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Gehring ND, Speed KA, Launier K, O'Brien D, Campbell S, Hyshka E. The state of science on including inhalation within supervised consumption services: A scoping review of academic and grey literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103589. [DOI: 10.1016/j.drugpo.2022.103589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/09/2023]
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2
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Kidorf M, Brooner RK, Yan H, Peirce J. Sexual-risk reduction following the referral of syringe exchange registrants to methadone maintenance: Impact of gender and drug use. J Subst Abuse Treat 2021; 124:108286. [PMID: 33771283 DOI: 10.1016/j.jsat.2021.108286] [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: 06/11/2020] [Revised: 12/06/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
This study evaluates the impact of enrolling syringe exchange registrants in methadone maintenance on change in sexual-risk behaviors. Baltimore Needle Exchange Program (BNEP) registrants (n = 210) participated in a parent study evaluating strategies for initiating methadone maintenance treatment and the study followed them for six months. Study staff administered the Risk Assessment Battery (RAB; Metzger, 1993) monthly throughout treatment. Staff conducted urinalysis testing weekly. Results showed that treatment enrollment reduced sexual-risk behaviors at month 1, though a longer treatment duration provided no further reductions in risky behaviors. Women reported higher levels of sexual risk throughout the observation period, and the use of cocaine diminished risk-reduction benefits. These findings demonstrate that participation in methadone maintenance reduces sexual-risk behaviors in syringe exchange registrants. Efforts to help more patients reduce cocaine use, and to help women address gender-specific psychosocial vulnerabilities, may further reduce risky behaviors during the treatment episode.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States of America.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States of America
| | - Haijuan Yan
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States of America
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States of America
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Kidorf M, Brooner RK, Leoutsakos JM, Peirce J. Reducing Risky Drug Use Behaviors by Enrolling Syringe Exchange Registrants in Methadone Maintenance. Subst Use Misuse 2021; 56:546-551. [PMID: 33616479 DOI: 10.1080/10826084.2021.1887253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Referral of syringe exchange registrants with opioid use disorder to agonist treatment provides a pathway to further reduce drug use risk behaviors. Objective: This study evaluates the drug use risk reduction benefits of enrolling syringe exchange registrants in methadone maintenance, and the impact of continued illicit drug use on risk reduction. Method: Baltimore Needle Exchange Program (BNEP) registrants (n = 210) participated in a parent study evaluating treatment initiation strategies for methadone maintenance and were followed for six months. The Risk Assessment Battery (RAB; Metzger, 1993) was administered monthly to evaluate drug use risks; urinalysis testing was conducted weekly. Results: Treatment enrollment reduced drug use risk behaviors, and longer treatment episodes resulted in additional, though modest, risk reduction. Use of opioids or cocaine in treatment diminished risk-reduction benefits, though drug use risks declined over time and remained well below baseline levels. Conclusions: These findings demonstrate that methadone maintenance enhances the well-known risk-reduction benefits of syringe exchange participation. Improving coordination between syringe exchanges and treatment facilities may enhance the public health.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Clingan SE, Fisher DG, Reynolds GL, Janson MA, Rannalli DA, Huckabay L, Nguyen HHD. Survival Sex Trading in Los Angeles County, California, USA. JOURNAL OF SEX RESEARCH 2020; 57:943-952. [PMID: 31902245 PMCID: PMC7334079 DOI: 10.1080/00224499.2019.1703885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most studies on survival sex, defined as sex trading for money, drugs, or other needs, have limited their focus to adolescents. The current study reports about the relationships between survival sex trading (SST) and high-risk behaviors in a sample of adults. Bivariate analysis shows that HIV-positive status, use of cocaine, ketamine, methamphetamine, heroin, having received drug treatment, and having received medical services are associated with SST. SST are more likely to not use condoms with partners other than their main partner, to have partners who inject drugs and are more likely to use drugs with sex. A logistic regression model included unwanted sexual touching, partner abuse, identifying as bisexual, African American, higher age, gender (women more likely), homelessness, a higher number of sexual partners, having anal sex, injection drug use, HIV seropositivity, crack use, and the likelihood of injecting drugs. The model was retested on independently collected Risk Behavior Assessment (RBA) data and showed significant relationships between survival sex and crack use, gender (women more likely), HIV positivity, identifying as bisexual, having anal sex, African American, and a higher number of sex partners. These findings make it imperative to integrate victimization counseling and HIV education into substance abuse treatment programs.
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Affiliation(s)
- Sarah E Clingan
- Joint Doctoral Program, Interdisciplinary Research on Substance Use, San Diego State University/University of California San Diego
| | - Dennis G Fisher
- Center for Behavioral Research and Services, and Psychology Department, California State University
| | - Grace L Reynolds
- Center for Behavioral Research and Services, and Department of Health Care Administration, California State University
| | - Michael A Janson
- Division of HIV and STD Programs, Los Angeles County Department of Public Health
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5
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Pan Y, Metsch LR, Wang W, Philbin M, Kyle TL, Gooden LK, Feaster DJ. The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors Among People Currently Seeking or Receiving Services in Substance Use Disorder Treatment Programs. J Prim Prev 2020; 41:363-382. [PMID: 32617888 PMCID: PMC7384551 DOI: 10.1007/s10935-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although HIV risk behaviors such as substance use and condomless sex are prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population have not been well studied. We examined the associations between housing status, substance use and HIV-related sexual risk behaviors among 1281 participants from 12 US community-based SUD programs. In addition, substance use was examined as a potential mediator of the relationship between housing status and sexual risk behaviors. We conducted Chi-square, univariate and multivariate logistic regression models on data from the National Drug Abuse Treatment Clinical Trials Network HIV Rapid Testing and Counseling study. Path analysis was used to test the mediation and indirect effects. Unstable housing was significantly associated with having multiple concurrent condomless sex partners, condomless sex with non-primary partners, and partners of unknown HIV serostatus. Homelessness was significantly associated with condomless vaginal sex and condomless sex with any substance use. The path between unstable housing and sexual risk behaviors was mediated by problematic drug use, particularly by cocaine, opioids, and marijuana use. Because housing status impacts HIV risk behaviors for individuals in SUD treatment programs, both housing status and substance use behaviors should be assessed upon program entry in order to identify and mitigate risk behaviors.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Center for Research on US Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Morgan Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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Dressel A, Hawkins M, Lopez AA, Pittman-McGee B, Kako P, Gakii D, Mkandawire-Valhmu L. Nia Imani Model of Care's Impact on Homeless African-American Women. West J Nurs Res 2020; 42:1059-1067. [PMID: 32419671 DOI: 10.1177/0193945920922497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative study assessed the impact of the Nia Imani model of care on homeless African-American women, many of whom abused drugs, experienced interpersonal violence, and faced other challenges when seeking to improve their lives and health. Nia Imani Family, Inc., is Milwaukee, Wisconsin's, only long-term transitional living facility. Grounded in Black feminist thought, our study included focus group interviews with 39 women who had lived at Nia Imani, and successfully completed its programs; and one individual interview with the founder, who had also experienced homelessness (N=40). Themes were identified through thematic analysis, and included the following: crucial social support, learning self-worth, stability and structure, appreciation for strict rules, and importance of parenting and financial literacy classes. To ensure effective interventions, there is a need for nurses to understand how community-based and community-led programs, like Nia Imani, impact the health and well-being of African-American women, who have experienced homelessness.
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Affiliation(s)
- Anne Dressel
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maren Hawkins
- Joseph J. Zilber School of Public Health University of Wisconsin-Milwaukee, Milwaukee, USA
| | - Alexa A Lopez
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Peninnah Kako
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Dorothy Gakii
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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de Guglielmo G, Fu Y, Chen J, Larrosa E, Hoang I, Kawamura T, Lorrai I, Zorman B, Bryant J, George O, Sumazin P, Lefebvre C, Repunte-Canonigo V, Sanna PP. Increases in compulsivity, inflammation, and neural injury in HIV transgenic rats with escalated methamphetamine self-administration under extended-access conditions. Brain Res 2020; 1726:146502. [PMID: 31605699 PMCID: PMC7195807 DOI: 10.1016/j.brainres.2019.146502] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/16/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
The abuse of stimulants, such as methamphetamine (METH), is associated with treatment non-compliance, a greater risk of viral transmission, and the more rapid clinical progression of immunological and central nervous system human immunodeficiency virus (HIV) disease. The behavioral effects of METH in the setting of HIV remain largely uncharacterized. We used a state-of-the-art paradigm of the escalation of voluntary intravenous drug self-administration in HIV transgenic (Tg) and wildtype rats. The rats were first allowed to self-administer METH under short-access (ShA) conditions, which is characterized by a nondependent and more "recreational" pattern of METH use, and then allowed to self-administer METH under long-access (LgA) conditions, which leads to compulsive (dependent) METH intake. HIV Tg and wildtype rats self-administered equal amounts of METH under ShA conditions. HIV Tg rats self-administered METH under LgA conditions following a 4-week enforced abstinence period to model the intermittent pattern of stimulant abuse in humans. These HIV Tg rats developed greater motivation to self-administer METH and self-administered larger amounts of METH. Impairments in function of the medial prefrontal cortex (mPFC) contribute to compulsive drug and alcohol intake. Gene expression profiling of the mPFC in HIV Tg rats with a history of escalated METH self-administration under LgA conditions showed transcriptional evidence of increased inflammation, greater neural injury, and impaired aerobic glucose metabolism than wildtype rats that self-administered METH under LgA conditions. The detrimental effects of the interaction between neuroHIV and escalated METH intake on the mPFC are likely key factors in the greater vulnerability to excessive drug intake in the setting of HIV.
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Affiliation(s)
- Giordano de Guglielmo
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Yu Fu
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA; European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - Jihuan Chen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Estefania Larrosa
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ivy Hoang
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Tomoya Kawamura
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Irene Lorrai
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA; Department of Biomedical Sciences, University of Cagliari, Monserrato, Cagliari, Italy
| | - Barry Zorman
- Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Bryant
- University of Maryland and Institute of Human Virology, Baltimore, MD, United States
| | - Olivier George
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Pavel Sumazin
- Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Celine Lefebvre
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA; Bioinformatics and Computational Biology, Servier, Paris, France
| | - Vez Repunte-Canonigo
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA.
| | - Pietro Paolo Sanna
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA.
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de Vet R, Beijersbergen MD, Lako DAM, van Hemert AM, Herman DB, Wolf JRLM. Differences between homeless women and men before and after the transition from shelter to community living: A longitudinal analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1193-1203. [PMID: 30989763 PMCID: PMC6850267 DOI: 10.1111/hsc.12752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/14/2019] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
Social quality is the extent to which people are able to participate in social relationships under conditions which enhance their well-being, capacities and potential and enables them to shape their own circumstances and contribute to societal development. We assessed whether women in homeless shelters differed from men on social quality factors that constitute the quality of their daily life and whether factor scores changed at a different rate for women and men after shelter exit. Data were collected as part of a randomised controlled trial. In 18 shelters across the Netherlands, 183 participants were recruited between December 2010 and December 2012 and followed for 9 months. Adults were eligible if they were about to move from shelter to (supported) independent housing and their shelter stay had been shorter than 14 months. At baseline, women were significantly younger than men. They were more likely to have children, to have minor children staying with them, to be lower educated, to be unemployed and to have been victimised than men. Women had used more services and reported lower self-esteem, less satisfaction with health and empowerment and higher psychological distress. They were less likely than men to have used alcohol excessively or cannabis. We found no significant differences between women and men in changes over time on the social quality factors. As women were disadvantaged at baseline compared to men regarding many factors, we concluded that women in homeless shelters are a particularly vulnerable group. Moreover, an opportunity remains for shelter services to improve women's social quality during and after their shelter stay.
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Affiliation(s)
- Renée de Vet
- Impuls ‐ Netherlands Center for Social Care Research, Radboud Institute for Health SciencesRadboud university medical centerNijmegenthe Netherlands
| | - Mariëlle D. Beijersbergen
- Impuls ‐ Netherlands Center for Social Care Research, Radboud Institute for Health SciencesRadboud university medical centerNijmegenthe Netherlands
| | - Danielle A. M. Lako
- Impuls ‐ Netherlands Center for Social Care Research, Radboud Institute for Health SciencesRadboud university medical centerNijmegenthe Netherlands
- Research Centre for Social InnovationHU University of Applied Sciences UtrechtUtrechtthe Netherlands
| | | | - Daniel B. Herman
- Silberman School of Social Work at Hunter CollegeCity University of New YorkNew YorkNew York
| | - Judith R. L. M. Wolf
- Impuls ‐ Netherlands Center for Social Care Research, Radboud Institute for Health SciencesRadboud university medical centerNijmegenthe Netherlands
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Hahn AM, Simons RM, Simons JS, Wiers RW, Welker LE. Can cognitive bias modification simultaneously target two behaviors? Approach bias retraining for alcohol and condom use. Clin Psychol Sci 2019; 7:1078-1093. [PMID: 31890350 DOI: 10.1177/2167702619834570] [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] [Indexed: 11/15/2022]
Abstract
This study tested the effectiveness of a cognitive bias modification (CBM) intervention to simultaneously reduce approach biases toward alcohol and increase approach biases toward condoms among high-risk young adults. Participants (N = 102) were randomly assigned to either a training condition or a sham-training condition. Participants in the training condition were trained to make avoidance movements away from alcohol stimuli and approach movements toward condom stimuli over four training sessions. Approach biases and behavior were assessed at pretest, posttest, and 3-month follow-up. Approach biases changed for both stimulus categories in accordance with training condition. Condom behavior and attitudes also changed as a function of training condition, such that participants in the training condition reported fewer instances of condom nonuse and a more positive attitudes toward condoms at a three-month follow-up. Participants in both conditions had significant reductions in alcohol consumption following the intervention and did not differ by training condition.
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Affiliation(s)
- Austin M Hahn
- Department of Psychology, University of South Dakota
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10
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Coupland H, Page K, Stein E, Carrico A, Evans J, Dixon T, Sokunny M, Phou M, Maher L. Structural interventions and social suffering: Responding to amphetamine-type stimulant use among female entertainment and sex workers in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 64:70-78. [PMID: 30583088 DOI: 10.1016/j.drugpo.2018.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. METHODS Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. RESULTS In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. CONCLUSION In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
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Affiliation(s)
- Heidi Coupland
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; Drug Health Services, Sydney Local Health District & Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Centre, Albuquerque, NM, USA.
| | - Ellen Stein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, Florida, USA.
| | - Jennifer Evans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Thomas Dixon
- Faculty of Law, The University of Sydney, Sydney, Australia.
| | | | - Maly Phou
- FHI360 Cambodia, Phnom Penh, Cambodia.
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; The Burnet Institute, Melbourne, Australia.
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Carney T, Myers B, Kline TL, Johnson K, Wechsberg WM. Aggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence. BMC WOMENS HEALTH 2017; 17:93. [PMID: 28964269 PMCID: PMC5622560 DOI: 10.1186/s12905-017-0447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/20/2017] [Indexed: 11/10/2022]
Abstract
Background Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. Method This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. Results Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). Conclusions The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.
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Affiliation(s)
- Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. .,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tracy L Kline
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Wendee M Wechsberg
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,RTI Gender Global Gender Center, Research Triangle Park, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,Health, Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA.,Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.,Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
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12
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Kim JE, Flentje A, Tsoh JY, Riley ED. Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 2017; 94:514-524. [PMID: 28589340 PMCID: PMC5533665 DOI: 10.1007/s11524-017-0166-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR = 1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.
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Affiliation(s)
- Jin E Kim
- University of California San Francisco, San Francisco, CA, USA.
| | - Annesa Flentje
- University of California San Francisco, San Francisco, CA, USA
| | - Janice Y Tsoh
- University of California San Francisco, San Francisco, CA, USA
| | - Elise D Riley
- University of California San Francisco, San Francisco, CA, USA
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13
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Morgan E, Nyaku AN, D’Aquila RT, Schneider JA. Determinants of HIV Phylogenetic Clustering in Chicago Among Young Black Men Who Have Sex With Men From the uConnect Cohort. J Acquir Immune Defic Syndr 2017; 75:265-270. [PMID: 28328553 PMCID: PMC5472497 DOI: 10.1097/qai.0000000000001379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Phylogenetic analysis determines similarities among HIV genetic sequences from persons infected with HIV, identifying clusters of transmission. We determined characteristics associated with both membership in an HIV transmission cluster and the number of clustered sequences among a cohort of young black men who have sex with men (YBMSM) in Chicago. METHODS Pairwise genetic distances of HIV-1 pol sequences were collected during 2013-2016. Potential transmission ties were identified among HIV-infected persons whose sequences were ≤1.5% genetically distant. Putative transmission pairs were defined as ≥1 tie to another sequence. We then determined demographic and risk attributes associated with both membership in an HIV transmission cluster and the number of ties to the sequences from other persons in the cluster. RESULTS Of 86 available sequences, 31 (36.0%) were tied to ≥1 other sequence. Through multivariable analyses, we determined that those who reported symptoms of depression and those who had a higher number of confidants in their network had significantly decreased odds of membership in transmission clusters. We found that those who had unstable housing and who reported heavy marijuana use had significantly more ties to other individuals within transmission clusters, whereas those identifying as bisexual, those participating in group sex, and those with higher numbers of sexual partners had significantly fewer ties. CONCLUSIONS This study demonstrates the potential for combining phylogenetic and individual and network attributes to target HIV control efforts to persons with potentially higher transmission risk, as well as suggesting some unappreciated specific predictors of transmission risk among YBMSM in Chicago for future study.
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Affiliation(s)
- Ethan Morgan
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - Amesika N Nyaku
- Department of Medicine, Northwestern University, Chicago, USA
| | | | - John A Schneider
- Department of Public Health Sciences, University of Chicago, Chicago, USA
- Department of Medicine, University of Chicago, Chicago, USA
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14
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Davis A, Jiwatram-Negrón T, Primbetova S, Terlikbayeva A, Bilokon Y, Chubukova L, El-Bassel N. Multi-level risk factors associated with sex trading among women living with HIV in Kazakhstan: A neglected key population. Int J STD AIDS 2017; 28:1397-1404. [PMID: 28492343 DOI: 10.1177/0956462417708678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Little is known about the prevalence and risk factors associated with sex trading among HIV-positive women. A total of 242 HIV-positive women were recruited in five regions in Kazakhstan. These women completed a survey containing items on socio-demographics, HIV stigma, intimate partner violence, and partner risk behaviors. Multivariate regression was used to examine associations between risk factors and sex trading after controlling for socio-demographic factors. Fifty-six (23.1%) women reported trading sex in the past 90 days. Women who reported recent sex trading were more likely than women who did not trade sex in the past 90 days to experience intimate partner violence (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.08-4.73), to have been homeless in the past 90 days (AOR: 4.12; 95% CI: 1.19-14.29), and to know or suspect a male partner had a sexually transmitted infection (AOR: 2.20; 95% CI: 1.07-4.53), had sex with another partner (AOR: 4.53; 95% CI: 2.25-9.14), or injected drugs in the past year (AOR: 3.31; 95% CI: 1.64-6.65). These findings underscore the need for comprehensive HIV prevention and intervention programs that address the multi-level risk factors associated with sex trading for women infected with HIV.
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Affiliation(s)
- Alissa Davis
- 1 HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, & Health, Columbia University, New York City, NY, USA.,2 New York State Psychiatric Institute, New York City, NY, USA.,3 Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Tina Jiwatram-Negrón
- 3 Global Health Research Center of Central Asia, Almaty, Kazakhstan.,4 School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Yelena Bilokon
- 5 Kazakhstan Network of Women Living with HIV, Almaty, Kazakhstan
| | - Lyubov Chubukova
- 5 Kazakhstan Network of Women Living with HIV, Almaty, Kazakhstan
| | - Nabila El-Bassel
- 3 Global Health Research Center of Central Asia, Almaty, Kazakhstan.,6 School of Social Work, Columbia University, New York City, NY, USA
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15
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Roy É, Arruda N, Jutras-Aswad D, Berbiche D, Perreault M, Bertrand K, Dufour M, Bruneau J. Examining the link between cocaine binging and individual, social and behavioral factors among street-based cocaine users. Addict Behav 2017; 68:66-72. [PMID: 28103534 DOI: 10.1016/j.addbeh.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 01/27/2023]
Abstract
AIMS To estimate the prevalence of cocaine binging and examine associated factors, to characterize binge episodes and to study the relationship between cocaine binging and HIV and HCV risk behaviors among street-based cocaine users. METHODS A prospective cohort study was conducted in Montréal, Canada. Interviewer-administered questionnaire were carried out at 3-month intervals. Cocaine binging was defined as using large quantities of cocaine, without stopping, over a limited period of time, until resources run out or until being physically incapable of consuming. Generalized Estimation Equations (GEE) analyses were used. Covariates considered included demographic, behavioral, mental health and social risk factors. FINDINGS In total, 605 participants were recruited. Prevalence of cocaine binging over the month prior to recruitment was 24.5%. Correlates of cocaine binging were older age (AOR 1.46), homelessness (AOR 1.44), criminal/marginal income strategies (AOR 1.61), high psychological distress (AOR 1.31), high cocaine dependence (AOR 3.71), drug overdoses (AOR 1.56) and smoking as the main route of cocaine administration (AOR 1.38). Additional GEE analyses showed that cocaine binging was significantly associated with the sharing of drug paraphernalia (AOR 1.35) and sexual relations under the influence of cocaine (AOR 1.21). CONCLUSION Cocaine binging is frequent among street-based cocaine users and is associated with markers of vulnerability. It is also associated with increased odds of both sexual and drug use risk behaviors. Interventions need to be tailored in order to help cocaine bingers develop personal strategies that could prevent binging. Harm reduction programs should help cocaine bingers adequately assess their drug equipment needs.
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16
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Jones DJ. HIV Risk-Reduction Strategies for Substance Abusers: Effecting Behavior Change. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403259246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Substance abuse has a strong link to HIV/AIDS in the United States. Use and abuse of alcohol and other drugs often reduce inhibitions and encourage engagement in high-risk sexual behaviors that can ultimately result in HIV and AIDS. The HIV/AIDS epidemic in the United States has disproportionately affected minorities with African Americans being the group hardest hit. This article presents some of the behavioral, social, and psychological factors that influence the risk for drug use. It highlights and assesses the effectiveness of HIV risk-reduction strategies developed for drug-using populations and makes recommendations for a more holistic and integrated approach utilizing multiple interventions at multiple levels.
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Affiliation(s)
- Dionne J. Jones
- National Institute on Drug Abuse, National Institutes of Health
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17
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Bowen EA. A Multilevel Ecological Model of HIV Risk for People Who Are Homeless or Unstably Housed and Who Use Drugs in the Urban United States. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:264-275. [PMID: 27093240 DOI: 10.1080/19371918.2015.1137511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Elevated HIV prevalence has been observed among urban U.S. individuals who use drugs and who lack stable housing. This article synthesizes extant research on this population and situates it in a multilevel, ecologically based model of HIV risk. Based on a multidisciplinary review of the literature, the model applies social-ecological theory on human development to identify factors shaping the HIV risk context for individuals who use drugs and who are unstably housed at global, societal, neighborhood, household, and individual levels of influence. At the global level, the model includes neoliberal ideologies contributing to the social inequalities that frame the HIV epidemic. U.S. housing and drug policy, including urban renewal, HOPE VI, and the War on Drugs, is the focus of the societal level. At the neighborhood level, mechanisms of the built environment and psychosocial mechanisms are explored for their salience to HIV risk. Research on the association between housing instability and HIV risk is reviewed at the household level. At the last level, relevant individual differences in biology, psychology, and cognition are discussed. Modeling risk at multiple levels of the environment underscores the need to expand the focus of research, treatment, and prevention interventions for HIV/AIDS and addictions beyond individuals and their risk behaviors to address facets of structural violence and incorporate the broader social, political, and economic contexts of risk and health.
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Affiliation(s)
- Elizabeth A Bowen
- a School of Social Work, University at Buffalo, State University of New York , Buffalo , New York , USA
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18
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Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2016; 36:295-304. [PMID: 27242102 DOI: 10.1111/dar.12427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/24/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care. DESIGN AND METHODS A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined. RESULTS Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs. DISCUSSION AND CONCLUSION Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304].
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Inner City Health and Wellness Program, 606-1 Community Services Centre, Royal Alexandra Hospital, Edmonton, Canada
| | - Jalene Tayler Anderson
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Human Geography Program, Department of Earth and Atmospheric Sciences, 1-26 Earth Sciences Building, University of Alberta, Edmonton, Canada
| | - T Cameron Wild
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
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19
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Wechsberg WM, Zule WA, El-Bassel N, Doherty IA, Minnis AM, Novak SD, Myers B, Carney T. The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township. Drug Alcohol Depend 2016; 161:307-15. [PMID: 26946991 PMCID: PMC5645020 DOI: 10.1016/j.drugalcdep.2016.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence. METHODS Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners. RESULTS At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm. CONCLUSIONS A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.
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Affiliation(s)
- Wendee M Wechsberg
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
| | - Irene A Doherty
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States
| | - Alexandra M Minnis
- RTI International, 351 California Street, San Francisco, CA, United States
| | - Scott D Novak
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tara Carney
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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20
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Riley ED, Shumway M, Knight KR, Guzman D, Cohen J, Weiser SD. Risk factors for stimulant use among homeless and unstably housed adult women. Drug Alcohol Depend 2015; 153:173-9. [PMID: 26070454 PMCID: PMC4510017 DOI: 10.1016/j.drugalcdep.2015.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND One of the most common causes of death among homeless and unstably housed women is acute intoxication where cocaine is present. While correlates of stimulant use have been determined in prior research, few studies have assessed risk factors of use specifically in this high-risk population. METHODS We sampled biological women with a history of housing instability from community-based venues to participate in a cohort study. Baseline and 6-month follow-up data were used to determine the relative risk of stimulant use (crack cocaine, powder cocaine or methamphetamine) among individuals who did not use at baseline. RESULTS Among 260 study participants, the median age was 47 years, 70% were women of color; 47% reported having unmet subsistence needs and 53% reported abstinence from stimulants at baseline. In analyses adjusting for baseline sociodemographics and drug treatment, the risk of using stimulants within 6 months was significantly higher among women who reported recent sexual violence (Adjusted Relative Risk [ARR]=4.31; 95% CI:1.97-9.45), sleeping in a shelter or public place (ARR=2.75; 95% CI:1.15-6.57), and using unprescribed opioid analgesics (ARR=2.54; 95% CI:1.01-6.38). CONCLUSION We found that almost half of homeless and unstably housed women used stimulants at baseline and 14% of those who did not use began within 6 months. Addressing homelessness and sexual violence is critical to reduce stimulant use among impoverished women.
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Affiliation(s)
- Elise D Riley
- School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Martha Shumway
- School of Medicine, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kelly R Knight
- School of Medicine, Department of Anthropology, History and Social Medicine, University of California, San Francisco, CA, USA
| | - David Guzman
- School of Medicine, Department of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Jennifer Cohen
- School of Medicine, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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21
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Wechsberg WM, Deren S, Myers B, Kirtadze I, Zule WA, Howard B, El-Bassel N. Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S128-39. [PMID: 25978479 PMCID: PMC4505613 DOI: 10.1097/qai.0000000000000627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, NC, USA
- University of North Carolina, Chapel Hill, NC, USA
- Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Irma Kirtadze
- Addiction Research Center, Alternative Georgia, Tbilisi, Georgia
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22
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Keen L, Khan M, Clifford L, Harrell PT, Latimer WW. Injection and non-injection drug use and infectious disease in Baltimore City: differences by race. Addict Behav 2014; 39:1325-8. [PMID: 24837755 PMCID: PMC4078397 DOI: 10.1016/j.addbeh.2014.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al., 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors. RESULTS 59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X(2) (2)=6.18, p=.015). CONCLUSIONS The current findings are consistent with trends in the recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors.
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Affiliation(s)
- Larry Keen
- Department of Clinical and Health Psychology, University of Florida, United States.
| | - Maria Khan
- Department of Epidemiology, University of Florida, United States
| | - Lisa Clifford
- Department of Clinical and Health Psychology, University of Florida, United States
| | - Paul T Harrell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, United States
| | - William W Latimer
- Department of Clinical and Health Psychology, University of Florida, United States
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23
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Outcomes of a behavioral intervention to reduce HIV risk among drug-involved female sex workers. AIDS Behav 2014; 18:726-39. [PMID: 24558098 DOI: 10.1007/s10461-014-0723-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives.
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24
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Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Lipman L, Burnett C, Fischer B. Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil. BMC Health Serv Res 2013; 13:536. [PMID: 24373346 PMCID: PMC3893546 DOI: 10.1186/1472-6963-13-536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/17/2013] [Indexed: 11/11/2022] Open
Abstract
Background Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil. Methods N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. Results The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.
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Affiliation(s)
| | | | | | | | | | | | | | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400 - 515 W Hasting St, Vancouver, BC V6B 5K3, Canada.
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25
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Neighbourhood structural characteristics and crack cocaine use: exploring the impact of perceived neighbourhood disorder on use among African Americans. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:616-23. [PMID: 24445119 DOI: 10.1016/j.drugpo.2013.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/11/2013] [Accepted: 12/06/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Crack cocaine use and associated negative social and health consequences remain a significant public health problem. Research that expands beyond the individual by considering the environmental context as a determinant of cocaine use is growing. The main objectives of this paper are to examine the effects of perceived neighbourhood disorder as an independent correlate of the frequency of recent crack cocaine use and whether its impact is mediated by use-related practices and social context of use among an African American adult sample in Atlanta (GA). METHODS Cross-sectional data were collected from 461 respondents who were recruited through active and passive community outreach from 70 disadvantaged urban neighbourhoods across Atlanta. Multivariable negative binomial regression was performed to assess the independent association of perceived neighbourhood disorder with crack cocaine use frequency and to explore potential mediation by use-related practices and social context of use. RESULTS Perceived neighbourhood disorder did not remain statistically significant after accounting for use-related practices and social context of use. Involvement in drug distribution and having traded sex were associated with increases in frequency of drug use, while using in safer places and using alone were associated with decreases in frequency of use. CONCLUSION The results show that perceived neighbourhood disorder is associated with frequency of crack cocaine use independently of socio-demographics. However, its significance was eliminated when controlling for use-related practices and the social context of use. Such practices and the social context of use may mediate the relationship between neighbourhood disorder and crack cocaine use. Future research is needed to more fully elucidate the links between individual and neighbourhood characteristics that are related to crack cocaine use and strategies to reduce use must consider the salience of use-related practices and the social context of use.
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26
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Montgomery AE, Cutuli JJ, Evans-Chase M, Treglia D, Culhane DP. Relationship among adverse childhood experiences, history of active military service, and adult outcomes: homelessness, mental health, and physical health. Am J Public Health 2013; 103 Suppl 2:S262-8. [PMID: 24148064 PMCID: PMC3969137 DOI: 10.2105/ajph.2013.301474] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined whether a report of adverse childhood experiences predicts adult outcomes related to homelessness, mental health, and physical health and whether participation in active military service influences the relationship between childhood and adult adversity. METHODS Using data from the 2010 Washington State Behavioral Risk Factor Surveillance System, we tested by means of logistic regression the relationship between adverse childhood experiences and 3 adult outcomes--homelessness, mental health, and physical health--as well as differences among those with a history of active military service. RESULTS Adverse childhood experiences separately predicted increased odds of experiencing homelessness as an adult and mental health and physical health problems. Childhood adversity increased the likelihood of adult homelessness and poor physical health among individuals with no history of active military service and the likelihood of mental health problems among individuals with a history of active military service. CONCLUSIONS The relationship between childhood adversity and adult adversity changes in degree when history of active military service is controlled, which has implications for Armed Forces recruitment strategies and postmilitary service risk assessment.
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Affiliation(s)
- Ann Elizabeth Montgomery
- Ann Elizabeth Montgomery, J. J. Cutuli, Michelle Evans-Chase, Dan Treglia, and Dennis P. Culhane are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dennis P. Culhane is also a guest editor for this supplement issue
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Cederbaum JA, Wenzel SL, Gilbert ML, Chereji E. The HIV risk reduction needs of homeless women in Los Angeles. Womens Health Issues 2013; 23:e167-72. [PMID: 23541392 DOI: 10.1016/j.whi.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Substance use, housing instability, and transactional sex all contribute to HIV risk engagement among homeless women. Because of the increased risk of HIV among homeless women, this study sought to understand the context of sexual behaviors and condom use among homeless women and elucidate modifiable factors that can be targeted by interventions. METHODS Homeless women (n = 45) participated in focus groups (n = 6) at shelters throughout Los Angeles County. Thematic analyses revealed that similar to other high-risk women, homeless women engage in sex with multiple types of partners (steady, casual, and transactional). FINDINGS Our findings indicate that, similar to use among other high-risk women, condom use by homeless women varied by type of partner. Substance use also contributed to condom non-use. In a departure from previous research, homeless women reported overarching feelings of hopelessness. Participants spoke of hopelessness contributing to risk engagement, specifically the number of ongoing stressors experienced because of homelessness contributing to despair. Without acknowledgement of this unique quality of homelessness, women felt their risk reduction needs would never truly be understood. CONCLUSIONS Interventions involving homeless women should include self-esteem building, acknowledgment and use of inherent resilience qualities gained during homelessness, respect for current knowledge and skills, and an exploration of when women choose to trust their partners and how they make safer sex choices.
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Affiliation(s)
- Julie A Cederbaum
- University of Southern California School of Social Work, Los Angeles, California 90089-0411, USA.
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MacMaster SA. Perceptions of need, service use, and barriers to service access among female methamphetamine users in rural Appalachia. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:109-18. [PMID: 23461346 DOI: 10.1080/19371918.2011.560820] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Active substance users have been characterized as ambivalent about accessing treatment services. Few studies have addressed the social context and related barriers that individuals experience in addressing substance abuse problems. These barriers appear to be heightened for female methamphetamine users living in rural areas of Appalachia. The purpose of this study is to document the willingness of active female methamphetamine users to access substance abuse treatment services, their ability to access substance abuse treatment services, and the barriers they experienced in accessing substance abuse treatment services. Findings from a sample of 153 rural female methamphetamine users revealed the majority of respondents met the criteria for substance dependence (99.3%), believed they had a drug problem (84.9%), believed they needed treatment services (62.9%), and wanted to go to treatment "now" (51.4%). However, only one fourth (26.8%) had accessed treatment, and many had experienced barriers in attempting to enter treatment services.
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Affiliation(s)
- Samuel A MacMaster
- College of Social Work, University of Tennessee, Nashville Campus, Nashville, Tennessee 37210, USA.
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Grieb SMD, Davey-Rothwell M, Latkin CA. Social and sexual network characteristics and concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS Behav 2012; 16:882-9. [PMID: 21861193 DOI: 10.1007/s10461-011-0030-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social networks, including sexual networks, have increasingly been considered in research addressing HIV disparities in the United States. The goal of this study is to examine correlates of concurrent involvement in multiple sexual partnerships with social (i.e., non-sexual) and sexual network characteristics among a sample of 337 low-income urban African American women reporting main sexual partnerships longer than 6 months in duration. In the multivariate analyses, women who had larger non-sexual social networks, more family members in that network, and reported high levels of trust in their partner(s) were less likely to be in concurrent partnerships. Women who had one or more sexual partner who used drugs in the past 6 months were more likely to be in concurrent partnerships. Our results provide further evidence of the important association of drug use and concurrent sexual partnerships, but suggest that family members, immediate and extended, may be an important area of focus in addition to structural interventions that address the root causes of poverty and drug abuse.
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Affiliation(s)
- Suzanne M Dolwick Grieb
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Trenz R, Penniman T, Scherer M, Zur J, Rose J, Latimer W. Problem recognition, intention to stop use, and treatment use among regular heroin injectors. J Subst Abuse Treat 2012; 43:204-10. [PMID: 22301081 DOI: 10.1016/j.jsat.2011.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 11/16/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022]
Abstract
This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.
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Affiliation(s)
- Rebecca Trenz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Wechsberg WM. Promising international interventions and treatment for women who use and abuse drugs: focusing on the issues through the InWomen's Group. Subst Abuse Rehabil 2012; 3:1-4. [PMID: 24474871 PMCID: PMC3889180 DOI: 10.2147/sar.s21291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park ; Gillings Global School of Public Health, University of North Carolina at Chapel Hill ; Psychology in the Public Interest, North Carolina State University, Raleigh ; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Sun AP. Helping homeless individuals with co-occurring disorders: the four components. SOCIAL WORK 2012; 57:23-37. [PMID: 22768626 DOI: 10.1093/sw/swr008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless individuals with co-occurring disorders (CODs) of severe mental illness and substance use disorder are one of the most vulnerable populations. This article provides practitioners with a framework and strategies for helping this client population. Four components emerged from a literature review: (1) ensuring an effective transition for individuals with CODs from an institution (such as a hospital, foster care, prison, or residential program) into the community, a particularly important component for clients who were previously homeless, impoverished, or at risk of homelessness; (2) increasing the resources of homeless individuals with CODs by helping them apply for government entitlements or supported employment (3) linking homeless individuals to supportive housing, including housing first options as opposed to only treatment first options, and being flexible in meeting their housing needs; and (4) engaging homeless individuals in COD treatment, incorporating modified assertive community treatment, motivational interviewing, cognitive-behavioral therapy, contingency management, and COD specialized self-help groups.
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Affiliation(s)
- An-Pyng Sun
- School of Social Work, University of Neveda, Las Vegas, Nevada 89154-5032, USA.
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Dickson-Gomez J, McAuliffe T, Convey M, Weeks M, Owczarzak J. Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents. Subst Abuse Treat Prev Policy 2011; 6:31. [PMID: 22112385 PMCID: PMC3283493 DOI: 10.1186/1747-597x-6-31] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents. METHODS Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior. RESULTS Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations. CONCLUSIONS Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.
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Affiliation(s)
- Julia Dickson-Gomez
- Department of Psychiatry and Behavioral Health, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI 53202, USA
| | - Timothy McAuliffe
- Department of Psychiatry and Behavioral Health, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI 53202, USA
| | - Mark Convey
- Institute for Community Researh, 2 Hartford Square West, Suite 100, Harford, CT 06106, USA
| | - Margaret Weeks
- Institute for Community Researh, 2 Hartford Square West, Suite 100, Harford, CT 06106, USA
| | - Jill Owczarzak
- Department of Psychiatry and Behavioral Health, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI 53202, USA
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Schottenfeld RS, Moore B, Pantalon MV. Contingency management with community reinforcement approach or twelve-step facilitation drug counseling for cocaine dependent pregnant women or women with young children. Drug Alcohol Depend 2011; 118:48-55. [PMID: 21454024 DOI: 10.1016/j.drugalcdep.2011.02.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/23/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cocaine abuse among women of child-bearing years is a significant public health problem. This study evaluated the efficacy of contingency management (CM), the community reinforcement approach (CRA), and twelve-step facilitation (TSF) for cocaine-dependent pregnant women or women with young children. METHODS Using a 2×2 study design, 145 cocaine dependent women were randomized to 24 weeks of CRA or TSF and to monetary vouchers provided contingent on cocaine-negative urine tests (CM) or non-contingently but yoked in value (voucher control, VC). Primary outcome measures included the longest consecutive period of documented abstinence, proportion of cocaine-negative urine tests (obtained twice-weekly), and percent days using cocaine (PDC) during treatment. Documented cocaine abstinence at baseline and 3, 6, 9 and 12 months following randomization was a secondary outcome. FINDINGS CM was associated with significantly greater duration of cocaine abstinence (p<.01), higher proportion of cocaine-negative urine tests (p<0.01), and higher proportion of documented abstinence across the 3-, 6-, 9- and 12-month assessments (p<0.05), compared to VC. The differences between CRA and TSF were not significant for any of these measures (all p values ≥0.75). PDC decreased significantly from baseline during treatment in all four groups (p<0.001) but did not differ significantly between CM and VC (p=0.10) or between TSF and CRA (p=0.23). INTERPRETATION The study findings support the efficacy of CM for cocaine dependent pregnant women and women with young children but do not support greater efficacy of CRA compared to TSF or differential efficacy of CM when paired with either CRA or TSF.
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Affiliation(s)
- Richard S Schottenfeld
- Department of Psychiatry, Yale University School of Medicine, 34 Park St. -S205, New Haven, CT 06519, USA.
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Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. AIDS Behav 2011; 15:1347-58. [PMID: 20976538 PMCID: PMC3180610 DOI: 10.1007/s10461-010-9840-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
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Affiliation(s)
- Allison J Ober
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, 90025, USA.
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Duff P, Deering K, Gibson K, Tyndall M, Shannon K. Homelessness among a cohort of women in street-based sex work: the need for safer environment interventions. BMC Public Health 2011; 11:643. [PMID: 21838894 PMCID: PMC3170620 DOI: 10.1186/1471-2458-11-643] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 08/12/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drawing on data from a community-based prospective cohort study in Vancouver, Canada, we examined the prevalence and individual, interpersonal and work environment correlates of homelessness among 252 women in street-based sex work. METHODS Bivariate and multivariate logistic regression using generalized estimating equations (GEE) was used to examine the individual, interpersonal and work environment factors that were associated with homelessness among street-based sex workers. RESULTS Among 252 women, 43.3% reported homelessness over an 18-month follow-up period. In the multivariable GEE logistic regression analysis, younger age (adjusted odds ratio [aOR] = 0.93; 95%confidence interval [95%CI] 0.93-0.98), sexual violence by non-commercial partners (aOR = 2.14; 95%CI 1.06-4.34), servicing a higher number of clients (10+ per week vs < 10) (aOR = 1.68; 95%CI 1.05-2.69), intensive, daily crack use (aOR = 1.65; 95%CI 1.11-2.45), and servicing clients in public spaces (aOR = 1.52; CI 1.00-2.31) were independently associated with sleeping on the street. CONCLUSIONS These findings indicate a critical need for safer environment interventions that mitigate the social and physical risks faced by homeless FSWs and increase access to safe, secure housing for women.
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Affiliation(s)
- Putu Duff
- 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, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, CANADA
| | - Kathleen Deering
- 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, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, CANADA
| | - Kate Gibson
- WISH Drop-In Centre Society, Vancouver, BC, V6B 1S5, CANADA
| | - Mark Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, CANADA
| | - Kate Shannon
- 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, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, CANADA
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, CANADA
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Stein JA, Andersen RM, Robertson M, Gelberg L. Impact of hepatitis B and C infection on health services utilization in homeless adults: a test of the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Health Psychol 2011; 31:20-30. [PMID: 21574705 DOI: 10.1037/a0023643] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Homeless people have disproportionately high rates of viral hepatitis. The Gelberg-Andersen Behavioral Model for Vulnerable Populations (predisposing, enabling, and need variables) was expanded to predict prevalence and awareness of hepatitis B (HBV) or hepatitis C (HCV) infection, as well as health services utilization (HSU) among homeless adults using structural equation modeling. DESIGN A population-based sample of 534 homeless adults in Los Angeles' "Skid Row" was interviewed and tested for HBV and HCV. MAIN OUTCOME MEASURES Main outcome measures included HBV/HCV seropositivity, awareness of seropositivity, and HSU in the previous 12 months. RESULTS Seropositivity (43%), usually unknown (72% of seropositives), was predicted by injection drug use, alcohol use, older age, and risky sexual behavior. No regular source of care, risky sexual behavior, less case management, and greater age predicted not knowing one's positive status. Health insurance, younger age, alcohol use, perceived bad health and more medical conditions predicted emergency room (ER) use; ER use was less likely among seropositives. Hospitalizations were predicted by more medical conditions and greater percentage of life homeless and were less frequent among African Americans and males. Ambulatory visits were predicted by a regular source of care, case management, more education and perceived bad health; they were less likely among seropositives. CONCLUSION The Gelberg-Andersen Behavioral Model provided a useful guide for predicting HBV/HCV positivity as well as HSU in homeless adults. Most hepatitis-positives did not know their status and used health services less often than other homeless adults. More aggressive detection of hepatitis B and C among homeless adults is needed.
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Affiliation(s)
- Judith A Stein
- Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA.
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Francis SA. Using a Framework to Explore Associations Between Parental Substance Use and the Health Outcomes of their Adolescent Children. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2010. [DOI: 10.1080/1067828x.2010.517736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Werb D, Debeck K, Kerr T, Li K, Montaner J, Wood E. Modelling crack cocaine use trends over 10 years in a Canadian setting. Drug Alcohol Rev 2010; 29:271-7. [PMID: 20565519 DOI: 10.1111/j.1465-3362.2009.00145.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Crack cocaine use among illicit drug users is associated with a range of health and community harms. However, long-term epidemiological data documenting patterns and risk factors for crack use initiation remain limited especially among injection drug users. We investigated longitudinal patterns of crack cocaine use among polydrug users in Vancouver, Canada. DESIGN AND METHODS We examined the rate of crack use among injection drug users enrolled in a prospective cohort study in Vancouver, Canada between 1996 and 2005. We also used a Cox proportional hazards regression analysis to identify independent predictors of crack use initiation among this population. RESULTS In total, 1603 injection drug users were recruited between May 1996 and December 2005. At baseline, 7.4% of participants reported ever using crack and this rate increased to 42.6% by the end of the study period (Mantel trend test P < 0.001). Independent predictors of crack use initiation during the study period included frequent cocaine injection, crystal methamphetamine injection, residency in the city's drug using epicenter and involvement in the sex trade (all P < 0.05). DISCUSSION AND CONCLUSIONS These findings demonstrate a massive increase in crack use among injection drug users in a Canadian setting. Our findings also highlight the complex interactions that contribute to the initiation of crack use among injection drug users and suggest that evidence-based interventions are urgently needed to address crack use initiation and to address harms associated with its ongoing use.
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Affiliation(s)
- Dan Werb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Wechsberg WM, Luseno WK, Kline TL, Browne FA, Zule WA. Preliminary findings of an adapted evidence-based woman-focused HIV intervention on condom use and negotiation among at-risk women in Pretoria, South Africa. J Prev Interv Community 2010; 38:132-46. [PMID: 20391060 DOI: 10.1080/10852351003640799] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article presents the results of a randomized trial in South Africa of an adapted evidence-based Woman-Focused intervention on condom use with primary sex partners. The preliminary findings show that regardless of HIV status, condom negotiation was significantly associated with condom use at the 3- and 6-month follow-ups. By intervention group, significant intervention effects were found at 6-month follow-up for HIV-positive and HIV-unknown status women in the Woman-Focused intervention who were more likely than women in the Standard intervention to report condom use with a primary male partner. Among HIV-positive women, those in the Woman-Focused group and those with greater sexual control were more likely to report condom use at the 6-month follow-up. The findings indicate that gender-based interventions for women may result in increased condom negotiation skills.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC 27709-2194, USA.
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Wechsberg WM, Novak SP, Zule WA, Browne FA, Kral AH, Ellerson RM, Kline T. Sustainability of intervention effects of an evidence-based HIV prevention intervention for African American women who smoke crack cocaine. Drug Alcohol Depend 2010; 109:205-12. [PMID: 20219294 PMCID: PMC2875347 DOI: 10.1016/j.drugalcdep.2010.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/09/2010] [Accepted: 01/12/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND HIV prevention intervention efficacy is often assessed in the short term. Thus, we conducted a long-term (mean 4.4 years) follow-up of a woman-focused HIV intervention for African American crack smokers, for which we had previously observed beneficial short-term gains. METHODS 455 out-of-treatment African American women in central North Carolina participated in a randomized field experiment and were followed up to determine sustainability of intervention effects across three conditions: the woman-focused intervention, a modified NIDA intervention, and a delayed-treatment control condition. We compared these groups in terms of HIV risk behavior at short-term follow-up (STFU; 3-6 months) and long-term follow-up (LTFU; average 4 years). RESULTS The analyses revealed two distinct groups at STFU: women who either eliminated or greatly reduced their risk behaviors (low-risk class) and women who retained high levels of risk across multiple risk domains (high-risk class). At STFU, women in the woman-focused intervention were more likely to be in the low HIV risk group than the women in control conditions, but this effect was not statistically significant at LTFU. However, low-risk participants at STFU were less likely to be retained at LTFU, and this retention rate was lowest among women in the woman-focused intervention. CONCLUSIONS Short-term intervention effects were not observed over 4 years later, possibly due to differential retention across conditions. The retention of the highest risk women presents an opportunity to extend intervention effects through booster sessions for these women.
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Affiliation(s)
- Wendee M Wechsberg
- RTI International,, Substance Abuse Treatment Evaluations and Interventions, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194 USA.
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Okpaku S, Macmaster SA, Dennie S, Tolliver D, Cooper RL, Rasch RFR. Preliminary outcomes of a model program for increasing treatment access for African American women who use crack cocaine and are at risk for contracting HIV. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2010; 7:41-57. [PMID: 20178024 DOI: 10.1080/15433710903175874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In the United States, the threat of HIV/AIDS to African American women's health has become the focus of much concern. This paper describes a federally funded community-based program that provides services to African American women at risk for HIV/AIDS in Nashville, Tennessee. The program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important for the continued development of culturally relevant interventions aimed at reducing the disproportionate rates of HIV/AIDS within the African American community by ensuring treatment access to all populations.
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Affiliation(s)
- Samuel Okpaku
- Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee 37208, USA.
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Werb D, Kerr T, Li K, Montaner J, Wood E. Risks surrounding drug trade involvement among street-involved youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2008; 34:810-20. [PMID: 19016187 DOI: 10.1080/00952990802491589] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Street-involved youth have been shown to be involved in the street-level illicit drug trade in a number of jurisdictions, though little is known about risk factors and sequelae of this behavior. The present study was therefore conducted to investigate factors associated with the street-level drug trade involvement among street-based youth. METHODS We used logistic regression to examine factors associated with drug dealing among participants in the At-Risk Youth Study in Vancouver, Canada. We also examined motivations for drug trade involvement and types of drugs sold by participants. RESULTS Overall, 529 street-involved youth were followed during the study period, of whom 307 (58.0%) reported having been involved in the drug trade in the last six months. In a logistic regression analysis, crack cocaine use (Adjusted Odds Ratio [AOR] = 1.84, 95% CI: 1.28-2.67), homelessness (AOR = 1.58, 95% CI: 1.04-2.40), and self-reported police assault [corrected] (AOR = 1.85, 95% CI: 1.14-3.00) were independently associated with drug dealing among cohort participants. Among participants who reported drug dealing, 263 (85.6%) individuals stated that the main reason that they sold drugs was to pay for their personal drug use. CONCLUSIONS In our setting, street-involved youth implicated in the drug trade are characterized by drug-related and sociodemographic vulnerabilities. These individuals also appear to be motivated by drug dependence and report elevated levels of physical confrontation with police [corrected]. Our findings have immediate implications for drug strategies targeting street-level drug dealing.
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Affiliation(s)
- Daniel Werb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Marshall BD, Fairbairn N, Li K, Wood E, Kerr T. Physical violence among a prospective cohort of injection drug users: a gender-focused approach. Drug Alcohol Depend 2008; 97:237-46. [PMID: 18487025 PMCID: PMC2570226 DOI: 10.1016/j.drugalcdep.2008.03.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 03/26/2008] [Accepted: 03/26/2008] [Indexed: 10/22/2022]
Abstract
Although dramatically heightened rates of violence have been observed among injection drug users (IDU), little is known about the gender differences associated with violence among this population. Employing a risk environment framework, we performed an analysis of the factors associated with experiencing violence among participants enrolled in a prospective cohort study of IDU during the years 1996-2005 using generalized estimating equations (GEE). Among 1114 individuals, 291 (66%) of females and 470 (70%) of males reported experiencing violence during the study period. In multivariate analyses, mental illness, frequent alcohol use, frequent crack use, homelessness, Downtown Eastside residency, and requiring help injecting were positively associated with experiencing violence for both sexes (all p<0.05). For females, binge drug use (AOR=1.30) and drug dealing (AOR=1.42) were positively associated with violence, while younger age (AOR=1.02), frequent heroin injection (AOR=1.24), and incarceration (AOR=1.50) were significant for males. Women were more likely to be attacked by acquaintances, partners, and sex trade clients, while men were more likely to experience violence from strangers and the police. These findings indicate that susceptibility to violence among IDU is structured by environmental factors such as homelessness and drug-related factors such as frequent alcohol use and involvement in drug economies. Furthermore, important gender differences with respect to the predictors and characteristics of violent attacks do exist. These findings indicate an urgent need for the development of comprehensive programs and structural interventions that take a gender-focused approach to violence among IDU.
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Affiliation(s)
- Brandon D.L. Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6, Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada, V6T 1Z3
| | - Nadia Fairbairn
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Kathy Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - 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, Vancouver Hospital & Health Sciences Centre, Room 3300-950 West 10th Avenue Vancouver, BC, Canada, V5Z 4E3
| | - 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, Vancouver Hospital & Health Sciences Centre, Room 3300-950 West 10th Avenue Vancouver, BC, Canada, V5Z 4E3, Corresponding author: Thomas Kerr, PhD, Research Scientist, B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, CANADA, Tel: (604) 806-9116, Fax: (604) 806-9044,
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Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women's experiences in North America's first supervised injection facility. Soc Sci Med 2008; 67:817-23. [DOI: 10.1016/j.socscimed.2008.05.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Indexed: 11/24/2022]
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Shannon K, Kerr T, Bright V, Gibson K, Tyndall MW. Drug sharing with clients as a risk marker for increased violence and sexual and drug-related harms among survival sex workers. AIDS Care 2008; 20:228-34. [PMID: 18293134 DOI: 10.1080/09540120701561270] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous studies have described links between violence, decreased condom use and drug sharing among intimate partners, though limited information exists about the predictors of drug sharing among female sex workers and their clients. The following analysis explored the association between sharing illicit drugs with clients and sexual and drug-related harms among survival sex workers. A total of 198 women participated in interview-administered questionnaires and confidential HIV testing. Of the total, 117 (59%) reported sharing drugs with clients/johns in the last six months and crack cocaine was the primary drug shared (n=108). In logistic regression analysis, sharing drugs with clients/johns was associated with borrowing a used crack pipe (AOR=5.63; 95%CI: 2.71-9.44; p<0.001), intensive/daily crack cocaine smoking (AOR=3.78; 95%CI:1.60-8.92; p<0.002), inconsistent condom use by a client/john (AOR=3.17; 95%CI:1.48-6.77; p<0.003) and having a recent bad date (verbal harassment, physical and/or sexual assault) (AOR=2.71; 95%CI:1.17-6.32; p=0.021). Sharing illicit drugs with clients/johns may be a crucial risk marker for increased violence and sexual and drug-related harms among survival sex workers. HIV prevention and harm reduction initiatives targeting both women and clients/johns are urgently needed, including enhanced support for community and peer-driven sex work initiatives, to address some of the structural facilitators for HIV transmission.
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Affiliation(s)
- K Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.
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Wechsberg WM, Luseno W, Riehman K, Karg R, Browne F, Parry C. Substance use and sexual risk within the context of gender inequality in South Africa. Subst Use Misuse 2008; 43:1186-201. [PMID: 18649238 PMCID: PMC3129982 DOI: 10.1080/10826080801918247] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examines substance use and sexual risk within the context of gender inequality among 163 women from an urban region of South Africa who were participating in a 2004-2006 study funded by the National Institute of Alcohol Abuse and Alcoholism. Items assessed patterns of substance use, gender inequality, risk communication, and psychological distress. Multivariate logistic regression analyses revealed that economic dependence on a main partner and traditional beliefs about a woman's right to refuse sex were associated with substance use prior to or during sex with that partner. The findings demonstrate that substance abuse prior to sex may reinforce traditional beliefs and that women with more progressive beliefs about gender ideology seem better able to control their substance use in risky environments.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
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Panchanadeswaran S, El-Bassel N, Gilbert L, Wu E, Chang M. An examination of the perceived social support levels of women in methadone maintenance treatment programs who experience various forms of intimate partner violence. Womens Health Issues 2008; 18:35-43. [PMID: 18215763 DOI: 10.1016/j.whi.2007.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 06/27/2007] [Accepted: 10/15/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) has emerged as a serious problem among women in drug treatment programs. Research has underscored the importance of social support for abused women as well as women who use substances. OBJECTIVES The main objectives of this study were to describe the perceived social support levels and examine the associations between various forms of IPV and perceived levels of available social support perceived levels among a sample of women in drug treatment programs. METHODS Face-to-face, structured interviews were conducted with randomly selected 416 women on methadone. RESULTS The prevalence of physical, sexual, and injurious IPV in the sample was 39%, 31%, and 16% respectively, and the combined IPV prevalence was 44.5%. Findings from multiple linear regression models revealed that lower levels of perceived social support were significantly associated with physical aggression (beta = -4.71; p = .0001), sexual assaults (beta = -4.10; p = .003), and injurious attacks (beta = -4.03; p = .022). Respondents perceived highest levels of social support from their "significant others" (mean = 5.64; standard deviation [SD] = 1.27) and lowest levels of social support from friends (mean = 4.20; SD = 1.48). The average network size was 2.7 individuals. IMPLICATIONS Findings from this study highlighted significantly lower levels of perceived social support levels for drug-using women in the context of IPV experiences. Interventions with these women should focus on strengthening social support networks that enable help seeking for both IPV and substance abuse issues.
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Correlates of HIV-related risk behaviors in African American adolescents from substance-using families: patterns of adolescent-level factors associated with sexual experience and substance use. J Adolesc Health 2008; 42:161-9. [PMID: 18207094 DOI: 10.1016/j.jadohealth.2007.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 07/19/2007] [Accepted: 07/31/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine adolescent-level correlates of HIV-related risk behaviors among urban African American adolescents whose mothers use crack cocaine. METHODS Interviews were conducted with 208 African American adolescents (aged 12-17 years) to assess psychosocial, behavioral, and perceived environment correlates of HIV-related risk behavior. Adolescents were children of community-recruited African American women not currently in drug treatment who reported crack cocaine use (in last 6 months). Bivariate and multivariate regression models were used to evaluate associations among adolescent-level factors, sexual experience, and substance use. RESULTS Of the adolescents, 30% reported being sexually experienced, and 23% reported alcohol or drug use in the past month. Older age and lower school satisfaction were associated with both sexual experience and substance use, but no other factors were associated with both risk behaviors. Male gender, current substance use, high HIV/AIDS knowledge, and high risk perception were associated with being sexual experienced. Sexual experience and lower expectations for future life outcomes were associated with substance use. A general pattern of protective factors related to attitudes about future goals, help-seeking behavior, and positive feelings about school emerged for substance use. CONCLUSIONS These results suggest that the patterns of adolescent-level risk and protective factors for sexual experience and substance use may be unique in African American adolescents from substance-abusing families. Instead of an increase in problem behaviors associated with using substances, protective factors were evident, suggesting these adolescents may have resiliency for dealing with environmental stressors related to substance use. Implications for HIV prevention programs involving mentoring and goal development are discussed.
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Wechsberg WM, Luseno WK, Karg RS, Young S, Rodman N, Myers B, Parry CDH. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: a small randomized trial in the Western Cape. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:130-9. [PMID: 18207723 DOI: 10.1016/j.drugpo.2007.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 11/20/2007] [Accepted: 11/25/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a pressing need for brief behavioural interventions to address the intersection of high HIV prevalence, increasing substance use, and high-risk sex practices among South African women. The primary aim of this pilot, randomized trial was to examine whether an adapted evidence-based intervention would be equally, more, or less effective at reducing HIV risk behaviours when delivered using an individual or group format. The secondary aim was to examine differences between Black and Coloured South African women across pre- and post-intervention measures of alcohol and illicit drug use and sex risk behaviours. METHODS The Cape Town Women's Health CoOp was adapted from an evidence-based intervention known as the Women's CoOp. Study participants included Black (n=60) and Coloured (n=52) women living in the township communities of Cape Town, South Africa, who reported using illicit drugs and alcohol. RESULTS Coloured women reported greater methamphetamine use (13 days in the past 30 days) and Black women reported mostly cannabis use (27 days in the past 30 days). Although both groups reported having unprotected sex under the influence of alcohol and/or other drugs, Black women reported greater condom use and having one partner; Coloured women reported having more than one sex partner. One-month post-intervention assessments indicated significant reductions in substance use and sex risk behaviours. After controlling for baseline measures, there were no significant differences between the two intervention conditions. CONCLUSION Significant differences in risk behaviours were observed between Black and Coloured South African women. However, both ethnic groups were responsive to the adapted intervention and no differences were found by intervention assignment. These findings support the assertion that group interventions may be more cost-effective in reaching at-risk women in resource-scarce environments. Larger studies are needed to show efficacy and effectiveness of woman-focused group prevention interventions.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC 27709-2194, USA.
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