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Liu Y, Manavalan P, Siddiqi K, Cook RL, Prosperi M. Comorbidity Burden and Health Care Utilization by Substance use Disorder Patterns among People with HIV in Florida. AIDS Behav 2024; 28:2286-2295. [PMID: 38551720 PMCID: PMC11199104 DOI: 10.1007/s10461-024-04325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 05/16/2024]
Abstract
Substance use disorder (SUD), a common comorbidity among people with HIV (PWH), adversely affects HIV clinical outcomes and HIV-related comorbidities. However, less is known about the incidence of different chronic conditions, changes in overall comorbidity burden, and health care utilization by SUD status and patterns among PWH in Florida, an area disproportionately affected by the HIV epidemic. We used electronic health records (EHR) from a large southeastern US consortium, the OneFlorida + clinical research data network. We identified a cohort of PWH with 3 + years of EHRs after the first visit with HIV diagnosis. International Classification of Diseases (ICD) codes were used to identify SUD and comorbidity conditions listed in the Charlson comorbidity index (CCI). A total of 42,271 PWH were included (mean age 44.5, 52% Black, 45% female). The prevalence SUD among PWH was 45.1%. Having a SUD diagnosis among PWH was associated with a higher incidence for most of the conditions listed on the CCI and faster increase in CCI score overtime (rate ratio = 1.45, 95%CI 1.42, 1.49). SUD in PWH was associated with a higher mean number of any care visits (21.7 vs. 14.8) and more frequent emergency department (ED, 3.5 vs. 2.0) and inpatient (8.5 vs. 24.5) visits compared to those without SUD. SUD among PWH was associated with a higher comorbidity burden and more frequent ED and inpatient visits than PWH without a diagnosis of SUD. The high SUD prevalence and comorbidity burden call for improved SUD screening, treatment, and integrated care among PWH.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA.
| | - Preeti Manavalan
- Department of Medicine, Division of Infectious Diseases & Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Khairul Siddiqi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA
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Smith LR, Perez-Brumer A, Nicholls M, Harris J, Allen Q, Padilla A, Yates A, Samore E, Kennedy R, Kuo I, Lake JE, Denis C, Goodman-Meza D, Davidson P, Shoptaw S, El-Bassel N. A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities. Implement Sci 2024; 19:39. [PMID: 38831415 PMCID: PMC11149235 DOI: 10.1186/s13012-024-01363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. METHODS We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. RESULTS Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. CONCLUSIONS Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. TRIAL REGISTRATION ClincalTrials.gov, Registration Number: NCT04804072 . Registered 18 February 2021.
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Affiliation(s)
- Laramie R Smith
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melanie Nicholls
- School of Social Work, San Diego State University, San Diego, USA
| | - Jayla Harris
- HIV Prevention Trials Network, Family Health International 360, Durham, USA
| | - Qiana Allen
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Alan Padilla
- Columbia University, ICAP, Mailman School of Public Health, New York, USA
| | - Autumn Yates
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eliza Samore
- Center for Behavioral and Addiction Medicine at UCLA, Los Angeles, USA
| | - Rebecca Kennedy
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Jordan E Lake
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Cecile Denis
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | | | - Peter Davidson
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Grinsztejn B, Mussini C, Cortes C, Tan DHS, Phanuphak N. Beating the odds: medicines alone will not stop HIV. J Int AIDS Soc 2024; 27:e26321. [PMID: 38923714 PMCID: PMC11197959 DOI: 10.1002/jia2.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FIOCRUZRio de JaneiroBrazil
| | | | - Claudia Cortes
- HIV/AIDS WorkgroupFaculty of MedicineUniversity of ChileSantiagoChile
- Department of Internal MedicineFaculty of MedicineUniversity of ChileSantiagoChile
- Hospital Clínico San Borja Arriarán & Fundación ArriaránSantiagoChile
- Millenium Institute on Immunology and ImmunotherapySantiagoChile
| | - Darrell H. S. Tan
- Division of Infectious DiseasesSt. Michael's HospitalTorontoOntarioCanada
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationDalla Lana School of Public HealthTorontoOntarioCanada
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Sorato MM, Alemu T, Toma A, Paulos G, Mekonnen S. Effect of HIV and substance use disorder comorbidity on the placenta, fetal and maternal health outcomes: systematic review and meta-analysis protocol. BMJ Open 2024; 14:e083037. [PMID: 38772595 PMCID: PMC11110607 DOI: 10.1136/bmjopen-2023-083037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Substance use disorders and HIV infection have a bidirectional relationship. People who use illicit drugs are at increased risk of contracting HIV/AIDS, and people living with HIV/AIDS are at increased risk of using substances due to disease-related complications like depression and HIV-associated dementia. There is no adequate evidence on the effect of HIV/AIDS and substance use disorder comorbidity-related effects on placental, fetal, maternal and neonatal outcomes globally. METHODS AND ANALYSIS We will search articles written in the English language until 30 January 2024, from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Sciences, SUMsearch2, Turning Research Into Practice database and Google Scholar. A systematic search strategy involving AND/OR Boolean Operators will retrieve information from these databases and search engines. Qualitative and quantitative analysis methods will be used to report the effect of HIV/AIDS and substance use disorders on placental, fetal and maternal composite outcomes. Descriptive statistics like pooled prevalence mean and SD will be used for qualitative analysis. However, quantitative analysis outcomes will be done by using Comprehensive Meta-Analysis Software for studies that are combinable. The individual study effects and the weighted mean difference will be reported in a forest plot. In addition to this, the presence of multiple morbidities like diabetes, chronic kidney disease and maternal haemoglobin level could affect placental growth, fetal growth and development, abortion, stillbirth, HIV transmission and composite maternal outcomes. Therefore, subgroup analysis will be done for pregnant women with multiple morbidities. ETHICS AND DISSEMINATION Since systematic review and meta-analysis will be conducted by using published literature, ethical approval is not required. The results will be presented in conferences and published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42023478360.
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Affiliation(s)
- Mende Mensa Sorato
- Pharmacy, School of Medicine, Komar University of Science and Technology, Sulaymania, Iraq
| | - Tsegaye Alemu
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations, Ethiopia
| | - Alemayehu Toma
- Pharmacy, School of Medicine, Komar University of Science and Technology, Sulaymania, Iraq
| | - Getahun Paulos
- Pharmacy, School of Medicine, Komar University of Science and Technology, Sulaymania, Iraq
| | - Shewangizaw Mekonnen
- Nursing, School of Medicine, Komar University of Science and Technology, Sulaymania, Iraq
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Brener L, Caruana T, Cama E, Gilford C, Crawford S, Capell-Hattam T, von Hippel C. Stigma by association among alcohol and other drug and harm reduction workers: Implications for workplace outcomes. Drug Alcohol Rev 2024. [PMID: 38693827 DOI: 10.1111/dar.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION The negative attitudes people hold towards those who use alcohol or other drugs (AOD) can also affect the people who work with this community, leading to lowered productivity and wellbeing. The impact of this stigma by association in the AOD and harm reduction sector is particularly significant because workers may have lived experience of AOD use and identify strongly with their client group. This study aimed to examine how stigma by association among health workers in the AOD/harm reduction sector relates to workplace outcomes. A secondary aim was to explore how lived experience influences experiences of stigma by association. METHODS The research used a cross-sectional survey design and data collection occurred in 2023. Australian AOD/harm reduction workers (n = 228) completed an online survey assessing stigma by association as well as various workplace outcomes measures. RESULTS Participants who reported experiencing more stigma by association experienced poorer workplace wellbeing, higher burnout and greater intentions to leave the AOD/harm reduction field. Experiences of stigma by association were unrelated to job satisfaction. Additional analyses revealed that participants with lived experience reported higher levels of job satisfaction and lowered intentions to leave the sector, but findings of stigma by association and its impacts on workplace outcomes did not differ from those without lived experience. DISCUSSION AND CONCLUSIONS Identifying staff experiences of stigma by association and developing support and advocacy mechanisms to address this is likely to be key to reducing these experiences and ultimately to increasing positive workplace outcomes for AOD and harm reduction staff.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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7
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Dertadian GC. The Coloniality of drug prohibition. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104368. [PMID: 38452423 DOI: 10.1016/j.drugpo.2024.104368] [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] [Received: 10/24/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
There have been several recent commentaries which have highlighted the relevance of the postcolonial perspective to drug prohibition and called for the decolonisation of drug policy (Daniels et al., 2021; Hillier, Winkler & Lavallée, 2020; Lasco, 2022; Mills, 2019). While these are significant interventions in the field, sparse drugs scholarship has engaged more directly with well-developed literature and concepts from Critical Indigenous Studies (Moreton-Robinson, 2016) and Indigenous Standpoint Theory (Moreton-Robinson, 2013; Nakata, 2007) and reflected on its applicability to the drug and alcohol field. In contrast to the postcolonial perspective, which understands colonisation as a historical event with contemporary impacts, Indigenous scholarship conceptualises colonisation as an active and ongoing part of how the settler-state continues to impose itself. From this vantage point I explore coloniality as a system of power and reflect on the way prohibition acts as a key arm of the settler-colonial state. The paper explores the way concepts like vulnerability, marginality, overrepresentation, disproportionality and addiction involve colonial violence, knowledge practices and narratives which are central to the way coloniality is maintained and continues to assert itself in contemporary settler societies.
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8
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Singleton CR. Exploring the Interconnectedness of Crime and Nutrition: Current Evidence and Recommendations to Advance Nutrition Equity Research. J Acad Nutr Diet 2024:S2212-2672(24)00124-2. [PMID: 38492635 DOI: 10.1016/j.jand.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
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Bardwell G, Ivsins A, Wallace JR, Mansoor M, Kerr T. "The machine doesn't judge": Counternarratives on surveillance among people accessing a safer opioid supply via biometric machines. Soc Sci Med 2024; 345:116683. [PMID: 38364722 DOI: 10.1016/j.socscimed.2024.116683] [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] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
People who use illegal drugs experience routine surveillance, including in healthcare and harm reduction settings. The MySafe Project - a safer supply pilot project that dispenses prescription opioids via a biometric vending machine - exists in the Canadian province of British Columbia. The machine scans a participant's palmprint and has a built-in camera that records every machine interaction. The aim of this paper is to understand participants' experiences of surveillance, privacy, and personal security when accessing this novel program. An integrative case study and grounded theory methodology was employed. Qualitative one-to-one interviews were conducted with 46 MySafe participants across three different program sites in Vancouver. We used a team-based approach to code interview transcripts and utilized directed and conventional content analyses for deductive and inductive analyses. While participants described negative experiences of surveillance in other public and harm reduction settings, they did not have concerns regarding cameras, collection of personal information, tracking, nor staff issues associated with MySafe. Similarly, while some participants had privacy concerns in other settings, very few privacy and confidentiality concerns were expressed regarding accessing the machine in front of others. Lastly, while some participants reported being targeted by others when accessing the machines, most participants described how cameras, staff, and machine locations helped ensure a sense of safety. Despite negative experiences of surveillance and privacy issues elsewhere, participants largely lacked concern regarding the MySafe program and machines. The machine-human interaction was characterized as different than some human-human interactions as the machine is completing tasks in a manner that is acceptable and comfortable to participants, leading to a social preference toward the machines in comparison to other surveilled means of accessing medications. These findings provide an opportunity to rethink how we conceptualize surveillance, medication access, and harm reduction programs targeting people who use drugs.
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Affiliation(s)
- Geoff Bardwell
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; 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.
| | - Andrew Ivsins
- 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.
| | - James R Wallace
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Thomas Kerr
- 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.
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Stowe MJ, Gatonye R, Maharjan I, Kehinde S, Arya S, Valderrábano JH, Mcbride A, Scheibein F, Igonya EK, Fast D. The war on drugs is a war on us: young people who use drugs and the fight for harm reduction in the Global South. Harm Reduct J 2024; 21:43. [PMID: 38368391 PMCID: PMC10874574 DOI: 10.1186/s12954-023-00914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/19/2024] Open
Abstract
In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the efforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings.
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Affiliation(s)
- M-J Stowe
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa.
- Community Orientated Substance Use Program, University of Pretoria, Pretoria, South Africa.
| | - Rita Gatonye
- Women in Response to HIV/AIDS and Drug Addiction, Umuahia, Nigeria
| | | | - Seyi Kehinde
- Youth RISE Nigeria, Federal Capital Territory, Nigeria
| | - Sidarth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt B.D.S University of Health Sciences, Rohtak, India
| | | | - Angela Mcbride
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa
| | - Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | | | - Danya Fast
- University of British Columbia and British Columbia Centre On Substance Use, Vancouver, Canada
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11
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Scheibein F, Caballeria E, Taher MA, Arya S, Bancroft A, Dannatt L, De Kock C, Chaudhary NI, Gayo RP, Ghosh A, Gelberg L, Goos C, Gordon R, Gual A, Hill P, Jeziorska I, Kurcevič E, Lakhov A, Maharjan I, Matrai S, Morgan N, Paraskevopoulos I, Puharić Z, Sibeko G, Stola J, Tiburcio M, Tay Wee Teck J, Tsereteli Z, López-Pelayo H. Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise. JMIR Hum Factors 2023; 10:e46678. [PMID: 38085569 PMCID: PMC10751634 DOI: 10.2196/46678] [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] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.
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Affiliation(s)
- Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Elsa Caballeria
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Md Abu Taher
- United Nations Office of Drugs and Crime, Dhaka, Bangladesh
| | - Sidharth Arya
- Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte De Kock
- Institute for Social Drug Research, Ghent University, Ghent, Belgium
| | - Nazish Idrees Chaudhary
- International Grace Rehab, Lahore School of Behavioral Sciences, The University of Lahore, Lahore, Pakistan
| | | | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cees Goos
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Rebecca Gordon
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Penelope Hill
- The National Centre for Clinical Research on Emerging Drugs, Randwick, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Iga Jeziorska
- Correlation European Harm Reduction Network, Amsterdam, Netherlands
- Department of Public Policy, Institute of Social and Political Sciences, Corvinus University of Budapest, Budapest, Hungary
| | | | - Aleksey Lakhov
- Humanitarian Action Charitable Fund, St Petersburg, Russian Federation
| | | | - Silvia Matrai
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Nirvana Morgan
- Network of Early Career Professionals in Addiction Medicine, Seligenstadt, Germany
| | | | - Zrinka Puharić
- Faculty of Dental Medicine and Health Osijek, Bjelovar University of Applied Sciences, Bjelovar, Croatia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jan Stola
- Youth Organisations for Drug Action, Warsaw, Poland
| | - Marcela Tiburcio
- Head of the Department of Social Sciences in Health, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Zaza Tsereteli
- Alcohol and Substance Use Expert Group, Northern Dimension Partnership in Public Health and Social Well-Being, Tallinn, Estonia
| | - Hugo López-Pelayo
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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Smith-Sreen J, Bosire R, Farquhar C, Katz DA, Kimani J, Masyuko S, Mello MJ, Aluisio AR. Leveraging emergency care to reach key populations for 'the last mile' in HIV programming: a waiting opportunity. AIDS 2023; 37:2421-2424. [PMID: 37965739 PMCID: PMC10655840 DOI: 10.1097/qad.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Joshua Smith-Sreen
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health
- Department of Epidemiology
- Medicine, University of Washington, Seattle, Washington, USA
| | | | - Joshua Kimani
- University of Nairobi College of Health Sciences, Institute of Tropical and Infectious Diseases, Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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14
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Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
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Hajarizadeh B, Kairouz A, Ottaviano S, Ireland J, Willing A, Cunningham E, Webb P, Colledge-Frisby S, Wheeler A, Leung J, Tran LT, Price O, Vickerman P, Farrell M, Hickman M, Dore GJ, Bergenström A, Degenhardt L, Grebely J. Global, regional, and country-level coverage of testing and treatment for HIV and hepatitis C infection among people who inject drugs: a systematic review. Lancet Glob Health 2023; 11:e1885-e1898. [PMID: 37973339 DOI: 10.1016/s2214-109x(23)00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People who inject drugs are disproportionately affected by HIV and hepatitis C virus (HCV) infections, while there is little global data on HIV and HCV testing and treatment coverage of this population. We conducted a systematic review to evaluate country-level, regional, and global coverage of HIV and HCV testing and treatment among people who inject drugs. METHODS We did a systematic review, and searched bibliographic databases (MEDLINE, Embase, and PsycINFO) and grey literature for studies published between Jan 1, 2017, and April 30, 2022, that evaluated the proportion of people who inject drugs who received testing or treatment for HIV or HCV. For each country, we estimated the proportion of people who inject drugs tested for HIV antibodies in the past 12 months (recent), people who inject drugs ever tested for HCV antibodies and HCV RNA, people who inject drugs with HIV currently receiving antiretroviral therapy, and people who inject drugs with HCV ever receiving HCV antiviral treatment. Regional and global estimates, weighted by the population size of people who inject drugs, were generated where sufficient data were available. This study is registered with PROSPERO (CRD42020173974). FINDINGS 512 documents reported data eligible for analyses, including 337 peer-reviewed articles, 27 conference abstracts or presentations, and 148 documents from grey literature or supplementary searches. Data of recent HIV antibody testing were available for 67 countries and ever having had HCV antibody testing were available for 49 countries. Globally, an estimated 48·8% of people who inject drugs were recently tested for HIV antibodies (95% uncertainty interval [UI] 43·3-54·2%; range 0·9-86·0%), and 47·1% had ever been tested for HCV antibodies (95% UI 43·4-51·0%; range 0·0-93·3%). HCV RNA testing data were available from three countries. Coverage of HIV antibody testing was high (>75%) in four countries and for HCV antibody testing in 15 countries. The estimated uptake of current HIV treatment (18 countries) ranged from 2·6% to 81·9%, and the estimated uptake of ever having HCV treatment (23 countries) ranged from 1·8% to 88·6% across countries. Uptake of HIV treatment was high in two countries, and of HCV treatment in one country. INTERPRETATION HIV and HCV testing and treatment uptake among people who inject drugs was highly variable, and suboptimal in most countries. Strategies to improve access to HIV and HCV care among people who inject drugs and the availability of public health surveillance are urgently required. FUNDING Australian National Health and Medical Research Council and UK National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation.
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Affiliation(s)
- Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Abe Kairouz
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Ottaviano
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alex Willing
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Centre For Youth Substance Use Research, The University of Queensland, QLD, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anne Bergenström
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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16
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Hussain HU, Kumar KA, Rehan ST, Khan Z, Hashmi MR, Khabir Y, Fatir CA, Tahir MJ, Ahmed A, Shrateh ON, Huda MN. Odds of HIV among incarcerated drug users: a systematic review and meta-analysis of Asian countries. Ann Med Surg (Lond) 2023; 85:5584-5592. [PMID: 37915701 PMCID: PMC10617921 DOI: 10.1097/ms9.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background HIV makes up a large portion of infectious diseases globally. People injecting drugs in prisons are at high risk for contracting HIV infection. Prisons house ~10.2 million people globally, making them a high-risk setting for HIV transmission. This systematic review summarizes the available data on the odds of developing HIV infection among imprisoned people who inject drugs (PWIDs) in Asian regions. Methods The authors electronically assessed published studies from January, 2000 to December, 2022, including studies that investigated the odds of HIV in imprisoned PWIDs. We extensively searched PubMed, ERIC, and Cochrane Central and Google Scholar with no constraints in language or time. All the observational studies evaluating the chances of HIV in Asian prisoners with an exposure group of PWIDs and a control group of non-injecting-drug users were included in our analysis. Results The databases search yielded 254 potential studies, 10 observational studies of which having a total of 17 333 participants were included. A low or moderate risk of bias was reported in all the studies except one case-control. The pooled analysis showed a significant association between PWIDs and the chances of contracting HIV infection (Odds ratio=6.40; 95% CI=3.89-10.52; P<0.00001; I2=53%). Conclusion This study found a vital correlation between injecting-drug usage during imprisonment and HIV transmission speed. The results of this meta-analysis support the need to prevent HIV and conducting treatment programs in high-risk settings like prisons.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Oadi N. Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Md. Nazmul Huda
- School of Medicine
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
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Reddon H, Barker B, Bartlett S, Márquez AC, Sekirov I, Jassem A, Morshed M, Clemens A, Beck McGreevy P, Hayashi K, DeBeck K, Krajden M, Milloy MJ, Socías ME. Uptake of SARS-CoV-2 vaccination among structurally-marginalized people who use drugs in Vancouver, Canada. Sci Rep 2023; 13:17930. [PMID: 37863999 PMCID: PMC10589278 DOI: 10.1038/s41598-023-44069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023] Open
Abstract
We sought to evaluate the rates and predictors of SARS-CoV-2 vaccination among members of a structurally-marginalized population of people who use drugs (PWUD) during a targeted, community-wide, vaccination campaign in Vancouver, Canada. Interviewer-administered data were collected from study participants between June 2021 and March 2022. Generalized estimating equation analysis was used to identify factors associated with SARS-CoV-2 vaccine uptake, ascertained through a province-wide vaccine registry. Among 223 PWUD, 107 (48.0%) reported receipt of at least two SARS-CoV-2 vaccine doses at baseline and this increased to 151 (67.7%) by the end of the study period. Using social media as a source of vaccine information was negatively associated with SARS-CoV-2 vaccine uptake (Adjusted odds ratio [AOR] 0.27, 95% confidence interval [CI] 0.09-0.81) and HIV seropositivity (AOR 2.68, 95% CI 1.12-6.39) and older age (AOR 1.27, 95% CI 1.07-1.51) were positively associated with SARS-CoV-2 vaccine uptake. These findings suggest that the targeted vaccination campaign in Vancouver may be an effective model to promote SARS-CoV-2 vaccination in other jurisdictions. However, using social media as a source of vaccine information likely reduced SARS-CoV-2 vaccine uptake in PWUD arguing for further efforts to promote accessible and evidence-based vaccine information among marginalized populations.
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Affiliation(s)
- Hudson Reddon
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada.
- Division of Social Medicine, Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada.
| | - Brittany Barker
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada
| | - Sofia Bartlett
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
| | - Ana Citlali Márquez
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
| | - Inna Sekirov
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, V6T 1Z7, Canada
| | - Agatha Jassem
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, V6T 1Z7, Canada
| | - Muhammad Morshed
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, V6T 1Z7, Canada
| | - Ari Clemens
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
| | | | - Kanna Hayashi
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Kora DeBeck
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- School of Public Policy, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Mel Krajden
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, V6T 1Z7, Canada
| | - M-J Milloy
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada
| | - Maria Eugenia Socías
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada
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Paris A, Mair D, Zaloum S, Onen B, Noyce AJ. Nitrous oxide and its neurological harms. Lancet Neurol 2023; 22:882. [PMID: 37739567 DOI: 10.1016/s1474-4422(23)00329-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Alvar Paris
- Preventive Neurology Unit, Queen Mary University of London, London E1 4NS, UK
| | - Devan Mair
- Preventive Neurology Unit, Queen Mary University of London, London E1 4NS, UK
| | - Safiya Zaloum
- Preventive Neurology Unit, Queen Mary University of London, London E1 4NS, UK
| | - Barbara Onen
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Queen Mary University of London, London E1 4NS, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.
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Hinman K, Amon JJ. Human rights and HIV: rhetoric or determinants? BMJ Glob Health 2023; 8:e013571. [PMID: 37827727 PMCID: PMC10583038 DOI: 10.1136/bmjgh-2023-013571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
International donors and UN agencies emphasise the importance of human rights as a key determinant of HIV vulnerability and of access, uptake and retention in HIV prevention and treatment services. Yet, the extent to which HIV researchers are incorporating rights into their research, the specific rights being examined and the frequency of research assessing rights-based approaches, is unknown. METHODS We examined all articles published in the five highest impact-factor HIV journals: (1) Lancet HIV; (2) AIDS and Behavior; (3) AIDS; (4) Journal of the International AIDS Society (JIAS); and (5) Journal of Acquired Immune Deficiency Syndromes (JAIDS), between 1 January 2017 and 31 December 2022, for reference to 'human right(s)' or 'right(s)'. We analysed articles to assess: (1) what populations were identified in relation to specific human rights concerns; (2) what specific rights were mentioned; (3) whether researchers cited specific legal frameworks; and (4) if and what types of rights-based interventions were examined. RESULTS Overall, 2.8% (n=224) of the 8080 articles reviewed included a mention of 'human right(s)' or 'right(s)'. Forty-two per cent of these (n=94) were original research articles. The most common key population discussed was men who have sex with men (33 articles), followed by sex workers (21 articles) and transgender people (14 articles). Of the 94 articles, 11 mentioned the right to health and nine referenced reproductive rights. Few articles identified a specific authority-whether in national, regional or international law-for the basis of the rights cited. Fourteen articles discussed rights-based interventions. CONCLUSION Despite global recognition of the importance of human rights to HIV outcomes, few HIV researchers publishing in the top five cited HIV journals include attention to human rights, or rights-based interventions, in their research. When rights are mentioned, it is often without specificity or recognition of the legal basis for human rights.
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Affiliation(s)
- Kati Hinman
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Joseph J Amon
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Small W, O'Callaghan S. Commentary on Brothers et al.: The role of safer environment interventions in addressing injecting-related bacterial and fungal infections. Addiction 2023; 118:1878-1880. [PMID: 37544882 DOI: 10.1111/add.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Sean O'Callaghan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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21
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Brothers TD, Bonn M, Lewer D, Comeau E, Kim I, Webster D, Hayward A, Harris M. Social and structural determinants of injection drug use-associated bacterial and fungal infections: A qualitative systematic review and thematic synthesis. Addiction 2023; 118:1853-1877. [PMID: 37170877 DOI: 10.1111/add.16257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND AIMS Injection drug use-associated bacterial and fungal infections are increasingly common, and social contexts shape individuals' injecting practices and treatment experiences. We sought to synthesize qualitative studies of social-structural factors influencing incidence and treatment of injecting-related infections. METHODS We searched PubMed, EMBASE, Scopus, CINAHL and PsycINFO from 1 January 2000 to 18 February 2021. Informed by Rhodes' 'risk environment' framework, we performed thematic synthesis in three stages: (1) line-by-line coding; (2) organizing codes into descriptive themes, reflecting interpretations of study authors; and (3) consolidating descriptive themes into conceptual categories to identify higher-order analytical themes. RESULTS We screened 4841 abstracts and included 26 qualitative studies on experiences of injecting-related bacterial and fungal infections. We identified six descriptive themes organized into two analytical themes. The first analytical theme, social production of risk, considered macro-environmental influences. Four descriptive themes highlighted pathways through which this occurs: (1) unregulated drug supply, leading to poor drug quality and solubility; (2) unsafe spaces, influenced by policing practices and insecure housing; (3) health-care policies and practices, leading to negative experiences that discourage access to care; and (4) restrictions on harm reduction programmes, including structural barriers to effective service provision. The second analytical theme, practices of care among people who use drugs, addressed protective strategies that people employ within infection risk environments. Associated descriptive themes were: (5) mutual care, including assisted-injecting and sharing sterile equipment; and (6) self-care, including vein health and self-treatment. Within constraining risk environments, some protective strategies for bacterial infections precipitated other health risks (e.g. HIV transmission). CONCLUSIONS Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services and harmful health-care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community.
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Affiliation(s)
- Thomas D Brothers
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Matthew Bonn
- Canadian Association of People who Use Drugs (CAPUD), Dartmouth, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Emilie Comeau
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Inhwa Kim
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Duncan Webster
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Infectious Diseases, Saint John Regional Hospital, Saint John, Canada
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Wise A, Kianian B, Chang HH, Linton S, Wolfe ME, Smith J, Tempalski B, Des Jarlais D, Ross Z, Semaan S, Wejnert C, Sionean C, Cooper HL. Socioeconomic and racial/ethnic spatial polarization and incarceration among people who inject drugs in 19 US metropolitan areas, 2015. SSM Popul Health 2023; 23:101486. [PMID: 37635990 PMCID: PMC10448199 DOI: 10.1016/j.ssmph.2023.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/01/2022] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
The purpose of this study is to test, for the first time, the association between spatial social polarization and incarceration among people who inject drugs (PWID) in 19 large U.S. metropolitan statistical areas (MSAs) in 2015. PWID were recruited from MSAs for the Centers for Disease Control and Prevention's 2015 National HIV Behavioral Surveillance. Administrative data were used to describe the ZIP-code areas, counties, and MSAs where PWID lived. We operationalized spatial polarization using the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and household income at the ZIP-code level. We tested the association between spatial polarization and odds of past-year arrest and detainment using multilevel multivariable models. We found 37% of the sample reported being incarcerated in the past year. Report of past-year incarceration varied by race/ethnicity: 45% of non-Hispanic white PWID reported past-year incarceration, as did 25% of non-Hispanic Black PWID, and 43% of Hispanic/Latino PWID (N = 9047). Adjusted odds ratios suggest that Black PWID living in ZIP-code areas with a higher ICE score, meaning more white and affluent, had higher odds of past-year incarceration, compared to white PWID. In previous research, incarceration has been found to be associated with HIV acquisition and can deter PWID from engaging in harm reduction activities.
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Affiliation(s)
- Akilah Wise
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Behzad Kianian
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Howard H. Chang
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Sabriya Linton
- 615 Wolfe Street, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. Wolfe
- 1518 Clifton Road, School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Barbara Tempalski
- 71 W. 23rd Street, Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, 10010, USA
| | - Don Des Jarlais
- 708 Broadway, College of Global Public Health, New York University, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Cyprian Wejnert
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Catlainn Sionean
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
| | - Hannah L.F. Cooper
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - for the NHBS Study Group
- 1518 Clifton Road, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- 1518 Clifton Road, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- 615 Wolfe Street, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 1518 Clifton Road, School of Nursing, Emory University, Atlanta, GA, USA
- 71 W. 23rd Street, Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, 10010, USA
- 708 Broadway, College of Global Public Health, New York University, New York, NY, 10003, USA
- ZevRoss Spatial Analysis, New York, NY, USA
- 8 Corporate Square, Centers for Disease Control and Prevention, Atlanta, GA, 30324, USA
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Zaccheo SK, Marrone G, Pandey LR, Deuba K. The impact of border crossing and imprisonment on injection practices and risk of HIV and hepatitis C infection among men who inject drugs in Nepal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104145. [PMID: 37549595 DOI: 10.1016/j.drugpo.2023.104145] [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] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In Nepal, personal drug use is criminalized and among people who inject drugs (PWID), the majority of whom are men, movement across the border with India for drug procurement and use is common. Using a risk environment approach, this study examined associations between border crossing and imprisonment with respect to HIV, HCV and injection risk behavior among men who inject drugs in Nepal. METHODS This cross-sectional study analyzed data from 1345 participants from 14 districts across Nepal. Explanatory variables were prior imprisonment and past-month border crossing to procure or use drugs. We used multivariable logistic regression to evaluate associations between these variables and HIV, HCV, HIV/HCV co-infection and past-month injection risk behavior among PWID. RESULTS Over half of participants reported prior imprisonment (34.6% prior to past year, 21.6% within past year) and Indo-Nepal border crossing in the past year to use or buy drugs (31.2% sometimes, 20.8% often); over one quarter of participants (29.6%) reported both. Imprisonment prior to the past year was associated with higher odds of all outcome variables: HIV (adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI) 1.29-4.59), HCV (aOR 1.51, 95% CI 1.08-2.09), HIV/HCV co-infection (aOR 3.12, 95% CI 1.58-6.14) and injection risk behavior (aOR 1.64, 95% CI 1.20-2.25). Past-year border crossing to procure or use drugs was associated with HCV (aOR 2.06, 95% CI 1.42-2.98) and injection risk behavior (aOR 1.47, 95% CI 1.04-2.10), with larger effect sizes among PWID who reported both border crossing as well as history of imprisonment. CONCLUSION Imprisonment and border crossing were associated with injection risk behavior and disease outcomes. These findings indicate a need to implement cross-border disease surveillance and harm reduction initiatives in the Indo-Nepal border region and in Nepali prisons.
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Affiliation(s)
- Sonia K Zaccheo
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Lok Raj Pandey
- National Centre for AIDS and STD Control (NCASC), Ministry of Health and Population, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; National Centre for AIDS and STD Control (NCASC), Global Fund Programs, Kathmandu, Nepal.
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McAdam E, Small W, Mullins G, Graham B, Greer A, Winder N, DeBeck K. Decriminalization thresholds for drug possession: A multi-criteria policy analysis framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104126. [PMID: 37454608 PMCID: PMC10529211 DOI: 10.1016/j.drugpo.2023.104126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Decriminalization of personal possession of drugs has been proposed as an approach to mitigate the harms of drug prohibition. Despite growing interest, particularly in Canadian settings, analyses of approaches to defining the parameters of what constitutes personal possession within decriminalization models are lacking. Using the Province of British Columbia, Canada, as a case study, we undertook an evidence-based multi-criteria policy analysis of three models for defining personal possession: 1) a model that defines personal possession as the absence of evidence of drug trafficking; 2) a cumulative threshold of 15 grams; and 3) a cumulative threshold of 2.5 grams. METHODS We utilized data from four sources: qualitative interviews with 16 experts, including representatives from government and law enforcement; Vancouver Police drug seizure data; self-reported drug consumption data from longitudinal cohorts of people who use drugs in Vancouver; and publicly available government documents (e.g., the Government of BC's submission for decriminalization). Data was used to identify and define evaluation criteria which reflect the stated policy objectives of decriminalization alongside other policy considerations. This framework was used to conduct a multi-criteria policy analysis of the three different models. RESULTS The seven evaluation criteria included: 1) reduction in interactions with police; 2) reduction of police drug seizures; 3) coverage for those with high consumption; 4) impact on equity-deserving groups; and acceptance on the part key stakeholders, including: 5) people who use drugs; 6) law enforcement; and 7) the public. The model that performed the best was the cumulative threshold model of 15 grams. CONCLUSION Findings highlight that different threshold models advance and constrain the stated policy objectives of drug decriminalization to varying degrees. This analysis provides a framework that other jurisdictions considering decriminalization could use to help inform determinations of threshold levels based on stated policy objectives.
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Affiliation(s)
- Erica McAdam
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada.
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Garth Mullins
- Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada; BC Association of People on Opioid Maintenance (BCAPOM), Vancouver, BC, Canada; Crackdown Podcast, Vancouver, BC, Canada
| | - Brittany Graham
- Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Natahnee Winder
- School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada; Department of Indigenous Studies, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada
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26
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Smiley-McDonald HM, Attaway PR, Wenger LD, Greenwell K, Lambdin BH, Kral AH. "All carrots and no stick": Perceived impacts, changes in practices, and attitudes among law enforcement following drug decriminalization in Oregon State, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104100. [PMID: 37356287 DOI: 10.1016/j.drugpo.2023.104100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND By passing Ballot Measure 110 (BM 110), Oregon became the first U.S. state to decriminalize noncommercial possession of drugs that are illegal under the Controlled Substances Act. This study examined the perceived impacts of BM 110 on law enforcement and Oregon communities. METHODS Our team visited four geographically distinct Oregon counties in August 2022 (two urban, two rural). The qualitative study involved conducting 34 hour-long interviews with law enforcement, other criminal legal system personnel, and representatives from emergency medical services/fire and substance use treatment and harm reduction agencies. Interviewees were asked about their perceptions of BM 110's effects on law enforcement, their communities, and agencies. RESULTS Law enforcement interviewees viewed BM 110 as a failure; they perceived it resulted in an erosion of their authority. They expressed frustration that they could not use drug possession as a "tool" for investigations to pursue and build cases, establish probable cause, and impose what they believed necessary for social order. Law enforcement personnel in all four counties indicated they routinely seized drugs and drug paraphernalia during encounters with people using drugs, even when that was the only offense being committed. Police lacked knowledge that BM 110 included support for harm reduction services, housing assistance, and employment support. Law enforcement personnel had different opinions and practices regarding issuing Class E violations; those who did not issue them viewed them as a waste of time because they are not entry points into the criminal legal system. CONCLUSION This study provides insights into drug decriminalization in Oregon. This examination is critical for informing BM 110's continued implementation as Oregon proceeds with increased treatment and support service provision. Our findings have important implications regarding other states' design and implementation of drug policy alternatives, including ones that remove law enforcement's role in addressing drug use.
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Affiliation(s)
| | - Peyton R Attaway
- Justice Practice Area, RTI International, Research Triangle Park, NC, United States
| | - Lynn D Wenger
- Health Practice Area, RTI International, Berkeley, CA, United States
| | - Kathryn Greenwell
- Justice Practice Area, RTI International, Research Triangle Park, NC, United States
| | - Barrot H Lambdin
- Health Practice Area, RTI International, Berkeley, CA, United States
| | - Alex H Kral
- Health Practice Area, RTI International, Berkeley, CA, United States
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Kyaw KWY, Platt L, Bijl M, Rathod SD, Naing AY, Roberts B. The effect of different types of migration on symptoms of anxiety or depression and experience of violence among people who use or inject drugs in Kachin State, Myanmar. Harm Reduct J 2023; 20:45. [PMID: 37013591 PMCID: PMC10068727 DOI: 10.1186/s12954-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Evidence on the social determinants of mental health conditions and violence among people who inject or use drugs (PWUD) is limited, particularly in conflict-affected countries. We estimated the prevalence of symptoms of anxiety or depression and experience of emotional or physical violence among PWUD in Kachin State in Myanmar and examined their association with structural determinants, focusing on types of past migration (migration for any reason, economic or forced displacement). MATERIALS A cross-sectional survey was conducted among PWUD attending a harm reduction centre between July and November 2021 in Kachin State, Myanmar. We used logistic regression models to measure associations between past migration, economic migration and forced displacement on two outcomes (1) symptoms of anxiety or depression (Patient Health Questionnaire-4) and (2) physical or emotional violence (last 12 months), adjusted for key confounders. RESULTS A total of 406, predominantly male (96.8%), PWUD were recruited. The median age (IQR) was 30 (25, 37) years, most injected drugs (81.5%) and more commonly opioid substances such as heroin or opium (85%). Symptoms of anxiety or depression (PHQ4 ≥ 6) were high (32.8%) as was physical or emotional violence in the last 12 months (61.8%). Almost one-third (28.3%) had not lived in Waingmaw for their whole life (migration for any reason), 77.9% had left home for work at some point (economic migration) and 19.5% had been forced to leave home due to war or armed conflict (forced displacement). A third were in unstable housing in the last 3 months (30.1%) and reported going hungry in the last 12 months (27.7%). Only forced displacement was associated with symptoms of anxiety or depression [adjusted odds ratio, aOR 2.33 (95% confidence interval, CI 1.32-4.11)] and recent experience of violence [aOR 2.18 (95% CI 1.15-4.15)]. CONCLUSION Findings highlight the importance of mental health services integrated into existing harm reduction services to address high levels of anxiety or depression among PWUD, particularly among those who have been displaced through armed conflict or war. Findings reinforce the need to address broader social determinants, in the form of food poverty, unstable housing and stigma, in order to reduce mental health and violence.
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Affiliation(s)
- Khine Wut Yee Kyaw
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar.
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Murdo Bijl
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Sujit D Rathod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aung Yu Naing
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Jiang N, Bruneau J, Makarenko I, Minoyan N, Zang G, Høj SB, Larney S, Martel-Laferrière V. HCV treatment initiation in the era of universal direct acting antiviral coverage - Improvements in access and persistent barriers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103954. [PMID: 36758334 DOI: 10.1016/j.drugpo.2023.103954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Barriers to HCV treatment initiation persisted after the introduction of direct-acting antivirals (DAAs) in Canada among people who inject drugs (PWID); whether DAA universal coverage lifted these barriers remain unknown. We assessed the evolution of HCV treatment initiation and associated factors among PWID in Montreal, Canada, comparing eras of IFN-based regimens (2011-2013), of DAA restricted access (2014-02/2018), and universal coverage (03/2018-03/2020). METHODS We included chronically HCV-infected participants followed in a community-based PWID cohort in Montreal, Canada between 2011 and 03/2020 and collected data at 3-month intervals. Time-updated Cox regressions were conducted to examine 9 variables of interest associated with treatment initiation overall and for each of the three eras. RESULTS Of 276 participants, 126 initiated treatment during follow-up. Yearly initiation increased from 3% in 2011 to 19% in 2016, and 54% in 2018. PWID aged >40 (vs. ≤40) were twice as likely to initiate treatment in 2014-02/2018 (HR: 2.02 95%CI: [1.24-3.28]) but not in other periods (2011-2013: 0.55 [0.25-1.22]; 03/2018-03/2020: 1.14 [0.59-2.22])). Odds of initiation were lower for men than women in all periods, with women three times more likely to be treated under universal coverage (0.30 [0.11-0.77] vs 2011-2013: 0.67 [0.25-1.78] and 2014-02/2018: 0.75 [0.42-1.35]). Recent incarceration was negatively associated with initiation throughout all periods (2011-2013: 0.57 [0.13-2.43]; 2014-03/2018: 0.39 [0.17-0.91]; 03/2018-03/2020: 0.25 [0.07-0.83]). Barriers associated with high injection frequency appear to have diminished since DAA introduction (2014-02/2018: 0.71 [0.42-1.20]; 03/2018-03/2020: 1.05 [0.52-2.11] vs. 2011-2013: 0.26 [0.08-0.88]). Contact with a primary care physician and engagement in opioid agonist therapy were positively associated with treatment initiation, though estimates were attenuated under universal coverage relative to previous eras. CONCLUSION Treatment initiation rates have increased since the introduction of universal DAA coverage, though barriers such as incarceration persist.
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Affiliation(s)
- Nathalie Jiang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Julie Bruneau
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Iuliia Makarenko
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Department of Family Medicine, McGill University, 845 rue Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1×9, Canada
| | - Geng Zang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Stine Bordier Høj
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Sarah Larney
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Valérie Martel-Laferrière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Shaw G, Schaefer R, Schmidt HMA, Madden A, Chang J, Mozalevskis A, Msimanga-Radebe B, Mangadan Konath N, Verster A, Baggaley R, Rodolph M, Macdonald V. Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery. Harm Reduct J 2023; 20:16. [PMID: 36782321 PMCID: PMC9924874 DOI: 10.1186/s12954-023-00729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. METHODS Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. RESULTS PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. CONCLUSIONS This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.
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Affiliation(s)
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Heather-Marie A Schmidt
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland ,UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Annie Madden
- International Network of People who Use Drugs, London, UK
| | - Judy Chang
- International Network of People who Use Drugs, London, UK
| | - Antons Mozalevskis
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | | | | | - Annette Verster
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Rachel Baggaley
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Michelle Rodolph
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Virginia Macdonald
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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Gilbert L, Stoicescu C, Goddard-Eckrich D, Dasgupta A, Richer A, Benjamin SN, Wu E, El-Bassel N. Intervening on the Intersecting Issues of Intimate Partner Violence, Substance Use, and HIV: A Review of Social Intervention Group's (SIG) Syndemic-Focused Interventions for Women. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:178-192. [PMID: 37304833 PMCID: PMC10249965 DOI: 10.1177/10497315221121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intimate partner violence (IPV), HIV, and substance use are serious intersecting public health issues. This paper aims to describe the Social Intervention Group (SIG)'s syndemic-focused interventions for women that address the co-occurrence of IPV, HIV, and substance use, referred to as the SAVA syndemic. We reviewed SIG intervention studies from 2000 to 2020 that evaluated the effectiveness of syndemic-focused interventions which addressed two or more outcomes related to reducing IPV, HIV, and substance use among different populations of women who use drugs. This review identified five interventions that co-targeted SAVA outcomes. Of the five interventions, four showed a significant reduction in risks for two or more outcomes related to IPV, substance use, and HIV. The significant effects of SIG's interventions on IPV, substance use, and HIV outcomes among different populations of women demonstrate the potential of using syndemic theory and methods in guiding effective SAVA-focused interventions.
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Affiliation(s)
- Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Claudia Stoicescu
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
- Department of Public Health and Preventive Medicine, Monash University, BSD City, Indonesia
| | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Anindita Dasgupta
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Ariel Richer
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Shoshana N. Benjamin
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
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Crépault JF, Russell C, Watson TM, Strike C, Bonato S, Rehm J. What is a public health approach to substance use? A qualitative systematic review and thematic synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103958. [PMID: 36689841 DOI: 10.1016/j.drugpo.2023.103958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Psychoactive substance use and the regulations that govern it both have the potential to lead to harm. A 'public health approach' (PHA) is frequently invoked as a means of addressing these harms, but the term is used in inconsistent and contradictory ways. This study systematically reviewed the English-language academic literature to understand how a public health approach to substance use is defined and described. METHODS This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science. RESULTS 272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%). CONCLUSION There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.
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Affiliation(s)
- Jean-François Crépault
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Tara Marie Watson
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Sarah Bonato
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), 1001 Queen Street, Toronto, Ontario, M6J 1H4, Canada; Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
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Ivsins A, Warnock A, Small W, Strike C, Kerr T, Bardwell G. A scoping review of qualitative research on barriers and facilitators to the use of supervised consumption services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103910. [PMID: 36436364 DOI: 10.1016/j.drugpo.2022.103910] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
A substantial body of evidence demonstrates that supervised consumption services (SCS) mitigate a variety of drug-related harms, including decreasing overdose deaths, infectious disease transmission, and connecting people who use drugs (PWUD) to various health and social services. Research on SCS has predominantly been quantitative, though qualitative research on these services has increased substantially over the last decade. Qualitative methods provide a framework for developing a richer and more nuanced understanding of meanings and contexts associated with drug use, health service implementation, and experience. We present findings from a scoping review of qualitative studies on experiences of PWUD with SCS published between 1997 and 2022. In total, forty-two papers were included in this analysis. Four primary themes emerged from our analysis: 1) Influence of SCS on health and wellbeing among PWUD, 2) the physical environment of SCS can be both a facilitator and barrier to use, 3) social resources can shape and reshape the context within which PWUD benefit from SCS, and 4) various intersecting forces at play both support and harm PWUD in relation to their experiences with SCS. We discuss the primary facilitators and barriers of SCS use and conclude with suggestions to inform future qualitative research, SCS implementation, and PWUD-centered approaches to drug policy.
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Affiliation(s)
- Andrew Ivsins
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Ashley Warnock
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Psychiatry, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Geoff Bardwell
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Schoenberger SF, Idrisov B, Sereda Y, Kiriazova T, Makarenko O, Bendiks S, Ahuja N, Dutta A, Flanigan T, Gillani FS, Lunze K. Police abuse and care engagement of people with HIV who inject drugs in Ukraine. Glob Public Health 2022; 17:3638-3653. [PMID: 35343870 PMCID: PMC9515241 DOI: 10.1080/17441692.2022.2049341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Police abuse affects people who inject drugs (PWID), including those with HIV, and negatively impacts care engagement. This cross-sectional study evaluated police abuse among PWID receiving MOUD (medication for opioid use disorder) living with HIV and associations with HIV treatment adherence and receipt of NGO services. We assessed lifetime and past six-month rates of police abuse among a cohort of Ukrainian PWID with HIV receiving MOUD (n = 190) from August to September 2017. Logistic regression models evaluated associations between past six-month police abuse and past 30-day antiretroviral therapy (ART) adherence, and past six-month NGO service receipt. Almost all (90%) participants reported lifetime police abuse: 77% reported physical violence and 75% reported paying the police to avoid arrest. One in four females (25%) reported police-perpetrated sexual violence. Recent police abuse was reported by 16% of males and 2% of females and was not associated with ART adherence (aOR: 1.1; 95% CI:0.3-5.0) or NGO service receipt (aOR: 3.4; 95% CI:0.6-18.3). While lifetime police abuse rates were high, few participants reported recent police abuse, which was not linked to care engagement. These trends should encourage the Ukrainian government for public health-public safety partnerships and legal interventions to eliminate human rights violations against PWID living with HIV.
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Affiliation(s)
- Samantha F Schoenberger
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Bulat Idrisov
- Institute for Leadership and Health Management, Sechenov First Moscow State Medical University, Moscow, Russia
- Bashkir State Medical University, Ufa, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | | | | | | | - Sally Bendiks
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Arunima Dutta
- Section of Internal Medicine, McLaren Flint/Michigan State University, Flint, MI, USA
| | - Timothy Flanigan
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Fizza S Gillani
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Karsten Lunze
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Patel EU, Solomon SS, McFall AM, Prata Menezes N, Tomori C, Srikrishnan AK, Kumar MS, Celentano DD, Lucas GM, Mehta SH. Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. AIDS 2022; 36:1583-1589. [PMID: 35730390 PMCID: PMC9391282 DOI: 10.1097/qad.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of drug use stigma with antiretroviral therapy (ART) use and HIV viral suppression among people with HIV who inject drugs in India. DESIGN Cross-sectional biobehavioral survey. METHODS Between August 2016 and May 2017, persons aged at least 18 years who reported injection drug use in the past 2 years were recruited via respondent-driven sampling (RDS) in 12 Indian cities (approximately 1000 per city). The analysis was restricted to participants with laboratory-confirmed HIV infection who self-reported a prior HIV diagnosis and were eligible for ART per concurrent national HIV treatment guidelines. Enacted and internalized drug use stigma were each measured by five to six-item subscales. The study outcomes were HIV viral suppression (<150 copies/ml) and self-reported past 30-day ART use. RDS-II weighted multivariable logistic regression with a city-level random-intercept was used to estimate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs). RESULTS Among 971 ART-eligible participants previously diagnosed with HIV, 65.1% reported ART use and 56.1% were virally suppressed. Reporting any enacted stigma (vs. none) was associated with lower odds of ART use [aOR = 0.26 (95% CI = 0.15-0.44)] and viral suppression [aOR = 0.49 (95% CI = 0.31-0.78)]. High internalized stigma scores (>median vs. ≤median) were associated with lower odds of viral suppression among participants aged at least 35 years [aOR = 0.51 (95% CI = 0.27-0.97)] but not among participants aged less than 35 years [aOR = 1.22 (95% CI = 0.57-2.60)]. Similar associations were observed in analyses restricted to participants ever linked to HIV care. CONCLUSION Drug use stigma may be a barrier to HIV viral suppression among people with HIV who inject drugs, thereby hindering efforts to achieve HIV control.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Neia Prata Menezes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Cecília Tomori
- Johns Hopkins University School of Nursing
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Exploring the conceptualization, operationalization, implementation, and measurement of outreach in community settings with hard-to-reach and hidden populations: A scoping review. Soc Sci Med 2022; 309:115232. [DOI: 10.1016/j.socscimed.2022.115232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/23/2022] [Accepted: 07/16/2022] [Indexed: 11/20/2022]
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Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103750. [PMID: 35667193 PMCID: PMC10024805 DOI: 10.1016/j.drugpo.2022.103750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. METHODS We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. RESULTS A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and Poly-Victimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. CONCLUSION Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan.
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Murphy MJ, Rogers BG, Chambers LC, Zanowick-Marr A, Galipeau D, Noh M, Scott T, Napoleon SC, Rose J, Chan PA. Characterization of Risk Factors Among Individuals with a History of Incarceration Presenting to a Sexually Transmitted Infections Clinic: Implications for HIV and STI Prevention and Care. AIDS Patient Care STDS 2022; 36:291-299. [PMID: 35951448 PMCID: PMC9419926 DOI: 10.1089/apc.2022.0083] [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: 11/12/2022] Open
Abstract
More than 2 million people are incarcerated in the United States with many millions more processed through correctional facilities annually. Communities impacted by incarceration are also disproportionately impacted by the HIV and sexually transmitted infection (STI) epidemics. However, relatively little is known about the behaviors that place individuals with a history of incarceration at risk for HIV/STI acquisition. We utilized clinical data from patients presenting to an STI clinic located in Providence, Rhode Island. A latent class analysis was conducted on reported HIV acquisition risk behavior and STI testing results on a total of 1129 encounters where a history of incarceration was reported. A total of three classes were identified. Class 1 (N = 187, 11%), more frequently reported 10+ sexual partners (45%), an STI diagnosis (48%) and sex while intoxicated (86%) in the past year as well as identifying as a man who has sex with other men (60%). Class 2 (N = 57, 5%) was more likely to report giving (53%) and receiving (44%) money/drugs for sex in the past year as well as a history of injecting drugs (61%) and using methamphetamine (60%). Class 3 (N = 885, 78%) most frequently reported 0-2 sexual partners (48%), identified as Black (27%), Hispanic/Latino (69%) and a man who only has sex with women (80%). Class 1 had significantly higher odds ratio (1.8, 95% confidence interval = 1.3-2.5) of testing HIV/STI positive. The results provide important insights into risk subgroups for those with a history of incarceration at risk of HIV/STI acquisition.
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Affiliation(s)
- Matthew J Murphy
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Rhode Island Department of Corrections, Brown University, Providence, Rhode Island, USA
| | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Laura C Chambers
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Alexandra Zanowick-Marr
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Drew Galipeau
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Madeline Noh
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Siena C Napoleon
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Jennifer Rose
- Wesleyan University Quantitative Analysis Center, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
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A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study. Viruses 2022; 14:v14071555. [PMID: 35891535 PMCID: PMC9316739 DOI: 10.3390/v14071555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.
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Ali R, Stevens M. Moving toward Voluntary Community-Based Treatment for Drug Use and Dependence. Health Hum Rights 2022; 24:183-187. [PMID: 35747280 PMCID: PMC9212818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Robert Ali
- Associate professor at the School of Biomedicine, University of Adelaide, Australia, as well as a member of the Australian National Advisory Council on Alcohol and Drugs, the Cochrane Alcohol and Drug Group editorial board, and the World Health Organization Expert Advisory Panel on Drug Dependence and Alcohol Problems.,Please address correspondence to Robert Ali. .
| | - Matthew Stevens
- Research fellow at the School of Biomedicine, University of Adelaide, Australia
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Subronto YW, Kusmayanti NA, Januraga PP, Dewa Wirawan LN, Wisaksana R, Sukmaningrum E, Kawi NH, Iskandar S, Mulyani T, Sulaiman N, Magnani R, Kaldor J, Law M. Simplified clinical algorithm for immediate antiretroviral therapy initiation: The HATI [HIV awal (early) Test & Treat in Indonesia] implementation research in Indonesia. Indian J Med Res 2022; 156:729-741. [PMID: 37056072 DOI: 10.4103/ijmr.ijmr_239_23] [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: 04/15/2023] Open
Abstract
Background & objectives Although the World Health Organization recommends same day or rapid (< seven days) antiretroviral therapy (ART) initiation, delays in ART initiation remain common due to waiting for laboratory test results. This study employed a simplified clinical algorithm the HATI [HIV Awal (Early) Test & Treat Indonesia]-SAI (Simple ART Initiation) aimed to increase the proportion of ART uptake and decrease the time to ART initiation that can be used in various care settings. Methods This study compared the percentage of ART uptake and retention, viral load (VL) suppression and time to ART initiation between the observation and intervention phases among newly diagnosed HIV patients from key populations. As part of the intervention, the newly diagnosed patients underwent screening using a simple form [consisting of data on age, height and weight (for body mass index calculation), questions on the presence of symptoms of HIV stages 1 and 2, tuberculosis, history of diabetes, hypertension and kidney disease], to determine eligibility for immediate ART initiation. Those who met the pre-defined criteria immediately received a combination of tenofovir lamivudine and efavirenz for two weeks. The baseline laboratory examination due to this was moved up to two weeks post ART. Factors significantly associated with ART uptake were also determined and their odds ratios were measured using logistic regression analysis. Results A total of 2173 people newly diagnosed with HIV were recruited, with 1579 and 594 in the observation and intervention phases, respectively. In both phases, the majority were men who have sex with men, who were young (<30 yr old) and employed, with high levels of education. The intervention phase significantly increased the proportion of ART initiation [91%, 95% confidence interval (CI): 89-93% vs. 78%, 95% CI: 76-80%] but did not have any impact on the proportion of six months retention and VL suppression. The intervention also significantly decreased the time to ART initiation from median ± interquartile range: 9±20 days to 2±10 days. Interpretation & conclusions The findings of this study suggest that the HATI-SAI intervention increased the uptake and decreased the time for immediate ART initiation. The HATI-SAI provides a simple and safe clinical approach that can readily be adopted in different settings without a costly investment in technology.
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Affiliation(s)
- Yanri Wijayanti Subronto
- Center for Tropical Medicine; Department of Internal Medicine, Division of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Public Health, & Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bandung, Indonesia
| | | | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Evi Sukmaningrum
- Department of Psychology; Centre of Excellence Health Policy and HIV-AIDS, Jakarta, Indonesia
| | | | - Shelly Iskandar
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Tri Mulyani
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Nurjannah Sulaiman
- Indonesia Ministry of Health, Directorate Communicable Disease Control, Sydney, New South Wales, Australia
| | - Robert Magnani
- HIV-AIDS Research Centre, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Urbanik MM, Maier K, Greene C. A qualitative comparison of how people who use drugs’ perceptions and experiences of policing affect supervised consumption services access in two cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103671. [DOI: 10.1016/j.drugpo.2022.103671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
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Baker P, Beletsky L, Garfein R, Pitpitan E, Oren E, Strathdee SA, Cepeda JA. Impact of SHIELD Police Training on Knowledge of Syringe Possession Laws and Related Arrests in Tijuana, Mexico. Am J Public Health 2022; 112:860-864. [PMID: 35446602 PMCID: PMC9137025 DOI: 10.2105/ajph.2021.306702] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
Between 2015 and 2018, we provided training for 1806 municipal police officers in Tijuana, Mexico, in an effort to improve their knowledge and behaviors related to HIV and injection drug use. Correct knowledge of syringe possession laws improved from 56% before training to 94% after training and was sustained at 24 months (75%). Knowledge improvement was associated with decreases in arrests for syringe possession over time (adjusted odds ratio [AOR] = 0.87; 95% confidence interval [CI] = 0.85, 0.90). Officers with correct knowledge had significantly lower odds of reporting arrests (AOR = 0.63; 95% CI = 0.44, 0.89). Training was associated with sustained improvements in knowledge and practices that advance public health. (Am J Public Health. 2022;112(6):860-864. https://doi.org/10.2105/AJPH.2021.306702).
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Affiliation(s)
- Pieter Baker
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Leo Beletsky
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Richard Garfein
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Eileen Pitpitan
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Eyal Oren
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Steffanie A Strathdee
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Javier A Cepeda
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
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King C, Cook R, Giang LM, Bart G, Hoffman K, Waddell EN, Korthuis PT. Incarceration and compulsory rehabilitation impede use of medication for opioid use disorder and HIV care engagement in Vietnam. J Subst Abuse Treat 2022; 134:108451. [PMID: 33962813 PMCID: PMC8558110 DOI: 10.1016/j.jsat.2021.108451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-prescribed opioid use is illegal in Vietnam. People who are apprehended for use of non-prescribed opioids may be arrested and incarcerated or sent to compulsory rehabilitation centers. For those on medication to treat opioid use disorder (MOUD), incarceration in either setting may disrupt treatment. This study estimates the effects of incarceration and compulsory rehabilitation on MOUD and HIV treatment outcomes in Vietnam. METHODS Data are from a clinical trial testing the effects of MOUD on HIV viral suppression in six Vietnamese HIV clinics. Participants were assessed quarterly for 12 months. We assessed the associations between incarceration or compulsory rehabilitation during months 0-9 and study outcomes of receipt of MOUD, HIV clinic engagement, and antiretroviral therapy prescription during months 9-12, among those who were released by month 9 of the study, using logistic regression and zero-inflated negative binomial models. RESULTS At nine months, 25 of 258 participants (9.7%) were incarcerated or sent to compulsory rehabilitation at least once and completed the month 9 assessment. Of those, 19 (76.0%) did not receive MOUD in months 9 through 12. Both incarceration and compulsory rehabilitation were negatively associated with subsequent receipt of MOUD (aOR = 0.05, 95% CI = (0.01, 0.24); 0.14 (0.04, 0.50), respectively) and HIV clinic engagement (aOR = 0.13, 95% CI = (0.03, 0.71); 0.09 (0.02, 0.39), respectively). In the final three months of the study, participants who were incarcerated had 42.5 fewer days of MOUD (95% CI = 23.1, 61.9), and participants in compulsory rehabilitation had 46.1 fewer days of MOUD (95% CI = 33.8, 58.4) than those not incarcerated or in compulsory rehabilitation. CONCLUSION Our findings suggest that both incarceration and compulsory rehabilitation disrupt MOUD and HIV treatment among people with HIV and Opioid Use Disorder in Vietnam. Prioritization of evidence-based strategies to support engagement in care for people who use drugs could potentially expand HIV and Opioid Use Disorder treatment access and curb substance use more effectively than reliance on incarceration or compulsory rehabilitation.
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Affiliation(s)
- Caroline King
- MD/PhD Program, Oregon Health & Science University, Portland, OR, USA; Dept. of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Ryan Cook
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Viet Nam
| | - Gavin Bart
- Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Kim Hoffman
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Needham Waddell
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Iryawan AR, Stoicescu C, Sjahrial F, Nio K, Dominich A. The impact of peer support on testing, linkage to and engagement in HIV care for people who inject drugs in Indonesia: qualitative perspectives from a community-led study. Harm Reduct J 2022; 19:16. [PMID: 35148776 PMCID: PMC8832667 DOI: 10.1186/s12954-022-00595-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction People who use, including those who inject, drugs in Indonesia are disproportionately affected by HIV, but tend to be diagnosed at a late stage of infection, delay initiation to and have poor rates of retention in antiretroviral treatment, resulting in high rates of morbidity and mortality. In addition to legal, policy and health system barriers, PWID may be hesitant to engage in HIV, treatment and care due to lack of knowledge, distrust of the health care system, and stigma related to their dual drug use and HIV status. Implementation of formal peer support initiatives may reduce provider- and individual-level barriers and increase testing, linkage to, and engagement in HIV care among people who use drugs. Methods We conducted a community-led qualitative study to explore the impacts of peer support for people who inject drugs on HIV care access and engagement in Indonesia. Semi-structured, in-depth interviews were conducted with 20 participants in Jakarta and Bandung. Thematic analysis was used to explore how people who inject drugs living with HIV (PWID LHIV) (n = 8), peer support workers (n = 6), and service providers (n = 6) perceived peer support provision by non-governmental organisations. Results Participants unanimously described peer support as beneficial. Peer support workers were widely credited with facilitating access to HIV testing, referral to care, uptake of and adherence to antiretroviral treatment, as well as sustaining engagement in care for PWID. Support mechanisms that facilitated positive peer experiences included provision of HIV knowledge and awareness, emotional support, help with navigating complex bureaucracy, developing trust in health care services, enhancing confidence and motivation, and supporting peers to navigate a wide range of health and social welfare services beyond HIV-related care. Conclusions Findings indicate that peer support can enhance access to testing, linkage to, and engagement in HIV care for people who use drugs living with HIV in Indonesia. In a context of an ongoing HIV epidemic among people who use drugs, reduced funding and policy attention to HIV and harm reduction, there is an urgent need to prioritize peer support interventions to identify people who use drugs facing health risks and link them to appropriate services.
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Affiliation(s)
- Arif Rachman Iryawan
- Rumah Cemara, Jalan Gegerkalong Girang, No. 52, Kota Bandung, 40154, West Java, Indonesia.
| | - Claudia Stoicescu
- School of Social Work, Columbia University, New York, USA.,Centre for Criminology, University of Oxford, Oxford, UK
| | - Faisyal Sjahrial
- Rumah Cemara, Jalan Gegerkalong Girang, No. 52, Kota Bandung, 40154, West Java, Indonesia
| | - Kuntanto Nio
- Rumah Cemara, Jalan Gegerkalong Girang, No. 52, Kota Bandung, 40154, West Java, Indonesia
| | - Alexa Dominich
- Rumah Cemara, Jalan Gegerkalong Girang, No. 52, Kota Bandung, 40154, West Java, Indonesia
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Reaching the 90–90–90 UNAIDS treatment target for people who inject drugs receiving integrated clinical care at a drug-use outpatient treatment facility. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Brener L, Caruana T, Broady T, Cama E, Ezard N, Madden A, Treloar C. Addressing injecting related risks among people who inject both opioids and stimulants: Findings from an Australian survey of people who inject drugs. Addict Behav Rep 2022; 15:100398. [PMID: 35005190 PMCID: PMC8717740 DOI: 10.1016/j.abrep.2021.100398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 01/04/2023] Open
Abstract
Background Opioids and stimulants are the most commonly injected illicit drugs worldwide and in Australia. While some people who inject drugs (PWID) prefer either opioids or stimulants, others regularly use both opioids and stimulants. Limited available research indicates that those who use opioids and stimulants together, either in combination or alternating between the two, may engage in injection-related practices which potentially place them at greater health risk and could lead to poorer health outcomes. Methods Participants were recruited nationally through member organizations of the Australian Injecting and Illicit Drug Users League (AIVL); these organizations represent PWID in each Australian state and territory. This study compared a sample of PWID (N = 535) who reported past-month injection of opioids only (N = 173), stimulants only (N = 208), or both (N = 154) on a range of health and wellbeing outcomes. PWID completed a survey assessing drugs injected, frequency of injecting, receptive equipment sharing, psychological distress, self-reported hepatitis C (HCV) status, experienced and internalized stigma, drug use salience, and community attachment. Results People who injected both opioids and stimulants reported more frequent injecting, more experiences of stigma, and greater reported HCV diagnosis than people who injected stimulants or opioids alone. They also showed greater attachment to a community of PWID and greater salience of drug use to their identity. Conclusions The findings of increased injecting and broader harms associated with injecting both stimulants and opioids are important for tailoring harm reduction and intervention designs for people who use both opioid and stimulant drugs, including prioritizing peer-based approaches.
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Affiliation(s)
- L. Brener
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
- Corresponding author at: Centre for Social Research in Health, University of
New South Wales, Sydney 2052, Australia.
| | - T. Caruana
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - T. Broady
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - E. Cama
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - N. Ezard
- St Vincent’s Hospital Sydney, Alcohol and Drug Service and the National
Centre for Clinical Research in Emerging Drugs Drug and Alcohol Clinical Research and
Improvement Network, National Drug and Alcohol Centre, University of New South Wales,
Sydney, Australia
| | - A. Madden
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - C. Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
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Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J 2022; 19:1. [PMID: 34996466 PMCID: PMC8742380 DOI: 10.1186/s12954-021-00569-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.
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Affiliation(s)
- Monica Fadanelli
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - April M Ballard
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Umed Ibragimov
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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Saberi Zafarghandi MB, Eshrati S, Rashedi V, Vameghi M, Arezoomandan R, Clausen T, Waal H. Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review. Eur Addict Res 2022; 28:87-102. [PMID: 34794145 DOI: 10.1159/000519886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Places where people deal and/or use drugs publicly are known as open drug scenes (ODSs). Drug-related community impacts (DRCIs) refer to drug-related issues that negatively influence public and individual health, communities, businesses, and recreational and public space enjoyment. There are no well-established criteria for identification of DRCIs. We therefore performed a scoping review of literature to determine DRCIs indicators associated with ODSs. METHODS The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScP). We searched English articles in PubMed, Scopus, Web of Science, and EMBASE databases from 1990 to 2021. The keywords were drug-related crime, drug-related offense, misconduct, social marginalization, homeless drug users, open drug scene, drug-related street disorder, public nuisance, and community impact. RESULTS Sixty-four studies were identified. Twenty-five studies were included. Two studies (8%) were about drug-related public nuisance, 1 (4%) considered drug-related social problems, 2 (8%) focused on drug-related social disorder, and 18 studies (72%) discussed indicators of community impacts such as crime, drug-related litter, safety, noise, and drug use in public. Two studies (8%) included the frequency of drug use in ODSs. DISCUSSION DRCI indicators are heterogenic, and various factors affect the indicators. The factors include social mores, political discourse, and historical approaches to dealing with and using drugs. Some societies do not tolerate the existence of ODSs. In contrast, many countries have adopted harm reduction programs to manage DRCIs. Identified DRCI indicators were drug using and dealing in public, drug-related litter, crime, drug-related loitering, street-based income generation activities, noise, and unsafety feelings in inhabitants. To solve the problems associated with DRCIs and to make a major change in ODSs, it is necessary to pay attention to the improvement of the economic conditions (e.g., employment opportunities), amendment (e.g., determine the limits of criminalization in drug use), and adoption of social policies (e.g., providing low-threshold and supportive services for homeless drug users).
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Affiliation(s)
- Mohammad Bagher Saberi Zafarghandi
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Eshrati
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Arezoomandan
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Thomas Clausen
- Norwegian Center for Addiction Research (SERAF), Institution of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Waal
- Norwegian Center for Addiction Research (SERAF), Institution of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Armoon B, Higgs P, Mohammadi R. Mental health status, health service utilization, drug use behaviors associated with non-fatal overdose among people who use illicit drugs: A meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Mercer F, Miler JA, Pauly B, Carver H, Hnízdilová K, Foster R, Parkes T. Peer Support and Overdose Prevention Responses: A Systematic 'State-of-the-Art' Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12073. [PMID: 34831839 PMCID: PMC8621858 DOI: 10.3390/ijerph182212073] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
Abstract
Overdose prevention for people who use illicit drugs is essential during the current overdose crisis. Peer support is a process whereby individuals with lived or living experience of a particular phenomenon provide support to others by explicitly drawing on these experiences. This review provides a systematic search and evidence synthesis of peer support within overdose prevention interventions for people who use illicit drugs. A systematic search of six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus, and Web of Knowledge) was conducted in November 2020 for papers published in English between 2000 and 2020. Following screening and full-text review, 46 papers met criteria and were included in this review. A thematic analysis approach was used to synthesize themes. Important findings include: the value of peers in creating trusted services; the diversity of peers' roles; the implications of barriers on peer-involved overdose prevention interventions; and the stress and trauma experienced by peers. Peers play a pivotal role in overdose prevention interventions for people who use illicit drugs and are essential to the acceptability and feasibility of such services. However, peers face considerable challenges within their roles, including trauma and burnout. Future interventions must consider how to support and strengthen peer roles in overdose settings.
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Affiliation(s)
- Fiona Mercer
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Joanna Astrid Miler
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Kristina Hnízdilová
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK; (J.A.M.); (H.C.); (K.H.); (R.F.); (T.P.)
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