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Panlilio LV, Preston KL, Bertz JW, Moran LM, Tyburski M, Hertzel SK, Husami S, Adan F, Epstein DH, Phillips KA. Objective Neighborhood-Level Disorder Versus Subjective Safety as Predictors of HIV Transmission Risk and Momentary Well-Being. AIDS Behav 2024; 28:3326-3337. [PMID: 38965184 PMCID: PMC11427584 DOI: 10.1007/s10461-024-04413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
Mental health and HIV risk behavior have been studied with ecological momentary assessment (EMA), but this approach has not been combined with tracking of activity space (where people go and what they encounter there) in people with HIV and their social relations, who may be HIV+ or HIV-. Activity space represents a modifiable risk or protective factor for behavior related to health status and quality of life, in both clinical and nonclinical populations. We conducted an observational study with 286 participants (243 HIV+ and 43 HIV-), roughly matched for socioeconomic status and neighborhood of residence via three waves of snowball sampling. Each participant carried a smartphone for up to 4 weeks, making 5 randomly prompted entries and 1 end-of-day entry each day, plus self-initiated event-contingent entries for sexual activity and drug use. Responses to randomly prompted items provided subjective evaluations of the safety of the participant's current social and physical environment (the place they were and the people they were with). GPS-based location tracking-coupled with publicly available statistic indicating neighborhood-level physical disorder and socioeconomic disadvantage-provided an indicator of each participant's exposure to objective psychosocial hazard. We examined possible relationships of these objective and subjective environmental exposures with risky sexual and intravenous drug-use behavior, knowledge and utilization of antiretroviral treatment and prophylaxis, and momentary mental health (mood and stress, which relate to risky behavior and overall well-being). We found that both risky behavior and mental health were more related to participants' subjective evaluations of their activity space than to objective measures of neighborhood-level disorder, suggesting that, even within an objectively hazardous neighborhood, people who find a niche they perceive as socially and physically safe may engage in less risky behavior and have better well-being.Trial registration Clinicaltrials.gov Identifier NCT01571752.
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Affiliation(s)
- Leigh V Panlilio
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
- National Institutes of Health, NIDA Intramural Research Program, Translational Addiction Medicine Branch (TAMB), RAPT (Real-World Assessment, Prediction, and Treatment) Unit, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
| | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Jeremiah W Bertz
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Landhing M Moran
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Matthew Tyburski
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Sara K Hertzel
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Shireen Husami
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Fatumastar Adan
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
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2
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Kimaru LJ, Habila MA, Mantina NM, Madhivanan P, Connick E, Ernst K, Ehiri J. Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002870. [PMID: 38349915 PMCID: PMC10863897 DOI: 10.1371/journal.pgph.0002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
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Affiliation(s)
- Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Magdiel A. Habila
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth Connick
- Department of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Kacey Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
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The Relationship of Historical Redlining with Present-Day Neighborhood Environmental and Health Outcomes: A Scoping Review and Conceptual Model. J Urban Health 2022; 99:959-983. [PMID: 35915192 PMCID: PMC9342590 DOI: 10.1007/s11524-022-00665-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/31/2022]
Abstract
Following the Great Depression and related home foreclosures, the federal government established new agencies to facilitate access to affordable home mortgages, including the Home Owners' Loan Corporation (HOLC) and Federal Housing Administration (FHA). HOLC and FHA directed widespread neighborhood appraisals to determine investment risk, referred to as "redlining," which took into account residents' race. Redlining thereby contributed to segregation, disinvestment, and racial inequities in opportunities for homeownership and wealth accumulation. Recent research examines associations between historical redlining and subsequent environmental determinants of health and health-related outcomes. In this scoping review, we assess the extent of the current body of evidence, the range of outcomes studied, and key study characteristics, examining the direction and strength of the relationship between redlining, neighborhood environments, and health as well as different methodological approaches. Overall, studies nearly universally report evidence of an association between redlining and health-relevant outcomes, although heterogeneity in study design precludes direct comparison of results. We critically consider evidence regarding HOLC's causality and offer a conceptual framework for the relationship between redlining and present-day health. Finally, we point to key directions for future research to improve and broaden understanding of redlining's enduring impact and translate findings into public health and planning practice.
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4
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Cassie R, Hayashi K, DeBeck K, Milloy MJ, Cui Z, Strike C, West J, Kennedy MC. Difficulty accessing supervised consumption services during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. Harm Reduct J 2022; 19:126. [PMID: 36401299 PMCID: PMC9675060 DOI: 10.1186/s12954-022-00712-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. METHODS Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. RESULTS Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). CONCLUSIONS We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.
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Affiliation(s)
- Rachel Cassie
- grid.17089.370000 0001 2190 316XSchool of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave., Edmonton, AB T6G 1C9 Canada
| | - Kanna Hayashi
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Kora DeBeck
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - M.-J. Milloy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, St. Paul’s Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Zishan Cui
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Carol Strike
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7 Canada ,grid.415502.7La Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St., Toronto, ON M5B 1T8 Canada
| | - Jeff West
- grid.498786.c0000 0001 0505 0734Vancouver Coastal Health, 828 W 10th Ave., Vancouver, BC V5Z 1L8 Canada
| | - Mary Clare Kennedy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Social Work, University of British Columbia - Okanagan, 1147 Research Road (ARTS Building), Kelowna, BC V1V 1V7 Canada
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Edwards JK, Cole SR, Breger TL, Filiatreau LM, Zalla L, Mulholland GE, Horberg MA, Silverberg MJ, John Gill M, Rebeiro PF, Thorne JE, Kasaie P, Marconi VC, Sterling TR, Althoff KN, Moore RD, Eron JJ. Five-Year Mortality for Adults Entering Human Immunodeficiency Virus Care Under Universal Early Treatment Compared With the General US Population. Clin Infect Dis 2022; 75:867-874. [PMID: 34983066 PMCID: PMC9477443 DOI: 10.1093/cid/ciab1030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those in the US general population, even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care. METHODS Among 82 766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with those for similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics. RESULTS For the entire study period (1999-2017), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%-8.2%) higher than expected based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8%-8.6%). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6% (95% CI: 2.0%-3.3%) under observed treatment patterns and 2.1% (.0%-4.2%) under universal early treatment. CONCLUSIONS Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.
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Affiliation(s)
- Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Stephen R Cole
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Tiffany L Breger
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M Filiatreau
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Lauren Zalla
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Michael A Horberg
- Kaiser Permanent Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | | | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter F Rebeiro
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jennifer E Thorne
- School of Medicine, Johns Hopkins University, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vincent C Marconi
- School of Medicine, and Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USAand
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard D Moore
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph J Eron
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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6
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Tempalski B, Williams LD, Kolak M, Ompad DC, Koschinsky J, McLafferty SL. Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings. J Urban Health 2022; 99:701-716. [PMID: 35672547 PMCID: PMC9360264 DOI: 10.1007/s11524-022-00645-3] [Citation(s) in RCA: 4] [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] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.
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Affiliation(s)
- Barbara Tempalski
- Center for Community-Based Population Health Research, NDRI-USA, Inc., 31 West 34th Street, New York, NY 10001 USA
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607 USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, and the Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003 USA
| | - Julia Koschinsky
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Sara L. McLafferty
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, 1301 W Green Street, Urbana, IL 61801 USA
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7
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Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction 2022; 117:986-997. [PMID: 34854162 PMCID: PMC8904318 DOI: 10.1111/add.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed 'overdose prevention sites' (OPS), in Vancouver, Canada in December 2016. We measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs (PWID). DESIGN Segmented regression analyses of interrupted time series data from two community-recruited prospective cohorts of PWID from January 2015 to November 2018 were used to measure the impact of the OPS scale-up on changes in SIS use, public injection, syringe sharing and addiction treatment participation, controlling for pre-existing secular trends. SETTING Vancouver, Canada. PARTICIPANTS Of 745 PWID, 292 (39.7%) were women, 441 (59.6%) self-reported white ancestry and the median age was 47 years (interquartile range = 38, 53) at baseline. MEASUREMENTS Immediate (i.e. step level) and gradual (i.e. slope) changes in the monthly proportion of participants who self-reported past 6-month SIS use, public injection, syringe sharing and participation in any form of addiction treatment. FINDINGS Post OPS expansion, the monthly prevalence of SIS use immediately increased by an estimated 6.4% [95% confidence interval (CI) = 1.7, 11.2] and subsequently further increased by an estimated 0.7% (95% CI = 0.3, 1.1) per month. The monthly prevalence of addiction treatment participation immediately increased by an estimated 4.5% (95% CI = 0.5, 8.5) following the OPS expansion, while public injection and syringe sharing were estimated to immediately decrease by 5.5% (95% CI = 0.9, 10.0) and 2.5% (95% CI = 0.5, 4.6), respectively. Findings were inconclusive as to whether or not an association was present between the intervention and subsequent gradual changes in public injection, syringe sharing and addiction treatment participation. CONCLUSIONS Scaling-up overdose prevention sites in Vancouver, Canada in December 2016 was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
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8
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Beaulieu T, Hayashi K, Dong H, DeBeck K, Day A, McKendry R, Kaur G, Barrios R, Milloy MJ, Ti L. Impact of migration from an illicit drug scene on hospital outcomes among people who use illicit drugs in Vancouver, Canada. Drug Alcohol Rev 2020; 39:924-931. [PMID: 32485075 DOI: 10.1111/dar.13095] [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] [Received: 09/11/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND AIMS People who use illicit drugs (PWUD) are vulnerable to an array of negative health outcomes, and increased hospital services utilisation. PWUD are also a transient population which poses challenges to the provision of optimal health care. The objective of this study was to identify out-migration patterns from Vancouver's Downtown Eastside (DTES), a neighbourhood where services for PWUD are concentrated, and to estimate the impact of these patterns on hospitalisation events among PWUD. DESIGN AND METHODS Data were collected through three prospective cohorts of PWUD in Vancouver, which were linked with health administrative data. Latent class growth analysis was used to define migration trajectory groups. Poisson regression was used to estimate the effect of migration patterns on hospitalisation events. RESULTS A total of 1180 participants were included in the study. Four latent classes were identified: early migration out (243, 20.6%); frequent revisit (112, 9.5%); late migration out (219, 18.6%); and consistently living in the DTES (606, 51.4%). Compared with those who consistently lived in the DTES, participants in the early migration out group had lower hospitalisation events (adjusted rate ratio = 0.65; 95% confidence interval: 0.48-0.90). DISCUSSION AND CONCLUSION We found that PWUD who migrated out of the DTES early had lower hospitalisation events compared to those who consistently lived in the DTES, which may be a function of lesser addiction severity among this trajectory group. These findings underscore a need to provide transitional health and social service supports for other trajectory groups in an effort to minimise hospitalisation for preventable causes.
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Affiliation(s)
- Tara Beaulieu
- British Columbia Centre on Substance Use, Vancouver, Canada.,Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Andrew Day
- Vancouver Coastal Health, Vancouver, Canada
| | | | | | - Rolando Barrios
- Vancouver Coastal Health, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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9
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Ickowicz S, Dong H, Ti L, Nolan S, Fairbairn N, Barrios R, Milloy MJ. Behavioural, social and structural-level risk factors for developing AIDS among HIV-positive people who use injection drugs in a Canadian setting, 1996-2017. AIDS Care 2020; 32:1262-1267. [PMID: 32476442 DOI: 10.1080/09540121.2020.1772955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
People who use injection drugs (PWID) experience high rates of HIV acquisition and, as a result of lower rates of optimal access and adherence to combination antiretroviral therapy (ART), experience worse HIV treatment outcomes than other key affected populations. However, the incidence and risk factors for the development of AIDS among HIV-positive PWID have not been completely described. We used data from a community-recruited prospective cohort of HIV-positive PWID in Vancouver, Canada, a setting with universal no-cost ART and a comprehensive clinical monitoring registry. We used multivariable extended Cox models to identify factors associated with time to AIDS. Between 1996 and 2017, 396 participants, including 140 (35.4%) women, were followed for a median of 39.0 months (interquartile range: 16.6-76.2), among whom 165 (41.7%) developed AIDS. In a multivariable model, homelessness (Adjusted Hazard Ratio [AHR] = 1.76 (1.18-2.61)) and injection drug use within the preceding six months (AHR = 1.74 (1.17-2.58)) were independently associated with a higher risk of developing AIDS. Despite widespread scale-up of programmes to improve ART utilization, significant risk factors for the development of AIDS remain among HIV-positive PWID in this setting.
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Affiliation(s)
- S Ickowicz
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - H Dong
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - L Ti
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - S Nolan
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - N Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - R Barrios
- BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.,Faculty of Medicine, School of Population and Public Health, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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10
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Home and health among people living with HIV who use drugs: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102729. [PMID: 32388481 DOI: 10.1016/j.drugpo.2020.102729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Housing is a critical determinant of HIV-related outcomes among people living with HIV (PLHIV) who use drugs, including on HIV treatment adherence. Research shows that sense of home may have important implications for mitigating harms associated with low-income housing environments among PLHIV who use drugs, but how this shapes treatment is poorly understood. METHODS Semi-structured interviews were conducted with 31 PLHIV who use drugs recruited from an ongoing prospective cohort in Vancouver, Canada. Recruitment was targeted towards individuals living in single room occupancy housing who had previously reported low treatment adherence. Interviews were co-led with a peer research assistant, and focused on housing conditions, drug use patterns, and HIV management. Interviews were transcribed, analyzed thematically, and interpreted by drawing on concepts of home and place-making. RESULTS The ability to exert control over housing environments contributed to participants' perceptions of home by fostering feelings of safety and allowing for creation of personalized space. Participants readily identified the importance of housing stability and quality in maintaining health (e.g. food storage, pest-free), including HIV care. However, informed by social-structural mechanisms that undermined agency, negative experiences of home adversely impacted treatment adherence. CONCLUSIONS Findings indicate that sense of home may enable ability to manage HIV care, and is promoted through feelings of security within, and control over, housing environments. Supports in navigating competitive housing markets are needed to address the role that home plays in HIV treatment adherence.
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Olatosi B, Weissman S, Zhang J, Chen S, Haider MR, Li X. Neighborhood Matters: Impact on Time Living with Detectable Viral Load for New Adult HIV Diagnoses in South Carolina. AIDS Behav 2020; 24:1266-1274. [PMID: 31754967 PMCID: PMC8114415 DOI: 10.1007/s10461-019-02734-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the association between neighborhood disadvantages and percent person-time spent with increased transmission risk (VL > 1500 copies/ml) for people living with HIV (PLWH) in South Carolina (SC). The study population included PLWH diagnosed between 1/1/2014 and 12/31/2017, with two or more VL tests 6 months apart (n = 2076). Proportion of time living with VL > 1500 copies/ml after linkage to care was determined. Neighborhood disadvantage was assessed using the area deprivation index (ADI). A generalized linear model was fit to generate parameter estimates for time spent with detectable VL. Almost half of PLWH (49.5%) lived with VL > 1500 copies/ml for some time (median days = 46). Young adults and PLWH who injected drugs experienced the highest proportion for time living with detectable VL. Targeted programs are needed to improve VL suppression, reduce new transmissions and decrease disparities in HIV outcomes in all neighborhoods.
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Affiliation(s)
- Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Factors Associated With the Use of Supervised Consumption Facilities Among Women Who Inject Drugs in a Canadian Setting. J Addict Med 2020; 14:e226-e232. [PMID: 32142059 DOI: 10.1097/adm.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Supervised consumption facilities (SCFs) are evidence-based harm reduction interventions that have been shown to reduce the risk of social and health-related harms associated with injection drug use. Previous qualitative studies have highlighted important motivations for SCF use among women who use drugs. However, factors associated with SCF use among women have not previously been evaluated. METHODS Data were obtained from 2 longitudinal community-recruited cohorts of people who use drugs in Vancouver, Canada between 2003 and 2017. Multivariable generalized estimating equations were used to calculate the odds of SCF use associated with social and structural risk factors for drug-related harm among women who reported injection drug use in the preceding 6-months. RESULTS A total of 795 participants were included in the study, contributing to 6302 interviews, with 602 participants (76%) reporting SCF use in at least one interview. Multivariable analysis demonstrated daily heroin and crystal methamphetamine injection (Adjusted Odds Ratio [AOR] = 1.32 and 1.65, respectively), injecting in public (AOR = 1.77), binge injection (AOR = 1.22) and lack of housing (AOR = 1.74) to be associated with SCF use. CONCLUSIONS The current study demonstrates higher intensity patterns of drug use, including daily heroin and crystal methamphetamine injection, injecting in public and binge injection, as well as homelessness to be associated with SCF use among women. Future research should identify barriers to SCF use among women to minimize the risk of overdose and other drug-related harms.
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Goldenberg SM, Amram O, Braschel M, Moreheart S, Shannon K. Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort. Health Place 2020; 62:102288. [PMID: 32479365 PMCID: PMC7574814 DOI: 10.1016/j.healthplace.2020.102288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 01/07/2023]
Abstract
Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.
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Affiliation(s)
- Shira M Goldenberg
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888, University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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Ti L, Dong H, Day A, McKendry R, DeBeck K, Bingham B, Milloy MJ, Barrios R, Hayashi K. Longitudinal migration patterns from an open illicit drug scene among people who use illicit drugs in Vancouver, Canada. J Subst Abuse Treat 2019; 107:17-23. [PMID: 31757260 PMCID: PMC6892597 DOI: 10.1016/j.jsat.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
The objective of this study was to identify migration patterns from an open illicit drug scene (the Downtown Eastside [DTES] neighborhood) and describe factors associated with these migration patterns. Data were derived from three cohorts of people who use illicit drugs in Vancouver, Canada. Defined using latent class growth analysis, we identified four distinct migration trajectory groups: 1) consistently living in the DTES (47.8%); 2) early migration out, with a median time of migrating out of DTES of 5.3 months (21.5%); 3) late migration out, with a median time of migrating out of DTES of 38.0 months (20.1%); and 4) frequent revisit back-and-forth to DTES (10.6%). In a multivariable model, compared to the "consistently living in the DTES" group, factors associated with the "frequent revisit" group included being enrolled in non-pharmacological addiction treatment and having an HCV-positive serostatus. Factors associated with the "early migration out" group included being enrolled in detoxification or in other non-pharmacological addiction treatment, later calendar year, being on income assistance, living in a single room occupancy hotel, and having an HCV-positive serostatus. These findings point to the need for appropriate distribution of services in order to meet the needs of this population.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Andrew Day
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Rachael McKendry
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Brittany Bingham
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rolando Barrios
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Bardwell G, Strike C, Mitra S, Scheim A, Barnaby L, Altenberg J, Kerr T. "That's a double-edged sword": Exploring the integration of supervised consumption services within community health centres in Toronto, Canada. Health Place 2019; 61:102245. [PMID: 31740126 DOI: 10.1016/j.healthplace.2019.102245] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/29/2019] [Accepted: 11/08/2019] [Indexed: 01/04/2023]
Abstract
Supervised consumption services (SCS) have been integrated into community health centres in Toronto. We draw on qualitative interviews and ethnographic observations to examine the implementation contexts of these SCS. Participants' perspectives on the integration of SCS within CHCs were mixed. Some participants identified the benefits of integrated SCS such as convenience and access to other health and social services. However, others identified negative consequences of integration, including building design, lack of privacy and anonymity, and limited hours of operation. These perspectives highlight the ways in which contextual factors affect the experiences of clients in accessing SCS, and suggest that various factors need to be considered in order to improve service uptake.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Sanjana Mitra
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ayden Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 50 Bond Street, Toronto, ON, M5B 1W8, Canada; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Lorraine Barnaby
- Parkdale Queen West Community Health Centre, 168 Bathurst Street, Toronto, ON, M5V 2R4, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON, M4M 3P3, Canada
| | - Thomas Kerr
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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Ivsins A, Vancouver Area Network Of Drug Users, Benoit C, Kobayashi K, Boyd S. From risky places to safe spaces: Re-assembling spaces and places in Vancouver's Downtown Eastside. Health Place 2019; 59:102164. [PMID: 31382220 DOI: 10.1016/j.healthplace.2019.102164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023]
Abstract
Vancouver's Downtown Eastside (DTES) neighbourhood is commonly associated with stigmatized and criminalized activities and attendant risks and harms. Many spaces/places in this urban neighbourhood are customarily portrayed and experienced as risky and harmful, and are implicated in experiences of structural (and physical) violence and marginalization. Drawing on 50 qualitative interviews, this paper explores how spaces/places frequently used by structurally vulnerable people who use drugs (PWUD) in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as enabling safety and wellbeing. Study participants recounted both negative and positive experiences with particular spaces/places, suggesting the possibility of making these locations less risky and safer. Our findings demonstrate how spaces/places used by PWUD in this particular geographical context can be understood as assemblages, a variety of human and nonhuman forces - such as material objects, actors, processes, affect, temporal elements, policies and practices - drawn together in unique ways that produce certain effects (risk/harm or safety/wellbeing). Conceptualizing these spaces/places as assemblages provides a means to better understand how experiences of harm, or conversely wellbeing, unfold, and sheds light on how risky spaces/places can be re-assembled as spaces/places that enable safety and wellbeing.
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Affiliation(s)
- Andrew Ivsins
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada.
| | | | - Cecilia Benoit
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada
| | - Karen Kobayashi
- Department of Sociology, University of Victoria, Cornett Building, A333, Victoria, BC, V8P 5C2, Canada
| | - Susan Boyd
- Faculty of Human and Social Development, University of Victoria, HSD Building, Room A102, Victoria, BC, V8P 5C2, Canada
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Bardwell G, Boyd J, Kerr T, McNeil R. Negotiating space & drug use in emergency shelters with peer witness injection programs within the context of an overdose crisis: A qualitative study. Health Place 2018; 53:86-93. [PMID: 30059897 DOI: 10.1016/j.healthplace.2018.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/07/2018] [Accepted: 07/15/2018] [Indexed: 12/17/2022]
Abstract
Vancouver, Canada is experiencing an overdose crisis due to the proliferation of fentanyl and related analogues and novel overdose response interventions are being implemented across multiple high overdose risk environments, including emergency shelters. We draw on ethnographic fieldwork and qualitative interviews to examine how social, structural, and physical contexts at two emergency shelters implementing a peer-based supervised injection intervention influenced injection drug use and overdose risks. Findings reveal that the implementation of this intervention reduced stigma and shame through the normalization of drug use in shelter spaces, and yet underlying social norms and material constraints led people to inject alone in non-designated injecting spaces. Whereas these spatial dynamics of injection drug use potentially increased overdose vulnerability, an emerging sense of collective responsibility in relation to the overdose crisis led to the routinization of peer witnessing practices across the shelter environment to extend the impact of the intervention.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9.
| | - Jade Boyd
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9.
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9.
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, Canada V6Z 2A9.
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Conners EE, Gaines TL, Strathdee SA, Magis-Rodriguez C, Brouwer KC. Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S294-S302. [PMID: 29218799 PMCID: PMC5940512 DOI: 10.1111/dar.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. DESIGN AND METHODS A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. RESULTS Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). DISCUSSION AND CONCLUSIONS Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, USA
- San Diego State University, San Diego, USA
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, USA
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV and AIDS, Col Anzures, Distrito Federal, Mexico
| | - Kimberly C. Brouwer
- Department of Family Medicine & Public Health, University of California, San Diego, USA
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Rudolph A, Tobin K, Rudolph J, Latkin C. Web-Based Survey Application to Collect Contextually Relevant Geographic Data With Exposure Times: Application Development and Feasibility Testing. JMIR Public Health Surveill 2018; 4:e12. [PMID: 29351899 PMCID: PMC5797287 DOI: 10.2196/publichealth.8581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background Although studies that characterize the risk environment by linking contextual factors with individual-level data have advanced infectious disease and substance use research, there are opportunities to refine how we define relevant neighborhood exposures; this can in turn reduce the potential for exposure misclassification. For example, for those who do not inject at home, injection risk behaviors may be more influenced by the environment where they inject than where they live. Similarly, among those who spend more time away from home, a measure that accounts for different neighborhood exposures by weighting each unique location proportional to the percentage of time spent there may be more correlated with health behaviors than one’s residential environment. Objective This study aimed to develop a Web-based application that interacts with Google Maps application program interfaces (APIs) to collect contextually relevant locations and the amount of time spent in each. Our analysis examined the extent of overlap across different location types and compared different approaches for classifying neighborhood exposure. Methods Between May 2014 and March 2017, 547 participants enrolled in a Baltimore HIV care and prevention study completed an interviewer-administered Web-based survey that collected information about where participants were recruited, worked, lived, socialized, injected drugs, and spent most of their time. For each location, participants gave an address or intersection which they confirmed using Google Map and Street views. Geographic coordinates (and hours spent in each location) were joined to neighborhood indicators by Community Statistical Area (CSA). We computed a weighted exposure based on the proportion of time spent in each unique location. We compared neighborhood exposures based on each of the different location types with one another and the weighted exposure using analysis of variance with Bonferroni corrections to account for multiple comparisons. Results Participants reported spending the most time at home, followed by the location where they injected drugs. Injection locations overlapped most frequently with locations where people reported socializing and living or sleeping. The least time was spent in the locations where participants reported earning money and being recruited for the study; these locations were also the least likely to overlap with other location types. We observed statistically significant differences in neighborhood exposures according to the approach used. Overall, people reported earning money in higher-income neighborhoods and being recruited for the study and injecting in neighborhoods with more violent crime, abandoned houses, and poverty. Conclusions This analysis revealed statistically significant differences in neighborhood exposures when defined by different locations or weighted based on exposure time. Future analyses are needed to determine which exposure measures are most strongly associated with health and risk behaviors and to explore whether associations between individual-level behaviors and neighborhood exposures are modified by exposure times.
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Affiliation(s)
- Abby Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Amram O, Wang L, Sereda P, Shoveller JA, Barrios R, Montaner JSG, Lima VD. ASSESSING THE RELATIONSHIP BETWEEN PHYSICIAN AVAILABILITY AND VIRAL LOAD SUPPRESSION IN BRITISH COLUMBIA. THE CANADIAN GEOGRAPHER. GEOGRAPHE CANADIEN 2017; 62:120-129. [PMID: 30504965 PMCID: PMC6261522 DOI: 10.1111/cag.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In 2014, the Joint United Nations Programme HIV/AIDS (UNAIDS) set the target of dramatically reducing the burden of HIV through expansion of access to timely HIV treatment. In order to achieve this target it is necessary to expand access to care along the HIV cascade of care. This study examines the relationship between viral suppression and the availability of physicians providing HIV treatment in British Columbia, Canada. METHODS Data from the Drug Treatment Program of the British Columbia (BC) Centre for Excellence in HIV/AIDS was used for this analysis. The floating catchment method was used to assess physician availability. Multivariable Logistic Regression was used to implement a confounder selection technique to independently assess the relationship between physician availability and viral load suppression. RESULTS Individuals with more than 25 physicians within a one-hour catchment were more likely to reside in urban areas and almost twice as likely to have a suppressed viral load (adjusted odd ratio: 1.97; 95% CI 1.50 - 2.58). CONCLUSIONS This study highlights the impact of physicians' availability on viral load levels. Mapping technology was used to identify the locations in which patients were most impacted by the lack of physicians.
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Affiliation(s)
- Ofer Amram
- Spokane Health Education and Research Building Third Floor, P O Box 1495 , Spokane, WA 99210-1495. Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS. Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS
| | - Paul Sereda
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS
| | - Jean A Shoveller
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS. Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS. Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS. Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Viviane D Lima
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS. Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ. Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis. Drug Alcohol Depend 2017; 180:33-38. [PMID: 28865390 PMCID: PMC5811227 DOI: 10.1016/j.drugalcdep.2017.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND and Aims Injecting illicit drugs in public settings has been linked to a higher risk of a range of drug-related harms, including overdose and HIV infection. However, the factors associated with public injecting among HIV-positive individuals have not been previously explored. We investigated the links between public drug injecting, drug-related harm, and HIV treatment measures among a cohort of HIV-positive persons who inject drugs (PWID) in a Canadian setting. METHODS We used data from a prospective cohort of HIV-positive PWID recruited from community settings in Vancouver, Canada, linked to comprehensive clinical monitoring data in the context of an ongoing Treatment-as-Prevention (TasP) initiative to examine harms associated with public injecting. We used generalized linear mixed-effects analyses to identify longitudinal factors associated with self-reported public drug injection. RESULTS Between 2005 and 2014, 626 HIV-seropositive PWID were recruited, of whom 213 (34%) reported public injection in the preceding 180days. In a longitudinal multivariable model, public injection was positively associated with daily heroin injection (Adjusted Odds Ratio [AOR]=2.63), incarceration (AOR=1.78), and detectable plasma HIV-1 RNA viral load (VL, AOR=1.42). CONCLUSIONS Public injecting was linked to numerous drug-related harms among HIV-seropositive PWID in this setting. Given its link with detectable VL, an important marker of poor HIV treatment outcomes, our findings support prioritizing individuals engaged in public injecting with harm reduction strategies as well as clinical and social supports as a part of TasP-based efforts to prevent HIV-related morbidity and mortality, and HIV transmission.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
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23
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Tomita A, Vandormael AM, Bärnighausen T, de Oliveira T, Tanser F. Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa. J Acquir Immune Defic Syndr 2017; 75:164-174. [PMID: 28291049 PMCID: PMC5429974 DOI: 10.1097/qai.0000000000001349] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). METHODS The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. RESULTS The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations. CONCLUSION HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
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Affiliation(s)
- Andrew Tomita
- Nelson R Mandela School of Medicine, University of
KwaZulu-Natal
- Africa Health Research Institute, University of KwaZulu-Natal
| | - Alain M. Vandormael
- Nelson R Mandela School of Medicine, University of
KwaZulu-Natal
- Africa Health Research Institute, University of KwaZulu-Natal
| | - Till Bärnighausen
- Africa Health Research Institute, University of KwaZulu-Natal
- Department of Global Health and Population, Harvard T.H. Chan School
of Public Health
- Institute for Public Health, University of Heidelberg
| | - Tulio de Oliveira
- Nelson R Mandela School of Medicine, University of
KwaZulu-Natal
- Africa Health Research Institute, University of KwaZulu-Natal
- Centre for the AIDS Programme of Research in South Africa
(CAPRISA)
| | - Frank Tanser
- Africa Health Research Institute, University of KwaZulu-Natal
- Centre for the AIDS Programme of Research in South Africa
(CAPRISA)
- School of Nursing and Public Health, University of
KwaZulu-Natal
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24
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Smith-Morris C. Epidemiological placism in public health emergencies: Ebola in two Dallas neighborhoods. Soc Sci Med 2017; 179:106-114. [PMID: 28260635 DOI: 10.1016/j.socscimed.2017.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/11/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
Super-diverse cities face distinctive challenges during infectious disease outbreaks. For refugee and immigrant groups from epidemic source locations, identities of place blend with epidemiological logics in convoluted ways during these crises. This research investigated the relationships of place and stigma during the Dallas Ebola crisis. Ethnographic results illustrate how Africanness, more than neighborhood stigma, informed Dallas residents' experience of stigma. The problems of place-based stigma, the imprecision of epidemiological placism, and the cohesion of stigma to semiotically powerful levels of place - rather than to realistic risk categories - are discussed. Taking its authority from epidemiology, placism is an important source of potential stigma with critical implications for the success of public health messaging.
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Affiliation(s)
- Carolyn Smith-Morris
- Department of Anthropology, Southern Methodist University, 3225 Daniel Boulevard, Heroy Building #415, Dallas, TX 75275, United States.
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25
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Goldenberg SM, Deering K, Amram O, Guillemi S, Nguyen P, Montaner J, Shannon K. Community mapping of sex work criminalization and violence: impacts on HIV treatment interruptions among marginalized women living with HIV in Vancouver, Canada. Int J STD AIDS 2017; 28:1001-1009. [PMID: 28056726 DOI: 10.1177/0956462416685683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Despite the high HIV burden faced by sex workers, data on access and retention in antiretroviral therapy (ART) are limited. Using an innovative spatial epidemiological approach, we explored how the social geography of sex work criminalization and violence impacts HIV treatment interruptions among sex workers living with HIV in Vancouver over a 3.5-year period. Drawing upon data from a community-based cohort (AESHA, 2010-2013) and linked external administrative data on ART dispensation, GIS mapping and multivariable logistic regression with generalized estimating equations to prospectively examine the effects of spatial criminalization and violence near women's places of residence on 2-day ART interruptions. Analyses were restricted to 66 ART-exposed women who contributed 208 observations and 83 ART interruption events. In adjusted multivariable models, heightened density of displacement due to policing independently correlated with HIV treatment interruptions (AOR: 1.02, 95%CI: 1.00-1.04); density of legal restrictions (AOR: 1.30, 95%CI: 0.97-1.76) and a combined measure of criminalization/violence (AOR: 1.00, 95%CI: 1.00-1.01) were marginally correlated. The social geography of sex work criminalization may undermine access to essential medicines, including HIV treatment. Interventions to promote 'enabling environments' (e.g. peer-led models, safer living/working spaces) should be explored, alongside policy reforms to ensure uninterrupted treatment access.
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Affiliation(s)
- Shira M Goldenberg
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,2 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kathleen Deering
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Ofer Amram
- 3 Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Silvia Guillemi
- 3 Department of Geography, Simon Fraser University, Burnaby, Canada.,4 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Nguyen
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio Montaner
- 3 Department of Geography, Simon Fraser University, Burnaby, Canada.,5 Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,5 Department of Medicine, University of British Columbia, Vancouver, Canada
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26
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Sacks-Davis R, Daniel M, Roy É, Kestens Y, Zang G, Ramos Y, Hellard M, Jutras Aswad D, Bruneau J. The role of living context in prescription opioid injection and the associated risk of hepatitis C infection. Addiction 2016; 111:1985-1996. [PMID: 27238912 DOI: 10.1111/add.13470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/06/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Prescription opioid injection (POI) is a leading risk factor for hepatitis C virus (HCV). Residential context relates to high‐risk injection behaviour. This study assessed whether residence in the inner city (versus surrounding areas in Montréal Island) modified the effects of correlates of POI or the relationship between POI and HCV incidence. DESIGN Prospective cohort study. SETTING Montréal, Canada. PARTICIPANTS A total of 854 people who inject drugs (18% female, 25% age < 30 years), living on Montréal Island, were interviewed every 3–6 months from 2004 to 2012. MEASUREMENTS Study visits included HCV antibody testing and an interviewer‐administered questionnaire. Generalized estimating equations were used to test whether place of residence modified the effects of correlates of POI. Cox regression was used to test whether place of residence modified the relationship between POI and HCV incidence. FINDINGS At baseline, inner‐city participants were more likely to report POI in the past month (40 versus 25%, P < 0.001). The association between POI and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city. The hazard of HCV infection associated with POI was greater among inner‐city participants compared to those in the surrounding areas [adjusted hazard ratio (HR) = 3.38, 95% confidence interval (CI) = 1.88–6.07 versus HR = 1.26, 95% CI = 0.65–2.42, P = 0.025]. CONCLUSIONS Among people who inject prescription opioids in Montréal, Canada, those who live in inner‐city areas are more likely to engage in injecting‐related risk behaviours and have a higher risk of hepatitis C virus infection than those who live in the suburbs.
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Affiliation(s)
- Rachel Sacks-Davis
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mark Daniel
- School of Population Health, University of South Australia, Adelaide, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada.,Institut National de Santé Publique, Montréal, Canada
| | - Yan Kestens
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Yuddy Ramos
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Didier Jutras Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada. .,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada.
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27
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Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016; 42:148-158. [PMID: 27770671 PMCID: PMC5584790 DOI: 10.1016/j.healthplace.2016.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 01/14/2023]
Abstract
In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.
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Affiliation(s)
- Yusuf Ransome
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Denis Nash
- City University of New York (CUNY) Institute for Implementation Science in Population Health, NY, USA
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28
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Burke-Miller JK, Weber K, Cohn SE, Hershow RC, Sha BE, French AL, Cohen MH. Neighborhood community characteristics associated with HIV disease outcomes in a cohort of urban women living with HIV. AIDS Care 2016; 28:1274-9. [PMID: 27098593 DOI: 10.1080/09540121.2016.1173642] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recent studies have found geographic variations in immune and viral human immunodeficiency virus (HIV) disease outcomes associated with census measures of neighborhood poverty and segregation. Although readily available, such aggregate census measures are not based on health behavior models and provide limited information regarding neighborhood effect pathways. In contrast, survey-based measures can capture specific aspects of neighborhood disadvantage that may better inform community-based interventions. Therefore, the aim of this study is to assess the measurement validity of multi-dimensional survey measures of neighborhood disorder compared with census measures as predictors of HIV outcomes in a cohort of 197 low-income women in a major metropolitan area. The multi-dimensional survey measures were related to each other and to census measures of concentrated poverty and racial segregation, but not so highly correlated as to be uniform. We found notable variation between community areas in women's CD4 levels but there was no corresponding geographic variance in viral load, and relationships between community area measures and viral load disappeared after adjustment for individual characteristics, including HIV treatment adherence. In multilevel models adjusting for individual characteristics including substance use, depression, and HIV treatment adherence, one survey measure of neighborhood disadvantage (poor-quality built environment) and one census measure (racial segregation) were significantly associated with greater likelihood of CD4 < 500 (p < .05).
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Affiliation(s)
| | - Kathleen Weber
- a Hektoen Institute of Medicine , Chicago , IL , USA.,b Ruth M. Rothstein CORE Center, Cook County Health and Hospitals System , Chicago , IL , USA
| | - Susan E Cohn
- c Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Ronald C Hershow
- d University of Illinois at Chicago School of Public Health , Chicago , IL , USA
| | - Beverly E Sha
- e Rush University Medical Center , Chicago , IL , USA
| | - Audrey L French
- b Ruth M. Rothstein CORE Center, Cook County Health and Hospitals System , Chicago , IL , USA.,e Rush University Medical Center , Chicago , IL , USA
| | - Mardge H Cohen
- e Rush University Medical Center , Chicago , IL , USA.,f Stroger Hospital, Cook County Health and Hospitals System , Chicago , IL , USA
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29
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Graham LF, Padilla MB, Lopez WD, Stern AM, Peterson J, Keene DE. Spatial Stigma and Health in Postindustrial Detroit. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 36:105-13. [DOI: 10.1177/0272684x15627800] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An emerging body of research suggests that those who reside in socially and economically marginalized places may be marked by a stigma of place, referred to as spatial stigma, which influences their sense of self, their daily experiences, and their relations with outsiders. Researchers conducted 60 semistructured interviews at partnering community-based organizations during summer 2011 with African American and Latina/o, structurally disadvantaged youth of diverse gender and sexual identities who were between 18 and 26 years of age residing in Detroit, Michigan. The disadvantaged structural conditions and dilapidated built environment were common themes in participants’ narratives. Beyond these descriptions, participants’ framings and expressions of their experiences in and perceptions of these spaces alluded to reputational qualities of their city and particular areas of their city that appear related to spatial stigma. Young Detroit residents articulated the ways that they experience and navigate the symbolic degradation of their city.
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Affiliation(s)
- Louis F. Graham
- Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | - Mark B. Padilla
- Global and Sociocultural Studies, Florida International University, Miami, FL, USA
| | - William D. Lopez
- Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alexandra M. Stern
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Danya E. Keene
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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30
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Tan AX, Kapiga S, Khoshnood K, Bruce RD. Epidemiology of Drug Use and HIV-Related Risk Behaviors among People Who Inject Drugs in Mwanza, Tanzania. PLoS One 2015; 10:e0145578. [PMID: 26701616 PMCID: PMC4689416 DOI: 10.1371/journal.pone.0145578] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/04/2015] [Indexed: 12/02/2022] Open
Abstract
Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug use exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Unstable housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. More than half of heroin injectors left syringes in common locations, and half reported sharing needles and syringes. Other risk behaviors such as lack of condom use during sex, and the use of illicit drugs during sex was widely reported as well. Among the study sample, there was poor awareness of health risks posed by needle/syringe sharing and drug use. Our results show that heroin use and HIV risk related behaviors are pressing problems that should not be ignored in Mwanza. Harm reduction programs are urgently needed in this population.
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Affiliation(s)
- Annabel Xulin Tan
- Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Kaveh Khoshnood
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - R. Douglas Bruce
- Cornell Scott-Hill Health Center, New Haven, Connecticut, United States of America
- Yale University School of Medicine, New Haven, Connecticut, United States of America
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31
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Ickowicz S, Hayashi K, Dong H, Milloy MJ, Kerr T, Montaner JSG, Wood E. Benzodiazepine use as an independent risk factor for HIV infection in a Canadian setting. Drug Alcohol Depend 2015; 155:190-4. [PMID: 26243506 PMCID: PMC4581956 DOI: 10.1016/j.drugalcdep.2015.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the harms of prescription drug diversion are of growing international concern, the potential impact of prescription drug use on HIV infection has not been well assessed. We evaluated whether benzodiazepine use was associated with HIV seroconversion among a cohort of persons who inject drugs (PWID) in a Canadian setting. METHODS Between May, 1996 and November, 2013, data were derived through a prospective cohort study of PWID in Vancouver, Canada. A total of 1682 baseline HIV negative participants were followed for a median of 79.5 months (interquartile range: 32.1-119.1), among whom 501 (29.8%) reported benzodiazepine use at baseline, and 176 seroconverted during follow-up, equal to an incidence density of 1.5 (95% Confidence Interval [CI]: 1.3-1.7) cases per 100 person-years. Poisson regression with time-dependent variables was used to assess whether benzodiazepine use was associated with the time to HIV seroconversion. RESULTS After adjustment for potential confounders, benzodiazepine use (Adjusted Rate Ratio: 1.50; 95% CI: 1.01-2.24) was independently associated with a higher rate of HIV seroconversion. CONCLUSIONS Benzodiazepine use was an independent risk factor for HIV seroconversion among PWID in this setting. Greater recognition of the safety concerns related to benzodiazepine medications including diversion are needed.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada; Department of Medicine, University of British Columbia, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada; Department of Medicine, University of British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada; Department of Medicine, University of British Columbia, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada; Department of Medicine, University of British Columbia, Canada.
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32
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, Maddox L. Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011. Drug Alcohol Depend 2015. [PMID: 26208792 PMCID: PMC4536123 DOI: 10.1016/j.drugalcdep.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors. METHODS Florida surveillance data for persons diagnosed with HIV 2000-2008 were merged with 2007-2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors. RESULTS Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43-1.80). Factors associated with mortality for those with IDU history included: being 40-59 (aHR 6.48, 95% CI 1.41-121.05) and ≥60 years (aHR 18.75, 95% CI 3.83-356.45) compared with 13-19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87-2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19-2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06-2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without. CONCLUSION HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas.
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Affiliation(s)
- Diana M. Sheehan
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (CSALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Mary Jo Trepka
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL 33199, United States; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Frank R. Dillon
- Department of Educational and Counseling Psychology, School of Education, University at Albany – State University of New York, 1400 Washington Ave, Albany, NY, 12222
| | - Lorene Maddox
- HIV/AIDS Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, Florida 32399
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Jozaghi E. Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection. HEALTH & JUSTICE 2015; 3:16. [PMCID: PMC5151785 DOI: 10.1186/s40352-015-0028-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/17/2015] [Indexed: 07/28/2023]
Abstract
Background Supervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections. Methods The current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside. Results A conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios. Conclusions The sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia Canada
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The role of neighborhoods in shaping perceived norms: An exploration of neighborhood disorder and norms among injection drug users in Baltimore, MD. Health Place 2015; 33:181-6. [PMID: 25840353 DOI: 10.1016/j.healthplace.2015.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 11/22/2022]
Abstract
A large literature suggests that social norms contribute to HIV and substance use related behaviors. Less attention has been given to neighborhood factors that may contribute to the development of norms about risky behaviors. We examined the cross-sectional associations between perceptions of one's neighborhood and norms of perceived prevalence of, and peer support for sex exchange and risky injection behaviors. The sample consisted of 719 people who reported injecting heroin and cocaine and did not move in the past 6 months in Baltimore, MD. Living in a neighborhood with disorder was associated with believing that others exchanged sex, practiced risky injection behaviors (descriptive norms) and approved of risky injection behavior (injunctive norms).
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Jongbloed K, Thomas V, Pearce ME, Christian KW, Zhang H, Oviedo-Joekes E, Schechter MT, Spittal PM. The Cedar Project: Residential transience and HIV vulnerability among young Aboriginal people who use drugs. Health Place 2015; 33:125-31. [PMID: 25840350 DOI: 10.1016/j.healthplace.2015.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/18/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
Aboriginal homelessness is considered to be a result of historic dispossession of traditional territories and forced displacement from community structures. Using data collected from 2005-2010 from the Cedar Project, a cohort of young Aboriginal people who use drugs in two Canadian cities, we examined how residential transience shapes HIV vulnerability. At baseline, 48 of 260 participants (18.5%) reported sleeping in six or more places ('highly transient') in the past six months. Generalized linear mixed models identified associations between high transience and sex and drug related HIV vulnerabilities. Transience was independently associated with sex work (AOR:3.52, 95%CI:2.06, 6.05); sexual assault (AOR:2.48, 95%CI:1.26, 4.86); injection drug use (AOR:4.54, 95%CI:2.71, 7.61); daily cocaine injection (AOR:2.16, 95%CI:1.26, 3.72); and public injection (AOR:2.87, 95%CI:1.65, 5.00). After stratification, transience and sexual vulnerability remained significantly associated among women but not men. Ensuring that young Aboriginal people have access to safe spaces to live, work, and inject must include policies addressing residential transience as well as the absence of a roof and walls.
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Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Vicky Thomas
- The Cedar Project, Centre for Evaluation and Outcome Sciences, St. Paul׳s Hospital, Vancouver, Canada; Wuikinuxv Nation, The Cedar Project, Prince George, Canada
| | - Margo E Pearce
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Hongbin Zhang
- The Cedar Project, Centre for Evaluation and Outcome Sciences, St. Paul׳s Hospital, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Phillips M, Richardson L, Wood E, Nguyen P, Kerr T, DeBeck K. High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting. Subst Use Misuse 2015; 50:1805-13. [PMID: 26642870 PMCID: PMC4820061 DOI: 10.3109/10826084.2015.1058825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access. METHODS Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14-26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine. RESULTS From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. CONCLUSIONS High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.
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Affiliation(s)
- Mark Phillips
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Lindsey Richardson
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Evan Wood
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Paul Nguyen
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Thomas Kerr
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Kora DeBeck
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
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Hayden A, Hayashi K, Dong H, Milloy MJ, Kerr T, Montaner JSG, Wood E. The impact of drug use patterns on mortality among polysubstance users in a Canadian setting: a prospective cohort study. BMC Public Health 2014; 14:1153. [PMID: 25377274 PMCID: PMC4246520 DOI: 10.1186/1471-2458-14-1153] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Illicit drug use is a well-established risk factor for morbidity and mortality. However, few studies have examined the impact of different drug use patterns on mortality among polysubstance using populations. This study aimed to identify drug-specific patterns of mortality among a cohort of polysubstance using persons who inject drugs (PWIDs). Methods PWIDs in Vancouver, Canada were prospectively followed between May 1996 and December 2011. Participants were linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariate Cox proportional hazards regression to investigate the relationships between drug use patterns (daily alcohol use, heroin injection and non-injection use, cocaine injection, amphetamine injection and non-injection use, crack smoking and speedball injecting) and time to all-cause mortality. Results 2330 individuals were followed for a median of 61 months (inter-quartile range: 33 – 112). In total, 466 (19.1%) individuals died for an incidence density of 3.1 (95% confidence interval [CI]: 2.8 – 3.4) deaths per 100 person-years. In multivariate analyses, after adjusting for HIV infection and other potential confounders, only daily cocaine injection remained independently associated with all-cause mortality (adjusted hazard ratio [AHR] = 1.36, 95% CI: 1.06 – 1.76). Conclusions Although heroin injecting is traditionally viewed as carrying the highest risk of mortality, in this setting, only daily cocaine injecting was associated with all-cause mortality. These findings highlight the urgent need to identify novel treatments and harm reduction strategies for cocaine injectors.
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Affiliation(s)
| | | | | | | | | | | | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Kori N, Roth AM, Lozada R, Vera A, Brouwer KC. Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:525-32. [PMID: 24418632 DOI: 10.1016/j.drugpo.2013.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/08/2013] [Accepted: 12/06/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substance use and HIV are growing problems in the Mexico-U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an 'HIV incidence hotspot,' consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot. METHODS From 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV 'hotspot'. RESULTS Of 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors independently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14-2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67-6.38), deportation (AOR 1.58; 95%CI 1.18-2.12), active syphilis (AOR 3.03; 95%CI 1.63-5.62), needle sharing (AOR 0.57; 95%CI 0.42-0.78), various police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13-2.03), and health insurance status (AOR 0.53; 95%CI 0.33-0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2-30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08-6.93), injecting inside (AOR 5.26; 95%CI 1.54-17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56-15.15), prior HIV testing (AOR 2.45; 95%CI 1.04-5.81), and health insurance status (AOR 0.12; 95%CI 0.03-0.59). CONCLUSION While drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.
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Affiliation(s)
- Nana Kori
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA; Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Drive, San Diego, CA 92182-4162, USA
| | - Alexis M Roth
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA
| | - Remedios Lozada
- Pro-COMUSIDA, Niños héroes 697, Oficina 1 y 6, Zona Norte, Tijuana 22000, Baja California, Mexico
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA
| | - Kimberly C Brouwer
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA.
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Safe havens and rough waters: networks, place, and the navigation of risk among injection drug-using Malaysian fishermen. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:575-82. [PMID: 24332971 DOI: 10.1016/j.drugpo.2013.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 11/06/2013] [Accepted: 11/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND HIV prevalence among Malaysian fishermen is ten times that of the general population. Fishing boats are a key place where drug use occurs, but we know little about how these environments shape HIV risk behaviour. Utilizing Rhodes' 'risk environment' framework, we assessed drug use contexts and how characteristics of place associated with fishing and fishermen's social networks served as key axes along which drug use and HIV risk behaviour occurred. METHODS Data were collected during 2009-2011 in Kuantan, a fishing port on the eastern coast of Malaysia, and include 28 in-depth interviews and 398 surveys collected using RDS. Logistic regression was used to determine the effect of occupational, network and risk environment characteristics on unsafe injection behaviour and access to clean needles/syringes; qualitative data were coded and analyzed thematically. RESULTS Drug injecting was common and occurred on boats, often with other crewmembers. Captains and crewmembers were aware of drug use. Unsafe injection practices were significantly associated with having a larger proportion of drug injectors in network (OR=3.510, 95% CI=1.053-11.700) and having a captain provide drugs for work (OR=2.777, 95% CI=1.018-7.576). Size of fishermen network (OR=0.987, 95% CI=0.977-0.996), crewmembers' knowledge of drug use (OR=7.234, 95% CI=1.430-36.604), and having a captain provide drugs for work (OR=0.134, 95% CI=0.025-0.720) predicted access to clean needles/syringes. Qualitative analyses revealed that occupational culture and social relationships on boats drove drug use and HIV risk. CONCLUSIONS While marginalized in broader society, the acceptance of drug use within the fishing community created occupational networks of risk. Fishing boats were spaces of both risk and safety; where drug users participated in the formal economy, but also where HIV risk behaviour occurred. Understanding the interplay between social networks and place is essential for developing HIV prevention and harm reduction policies appropriate for the unique needs of this fishing population.
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Chami G, Werb D, Feng C, DeBeck K, Kerr T, Wood E. Neighborhood of residence and risk of initiation into injection drug use among street-involved youth in a Canadian setting. Drug Alcohol Depend 2013; 132:486-90. [PMID: 23587537 PMCID: PMC3927649 DOI: 10.1016/j.drugalcdep.2013.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND While research has suggested that exposure to environments where drug use is prevalent may be a key determinant of drug-related risk, little is known regarding the impact of such exposure on the initiation of illicit injection drug use. We assessed whether neighborhood of residence predicted rates of injecting initiation among a cohort of street-involved youth in Vancouver, British Columbia. METHODS We followed street-involved injecting naïve youth aged 14-26 and compared rates of injecting initiation between youth residing in Vancouver's Downtown Eastside (DTES) neighborhood (the site of a large street-based illicit drug market) to those living in other parts of the city. Univariate and multivariate Cox regression analyses were employed to determine whether residence in the DTES was independently associated with increased risk of initiation of injection drug use. RESULTS Between September, 2005 and November, 2011, 422 injection-naïve individuals were followed, among whom 77 initiated injecting for an incidence density of injecting of 10.3 (95% confidence interval [CI] 5.0-18.8) per 100 person years. In a multivariate model, residence in the DTES was independently associated with initiating injection drug use (adjusted hazard ratio [AHR]=2.16, 95% CI: 1.33-3.52, p=0.002). CONCLUSIONS These results suggest neighborhood of residence affects the risk of initiation into injection drug use among street-involved youth. The development of prevention interventions should target high-risk neighborhoods where risk of initiating into injecting drug use may be greatest.
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Affiliation(s)
- Goldis Chami
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
| | - Dan Werb
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Cindy Feng
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6,Division of AIDS, Department of Medicine; University of British Columbia
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608–1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6,Division of AIDS, Department of Medicine; University of British Columbia
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Abstract
The link between HIV infection and poverty in sub-Saharan Africa (SSA) is rather complex and findings from previous studies remain inconsistent. While some argue that poverty increases vulnerability, existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV. In this paper, we examine the association between HIV infection and urban poverty in SSA, paying particular attention to differences in risk factors of HIV infection between the urban poor and non-poor. The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA, conducted during 2003-2008. We apply multilevel logistic regression models, allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region. The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Furthermore, the gender disparity in HIV infection (i.e. the disproportionate higher risk among women) is amplified among the urban poor. The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection. The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations reside.
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Affiliation(s)
- Monica A Magadi
- Department of Sociology, School of Social Sciences, City University, Northampton Square, London EC1V 0HB, UK.
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Jozaghi E. The role of drug users’ advocacy group in changing the dynamics of life in the Downtown Eastside of Vancouver, Canada. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2013.775608] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. AMERICAN PSYCHOLOGIST 2013; 68:210-24. [PMID: 23688089 PMCID: PMC3717355 DOI: 10.1037/a0032704] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Handlovsky IE, Bungay V, Johnson J, Phillips JC. The process of safer crack use among women in Vancouver's Downtown Eastside. QUALITATIVE HEALTH RESEARCH 2013; 23:450-462. [PMID: 23258112 DOI: 10.1177/1049732312469465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article we discuss the findings from a grounded theory study in which we explored how women residing in Vancouver's Downtown Eastside (DTES) minimized some of the physical, psychological, and interpersonal harms associated with crack cocaine use, and identify the social, economic, and political factors that influence safer use. Data were collected over a 3-month period and involved group interviews with 27 women at an agency run by drug users in the DTES. A preliminary theory of safer crack use is discussed, consisting of the central phenomenon of caring for self and others. In addition, four thematic processes are described: (a) establishing a safe physical space, (b) building trusting relationships, (c) learning about safer crack use, and (d) accessing safer equipment. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.
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Jozaghi E, Andresen MMA. Should North America's first and only supervised injection facility (InSite) be expanded in British Columbia, Canada? Harm Reduct J 2013; 10:1. [PMID: 23414093 PMCID: PMC3599963 DOI: 10.1186/1477-7517-10-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 02/11/2013] [Indexed: 11/20/2022] Open
Abstract
Background This article reports qualitative findings from a sample of 31 purposively chosen injection drug users (IDUs) from Vancouver, Surrey and Victoria, British Columbia interviewed to examine the context of safe injection site in transforming their lives. Further, the purpose is to determine whether the first and only Supervised injection facility (SIF) in North America, InSite, needs to be expanded to other cities. Methods Semi-structured qualitative interviews were conducted in a classical anthropological strategy of conversational format as drug users were actively involved in their routine activities. Purposive sampling combined with snowball sampling techniques was employed to recruit the participants. Audio recorded interviews were transcribed verbatim and analyzed thematically using NVivo 9 software. Results Attending InSite has numerous positive effects on the lives of IDUs including: saving lives, reducing HIV and HCV risk behavior, decreasing injection in public, reducing public syringe disposal, reducing use of various medical resources and increasing access to nursing and other primary health services. Conclusions There is an urgent need to expand the current facility to cities where injection drug use is prevalent to reduce overdose deaths, reduce needle sharing, reduce hospital emergency care, and increase safety. In addition, InSite’s positive changes have contributed to a cultural transformation in drug use within the Downtown Eastside and neighboring communities.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, B,C, V5A 1S6, Burnaby, Canada.
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Mapping community viral load and social boundaries. AIDS 2012. [DOI: 10.1097/qad.0b013e328354f5e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Burns PA, Snow RC. The built environment & the impact of neighborhood characteristics on youth sexual risk behavior in Cape Town, South Africa. Health Place 2012; 18:1088-100. [PMID: 22704913 DOI: 10.1016/j.healthplace.2012.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/24/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Youth sexual risk behavior is often described in social terms, and there has been limited attention to date on how measures of the built environment, including access to municipal services, impact sexual risk behavior, particularly in resource-limited countries. Using the Cape Area Panel Study, we assessed the impact of neighborhood conditions (six single items and a built environment index (BEI)), net of individual socio-demographic factors. The results suggest that built environment factors are associated with sexual risk behavior. Also, the magnitude of associations between built environment factors and sexual risk behavior was more pronounced for females than for males.
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Affiliation(s)
- Paul A Burns
- Population Studies Center, University of Michigan, USA.
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Quesada J, Hart LK, Bourgois P. Structural vulnerability and health: Latino migrant laborers in the United States. Med Anthropol 2011; 30:339-62. [PMID: 21777121 DOI: 10.1080/01459740.2011.576725] [Citation(s) in RCA: 383] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Latino immigrants in the United States constitute a paradigmatic case of a population group subject to structural violence. Their subordinated location in the global economy and their culturally depreciated status in the United States are exacerbated by legal persecution. Medical Anthropology, Volume 30, Numbers 4 and 5, include a series of ethnographic analyses of the processes that render undocumented Latino immigrants structurally vulnerable to ill health. We hope to extend the social science concept of "structural vulnerability" to make it a useful concept for health care. Defined as a positionality that imposes physical/emotional suffering on specific population groups and individuals in patterned ways, structural vulnerability is a product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination, as well as complementary processes of depreciated subjectivity formation. A good-enough medicalized recognition of the condition of structural vulnerability offers a tool for developing practical therapeutic resources. It also facilitates political alternatives to the punitive neoliberal policies and discourses of individual unworthiness that have become increasingly dominant in the United States since the 1980s.
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Affiliation(s)
- James Quesada
- Department of Anthropology, San Francisco State University, 1600 Holloway Ave., San Francisco, CA 94132, USA.
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Cooper HL, Des Jarlais DC, Tempalski B, Bossak BH, Ross Z, Friedman SR. Drug-related arrest rates and spatial access to syringe exchange programs in New York City health districts: combined effects on the risk of injection-related infections among injectors. Health Place 2011; 18:218-28. [PMID: 22047790 DOI: 10.1016/j.healthplace.2011.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
Abstract
Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors' risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs' protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs.
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Affiliation(s)
- Hannah Lf Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Room 526, Atlanta, GA 30322, USA.
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Choi M, Kim H, Qian H, Palepu A. Readmission rates of patients discharged against medical advice: a matched cohort study. PLoS One 2011; 6:e24459. [PMID: 21931723 PMCID: PMC3169593 DOI: 10.1371/journal.pone.0024459] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/10/2011] [Indexed: 11/18/2022] Open
Abstract
Objective We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period. Methods A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group. Principal Findings AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p<0.001 by day 14. The AMA group were more likely to be readmitted within 14 days with a related diagnosis than the non-AMA group (Adjusted Odds Ratio 12.0; 95% Confidence Interval [CI]: 3.7–38.9). Patients who left AMA were more likely to be readmitted multiple times at one year compared to the non-AMA group (adjusted frequency ratio 1.6; 95% CI: 1.3–2.0). There was also higher all-cause in-hospital mortality during the 12-month follow-up in the AMA group compared to non-AMA group (6.7% vs. 2.4%, p = 0.01). Conclusions Patients discharged AMA were more likely to be homeless and have multiple co-morbid conditions. At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality. Interventions to reduce discharges AMA in high-risk groups need to be developed and tested.
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Affiliation(s)
- Mark Choi
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Haerin Kim
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, British Columbia, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, British Columbia, Canada
- * E-mail:
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