1
|
Alves J, Rust V, Baldwin M, Puleikis L, Claude A, Brett M, LaBelle CT, Ventura AS. Starting the Discussion: A Call to Enhance Care for People With Stimulant Use Disorder. Subst Abus 2023; 44:115-120. [PMID: 37728086 DOI: 10.1177/08897077231191005] [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: 09/21/2023]
Abstract
Stimulant use disorder (StUD) significantly contributes to substance-related morbidity and mortality in the United States. Overshadowed by the country's focus on opioid-related overdose deaths, stimulant and stimulant/opioid overdose deaths have increased dramatically over the last decade. Many individuals who use stimulants illicitly or have StUD have multiple, intersecting stigmatized characteristics which exacerbate existing barriers and create new obstacles to attaining addiction treatment. Illicit stimulant use, StUD, and stimulant-related overdose disproportionately impact minoritized racial and gender, and sexuality diverse groups. Historically, people who use illicit stimulants and those with StUD have been highly stigmatized, criminalized, and overly ignored by health care providers, policymakers, and the public compared to people who use other drugs and alcohol. As a result, most people needing treatment for StUD do not receive it. This is partly due to the lack of evidence-based treatment for StUD, which has resulted in few programs specializing in the care of people with StUD. The lack of available treatment is compounded by high rates of StUD in marginalized groups already reluctant to engage with the health care system. As health care professionals, we can improve outcomes for people with StUD by changing how we talk about, document, and respond to illicit stimulant use, related characteristics, behaviors, and social and structural determinants of health. To do this, we must seek to understand the lived realities of people with StUD and illicit stimulant use and use this knowledge to amend existing models of care.
Collapse
Affiliation(s)
- Justin Alves
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Victoria Rust
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Marielle Baldwin
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Logan Puleikis
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann Claude
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Meghan Brett
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Colleen T LaBelle
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Alicia S Ventura
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
2
|
Quinn K, John S, Hirshfield S, Algiers O, O'Neil A, Petroll A, Walsh J. Challenges to meeting the HIV care needs of older adults in the rural South. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100113. [PMID: 36620181 PMCID: PMC9815493 DOI: 10.1016/j.ssmqr.2022.100113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.
Collapse
Affiliation(s)
- K.G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S.A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S. Hirshfield
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
| | - O. Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - A. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, United States
| | - A.E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - J.L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| |
Collapse
|
3
|
Baugher AR, Whiteman A, Jeffries WL, Finlayson T, Lewis R, Wejnert C. Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017. AIDS 2021; 35:1637-1645. [PMID: 34270489 PMCID: PMC9030111 DOI: 10.1097/qad.0000000000002917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM). DESIGN/METHODS National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao-Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). RESULTS Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH 'got what they deserved' (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02-1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43-2.86; P < 0.001) than Black MSM in states without such laws. CONCLUSIONS HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies.
Collapse
Affiliation(s)
- Amy R. Baugher
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ari Whiteman
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, assigned to DHAP, Oak Ridge, TN, USA
| | - William L. Jeffries
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rashunda Lewis
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
4
|
Bonett S, Meanley S, Elsesser S, Bauermeister J. State-Level Discrimination Policies And HIV Pre-Exposure Prophylaxis Adoption Efforts In The US. Health Aff (Millwood) 2021; 39:1575-1582. [PMID: 32897779 DOI: 10.1377/hlthaff.2020.00242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a drug regimen recommended for anyone at high risk of getting HIV to prevent them from being infected. Little research exists on how state-level policies might be related to differential PrEP uptake across the United States. To better understand the associations between state-level policies and PrEP uptake, we examined HIV criminalization, nondiscrimination laws for sexual and gender minorities, Medicaid expansion, Ryan White funding, and sociodemographic characteristics in relation to the PrEP-to-need ratio, a measure of PrEP uptake. Using a cross-sectional design, we analyzed data from all fifty states; Washington, D.C.; and Puerto Rico (all of which we categorize as states here) regarding policy, socioeconomic factors, and PrEP-to-need ratio in 2018. States with HIV criminalization laws had lower PrEP-to-need ratio, and states with more nondiscrimination laws for sexual and gender minorities had higher PrEP-to-need ratio. We found no association between Medicaid expansion, Ryan White funding, percentage Hispanic, percentage uninsured, median household income, percentage with high school education, or state population and PrEP uptake. Legislators should consider how laws concerning HIV and sexual and gender minorities might protect against discrimination and subvert fear and stigma, given the potential impact of these policies on HIV prevention.
Collapse
Affiliation(s)
- Stephen Bonett
- Stephen Bonett is a doctoral student in the School of Nursing at the University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Steven Meanley
- Steven Meanley is a research associate in the School of Nursing at the University of Pennsylvania
| | - Steven Elsesser
- Steven Elsesser is a resident in the Department of Family Medicine and Community Health at the University of Pennsylvania
| | - José Bauermeister
- José Bauermeister is the Presidential Professor of Nursing in the School of Nursing at the University of Pennsylvania
| |
Collapse
|
5
|
Molldrem S, Hussain MI, McClelland A. Alternatives to sharing COVID-19 data with law enforcement: Recommendations for stakeholders. Health Policy 2020; 125:135-140. [PMID: 33390280 PMCID: PMC7648186 DOI: 10.1016/j.healthpol.2020.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/14/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
In jurisdictions around the world, police have been enforcing COVID-19-related measures. Researchers and civil society agree: criminalizing illnesses does more harm than good. We describe two North American jurisdictions that share coronavirus data with police. COVID-19 data policies will likely have broad ramifications for health data policy. We present seven concrete alternatives to sharing health data with law enforcement.
During the COVID-19 pandemic, in some jurisdictions, police have become involved in enforcing coronavirus-related measures. Relatedly, several North American jurisdictions have established COVID-19 data sharing protocols with law enforcement. Research across a range of fields has demonstrated that involving police in matters of public health disproportionately impacts the most vulnerable and does more harm than good. This is reflected in the consensus against COVID-19 criminalization that has emerged among civil society organizations focused on HIV, human rights, and harm reduction. The European Data Protection Board has also released guidelines against re-uses of COVID-19 data for law enforcement purposes. This article offers an overview of the harms of criminalizing illnesses and strategies for health stakeholders to seek alternatives to sharing COVID-19 data with police agencies while facilitating interoperability with healthcare first responders. It also presents case studies from two North American jurisdictions – Ontario and Minnesota – that have established routine COVID-19 data sharing with police. We recommended seven alternatives, including designating COVID-19 data as sensitive and implementing segmented interoperability with first responder agencies. These guidelines can help ensure that health information technology platforms do not become vehicles for the criminalization of COVID-19, and that health data stay within the health system.
Collapse
Affiliation(s)
- Stephen Molldrem
- Department of Anthropology, University of California, Irvine, Irvine, CA, USA.
| | - Mustafa I Hussain
- Department of Informatics, University of California, Irvine, Irvine, CA, USA
| | - Alexander McClelland
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON, Canada
| |
Collapse
|
6
|
Abstract
Black men who have sex with men (MSM) in the South have the highest rates of HIV diagnosis in the country adding to the persistent racial disparities in HIV experienced by this population. The current HIV prevention and care landscape is heavily driven by individual-level clinical and biomedical approaches that have shown progress in reducing HIV diagnoses, but yield less than adequate results in reducing the HIV racial disparities for Black MSM in the South. In efforts to enhance focus on reducing the racial HIV disparities and more completely address the needs of Black MSM in the South, we offer insight on comprehensive approaches that can complement our current HIV prevention and care portfolio. There are five domains we discuss which include: (1) leveraging and integrating resources; (2) building upon existing program models designed to reduce disparities; (3) workforce development and cultural sensitivity; (4) social determinants of health data utilization; and 5) policy considerations. We urge public health practitioners and healthcare providers to consider and incorporate the outlined approaches to improve HIV outcomes along the continuum of care and ultimately reduce disparities in HIV affecting the quality of life of Black MSM living in the South.
Collapse
Affiliation(s)
- Jarvis W Carter
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Rd, NE Mailstop US8-5, Atlanta, GA, 30329, USA.
| | - Stephen A Flores
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Rd, NE Mailstop US8-5, Atlanta, GA, 30329, USA
| |
Collapse
|