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Nation A, Dawson-Rose C, Waters C. Substance use experiences of HIV-positive and HIV-negative black, non-hispanic men who have sex with men (msm) ages 18-34 in the Bay Area: A qualitative narrative perspective. J Ethn Subst Abuse 2022:1-16. [PMID: 35767381 DOI: 10.1080/15332640.2022.2090043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Young Black men who have sex with men (MSM) represent the majority of individuals with new HIV infections in the U.S. Substance use is related to risk and acquisition t of HIV. The purpose of this study was to explore the perceptions and experiences about the role substance use plays in the lives HIV-positive and HIV-negative young Black MSM between the ages of 18-34. METHODS Using a qualitative, narrative perspective, we recruited and then interviewed participants in partnership with AIDS Service Organizations. Narrative and thematic analysis was used to analyze these Black men's personal stories with harm reduction used as the conceptual approach. RESULTS Nine HIV-positive and 3 HIV-negative participants(n = 12) shared stories about their own personal experiences with family relationships and substance use. Themes related to family included early exposure and initiation of substance use, substance use as a response to stigma around sexual orientation, kicked out of house, asked to leave or left home so they could be themselves and perceived benefits and advantages of methamphetamine. CONCLUSIONS The participants are subjected to adverse and stressful childhood experiences. These are important stories to understand if we expect to mount an adequate response, utilizing harm reduction, to the growing number of young Black MSM at-risk for HIV.
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Affiliation(s)
- Austin Nation
- California State University, Fullerton, California, USA
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The Missing Link: Exploring the History of Harm Reduction Nursing in Canada 1998-2018 to Provide Recommendations for Inpatient Mental Health Nurses. J Addict Nurs 2021; 32:121-125. [PMID: 34060763 DOI: 10.1097/jan.0000000000000398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Harm reduction is becoming integrated into the hospital setting, yet there is a dearth of published academic literature on the topic of harm reduction in mental health nursing practice. No results were found in a literature search focused specifically on harm reduction policies in the inpatient psychiatric settings using the databases CINAHL, Google Scholar, and PubMed. The purpose of this article was to provide a historical overview of harm reduction in Canadian nursing from 1998 to 2018. The aim was to help direct care nurses, educators, and administrators understand past and present trends and to identify future possibilities for integration in inpatient mental health care. A historical perspective was used to identify and explore Canadian harm reduction literature published from 1998 to 2018 to establish the significance to inform nursing practice. The exploration began with a brief description of outreach nursing in early Canada. Focus shifted to the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic of the 1980s and 1990s, on to the 2000s when a broader lens of harm reduction was adopted, looking beyond the goal of reducing sexually transmitted illnesses. Literature published in the mid-2000s focused on marginalized populations, highlighting the connection between ethical practice and harm reduction philosophy. At the beginning of the 2010s, the Canadian Nursing Association released position statements that explicitly identified the role of harm reduction in nursing practice. Toward the end of the 2010s, the opioid overdose crisis promoted harm reduction nurses taking a broader focus, entering the hospital settings.
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Islam S, Piggott DA, Moriggia A, Astemborski J, Mehta SH, Thomas DL, Kirk GD. Reducing injection intensity is associated with decreased risk for invasive bacterial infection among high-frequency injection drug users. Harm Reduct J 2019; 16:38. [PMID: 31208419 PMCID: PMC6580632 DOI: 10.1186/s12954-019-0312-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Bacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity. Methods Participants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use. Results Of 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5% and reduced injection intensity at 25.5% of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54% reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95% CI 0.25–0.84) and a 46% reduction at 6 months (OR 0.54, 95% CI 0.36–0.81). Reduced injection intensity was associated with a 36% reduction of infection at 3 months (OR 0.64, 95% CI 0.43–0.96) and a 26% reduction at 6 months (OR 0.74, 95% CI 0.56–0.98). Conclusions Both complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population. Electronic supplementary material The online version of this article (10.1186/s12954-019-0312-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salequl Islam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. .,Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
| | - Damani A Piggott
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alberto Moriggia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.,Division of Infectious and Tropical Diseases, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
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Abstract
The United States is in the midst of a nationwide public health emergency: an epidemic of opioid misuse and abuse that has been called the deadliest drug crisis in American history. This article reviews the current status of the opioid epidemic, the trends over the last 30-40 years that may have contributed to the epidemic, and a population health approach to addressing the epidemic. The epidemic is conceptualized from a population health perspective-an upstream and midstream perspective focusing on prevention and a downstream perspective targeting access to evidence-based interventions and maximizing health whether using or abstaining. Within the context of acute care, this approach will include patient screening for opioid use and other risk factors for addiction, use of opioid-sparing analgesics, and follow-up care that addresses pain and pain relief without opioids. For individuals who need addiction treatment, a gradualism philosophy is put forward. Gradualism recognizes the incremental nature of behavior change and recommends strategies to maximize health and functioning-through harm reduction-at all points along the journey to overcome addiction. Working within communities to address the broad factors that contribute to opioid-related substance use disorder is also essential.
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Affiliation(s)
- Susan Salmond
- Susan Salmond, EdD, RN, ANEF, FAAN, Executive Vice Dean and Professor, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, and Research Editor for Orthopaedic Nursing. Virginia Allread, MPH, Executive Assistant, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ
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Isenberg SR, Maragh-Bass AC, Ridgeway K, Beach MC, Knowlton AR. A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders. J Opioid Manag 2018; 13:5-16. [PMID: 28345742 PMCID: PMC5560049 DOI: 10.5055/jom.2017.0363] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. DESIGN Qualitative semistructured interviews and focus groups. SETTING Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. PARTICIPANTS HIV participants with chronic pain and a history of illicit drug use. METHODS Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. RESULTS The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. CONCLUSIONS Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
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Affiliation(s)
- Sarina R Isenberg
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allysha C Maragh-Bass
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen Ridgeway
- Graduate of the MSPH program, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary C Beach
- Professor of Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amy R Knowlton
- Associate Professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hawk M, Coulter RW, Egan JE, Friedman MR, Meanley S, Fisk S, Watson C, Kinsky S. Exploring the Healthcare Environment and Associations with Clinical Outcomes of People Living with HIV/AIDS. AIDS Patient Care STDS 2017; 31:495-503. [PMID: 29148966 PMCID: PMC5724582 DOI: 10.1089/apc.2017.0124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite three decades of dramatic treatment breakthroughs in antiretroviral regimens, clinical outcomes for people living with HIV vary greatly. The HIV treatment cascade models the stages of care that people living with HIV go through toward the goal of viral suppression and demonstrates that <30% of those living with HIV/AIDS in the United States have met this goal. Although some research has focused on the ways that patient characteristics and patient-provider relationships contribute to clinical adherence and treatment success, few studies to date have examined the ways that contextual factors of care and the healthcare environment contribute to patient outcomes. Here, we present qualitative findings from a mixed-methods study to describe contextual and healthcare environment factors in a Ryan White Part C clinic that are associated with patients' abilities to achieve viral suppression. We propose a modification of Andersen's Behavioral Model of Health Services Utilization, and its more recent adaptation developed by Ulett et al., to describe the ways that clinic, system, and provider factors merge to create a system of care in which more than 86% of the patient population is virally suppressed.
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Affiliation(s)
- Mary Hawk
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - James E. Egan
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mackey Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stuart Fisk
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Courtney Watson
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Suzanne Kinsky
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania
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Trend Analyses of Users of a Syringe Exchange Program in Philadelphia, Pennsylvania: 1999-2014. AIDS Behav 2016; 20:2922-2932. [PMID: 27066985 DOI: 10.1007/s10461-016-1393-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examines trends of injection drug users' (IDUs) use of a Philadelphia, Pennsylvania, syringe exchange program (SEP) from 1999 to 2014, including changes in demographics, drug use, substance abuse treatment, geographic indicators, and SEP use. Prevention Point Philadelphia's SEP registration data were analyzed using linear regression, Pearson's Chi square, and t-tests. Over time new SEP registrants have become younger, more racially diverse, and geographically more concentrated in specific areas of the city, corresponding to urban demographic shifts. The number of new registrants per year has decreased, however syringes exchanged have increased. Gentrification, cultural norms, and changes in risk perception are believed to have contributed to the changes in SEP registration. Demographic changes indicate outreach strategies for IDUs may need adjusting to address unique barriers for younger, more racially diverse users. Implications for SEPs are discussed, including policy and continued ability to address current public health threats.
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Souleymanov R, Allman D. Articulating Connections between the Harm-Reduction Paradigm and the Marginalisation of People Who Use Illicit Drugs. BRITISH JOURNAL OF SOCIAL WORK 2016; 46:1429-1445. [PMID: 27559236 PMCID: PMC4985724 DOI: 10.1093/bjsw/bcv067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.
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Affiliation(s)
- Rusty Souleymanov
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canadian Institutes for Health Research Fellow in Public Health Policy, Toronto, ON, Canada, M5S 1V4
| | - Dan Allman
- Dalla Lana School of Public Health, Faculty of the University of Toronto, 155 College Street, 5th Floor, Toronto, ON, Canada, M5 T 3M7
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Philbin MM, FuJie Z. Exploring stakeholder perceptions of facilitators and barriers to using needle exchange programs in Yunnan Province, China. PLoS One 2014; 9:e86873. [PMID: 24498286 PMCID: PMC3911934 DOI: 10.1371/journal.pone.0086873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Injection drug use is an ongoing urban health crisis in China and one of the largest drivers of the transmission of HIV/AIDS. Sentinel surveillance sites in Yunnan province show upwards of 20% of injection drug users (IDUs) are HIV positive. Though the Ministry of Health has scaled-up needle exchange programs (NEPs), they have not received official government recognition nor have they been extensively evaluated to explore factors influencing their acceptability and feasibility. Using in-depth qualitative interviews conducted from February to July 2008 with 35 participants consisting of IDUs and other key stakeholders, we explored facilitators and barriers to accessing needle exchange programs in Kunming, the capital of Yunnan province. Content analysis was conducted to identify themes including attitudes toward NEPs and harm reduction, barriers to access, and suggestions for improvement. Themes that emerged included fears of breached confidentiality and police interference at the exchange sites and tensions between the public health and law enforcement perspective. Low levels of NEP-related knowledge and awareness were uniformly reported among interviewees. Suggestions to facilitate an increase in NEP acceptance included raising awareness of harm reduction and HIV more generally, offering services such as psychological counseling, job training and behavioral therapy at NEPs, and increasing communication between police, government, and public health officials. High rates of HIV infection among injection drug users in China have prompted rapid scale up of NEPs. Additional adaptations are necessary, however, to increase needle exchange use among injection drug users. This study finds that an urgent need to raise awareness of NEPs among policy makers and IDUs and act upon identified steps for developing social-structural interventions to create enabling environments that facilitate increased access to NEPs among injection drug users in Kunming.
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Affiliation(s)
- Morgan M. Philbin
- HIV Center for Clinical & Behavioral Studies Columbia University and the NY State Psychiatric Institute, New York City, New York, United States of America
- * E-mail:
| | - Zhang FuJie
- Treatment and Care Division, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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10
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Phylogenetic inferences on HIV-1 transmission: implications for the design of prevention and treatment interventions. AIDS 2013; 27:1045-57. [PMID: 23902920 DOI: 10.1097/qad.0b013e32835cffd9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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James S, McField ES, Montgomery SB. Risk factor profiles among intravenous drug using young adults: a latent class analysis (LCA) approach. Addict Behav 2013; 38:1804-11. [PMID: 23254231 DOI: 10.1016/j.addbeh.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 08/27/2012] [Accepted: 09/04/2012] [Indexed: 12/19/2022]
Abstract
Using data from a cross-sectional study that examined health risk behaviors among urban intravenous drug-using (IDU) adolescents and young adults, this study investigated risk profiles among a high-risk sample (n=274). Risk profiles were empirically derived through latent class analysis based on indicators of engagement in health-risking behaviors, experience of abuse and violence as well as individual and family risk factors. The best fitting model was a 3-class model. Class 1 (n=95) captured participants with the lowest risk across all indicators. Compared to Class 1, Class 2 (n=128) and Class 3 (n=51) had elevated rates of engagement in health-risking behaviors as well as individual and family risk factors; however, Class 3 had the highest rate of engagement in sexual risk behavior, and backgrounds of substantial abuse and violence as well as familial psychopathology. Class 2 was the group most socioeconomically disadvantaged, with the highest percentage of participants coming from poor backgrounds, spending the longest time homeless and working the fewest months. Identifying subgroups of IDU has the potential to guide the development of more targeted and effective strategies for prevention and treatment of this high-risk population.
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Smolak A. White slavery, whorehouse riots, venereal disease, and saving women: historical context of prostitution interventions and harm reduction in New York City during the Progressive Era. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:496-508. [PMID: 23805804 PMCID: PMC3703872 DOI: 10.1080/19371918.2011.592083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Harm reduction and structural approaches to reduce HIV risk among sex workers face several barriers. One such barrier is based on moral arguments, and it has a rich historical context. This article examines the historical context of interventions with sex workers in New York City during the Progressive Era (1890-1920). Present at the time, though under a different name, the harm reduction approach was largely dismissed. These same moral underpinnings may be active today in driving interventions and policy toward those that are morally focused and away from those that focus on harm reduction and structural change.
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Affiliation(s)
- Alex Smolak
- Columbia University School of Social Work, New York, NY 10027, USA.
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Souza KMD, Monteiro S. A abordagem de redução de danos em espaços educativos não formais: um estudo qualitativo no estado do Rio de Janeiro, Brasil. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2011. [DOI: 10.1590/s1414-32832011000300017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este artigo discute as contribuições da abordagem de redução de danos para a prática educativa em saúde e drogas, em espaços não formais, a partir da análise dos fundamentos teórico-metodológicos e das atividades de um projeto desenvolvido pelo Instituto Oswaldo Cruz, com educadores de organizações não governamentais do estado do Rio de Janeiro, Brasil, de 2006 a 2007. Orientado por uma abordagem qualitativa, o estudo analisou a trajetória e as práticas profissionais de educadores e o contexto institucional, por meio da análise documental, de entrevistas e observações diretas. Os achados revelaram que houve apropriação e ressignificação, pelos educadores, dos conceitos abordados no projeto relativos à educação para autonomia, redução de danos e vulnerabilidade, orientados por uma abordagem dialógica e crítica do processo de construção do conhecimento.
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Eversman M. Harm reduction practices in outpatient drug-free substance abuse settings. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2010.540295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eversman MH. High and low threshold service provision in drug-free settings: Practitioner views. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:501-6. [DOI: 10.1016/j.drugpo.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/05/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022]
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Zerden LDS, Marilis López L, Lundgren LM. Needle sharing among Puerto Rican injection drug users in Puerto Rico and Massachusetts: place of birth and residence matter. Subst Use Misuse 2010; 45:1605-22. [PMID: 20438338 DOI: 10.3109/10826081003682842] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explored whether place of birth and residence was associated with needle sharing for Puerto Rican injection drug users (IDUs) (N = 348). In-person interviews were conducted in Puerto Rico and Massachusetts during 2005-2007. Multivariate regression analyses revealed IDUs born and living in Puerto Rico were four times more likely to have shared needles compared to those residing in Massachusetts. Respondents residing in Massachusetts were 76% less likely to have ever shared needles with an HIV-positive individual, controlling for covariates. Findings highlight the increased HIV-risk of Puerto Rican IDUs born and residing in Puerto Rico. Prevention and treatment needs are discussed.
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Roy É, Haley N, Leclerc P, Boudreau JF, Boivin JF. Risk factors for initiation into drug injection among adolescent street youth. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630701228947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zhou JS, Zhang KL, Zhang LL, Kang JX, Zhang JX, Lai WH, Liu L, Liu G, Zeng YL. A quasi-experimental study on a community-based behaviour change programme among injecting drug users in Sichuan, China. Int J STD AIDS 2009; 20:125-9. [PMID: 19182061 DOI: 10.1258/ijsa.2008.008145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study is to explore an effective model of comprehensive intervention on HIV/AIDS among injecting drug users (IDUs) in communities located in urban areas and to evaluate its feasibility in Sichuan Province, China. A quasi-experimental study was designed so that various intervention measures were conducted in the intervention city but not in the control city. A Behaviour Surveillance Survey was introduced to evaluate intervention exposure and the effect of behaviour change. In the intervention city, services received by IDUs increased over time (P < 0.001). Awareness of HIV increased from 34.2% in 2003 to 58.3% in 2004, and to 67.4% in 2005 (P < 0.001). The proportion of IDUs surveyed who shared a needle the last time they injected drugs decreased from 17.1% in 2003 to 7.0% in 2005, and in terms of the past month from 42.4% in 2003 to 18.4% in 2005 (P < 0.001). Data from a multivariate logistic regression analysis showed that comprehensive intervention was a protective factor for behaviour change (odds ratio [OR] =0.561; 95% confidence interval [CI], 0.424-0.741). A well-designed and organized comprehensive intervention programme will effectively change the high-risk behaviour among IDUs in these communities. A more comprehensive, expanded and integrated response is needed when conducting an HIV/AIDS prevention programme.
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Affiliation(s)
- J-S Zhou
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
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Pauly B(B, Goldstone I. Harm reduction in nursing practice: Current status and future directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:179-82. [DOI: 10.1016/j.drugpo.2008.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
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Pauly BB. Shifting moral values to enhance access to health care: harm reduction as a context for ethical nursing practice. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:195-204. [PMID: 18467086 DOI: 10.1016/j.drugpo.2008.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 02/11/2008] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND People who are street involved including those experiencing homelessness and substance use are at increased risk of morbidity and mortality. Such inequities are exacerbated when those facing the greatest inequities in health have the least access to health care. These concerns have rarely been addressed in bioethics and there has been a lack of explicit attention to the dominant societal and organizational values that structure such injustices. The purpose of this paper is to describe the underlying value tensions that impact ethical nursing practice and affect equity in access to health care for those who are street involved. METHODS In this paper, findings from a larger qualitative ethnographic study of ethical practice in nursing in the context of homelessness and substance use are reported. The original research was undertaken in two 'inner city' health care centres and one emergency department (ED) to gain a better understanding of ethical nursing practice within health care interactions. Data were collected over a period of 10 months through face-to-face interviews and participant observation. RESULTS In order to facilitate access to health care for those who are street-involved nurses had to navigate a series of value tensions. These value tensions included shifting from an ideology of fixing to reducing harm; stigma to moral worth; and personal responsibility to enhancing decision-making capacity. A context of harm reduction provided a basis for the development of relationships and shifted the moral orientation to reducing harm as a primary moral principle in which the worth of individuals and the development of their capacity for decision-making was fostered. CONCLUSIONS Implementation of a harm reduction philosophy in acute care settings has the potential to enhance access to health care for people who are street involved. However, explicit attention to defining the harms and values associated with harm reduction is needed. While nurses adopted values consistent with harm reduction and recognized constraints on personal responsibility, there was little attention to action on the social determinants of health such as housing. The individual and collective role of professional nurses in addressing the harms associated with drug use and homelessness requires additional examination.
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Magee C, Huriaux E. Ladies' night: evaluating a drop-in programme for homeless and marginally housed women in San Francisco's mission district. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:113-21. [PMID: 18313280 DOI: 10.1016/j.drugpo.2007.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 11/14/2007] [Accepted: 11/19/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gender, race, class, and sexuality create a unique set of requirements for addressing HIV risk among homeless and marginally housed (HMH) women. Though studies have recommended both individual and structural prevention strategies tailored to meet the expansive needs of this community, there is a paucity of research on interventions specific to HMH women. Ladies' Night is a service-rich drop-in programme for HMH women in San Francisco's Mission District. METHODS In 2006, an exploratory evaluation was conducted to examine the programme's benefits and challenges and identify opportunities to advocate for participants. The evaluation was grounded in ethnography and social network theory. It used three qualitative data collection tools in its methodology: (1) interviews with 5 providers and 8 participants; (2) a self-administered survey completed by 7 participants; and (3) observation field notes from 9 Ladies' Night sessions. RESULTS Evaluation findings demonstrate the following: (1) as a harm reduction-based program, Ladies' Night provides safety and social support for programme participants, fosters positive change and promotes health; and (2) the programme has two significant challenges-the social context of participants' lives and resource limitations that affect service provision. CONCLUSION Recommendations call for allocation of resources to support: (1) sustainable women-specific services for HMH women in San Francisco; and (2) consistent assessment and evaluation of those services.
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Affiliation(s)
- Catherine Magee
- Women's Community Clinic, 2166 Hayes Street, Suite 104, San Francisco, CA 94117, USA.
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Roman F, Hawotte K, Struck D, Ternes AM, Servais JY, Arendt V, Hoffman P, Hemmer R, Staub T, Seguin-Devaux C, Schmit JC. Hepatitis C virus genotypes distribution and transmission risk factors in Luxembourg from 1991 to 2006. World J Gastroenterol 2008; 14:1237-43. [PMID: 18300350 PMCID: PMC2690672 DOI: 10.3748/wjg.14.1237] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the Hepatitis C virus (HCV) genotype distribution and transmission risk factors in a population of unselected patients in Luxembourg.
METHODS: Epidemiological information (gender, age and transmission risks) were collected from 802 patients newly diagnosed for hepatitis C and living in Luxembourg, among whom 228 patients referred from prison. Genotyping using 5’noncoding (5’NC) sequencing was performed. We compared categorical data using the Fisher’s exact F-test and odds ratios (OR) were calculated for evaluating association of HCV genotype and risk factors.
RESULTS: The sex ratio was predominantly male (2.2) and individuals aged less than 40 years represented 49.6% of the population. Genotype 1 was predominant (53.4%) followed by genotype 3 (33%). Among risk factors, intravenous drug usage (IVDU) was the most frequently reported (71.4%) followed by medical-related transmission (17.6%) including haemophilia, transfusion recipients and other nosocomial reasons. Genotype 3 was significantly associated to IVDU (OR = 4.84, P < 0.0001) whereas genotype 1 was significantly associated with a medical procedure (OR = 2.42, P < 0.001). The HCV genotype distribution from inmate patients differed significantly from the rest of the population (Chi-square test with four degrees of freedom, P < 0.0001) with a higher frequency of genotype 3 (46.5% vs 27.5%) and a lower frequency of genotype 1 and 4 (44.7% vs 56.8% and 5.3% vs 9.6%, respectively). IVDU was nearly exclusively reported as a risk factor in prison.
CONCLUSION: We report the first description of the HCV genotype distribution in Luxembourg. The repartition is similar to other European countries, with one of the highest European prevalence rates of genotype 3 (33%). Since serology screening became available in 1991, IVDU remains the most common way of HCV transmission in Luxembourg.
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Pauly B. Harm reduction through a social justice lens. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:4-10. [PMID: 18226520 DOI: 10.1016/j.drugpo.2007.11.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 11/01/2007] [Accepted: 11/12/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND People who are street involved such as those experiencing homelessness and drug use face multiple inequities in health and access to health care. Morbidity and mortality are significantly increased among those who are street involved. Incorporation of a harm reduction philosophy in health care has the potential to shift the moral context of health care delivery and enhance access to health care services. However, harm reduction with a primary focus on reducing the harms of drug use fails focus on the harms associated with the context of drug use such as homelessness, violence and poverty. METHODS Ethical analysis of the underlying values of harm reduction and examination of different conceptions of justice are discussed as a basis for action that addresses a broad range of harms associated with drug use. RESULTS Theories of distributive justice that focus primarily on the distribution of material goods are limited as theoretical frameworks for addressing the root causes of harm associated with drug use. Social justice, reconceptualised and interpreted through a critical lens as described by Iris Marion Young, is presented as a promising alternative ethical framework. CONCLUSIONS A critical reinterpretation of social justice leads to insights that can illuminate structural inequities that contribute to the harms associated with the context of drug use. Such an approach provides promise as means of informing policy that aims to reduce a broad range of harms associated with drug use such as homelessness and poverty.
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Affiliation(s)
- Bernadette Pauly
- School of Nursing, University of Victoria, Box 1700, Victoria, BC V8W 2Y2, Canada.
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Kim S, De La Rosa M, Trepka MJ, Kelley M. Condom use among unmarried students in a Hispanic-serving university. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:448-461. [PMID: 17967114 DOI: 10.1521/aeap.2007.19.5.448] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study compares the prevalence of risky sexual behavior between unmarried Hispanic and non-Hispanic students in southern Florida and assesses the role of substance use in risky sexual behavior. Among 815 unmarried respondents, approximately 35% had two or more sexual partners within the past 12 months. Compared with non-Hispanic White students, Hispanic students were less likely to engage in unprotected sex under the influence of alcohol (25% vs. 16%) but also less likely to have been tested for HIV infection (55% vs. 43%). The percentage of students using a condom during their last sexual encounter was 8% (oral), 35% (anal), and 50% (vaginal). For both Hispanic and non-Hispanic students, condom use was low regardless of smoking, heavy alcohol consumption, and marijuana use. From the problem behavior theory perspective, condom use and substance use may have different behavioral origins. These findings can help target and guide the development of prevention programs in university settings.
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Affiliation(s)
- Sunny Kim
- Department of Epidemiology and Biostatistics, School of Public Health, Florida International University, Miami, FL 33199, USA.
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Tobias C, Cunningham WE, Cunningham CO, Pounds MB. Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS 2007; 21 Suppl 1:S3-8. [PMID: 17563287 DOI: 10.1089/apc.2007.9992] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite the availability and proven efficacy of medical treatment, many individuals living with HIV in the United States today are not engaged in regular HIV medical care or receiving antiretroviral medications. This journal supplement highlights results of a national 5-year multisite Outreach Initiative, funded by the Health Resources and Services Administration (HRSA) in 2001 to "engage people in HIV care, turn sporadic users of care into regular users, and promote retention in care." The introductory paper for the supplement provides background information on the characteristics of individuals who are not engaged in regular HIV care, the barriers they face, intervention options, and the public policy implications of this issue. Interventions to engage and retain underserved populations living with HIV in medical care are essential to ensure access to medical care and to reduce disparities in health outcomes.
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Affiliation(s)
- Carol Tobias
- Health and Disability Working Group, Boston University School of Public Health, Boston, Massachusetts 02210, USA.
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Abstract
Although intravenous drug use is the major route of transmission in several countries, sexual transmission is the dominant mode of HIV spread globally, with a concomitant epidemic in infants borne to HIV-infected mothers. The HIV epidemic varies substantially from one geographic area to another, and three broad epidemic categories describe the diversity of features observed globally: low epidemic settings, centrzated epidemics, and generalized epidemics. The introduction of highly active antiretroviral therapy in industrialized countries has transformed AIDS from an inevitably fatal condition to a chronic, treatable condition, but this goal has yet to be realized in most resource-constrained settings that bear a disproportionate burden of infection. This article describes the modes of HIV transmission, geographic distribution of the evolving AIDS pandemic, and case studies of each of the three types of HIV epidemics, and presents global trends in AIDS and mortality.
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Affiliation(s)
- Salim S Abdool Karim
- Centre for the AIDS Program of Research in South Africa-CAPRISA, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013 Durban, South Africa.
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Tobin KE, Hua W, Costenbader EC, Latkin CA. The association between change in social network characteristics and non-fatal overdose: results from the SHIELD study in Baltimore, MD, USA. Drug Alcohol Depend 2007; 87:63-8. [PMID: 16962254 DOI: 10.1016/j.drugalcdep.2006.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 08/02/2006] [Accepted: 08/04/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Social network factors have been reported to be associated with non-fatal overdose. Yet, few studies have examined how changes in social network characteristics may influence overdose risk. The purpose of this study was to examine the relationship between changes in social network and non-fatal overdose. METHODS Data for this study came from 659 participants enrolled in the Self-Help in Eliminating Life-Threatening Diseases (SHIELD) study, who reported details about their non-fatal overdose experience between enrollment and a follow-up visit. Social network characteristics were described at both time points and net change in network composition was calculated. RESULTS The sample was predominately male (56%), African-American (96%) and unemployed (78%). Experience of non-fatal overdose between time points was reported by 15%. Older age was associated with non-fatal overdose. Interaction between incarceration status and drug use was statistically significant. Protective factors were having a denser network at baseline and a network that became denser after adjusting for gender, homelessness, incarceration, drug use and total network size. CONCLUSIONS Drug users' social networks are an important target for overdose prevention interventions. Further research on overdose risk and movement of specific network members in and out of networks is warranted.
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Affiliation(s)
- Karin E Tobin
- Johns Hopkins Bloomberg School of Public Health, 1629 East Baltimore Street, Baltimore, MD 21231, USA.
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Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S. Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities. J Urban Health 2007; 84:126-36. [PMID: 17146712 PMCID: PMC2078257 DOI: 10.1007/s11524-006-9120-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.
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Affiliation(s)
- Leo Beletsky
- Temple University Beasley School of Law, Philadelphia, PA 19122, USA.
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Roy É, Morissette C, Haley N, Gutiérrez N, Rousseau L, Denis V. Pourquoi commencer ? L’initiation à l’injection de drogues selon les jeunes de la rue. ACTA ACUST UNITED AC 2006. [DOI: 10.7202/014302ar] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dans le cadre du développement d’une campagne de prévention du passage à l’injection de drogues chez les jeunes de la rue, nous avons mené sept groupes de discussion auprès de 37 d’entre eux âgés de 15 à 23 ans. L’analyse, à la fois déductive et inductive, a permis d’identifier les dimensions reflétant le point de vue des jeunes à propos de l’injection de drogues et des éléments qui favorisent le passage à l’injection dans leur milieu. Les résultats montrent que l’injection est généralement désapprouvée par les jeunes de la rue. Plusieurs ont des réserves, celles-ci étant liées aux conséquences négatives de l’injection. Ce que les jeunes redoutent le plus, c’est de devenir « accro », un risque qu’ils associent davantage à l’injection qu’aux autres modes de consommation. Malgré la désapprobation générale, au contact des utilisateurs de drogues par injection (UDI), il se produit une sorte de désensibilisation qui entraîne vers l’injection les plus vulnérables, soit les plus jeunes, surtout ceux qui satisfont leur besoin de sensations fortes à travers la drogue et recherchent une valorisation dans le monde de la rue. Divers éléments d’ordre individuel et social agissent alors pour amener ces jeunes à s’initier à l’injection. Plusieurs de ces éléments peuvent être modifiables par des interventions préventives.
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Wardman D, Quantz D. Harm reduction services for British Columbia's First Nation population: a qualitative inquiry into opportunities and barriers for injection drug users. Harm Reduct J 2006; 3:30. [PMID: 17034636 PMCID: PMC1618833 DOI: 10.1186/1477-7517-3-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Accepted: 10/11/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal injection drug users are the fastest growing group of new Human Immunodeficiency Virus cases in Canada. However, there remains a lack of comprehensive harm reduction services available to First Nation persons, particularly for First Nation people dwelling in rural and reserve communities. This paper reports findings from an exploratory study of current harm reduction practices in First Nation communities. The purpose of this study was to provide an overview of the availability and content of current harm reduction practices, as well as to identify barriers and opportunities for implementing these services in First Nation communities. METHODS Key informant interviews were conducted with 13 addictions service providers from the province of British Columbia, Canada. RESULTS Participants identified barriers to these services such as community size and limited service infrastructure, lack of financial resources, attitudes towards harm reduction services and cultural differences. CONCLUSION It was recommended that community education efforts be directed broadly within the community before establishing harm reduction services and that the readiness of communities be assessed.
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Affiliation(s)
- Dennis Wardman
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darryl Quantz
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
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Bourgois P, Martinez A, Kral A, Edlin BR, Schonberg J, Ciccarone D. Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach. PLoS Med 2006; 3:e452. [PMID: 17076569 PMCID: PMC1621100 DOI: 10.1371/journal.pmed.0030452] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 09/19/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Street-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level. METHODS AND FINDINGS We used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1) drug consumption; (2) income generation; (3) social and institutional relationships; and (4) personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s) when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its "War on Drugs." African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began engaging in drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off "dopesickness" rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories. CONCLUSIONS Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.
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Affiliation(s)
- Philippe Bourgois
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, California, United States of America.
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Qian HZ, Schumacher JE, Chen HT, Ruan YH. Injection drug use and HIV/AIDS in China: review of current situation, prevention and policy implications. Harm Reduct J 2006; 3:4. [PMID: 16451717 PMCID: PMC1402269 DOI: 10.1186/1477-7517-3-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 02/01/2006] [Indexed: 11/10/2022] Open
Abstract
Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem.
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Affiliation(s)
- Han-Zhu Qian
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Joseph E Schumacher
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Huey T Chen
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Yu-Hua Ruan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Rehman L, Gahagan J, DiCenso AM, Dias G. Harm Reduction and Women in the Canadian National Prison System: Policy or Practice? Women Health 2005; 40:57-73. [PMID: 15911510 DOI: 10.1300/j013v40n04_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Q.S.R. Nudist was used to assist with data management. A constant comparison method was used to derive categories, patterns, and themes. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.
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Affiliation(s)
- Laurene Rehman
- School of Health and Human Performance, Dalhousie University, 6230 South St, Halifax, NS, B3H 3J5, Canada.
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Gore-Felton C, Somlai AM, Benotsch EG, Kelly JA, Ostrovski D, Kozlov A. The influence of gender on factors associated with HIV transmission risk among young Russian injection drug users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2004; 29:881-94. [PMID: 14713145 DOI: 10.1081/ada-120026267] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
HIV infection rates are dramatically increasing in the Russian Federation. Epidemiological studies indicate that the greatest rise of HIV incidence has been among injection drug users (IDU). Young adults (N = 188) who reported injecting drug use completed surveys and interviews that assessed injection drug use behavior, sexual behavior, and HIV-related knowledge. The average age of participants was 21.3 years. Multiple linear regression analysis found male gender and younger age at sexual debut was positively and significantly associated with having multiple sexual partners. Gender moderated the effects of sexual debut and number of times injected drugs were used in the past month. Males who initiate sex at a younger age were more likely to report multiple sex partners and females who reported higher frequency of drug use were more likely to report multiple sex partners. Gender is an important factor, as well as moderator of risk behavior among Russian injection drug users. Delaying sexual debut, particularly for males, may be an effective strategy to reduce subsequent risk behavior. Prevention efforts among IDUs need to address sexual risk behavior in conjunction with injection risk behavior.
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Affiliation(s)
- Cheryl Gore-Felton
- Medical College of Wisconsin, Center for AIDS Intervention Research, Milwaukee, Wisconsin 53202, USA.
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Fagan P, King G, Lawrence D, Petrucci SA, Robinson RG, Banks D, Marable S, Grana R. Eliminating tobacco-related health disparities: directions for future research. Am J Public Health 2004; 94:211-7. [PMID: 14759929 PMCID: PMC1448230 DOI: 10.2105/ajph.94.2.211] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Certain groups in the United States remain at high risk and suffer disproportionately from tobacco-related illness and death despite progress made in reducing tobacco use. To address gaps in research on tobacco-related disparities and develop a comprehensive agenda aimed at reducing such disparities, representatives from funding agencies, community-based organizations, and academic institutions convened at the National Conference on Tobacco and Health Disparities in 2002. Conference participants reviewed the current research, identified existing gaps, and prioritized scientific recommendations. Panel discussions were organized to address research areas affecting underserved and understudied populations. We report major research recommendations made by the conference participants in several scientific domains. These recommendations will ultimately help guide the field in reducing and eliminating tobacco-related disparities in the United States.
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Affiliation(s)
- Pebbles Fagan
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7337, USA.
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