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Reddon H, Fairbairn N, Grant C, Milloy MJ. Experiencing homelessness and progression through the HIV cascade of care among people who use drugs. AIDS 2023; 37:1431-1440. [PMID: 37070552 PMCID: PMC10330029 DOI: 10.1097/qad.0000000000003570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care. DESIGN Prospective cohort study. METHODS Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care. RESULTS Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49-0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care. CONCLUSIONS Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41-54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - M-J Milloy
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Curtis M, Winter RJ, Dietze P, Wilkinson AL, Cossar RD, Stewart AC, Agius PA, Butler T, Aitken C, Kirwan A, Walker S, Stoové M. High rates of resumption of injecting drug use following release from prison among men who injected drugs before imprisonment. Addiction 2022; 117:2887-2898. [PMID: 35665554 PMCID: PMC9796148 DOI: 10.1111/add.15971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/17/2022] [Indexed: 01/01/2023]
Abstract
AIMS To estimate incidence of post-release injecting drug use (IDU) among men who injected drugs before imprisonment and determine factors associated with post-release IDU frequency. DESIGN, SETTING, PARTICIPANTS Prospective cohort study of men reporting monthly IDU before a period of sentenced imprisonment in Victoria, Australia, recruited between September 2014 and May 2016 (n = 195). MEASUREMENTS Any post-release IDU and IDU frequency was measured via self-report at 3-month follow-up interview. IDU frequency, measured over the preceding month, was categorised as no IDU, irregular IDU (1-4 days IDU) and regular IDU (≥5 days IDU). Incidence of any IDU was calculated at 3 months post-release. Factors associated with IDU frequency were estimated using ordinal logistic regression. FINDINGS Most (83%) participants reported post-release IDU (265 per 100 person-years, 95% CI, 227-309); with half (48%) reporting regular IDU, 23% irregular IDU and 29% no IDU in the month preceding follow-up. Poorer psychological well-being at follow-up (General Health Questionnaire [GHQ-12] score; adjusted odds ratio [AOR], 1.18; 95% CI, 1.07-1.29) and post-release unemployment (AOR, 4.57; 95% CI, 1.67-12.49) were associated with increased IDU frequency. Retention in opioid agonist treatment (AOR, 0.49; 95% CI, 0.24-0.98) was associated with reduced IDU frequency. Non-linear (inverted-u) associations between IDU frequency and age (age: AOR, 1.51; 95% CI, 1.17-1.96; age-squared: AOR, 0.99; 95% CI, 0.99-0.99) and pre-imprisonment IDU frequency (pre-imprisonment IDU frequency: AOR, 1.36; 95% CI, 1.15-1.61; pre-imprisonment IDU frequency-squared: AOR, 0.99; 95% CI, 0.99-0.99) were found, with odds peaking at age 39 and 19 days IDU, respectively. Longer baseline sentence length was associated with reduced odds of irregular and regular IDU (AOR, 0.99; 95% CI, 0.99-0.99). CONCLUSION Among Australian men who inject drugs before imprisonment, resumption of injecting drug use after release from prison appears to be common, with imprisonment seeming to have little impact on reducing injecting drug use behaviour.
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Affiliation(s)
- Michael Curtis
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Monash Addition Research CentreMonash UniversityMelbourneAustralia
| | - Rebecca J. Winter
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Department of GastroenterologySt Vincent's HospitalMelbourneAustralia
| | - Paul Dietze
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,National Drug Research InstituteCurtin UniversityPerthAustralia
| | - Anna L. Wilkinson
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Reece D. Cossar
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia
| | - Ashleigh C. Stewart
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Paul A. Agius
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Tony Butler
- Justice Health Research Program, School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Campbell Aitken
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Amy Kirwan
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia
| | - Shelley Walker
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,National Drug Research InstituteCurtin UniversityPerthAustralia
| | - Mark Stoové
- Behaviours and Health Risks Program, Public Health DisciplineBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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“Returning to Ordinary Citizenship”: A Qualitative Study of Chinese PWUD’s Self-Management Strategies and Disengagement Model of Identity. Behav Sci (Basel) 2022; 12:bs12080258. [PMID: 36004829 PMCID: PMC9404964 DOI: 10.3390/bs12080258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
How PWUD (people who use drugs) live under drug governance is an important research question. This study adopts a qualitative research method to explore how PWUD in China self-manage after perceiving the dilemma of incomplete citizenship and the social pressure brought by drug control arrangements. Through analysis of 130 PWUD’s files and in-depth interviews with 10 interviewees (from the 24 preliminary interviews), this study found that PWUD developed action strategies of hidden mobility (spatial isolation), disconnection of past experiences (time isolation), instrumental actions, as well as narrative strategies of reframing themselves as ordinary citizens with attempts of reversing identity disadvantages. Further, PWUD’s self-management strategies manifest as a disengagement model in which the actors (PWUD, not rehabilitation agencies) do not intend to develop integrative positive identities through dispersed, practiced behavioral strategies, but attempt to return to pre-addiction, non-socially exclusionary citizenship experiences. The disengagement model and its negative effect on PWUD’s social integration help us reflect on the current implementation of rehabilitation projects and institutional settings of drug governance.
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A longitudinal cross-sectional analysis of substance use treatment trends for individuals experiencing homelessness, criminal justice involvement, both, or neither - United States, 2006-2018. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100174. [PMID: 35382494 PMCID: PMC8979492 DOI: 10.1016/j.lana.2021.100174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Individuals experiencing homelessness or criminal justice involvement (CJI) have higher rates of substance use than the general public. Despite documented barriers to accessing treatment, few studies have compared substance use treatment patterns between these groups. Methods This paper uses data from the Treatment Episode Dataset-Admissions between 2006 to 2018 to describe characteristics and trends in substance use treatment admissions indicating homelessness (n=2,524,413), CJI (4,764,750), both (509,902), or neither (8,950,797) in the United States. We used multivariable logistic regression to examine trends independent of demographic differences between groups. Findings Between 2006 and 2018, the proportion of treatment admissions related to heroin increased across all groups. Methamphetamine-related admissions rose substantially for individuals experiencing homelessness, CJI, or both. By 2018, 27·8% (95% CI: 27·4-28·2%) of admissions for individuals experiencing both were methamphetamine-related and 16·7% (95% CI: 16·3-17·0%) were heroin-related. Conversely, among individuals experiencing neither, 7·5% (95% CI: 7·4-7·5%) of admissions were methamphetamine-related and 33·6% (95% CI: 33·4-33·7%) were heroin-related. Individuals experiencing both homelessness and CJI received lower rates of medications for opioid use disorder (OUD) (8·3%; 95% CI: 8·2-8·3%) compared to individuals experiencing neither (36·4%; 95% CI: 36·4-36·4%). Interpretation Community treatment facilities should be supported to provide medications for OUD and accommodate rising rates of methamphetamine and polysubstance-related treatment admissions in populations experiencing complex social drivers of health such as homelessness, CJI, or both. Funding National Institute of General Medical Sciences and National Institute of Diabetes and Digestive and Kidney Diseases.
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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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Rivera Saldana CD, Beletsky L, Borquez A, Kiene SM, Strathdee SA, Zúñiga ML, Martin NK, Cepeda J. Impact of cumulative incarceration and the post-release period on syringe-sharing among people who inject drugs in Tijuana, Mexico: a longitudinal analysis. Addiction 2021; 116:2724-2733. [PMID: 33620749 PMCID: PMC8380753 DOI: 10.1111/add.15445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. DESIGN Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. SETTING Tijuana, Mexico. PARTICIPANTS Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. MEASUREMENTS Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. FINDINGS At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. CONCLUSIONS A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.
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Affiliation(s)
- Carlos D. Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
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Diversity of incarceration patterns among people who inject drugs and the association with incident hepatitis C virus infection. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103419. [PMID: 34452807 DOI: 10.1016/j.drugpo.2021.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the relationship between short-term incarceration and risk of hepatitis C virus (HCV) infection among people who inject drugs (PWID). We investigated whether varying patterns of recent incarceration lasting less than two years are associated with HCV acquisition risk in this population. METHODS We followed prospectively PWID at risk of acquiring HCV infection in Montréal (2004-2019). At 6-month (up until 2011), then 3-month intervals, participants were tested for HCV antibodies or RNA, and self-reported whether they have been incarcerated in each of the previous 6 or 3 months. If incarcerated, they reported the setting and time spent in incarceration. We fit three separate multivariable time-updated Cox regression models, one for each measure of incarceration: any incarceration lasting less than two years (yes/no), incarceration stratified by setting (local police station/provincial prison/no) and incarceration stratified by time in incarceration (≤1 week/>1 week and ≤1 month/>1 month and <2 years/no). RESULTS Among 709 PWID followed over 2315.2 person-years, HCV incidence was 9.9/100 person-years (95% confidence interval (CI): 8.7-11.2)]. During follow-up, 248 PWID (35.0%) reported at least one recent incarceration episode of less than two years. Overall, compared to PWID who did not experience incarceration in the prior 6 or 3 months, PWID who did were 1.56 (95% CI: 1.13, 2.17) times more likely to acquire HCV. We found no statistically significant difference in the magnitude of associations across categories of setting and time in incarceration (likelihood ratio test P= 0.53 and 0.44, respectively). CONCLUSION Any recent incarceration lasting less than two years, regardless of the setting and time in incarceration, was associated with an elevated risk of HCV acquisition among PWID. Findings support the need to expand access to harm-reduction programs in short-term incarceration settings and, in parallel, to prioritise public health-oriented alternatives to incarcerating PWID where possible.
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Gjersing L, Bretteville-Jensen AL. Characteristics and risk of incarceration among "hard-to-reach" people who use drugs: A five-year prospective cohort study combining self-reports and registry data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103288. [PMID: 34004380 DOI: 10.1016/j.drugpo.2021.103288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense). METHODS In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city. RESULTS During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations. CONCLUSION In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway
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Ceasar RC, Kral AH, Simpson K, Wenger L, Goldshear JL, Bluthenthal RN. Factors associated with health-related cannabis use intentions among a community sample of people who inject drugs in Los Angeles and San Francisco, CA 2016 to 2018. Drug Alcohol Depend 2021; 219:108421. [PMID: 33301996 PMCID: PMC7856255 DOI: 10.1016/j.drugalcdep.2020.108421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. METHODS Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016-18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. RESULTS The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. CONCLUSION People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Kelsey Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Jesse L Goldshear
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
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Bouck Z, Jain S, Sun X, Milloy MJ, Werb D, Hayashi K. Recent incarceration and risk of first-time injection initiation assistance: A prospective cohort study of persons who inject drugs. Drug Alcohol Depend 2020; 212:107983. [PMID: 32380374 PMCID: PMC7293943 DOI: 10.1016/j.drugalcdep.2020.107983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the prevalence and harms of incarceration among persons who inject drugs (PWID) and their role in injection drug use initiation, we aimed to investigate whether recent incarceration influences the likelihood PWID assist others in their first-ever injection. METHODS Prospective cohort study of PWID in Vancouver, Canada who had their PReventing Injecting by Modifying Existing Responses (PRIMER) baseline visit between December 2014 and May 2017, reported never providing injection initiation assistance previously, and had ≥1 follow-up visit. The primary outcome, provision of injection initiation assistance, was defined via self-report as helping anybody inject for the first time in the past six months. The primary exposure was recent incarceration, i.e., self-report of being jailed, imprisoned or detained in the past six months. Participants were assessed biannually until November 2017, drop-out, or their first report of the primary outcome. RESULTS 1,199 PWID (62.1% male; mean (SD) age, 44.4 (12.3) years) were included in our study. Across 4,171 follow-up visits, 67 participants (5.6%) reported providing injection initiation assistance. The proportion of participants reporting recent incarceration varied between 2.4% to 5.1% per follow-up visit. Based on a multivariable discrete-time proportional hazards regression analysis, recent incarceration was associated with an increased risk of providing injection initiation assistance during the same six-month period (adjusted hazard ratio, 2.64; 95% CI, 1.19 to 5.86). CONCLUSIONS The observed association between recent incarceration and risk of providing injection initiation assistance suggests that incarceration could be contributing to the expansion of injection drug use practices within vulnerable populations over time.
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Affiliation(s)
- Zachary Bouck
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Dan Werb
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Division of Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
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Depression, post-traumatic stress disorder, suicidality and self-harm among people who inject drugs: A systematic review and meta-analysis. Drug Alcohol Depend 2020; 207:107793. [PMID: 31874449 DOI: 10.1016/j.drugalcdep.2019.107793] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID. METHODS We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm. FINDINGS We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0 % (95 % confidence interval [CI] = 21.3, 62.8 %), and for a depression diagnosis was 28.7 % (95 % CI = 20.8, 36.6 %). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1 % (95 % CI = 19.3, 24.9 %). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID. INTERPRETATION Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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Kennedy MC, Klassen DC, Dong H, Milloy MJS, Hayashi K, Kerr TH. Supervised Injection Facility Utilization Patterns: A Prospective Cohort Study in Vancouver, Canada. Am J Prev Med 2019; 57:330-337. [PMID: 31377091 PMCID: PMC7056297 DOI: 10.1016/j.amepre.2019.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Although the health and community benefits of supervised injection facilities are well documented, little is known about long-term patterns of utilization of this form of health service. The present study seeks to longitudinally characterize discontinuation of use of a supervised injection facility in Vancouver, Canada. METHODS Data were drawn from 2 community-recruited prospective cohorts of people who inject drugs between December 2005 and December 2016. In 2018, extended Cox regression for recurrent events was used to examine factors associated with time to cessation of supervised injection facility use during periods of active injection. RESULTS Of 1,336 people who inject drugs that were followed for a median of 50 months, 847 (63.4%) participants reported 1,663 6-month periods of supervised injection facility use cessation while actively injecting drugs (incidence density of 26.6 events per 100 person-years). An additional 2,282 (57.8%) of the total 3,945 6-month periods of supervised injection facility use cessation occurred during periods of injection cessation. In multivariable analyses, enrollment in methadone maintenance therapy (adjusted hazard ratio=1.41) and HIV seropositivity (adjusted hazard ratio=1.23) were positively associated with supervised injection facility use cessation during periods of active injection, whereas homelessness (adjusted hazard ratio=0.59), at least daily heroin injection (adjusted hazard ratio=0.70), binge injection (adjusted hazard ratio=0.68), public injection (adjusted hazard ratio=0.67), nonfatal overdose (adjusted hazard ratio=0.73), difficulty accessing addiction treatment (adjusted hazard ratio=0.69), and incarceration (adjusted hazard ratio=0.70) were inversely associated with this outcome (all p<0.05). The most commonly reported reasons for supervised injection facility use cessation were injection drug use cessation (42.3%) and a preference for injecting at home (30.7%). CONCLUSIONS These findings suggest that this supervised injection facility successfully retains people who inject drugs at elevated risk of drug-related harms and indicate that many supervised injection facility clients neither use this service nor inject drugs perpetually.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David C Klassen
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - M-J S Milloy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thomas H Kerr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Density of low-barrier opioid agonist clinics and risk of non-fatal overdose during a community-wide overdose crisis: A spatial analysis. Spat Spatiotemporal Epidemiol 2019; 30:100288. [PMID: 31421798 DOI: 10.1016/j.sste.2019.100288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/15/2019] [Accepted: 05/09/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In recent years, North America has witnessed a spike in the number of overdoses (OD) and OD-related deaths. The aim of this study was to assess spatial correlates of OD risk in Vancouver, Canada. METHODS Data utilized for this study was from three open and ongoing prospective cohorts of people who use drugs (PWUDs) in Vancouver, Canada. Logistic regression analyses with generalized linear mixed-effects models (GLMM) was used to examine correlates of residing in areas characterized by high OD rates. Mapping was used to examine areas showing OD clusters. RESULTS We included 1336 PWUDs who resided in the downtown area. In multivariable analysis, higher availability of methadone clinics within walking distance, daily cocaine injectors and daily crack users had independent decreased odds of living within an OD cluster. CONCLUSION This study found that higher availability of methadone clinics was associated with decreased odds of living within OD clusters.
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Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10(1500) copies/ml among illicit drug users. AIDS 2018; 32:1059-1067. [PMID: 29424782 DOI: 10.1097/qad.0000000000001777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log10(1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. DESIGN Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. METHODS We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log10(1500) copies/ml plasma in the previous 180 days. RESULTS Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log10(1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log10(1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). CONCLUSION Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.
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Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ. Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis. Drug Alcohol Depend 2017; 180:33-38. [PMID: 28865390 PMCID: PMC5811227 DOI: 10.1016/j.drugalcdep.2017.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND and Aims Injecting illicit drugs in public settings has been linked to a higher risk of a range of drug-related harms, including overdose and HIV infection. However, the factors associated with public injecting among HIV-positive individuals have not been previously explored. We investigated the links between public drug injecting, drug-related harm, and HIV treatment measures among a cohort of HIV-positive persons who inject drugs (PWID) in a Canadian setting. METHODS We used data from a prospective cohort of HIV-positive PWID recruited from community settings in Vancouver, Canada, linked to comprehensive clinical monitoring data in the context of an ongoing Treatment-as-Prevention (TasP) initiative to examine harms associated with public injecting. We used generalized linear mixed-effects analyses to identify longitudinal factors associated with self-reported public drug injection. RESULTS Between 2005 and 2014, 626 HIV-seropositive PWID were recruited, of whom 213 (34%) reported public injection in the preceding 180days. In a longitudinal multivariable model, public injection was positively associated with daily heroin injection (Adjusted Odds Ratio [AOR]=2.63), incarceration (AOR=1.78), and detectable plasma HIV-1 RNA viral load (VL, AOR=1.42). CONCLUSIONS Public injecting was linked to numerous drug-related harms among HIV-seropositive PWID in this setting. Given its link with detectable VL, an important marker of poor HIV treatment outcomes, our findings support prioritizing individuals engaged in public injecting with harm reduction strategies as well as clinical and social supports as a part of TasP-based efforts to prevent HIV-related morbidity and mortality, and HIV transmission.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver BC V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
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DeBeck K, Cheng T, Montaner JS, Beyrer C, Elliott R, Sherman S, Wood E, Baral S. HIV and the criminalisation of drug use among people who inject drugs: a systematic review. Lancet HIV 2017; 4:e357-e374. [PMID: 28515014 PMCID: PMC6005363 DOI: 10.1016/s2352-3018(17)30073-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment. METHODS Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language. FINDINGS We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects. INTERPRETATION These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use. FUNDING Canadian Institutes of Health Research and US National Institutes of Health.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Beyrer
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Susan Sherman
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Prescription opioid abuse in prison settings: A systematic review of prevalence, practice and treatment responses. Drug Alcohol Depend 2017; 171:122-131. [PMID: 28086177 DOI: 10.1016/j.drugalcdep.2016.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND To systematically review the quantitative and qualitative evidence base pertaining to the prevalence, practice of, and treatment response to the diversion of prescribed opiates in the prison setting. METHODS Medline, Embase, CINAHL, PsycINFO, Google Scholar, ASSIA and Science Direct databases were searched for papers from 1995 to the present relevant to the abuse of prescribed opiate medication. Identified journals and their reference lists were hand searched for other relevant articles. Of the abstracts identified as relevant, full text papers were retrieved and critiqued against the inclusion criteria for the review. RESULTS Three hundred and fifty-five abstracts were identified, leading to 42 full-text articles being retrieved. Of those, 10 papers were included in the review. Significant differences in abuse behaviours between different countries were reported. However, a key theme emerged from the data regarding a culture of nasal administration of prescribed sublingual buprenorphine within some prisons due to both reduced prevalence of injection within prison and reduced supplies of illicit drugs within prison. The buprenorphine/naloxone preparation appears to be less amenable to abuse. The review highlighted a paucity of empirical research pertaining to both prevalence of the phenomenon and treatment responses. CLINICAL AND RESEARCH IMPLICATIONS Healthcare providers within prisons need to prescribe opioids in the least abuseable preparation since the risk of abuse is significant, despite widespread processes of supervised dispensing. Prescription medication abuse is not limited to opioids and the predominant drug of abuse in an individual prison can rapidly change according to availability.
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Hull M, Shafran S, Wong A, Tseng A, Giguère P, Barrett L, Haider S, Conway B, Klein M, Cooper C. CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 Updated Canadian HIV/Hepatitis C Adult Guidelines for Management and Treatment. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2016; 2016:4385643. [PMID: 27471521 PMCID: PMC4947683 DOI: 10.1155/2016/4385643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2015] [Indexed: 12/13/2022]
Abstract
Background. Hepatitis C virus (HCV) coinfection occurs in 20-30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Purpose. To update national standards for management of HCV-HIV coinfected adults in the Canadian context with evolving evidence for and accessibility of effective and tolerable DAA therapies. The document addresses patient workup and treatment preparation, antiviral recommendations overall and in specific populations, and drug-drug interactions. Methods. A standing working group with HIV-HCV expertise was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published HCV antiviral data and update Canadian HIV-HCV Coinfection Guidelines. Results. The gap in sustained virologic response between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All coinfected individuals should be assessed for interferon-free, Direct Acting Antiviral HCV therapy. Regimens vary in content, duration, and success based largely on genotype. Reimbursement restrictions forcing the use of pegylated interferon is not acceptable if optimal patient care is to be provided. Discussion. Recommendations may not supersede individual clinical judgement. Treatment advances published since December 2015 are not considered in this document.
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Affiliation(s)
- Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | | | - Alex Wong
- Regina Qu'Appelle Health Region, Regina, SK, Canada S4P 1E2
| | - Alice Tseng
- Toronto General Hospital, Toronto, ON, Canada M5G 2C4
| | | | - Lisa Barrett
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada V6Z 2C7
| | | | - Curtis Cooper
- The Ottawa Hospital, General Campus, G12, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
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Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, Cepeda J, Comfort M, Goosby E, Goulão J, Hart C, Kerr T, Lajous AM, Lewis S, Martin N, Mejía D, Camacho A, Mathieson D, Obot I, Ogunrombi A, Sherman S, Stone J, Vallath N, Vickerman P, Zábranský T, Beyrer C. Public health and international drug policy. Lancet 2016; 387:1427-1480. [PMID: 27021149 PMCID: PMC5042332 DOI: 10.1016/s0140-6736(16)00619-x] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms.
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Affiliation(s)
| | | | - Michel Kazatchkine
- UN Special Envoy, HIV in Eastern Europe and Central Asia, Geneva, Switzerland
| | | | | | | | - Javier Cepeda
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Eric Goosby
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Carl Hart
- Columbia University, New York City, NY, USA
| | - Thomas Kerr
- University of British Columbia, Center of Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Susan Sherman
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nandini Vallath
- Trivandrum Institute of Palliative Sciences, Trivandrum, India
| | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Nyamathi AM, Zhang S, Salem BE, Farabee D, Hall B, Marlow E, Faucette M, Bond D, Yadav K. A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2016; 12:49-74. [PMID: 27217822 PMCID: PMC4874341 DOI: 10.1007/s11292-015-9236-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. METHODS The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. RESULTS When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. CONCLUSIONS In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.
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Affiliation(s)
- Adeline M. Nyamathi
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
| | | | - Benissa E. Salem
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
| | - David Farabee
- University of California Los Angeles, Integrated Substance Abuse Programs, San Diego, CA, USA
| | - Betsy Hall
- University of California Los Angeles, Integrated Substance Abuse Programs, San Diego, CA, USA
| | - Elizabeth Marlow
- University of California, San Francisco, School of Nursing, San Diego, CA, USA
| | | | - Doug Bond
- Amity Foundation, Los Angeles, CA, USA
| | - Kartik Yadav
- University of California at Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA
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Abstract
BACKGROUND The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. OBJECTIVES To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. RESULTS Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26-0.98). Participants aged 37-89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19-0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04-5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13-5.69). CONCLUSIONS Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.
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Affiliation(s)
| | - Stephen A Sampong
- a School of Nursing , Columbia University , New York , New York , USA
| | - Montina Befus
- a School of Nursing , Columbia University , New York , New York , USA
| | | | - Elaine L Larson
- a School of Nursing , Columbia University , New York , New York , USA
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Larney S, Cama E, Nelson E, Larance B, Degenhardt L. A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia. Drug Alcohol Rev 2015; 35:686-692. [PMID: 26711174 DOI: 10.1111/dar.12357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/16/2015] [Accepted: 09/22/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND AIMS Involvement in the criminal justice system is common among opioid-dependent people. This study aimed to determine prevalence and adolescent-onset correlates of adult imprisonment among opioid-dependent men and women in New South Wales, Australia. DESIGN AND METHODS Participants were recruited from opioid substitution therapy clinics and completed a face-to-face, structured interview. Data were collected on demographic characteristics, family history, substance dependence and psychiatric disorders. Adolescent-onset correlates of adult incarceration (including interactions with gender) were examined using logistic regression. RESULTS Opioid-dependent men were significantly more likely than opioid-dependent women to report adult imprisonment (66% vs 40%; P < 0.001). In a multivariable logistic regression model, older age, male gender, having completed high school education only, having dependent children or living independently prior to age 18 years, a history of juvenile detention and adolescent-onset opioid dependence were all significantly associated with increased odds of adult imprisonment. Adolescent-onset depression was associated with a halving of odds of adult imprisonment. The only variable for which we observed an interaction with gender was juvenile detention, which had a significantly greater impact on the odds of imprisonment for men than women. DISCUSSION AND CONCLUSIONS More than half of this sample of opioid dependent adults had a history of imprisonment. Variables that are associated with imprisonment in the general population, such as childhood maltreatment, were not important in predicting imprisonment in this sample. Further study is required to understand the interaction between sex and juvenile detention in predicting adult imprisonment. [Larney S, Cama E, Nelson E, Larance B, Degenhardt L. A cross-sectional study of correlates of imprisonment in opioid-dependent men and women in New South Wales, Australia. Drug Alcohol Rev 2016;35:686-692].
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Alpert Medical School, Brown University, Providence, USA
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Elliot Nelson
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, USA.,Murdoch Children's Research Institute, Melbourne, Australia
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Degenhardt L, Larney S, Gisev N, Trevena J, Burns L, Kimber J, Shanahan M, Butler T, Mattick RP, Weatherburn D. Imprisonment of opioid-dependent people in New South Wales, Australia, 2000–2012: a retrospective linkage study. Aust N Z J Public Health 2015; 38:165-70. [PMID: 25874282 DOI: 10.1111/1753-6405.12123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There are few data about the incarceration of opioid-dependent people involving large representative cohorts. We aimed to determine the prevalence and duration of incarceration in a large cohort of opioid-dependent people in Australia using data linkage methods, and estimate the costs associated with their incarceration.Method: Retrospective linkage study of all entrants to opioid substitution therapy (OST) for the treatment of opioid dependence in NSW, 1985–2010, with data on incarceration, 2000-2012. The number and duration of incarcerations were calculated. The average daily cost of incarceration was applied to days of incarceration in the cohort.Results: Among 47,196 opioid-dependent people, 37% (43% of men and 24% of women) had at least one episode of incarceration lasting one or more days. Men had a median of three(ranging between 1-47) incarcerations, and women, two (1-35). Indigenous men spent 23% of follow-up time incarcerated, compared with 8% for non-Indigenous men; similarly, Indigenous women spent a substantially greater proportion of time incarcerated than non-Indigenous women (8% vs. 2%). Costs of incarceration of this cohort between 2000 and 2012 totalled nearly AUD $3 billion.Conclusions: This is the first study to examine incarceration of opioid-dependent people across an entire population of such users. Our findings suggest that a substantial minority of opioid-dependent people experience incarceration, usually on multiple occasions and at significant cost. Treatment for opioid dependence, inside and outside prisons, may help reduce incarceration of this cohort.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales; 2. Melbourne School of Population and Global Health, University of Melbourne, Victoria.
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Barker B, Alfred GT, Fleming K, Nguyen P, Wood E, Kerr T, DeBeck K. Aboriginal street-involved youth experience elevated risk of incarceration. Public Health 2015; 129:1662-8. [PMID: 26390949 DOI: 10.1016/j.puhe.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Past research has identified risk factors associated with incarceration among adult Aboriginal populations; however, less is known about incarceration among street-involved Aboriginal youth. Therefore, we undertook this study to longitudinally investigate recent reports of incarceration among a prospective cohort of street-involved youth in Vancouver, Canada. STUDY DESIGN Prospective cohort study. METHODS Data were collected from a cohort of street-involved, drug-using youth from September 2005 to May 2013. Multivariate generalized estimating equation analyses were employed to examine the potential relationship between Aboriginal ancestry and recent incarceration. RESULTS Among our sample of 1050 youth, 248 (24%) reported being of aboriginal ancestry, and 378 (36%) reported being incarcerated in the previous six months at some point during the study period. In multivariate analysis controlling for a range of potential confounders including drug use patterns and other risk factors, Aboriginal ancestry remained significantly associated with recent incarceration (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI]: 1.12-1.86). CONCLUSIONS Even after adjusting for drug use patterns and other risk factors associated with incarceration, this study found that Aboriginal street-involved youth were still significantly more likely to be incarcerated than their non-Aboriginal peers. Given the established harms associated with incarceration these findings underscore the pressing need for systematic reform including culturally appropriate interventions to prevent Aboriginal youth from becoming involved with the criminal justice system.
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Affiliation(s)
- B Barker
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Canada
| | - G T Alfred
- Indigenous Governance Program, University of Victoria, Canada
| | - K Fleming
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - P Nguyen
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - T Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - K DeBeck
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada.
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Genberg BL, Astemborski J, Vlahov D, Kirk GD, Mehta SH. Incarceration and injection drug use in Baltimore, Maryland. Addiction 2015; 110:1152-9. [PMID: 25845621 PMCID: PMC4478154 DOI: 10.1111/add.12938] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/16/2014] [Accepted: 03/31/2015] [Indexed: 12/01/2022]
Abstract
AIMS There is limited longitudinal research examining incarceration and subsequent changes in drug use among people who inject drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent injection drug use among current and former PWIDs in one US city. DESIGN ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. SETTING Baltimore, Maryland, USA. PARTICIPANTS A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7-25). MEASUREMENTS Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported injection drug use in the previous 6 months. FINDINGS At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent injection drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37-1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88-2.37). CONCLUSIONS In the United States, incarceration of people who had previously stopped injecting drugs appears to be associated with an increased risk of subsequent injecting.
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Affiliation(s)
- Becky L. Genberg
- Brown University, Department of Health Services, Policy & Practice, Providence, RI
| | - Jacquie Astemborski
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - David Vlahov
- University of California – San Francisco, School of Nursing, San Francisco, CA
| | - Gregory D. Kirk
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
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Mizuno Y, Purcell DW, Knowlton AR, Wilkinson JD, Gourevitch MN, Knight KR. Syndemic vulnerability, sexual and injection risk behaviors, and HIV continuum of care outcomes in HIV-positive injection drug users. AIDS Behav 2015; 19:684-93. [PMID: 25249392 DOI: 10.1007/s10461-014-0890-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.
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Affiliation(s)
- Yuko Mizuno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA, 30333, USA,
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Phillips M, Richardson L, Wood E, Nguyen P, Kerr T, DeBeck K. High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting. Subst Use Misuse 2015; 50:1805-13. [PMID: 26642870 PMCID: PMC4820061 DOI: 10.3109/10826084.2015.1058825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access. METHODS Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14-26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine. RESULTS From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. CONCLUSIONS High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.
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Affiliation(s)
- Mark Phillips
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Lindsey Richardson
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Evan Wood
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Paul Nguyen
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Thomas Kerr
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
| | - Kora DeBeck
- a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada
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Havnes IA, Clausen T, Brux C, Middelthon AL. The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment. Harm Reduct J 2014; 11:24. [PMID: 25142321 PMCID: PMC4142255 DOI: 10.1186/1477-7517-11-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/14/2014] [Indexed: 01/23/2023] Open
Abstract
Background Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions. Methods Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach. Findings Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. Conclusions Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.
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Affiliation(s)
- Ingrid Amalia Havnes
- Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4956, Oslo, Nydalen 0424, Norway.
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30
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Izenberg JM, Bachireddy C, Wickersham JA, Soule M, Kiriazova T, Dvoriak S, Altice FL. Within-prison drug injection among HIV-infected Ukrainian prisoners: prevalence and correlates of an extremely high-risk behaviour. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:845-52. [PMID: 24951025 DOI: 10.1016/j.drugpo.2014.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/09/2014] [Accepted: 02/16/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND In Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV. METHODS A convenience sample of 97 HIV-infected adults recently released from prison within 1-12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI. RESULTS Complete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0-30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005). CONCLUSIONS Among these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programmes within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful.
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Affiliation(s)
- Jacob M Izenberg
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Chethan Bachireddy
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Jeffrey A Wickersham
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Michael Soule
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Tetiana Kiriazova
- Future Without AIDS Foundation, Odessa, Ukraine; Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
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Ti L, Kerr T. The impact of harm reduction on HIV and illicit drug use. Harm Reduct J 2014; 11:7. [PMID: 24559062 PMCID: PMC3936850 DOI: 10.1186/1477-7517-11-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 11/29/2022] Open
Abstract
There has been widespread support for harm reduction programs as an essential component for responding to the HIV and illicit drug use epidemics. However, despite the growing international acceptance of harm reduction, there continues to be strong opposition to this approach, with critics alleging that harm reduction programs enable drug use. Vancouver, Canada provides a compelling case study that demonstrates that many positive impacts of harm reduction can be attained while addiction treatment-related goals are simultaneously supported. While the evidence for harm reduction is clearly mounting, it is unfortunate that ideological and political barriers to implementing harm reduction programs in Canada remain. As evidenced by Vancouver and elsewhere, harm reduction programs do not exacerbate drug use and undermine treatment efforts and should thereby occupy a well-deserved space within the continuum of programs and services offered to people who inject drugs.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
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Milloy MJ, Kerr T, Salters K, Samji H, Guillemi S, Montaner J, Wood E. Incarceration is associated with used syringe lending among active injection drug users with detectable plasma HIV-1 RNA: a longitudinal analysis. BMC Infect Dis 2013; 13:565. [PMID: 24289651 PMCID: PMC3924231 DOI: 10.1186/1471-2334-13-565] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background Informed by recent studies demonstrating the central role of plasma HIV-1 RNA viral load (VL) on HIV transmission, interventions to employ HIV antiretroviral treatment as prevention (TasP) are underway. To optimize these efforts, evidence is needed to identify factors associated with both non-suppressed VL and HIV risk behaviours. Thus, we sought to assess the possible role played by exposure to correctional facilities on VL non-suppression and used syringe lending among HIV-seropositive people who use injection drugs (PWID). Methods We used data from the ACCESS study, a community-recruited prospective cohort. We used longitudinal multivariate mixed-effects analyses to estimate the relationship between incarceration and plasma HIV-1 RNA > 500 copies/mL among antiretroviral therapy (ART)-exposed active PWID and, during periods of non-suppression, the relationship between incarceration and used syringe lending. Results Between May 1996 and March 2012, 657 ART-exposed PWID were recruited. Incarceration was independently associated with higher odds of VL non-suppression (Adjusted Odds Ratio [AOR] = 1.54, 95% Confidence Interval [95% CI]: 1.10, 2.16). In a separate multivariate model restricted to periods of VL non-suppression, incarceration was independently associated with lending used syringes (AOR = 1.81, 95% CI: 1.03, 3.18). Conclusions The current findings demonstrate that incarceration is associated with used syringe lending among active PWID with detectable plasma HIV-1 RNA. Our results provide a possible pathway for the commonly observed association between incarceration and increased risk of HIV transmission. Our results suggest that alternatives to incarceration of non-violent PWID and evidence-based combination HIV prevention interventions for PWID within correctional facilities are urgently needed.
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Affiliation(s)
| | | | | | | | | | | | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, Vancouver, British Columbia, Canada.
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Omura JD, Wood E, Nguyen P, Kerr T, DeBeck K. Incarceration among street-involved youth in a Canadian study: implications for health and policy interventions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:291-6. [PMID: 24405564 DOI: 10.1016/j.drugpo.2013.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/23/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Risk factors for incarceration have been well described among adult drug using populations; however, less is known about incarceration among at-risk youth. This study examines the prevalence and correlates of incarceration among street-involved youth in a Canadian setting. METHODS From September 2005 to May 2012, data were collected from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14-26 who use illicit drugs. Generalized estimating equation (GEE) logistic regression was used to identify factors associated with recent incarceration defined as incarceration in the previous six months. RESULTS Among 1019 participants, 362 (36%) reported having been recently incarcerated during the study period. In multivariate GEE analysis, homelessness (adjusted odds ratio [AOR]=1.60), daily crystal methamphetamine use (AOR=1.56), public injecting (AOR=1.33), drug dealing (AOR=1.48) and being a victim of violence (AOR=1.68) were independently associated with incarceration (all p<0.05). Conversely, female gender (AOR=0.48), lesbian, gay, bisexual, transgender or two-spirited (LGBTT) identification (AOR=0.47) and increasing age of first hard drug use (AOR=0.96) were negatively associated with incarceration (all p<0.05). CONCLUSION Incarceration was common among our study sample. Youth who were homeless, used crystal methamphetamine, and engaged in risky behaviors including public injection and drug dealing were significantly more likely to have been recently incarcerated. Structural interventions including expanding addiction treatment and supportive housing for at-risk youth may help reduce criminal justice involvement among this population and associated health, social and fiscal costs.
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Affiliation(s)
- John D Omura
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Public Policy, Simon Fraser University, SFU Harbour Centre, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada V6B 5K3.
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Fu JJ, Herme M, Wickersham JA, Zelenev A, Althoff A, Zaller ND, Bazazi AR, Avery AK, Porterfield J, Jordan AO, Simon-Levine D, Lyman M, Altice FL. Understanding the revolving door: individual and structural-level predictors of recidivism among individuals with HIV leaving jail. AIDS Behav 2013; 17 Suppl 2:S145-55. [PMID: 24037440 DOI: 10.1007/s10461-013-0590-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Incarceration, particularly when recurrent, can significantly compromise the health of individuals living with HIV. Despite this, the occurrence of recidivism among individuals with HIV has been little examined, particularly among those leaving jail, who may be at especially high risk for return to the criminal justice system. We evaluated individual- and structural-level predictors of recidivism and time to re-incarceration in a cohort of 798 individuals with HIV leaving jail. Nearly a third of the sample experienced at least one re-incarceration event in the 6 months following jail release. Having ever been diagnosed with a major psychiatric disorder, prior homelessness, having longer lifetime incarceration history, having been charged with a violent offense for the index incarceration and not having health insurance in the 30 days following jail release were predictive of recidivism and associated with shorter time to re-incarceration. Health interventions for individuals with HIV who are involved in the criminal justice system should also target recidivism as a predisposing factor for poor health outcomes. The factors found to be associated with recidivism in this study may be potential targets for intervention and need to be further explored. Reducing criminal justice involvement should be a key component of efforts to promote more sustainable improvements in health and well-being among individuals living with HIV.
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Affiliation(s)
- Jeannia J Fu
- Section of Infectious Diseases, AIDS Program, Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA,
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Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD. Drug Alcohol Depend 2013; 132:457-65. [PMID: 23578590 PMCID: PMC3926693 DOI: 10.1016/j.drugalcdep.2013.03.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/04/2013] [Accepted: 03/09/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. METHODS Among a cohort of 1405 current and former injection drug users in follow-up from 2005 to 2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month. RESULTS Homelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)]. CONCLUSION Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors.
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Affiliation(s)
- Sabriya L. Linton
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - David D. Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Shruti H. Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
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Transitions into and out of homelessness among street-involved youth in a Canadian setting. Health Place 2013; 23:122-7. [PMID: 23838565 DOI: 10.1016/j.healthplace.2013.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/16/2013] [Accepted: 06/04/2013] [Indexed: 11/23/2022]
Abstract
The impact of transitions in housing status among street youth have not been well explored. This study uses a generalized linear mixed effects model to identify factors associated with transitions into and out of homelessness among a prospective cohort of 685 drug-using street-involved youth aged 14-26. In multivariate analysis, high intensity substance use, difficulty accessing addiction treatment, incarceration, sex work, and difficulty accessing housing (all p<0.05) either significantly facilitated or hindered housing transitions. Findings highlight the importance of external structural factors in shaping youth's housing status and point to opportunities to improve the housing stability of vulnerable youth.
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Horyniak D, Higgs P, Jenkinson R, Degenhardt L, Stoové M, Kerr T, Hickman M, Aitken C, Dietze P. Establishing the Melbourne Injecting Drug User Cohort Study (MIX): rationale, methods, and baseline and twelve-month follow-up results. Harm Reduct J 2013; 10:11. [PMID: 23786848 PMCID: PMC3691755 DOI: 10.1186/1477-7517-10-11] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/14/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cohort studies provide an excellent opportunity to monitor changes in behaviour and disease transmission over time. In Australia, cohort studies of people who inject drugs (PWID) have generally focused on older, in-treatment injectors, with only limited outcome measure data collected. In this study we specifically sought to recruit a sample of younger, largely out-of-treatment PWID, in order to study the trajectories of their drug use over time. METHODS Respondent driven sampling, traditional snowball sampling and street outreach methods were used to recruit heroin and amphetamine injectors from one outer-urban and two inner-urban regions of Melbourne, Australia. Information was collected on participants' demographic and social characteristics, drug use characteristics, drug market access patterns, health and social functioning, and health service utilisation. Participants are followed-up on an annual basis. RESULTS 688 PWID were recruited into the study. At baseline, the median age of participants was 27.6 years (IQR: 24.4 years - 29.6 years) and two-thirds (67%) were male. Participants reported injecting for a median of 10.2 years (range: 1.5 months - 21.2 years), with 11% having injected for three years or less. Limited education, unemployment and previous incarceration were common. The majority of participants (82%) reported recent heroin injection, and one third reported being enrolled in Opioid Substitution Therapy (OST) at recruitment. At 12 months follow-up 458 participants (71% of eligible participants) were retained in the study. There were few differences in demographic and drug-use characteristics of those lost to follow-up compared with those retained in the study, with attrition significantly associated with recruitment at an inner-urban location, male gender, and providing incomplete contact information at baseline. CONCLUSIONS Our efforts to recruit a sample of largely out-of-treatment PWID were limited by drug market characteristics at the time, where fluctuating heroin availability has led to large numbers of PWID accessing low-threshold OST. Nevertheless, this study of Australian injectors will provide valuable data on the natural history of drug use, along with risk and protective factors for adverse health outcomes associated with injecting drug use. Comprehensive follow-up procedures have led to good participant retention and limited attrition bias.
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Affiliation(s)
- Danielle Horyniak
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia.
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Hull M, Klein M, Shafran S, Tseng A, Giguère P, Côté P, Poliquin M, Cooper C. CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian guidelines for management and treatment of HIV/hepatitis C coinfection in adults. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2013; 24:217-38. [PMID: 24489565 PMCID: PMC3905006 DOI: 10.1155/2013/781410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV-HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens. OBJECTIVE To develop national standards for the management of HCV-HIV coinfected adults in the Canadian context. METHODS A panel with specific clinical expertise in HIV-HCV co-infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality-of-evidence scale. RESULTS All HIV-HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight-based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2-6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients. DISCUSSION Recommendations may not supersede individual clinical judgement.
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Affiliation(s)
- Mark Hull
- University of British Columbia, British Columbia Centre for Excellent in HIV/AIDS, Vancouver, British Columbia
| | | | | | | | | | - Pierre Côté
- Clinique médicale du Quartier Latin, Montréal, Quebec
| | - Marc Poliquin
- Clinique médicale du Quartier Latin, Montréal, Quebec
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Morozova O, Azbel L, Grishaev Y, Dvoryak S, Wickersham JA, Altice FL. Ukrainian prisoners and community reentry challenges: implications for transitional care. Int J Prison Health 2013; 9:5-19. [PMID: 25152767 PMCID: PMC4138714 DOI: 10.1108/17449201311310760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The study aims to assess reentry challenges faced by Ukrainian prisoners and to determine the factors associated with having a greater number of challenges in order to suggest pre- and post-release interventions with the aim of facilitating community reintegration. DESIGN/METHODOLOGY/APPROACH A representative national cross-sectional study with a sample size of 402 prisoners was conducted among imprisoned adults within six months of release. The study consisted of interviews and biological testing for infectious diseases. Anticipated reentry challenges were assessed using a structured questionnaire. FINDINGS The most difficult and relatively important challenges identified were finding a job or a stable source of income and staying out of prison following release. Risk-specific challenges pertinent to drug users and HIV-infected individuals were assessed as difficult, but generally less important. Similarly, challenges associated with reducing drug relapse were ranked as less important, with only 0.6 percent identifying opioid substitution therapy as a helpful measure. In the multivariate analysis, having a greater number of challenges is associated with previous incarcerations, drug use immediately before incarceration and lower levels of social support. PRACTICAL IMPLICATIONS To facilitate community re-integration, it is vital to design interventions aimed at reducing recidivism and improvement of social support through comprehensive case management as well as to improve understanding about and address drug dependence issues among inmates by implementing evidence-based treatment both within prisons and after release. ORIGINALITY/VALUE This is the first comprehensive assessment of community reentry challenges by prisoners in the former Soviet Union.
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Affiliation(s)
- Olga Morozova
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
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Kinner SA, Jenkinson R, Gouillou M, Milloy MJ. High-risk drug-use practices among a large sample of Australian prisoners. Drug Alcohol Depend 2012; 126:156-60. [PMID: 22658284 DOI: 10.1016/j.drugalcdep.2012.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. METHODS Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. RESULTS We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95% CI 1.83-5.12), being unemployed prior to incarceration (ARR=1.34, 95% CI 1.01-1.76), use of three or more drug types prior to incarceration (ARR=1.80, 95% CI 1.40-2.31), a history of needle/syringe sharing (ARR=5.00, 95% CI 3.06-8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95% CI 1.67-2.86) and HCV exposure (ARR=1.47, 95% CI 1.08-2.02). Older age was protective (ARR=0.90 per 5 years older, 95% CI 0.83-0.99). CONCLUSION Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.
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Police confrontations among street-involved youth in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:46-51. [PMID: 22883543 DOI: 10.1016/j.drugpo.2012.06.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 06/21/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Street-level policing has been recognized as a driver of health-related harms among people who inject drugs (IDU). However, the extent of interaction between police and street-involved youth has not been well characterized. We examined the incidence and risk factors for police confrontations among street-involved youth in a Canadian setting. METHODS Using data derived from participants enrolled in the At-Risk Youth Study (ARYS) between 2005 and 2011, we assessed factors associated with being stopped, searched, or detained by police without arrest in the previous six months using generalized estimating equations (GEE) with logit link for binary outcomes. RESULTS Among 991 participants followed during the study period, 440 (44.4%) reported being stopped, searched, or detained by police for an incidence density of 49.20 (95% confidence interval [CI]: 36.42-65.01) per 100 person years. In multivariate GEE analyses, factors associated with police confrontations included: male gender (adjusted odds ratio [AOR]=1.35), homelessness (AOR=2.05), recent incarceration (AOR=1.78), daily cannabis use (AOR=1.31), daily heroin injecting (AOR=1.36), crack pipe/syringe sharing (AOR=1.61), injection drug use (AOR=1.37), public drug use (AOR=2.19), sex work involvement (AOR=1.67), and drug dealing (AOR=1.49) (all p<0.05). In total, 19.0% of participants reported that police confiscated their drug paraphernalia without arresting them. Additionally, 16.9% of individuals reported experiencing violence at the hands of police. CONCLUSION We found that various factors, such as homelessness and markers of more severe addiction, increased the likelihood of being confronted by police, and police confrontations were associated with markers of health-related harm among street youth. These findings highlight the need for social and structural interventions that best enable police to fulfil public safety and public order objectives without negatively influencing health behaviours of street youth.
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Small D. Canada's highest court unchains injection drug users; implications for harm reduction as standard of healthcare. Harm Reduct J 2012; 9:34. [PMID: 22817679 PMCID: PMC3492113 DOI: 10.1186/1477-7517-9-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 07/04/2012] [Indexed: 11/23/2022] Open
Abstract
North America’s only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS), the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights). The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system.
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Affiliation(s)
- Dan Small
- PHS Community Services Society, 20 West Hastings Street, Vancouver, British Columbia, V6B 1G6, Canada.
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Kinner SA, Dietze PM, Gouillou M, Alati R. Prevalence and correlates of alcohol dependence in adult prisoners vary according to Indigenous status. Aust N Z J Public Health 2012. [DOI: 10.1111/j.1753-6405.2012.00884.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Small W, Moore D, Shoveller J, Wood E, Kerr T. Perceptions of risk and safety within injection settings: Injection drug users' reasons for attending a supervised injecting facility in Vancouver, Canada. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.680950] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. J Acquir Immune Defic Syndr 2012; 59:393-9. [PMID: 22134149 DOI: 10.1097/qai.0b013e3182433288] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Evidence is needed to improve HIV treatment outcomes for individuals who use injection drugs (IDU). Although studies have suggested higher rates of plasma viral load (PVL) rebound among IDU on antiretroviral therapy (ART), risk factors for rebound have not been thoroughly investigated. METHODS We used data from a long-running community-recruited prospective cohort of IDU in Vancouver, Canada, linked to comprehensive ART and clinical monitoring records. Using proportional hazards methods, we modeled the time to confirmed PVL rebound above 1000 copies per milliliter among IDU on ART with sustained viral suppression, defined as 2 consecutive undetectable PVL measures. RESULTS Between 1996 and 2009, 277 individuals had sustained viral suppression. Over a median follow-up of 32 months, 125 participants (45.1%) experienced at least 1 episode of virologic failure for an incidence of 12.6 [95% confidence interval (CI): 10.5 to 15.0] per 100 person-years. In a multivariate model, PVL rebound was independently associated with sex-trade involvement [adjusted hazard ratio (AHR) = 1.40, 95% CI: 1.08 to 1.82) and recent incarceration (AHR = 1.83, 95% CI: 1.33 to 2.52). Methadone maintenance therapy (AHR = 0.79, 95% CI: 0.66 to 0.94) was protective. No measure of illicit drug use was predictive. CONCLUSIONS In this setting of free ART, several social and environmental factors predicted higher risks of viral rebound among IDU, including sex-trade involvement and incarceration. These findings should help inform efforts to identify individuals at risk of viral rebound and targeted interventions to treat and retain individuals in effective ART.
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Peña-Orellana M, Hernández-Viver A, Caraballo-Correa G, Albizu-García CE. Prevalence of HCV risk behaviors among prison inmates: tattooing and injection drug use. J Health Care Poor Underserved 2011; 22:962-82. [PMID: 21841290 DOI: 10.1353/hpu.2011.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus (HCV) is the most common blood-borne chronic viral infection in the United States and it is over represented in incarcerated populations. This study estimates if in prison tattooing is associated with self reported HCV infection in a probabilistic sample of 1,331 sentenced inmates in Puerto Rico prisons anonymously surveyed in 2004, who had previously been tested for HCV. Analysis were carried out with the total sample and among non-injectors (n=796) to control for injection drug use (IDU) and other confounders. Nearly 60% of inmates had acquired tattoos in prison. HCV was reported by 27% of subjects in the total sample and by 12% of non-injectors who had undergone tattoos in prison. IDU was the strongest predictor of HCV in the total sample (OR=5.6, 95% CI=3.2-9.7). Among non injectors, tattooing with reused needles or sharp objects and/ or reusing ink was positively associated with HCV self-report (OR=2.6, 95% CI=1.3-5.5). Tattooing is a common occurrence in this prison setting. Findings suggest that preventive interventions are required to reduce the risk of HCV transmission through unsterile tattooing and injection practices.
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Affiliation(s)
- Marisol Peña-Orellana
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Milloy MJ, Wood E, Lloyd-Smith E, Grafstein E, Tyndall M, Montaner J, Kerr T. Recent incarceration linked to cutaneous injection-related infections among active injection drug users in a Canadian setting. J Community Health 2011; 35:660-6. [PMID: 20364303 DOI: 10.1007/s10900-010-9269-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous injection-related infections (CIRI), such as abscesses and cellulitis, are the cause of a substantial burden of morbidity and mortality among injection drug users (IDU). The possible contribution of exposure to correctional environments to CIRI risk has not been fully investigated. Thus, we sought to test the possible relationship between incarceration and CIRI using data from a community-based sample of IDU. Data for these analyses was from the Scientific Evaluation of Supervised Injecting (SEOSI) cohort, linked with administrative records of a local ED in Vancouver, Canada. Using longitudinal analysis we assessed the relationship between the number of ED visits for CIRI care and recent incarceration in a multivariate model including information on possible confounders. Between June 2004 and December 2006, 901 individuals were eligible for our analysis. Of these, 214 (9.6%) visited the ED for CIRI care at least once during the study period. The incidence of ED care for CIRI was 72.9 per 100 person years. In a multivariate model, recent incarceration was associated with a greater number of ED visits for CIRI care (adjusted relative rate = 1.56, 95% confidence interval: 1.31-1.85, P < 0.001). The need for ED treatment for CIRI was common among a sample of local IDU. Exposure to correctional environments was an independent risk factor for visiting the ED for CIRI care, suggesting improvements in infection control in local prisons is urgently needed.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Stockman JK, Strathdee SA. HIV among people who use drugs: a global perspective of populations at risk. J Acquir Immune Defic Syndr 2010; 55 Suppl 1:S17-22. [PMID: 21045594 PMCID: PMC3059238 DOI: 10.1097/qai.0b013e3181f9c04c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article examines the epidemiology of HIV among selected subgroups of drug users around the world who are "most at risk"--men who have sex with men, female sex workers, prisoners, and mobile populations. The underlying determinants of HIV infection among these populations include stigma, physical and sexual violence, mental illness, social marginalization, and economic vulnerability. HIV interventions must reach beyond specific risk groups and individuals to address the micro-level and macro-level determinants that shape their risk environments. Public health interventions that focus on the physical, social, and health policy environments that influence HIV risk-taking in various settings are significantly more likely to impact the incidence of HIV and other blood-borne and sexually transmitted infections across larger population groups.
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Affiliation(s)
- Jamila K Stockman
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
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Small D. An appeal to humanity: legal victory in favour of North America's only supervised injection facility: Insite. Harm Reduct J 2010; 7:23. [PMID: 20932338 PMCID: PMC2959029 DOI: 10.1186/1477-7517-7-23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/09/2010] [Indexed: 11/23/2022] Open
Abstract
Canada's federal government has once again failed to shut North America's only authorized supervised injection facility: Insite. A majority ruling issued by the BC Court of Appeal on 15 January 2010 upheld an earlier British Columbia Supreme Court ruling in 2008 that protected the rights of injection drug users (IDUs) to access Insite as a health facility as per the Charter of Rights and Freedoms component of the Constitution of Canada. The majority decision from Honourable Madam Justices Rowles, Huddart and Smith also established a jurisdictional victory safeguarding Insite as most appropriately run under the authority of the province of British Columbia rather than the federal Government of Canada. The Federal Government has appealed the case to the Supreme Court of Canada. A hearing date has been set for 12 May 2011. The appeal will be a legal one but even more so, it will be an appeal to humanity.
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Affiliation(s)
- Dan Small
- Director PHS Community Services Society Vancouver, Canada.
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Milloy MJS, Kerr T, Zhang R, Tyndall M, Montaner J, Wood E. Inability to access addiction treatment and risk of HIV infection among injection drug users recruited from a supervised injection facility. J Public Health (Oxf) 2010; 32:342-9. [PMID: 19776079 PMCID: PMC3143434 DOI: 10.1093/pubmed/fdp089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment for drug addiction is effective in reducing the harms of injection drug use, including infection with HIV and/or hepatitis C. We sought to examine the prevalence and correlates of being unable to access addiction treatment in a representative sample of injection drug users randomly recruited from a supervised injection facility. METHODS Using generalized estimating equations, we determined the prevalence and factors associated with being unable to access addiction treatment. RESULTS Between 1 July 2004 and 30 June 2006, 889 individuals completed at least one interview and were included in this analysis. At each interview, approximately 20% of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months. Being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. In a secondary question, the majority of individuals reported waiting lists were the reason for being unable to access treatment. CONCLUSION Given the independent association between inability to access addiction treatment and elevated HIV risk behavior, these results suggest expanding addiction treatment may contribute significantly to HIV prevention efforts in this population.
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Affiliation(s)
- M-J S Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
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