; 275:113809. [PMID: 33735778 DOI: 10.1016/j.socscimed.2021.113809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has the ability to curb HIV transmission among women if they are highly adherent (e.g. 6/7 weekly doses). In a recent PrEP demonstration project with 95 women who inject drugs (WWID) in Philadelphia, PA, USA, PrEP uptake was high but adherence was low. This qualitative study draws upon the Behavioral Model for Vulnerable Populations (BMVP) to describe how the context of 23 WWID's lives challenged PrEP adherence using narrative data from in-depth interviews. Content analysis suggests that women's need to organize their day around predisposing survival needs made it difficult to prioritize PrEP. Adherence was further challenged by dis-enabling structural forces such as entry into institutions that do not provide PrEP (e.g., drug treatment and correctional facilities) and medication diversion to illicit marketplaces. Overtime, women's perceived need for PrEP was dynamic: in periods they characterized as risky, women considered PrEP highly beneficial and described enhanced motivation to adhere. In periods of low perceived risk, women were less committed to continuing daily PrEP in the context of their competing survival needs. In sum, WWID faced challenges to PrEP adherence that correspond to all of the BMVP domains. To optimize PrEP for WWID, multi-level programs are needed that address the determinants that both increase HIV susceptibility and undermine adherence.
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Affiliation(s)
- Marisa Felsher
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Eliza Ziegler
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - K Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Jennie Coleman
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA, 19134, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
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22
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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23
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Walters SM, Seal DW, Stopka TJ, Murphy ME, Jenkins WD. COVID-19 and People Who Use Drugs - A Commentary. HEALTH BEHAVIOR AND POLICY REVIEW 2020; 7:489-497. [PMID: 33134405 PMCID: PMC7595339 DOI: 10.14485/hbpr.7.5.11] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE People who use drugs (PWUD) face increased risk of exposure to COVID-19, but also elevated risk associated from injection drug use. We describe factors underlying their increased risk and identify mechanisms for reducing or minimizing rates of COVID-19 transmission and other health outcomes. METHODS Our commentary draws upon empirical data, governmental and other reports, and field-based unpublished data from our own studies to inform our conclusion and recommendations. RESULTS Co-morbid health conditions (eg, diabetes), structural challenges (eg, homelessness, criminal justice involvement), stigma (eg, social devaluation, discrediting), and syndemic clustering of of overdose, HCV, and HIV among PWUD are exacerbated by COVID-19. CONCLUSIONS Beyond the many challenges all people face to remain safe and healthy during the COVID-19 pandemic, PWUD face additional barriers to remaining safe not only from COVID-19 but from negative health outcomes associated with their living environments, socioeconomic positions, and injection drug use. Collaborative efforts among governmental agencies, health providers, SSPs, CBOs, and other agencies providing services to PWUD is essential to the development of programs and services to meet the many needs of PWUD, which have been particularly accentuated during the COVID-19 pandemic.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - David W Seal
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States
| | - Megan E Murphy
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, United States
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24
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Walters SM, Kral AH, Simpson KA, Wenger L, Bluthenthal RN. HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016-2018. Subst Use Misuse 2020; 55:2409-2419. [PMID: 32962490 PMCID: PMC7665852 DOI: 10.1080/10826084.2020.1823419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies do not focus on PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID. Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n = 469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported. Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increased HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use. Conclusion: PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, California, USA
| | - Kelsey A Simpson
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, San Francisco, California, USA
| | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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