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Jaibat L, Cui Z, Mitra S, Loh J, Reddon H, Fairbairn N, Milloy MJ. Perceived Mistreatment in Health Care Settings and its Relationship with HIV Clinical Outcomes in HIV-positive People who Use Drugs in Vancouver, Canada. AIDS Behav 2023; 27:1636-1646. [PMID: 36318426 PMCID: PMC10149567 DOI: 10.1007/s10461-022-03895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
People living with HIV (PLWH) often experience stigma and discrimination by health care professionals. We investigated the prevalence of perceived mistreatment in health care settings and its associations with HIV clinical outcomes and health care-seeking behaviour using data from a long-running prospective cohort of PLWH who use drugs. Of the 857 participants included, 19% reported at least one instance of perceived mistreatment during the study period. In adjusted longitudinal analyses, perceived mistreatment was positively associated with not being on ART in the same follow-up period, and participants who reported perceived mistreatment were less likely to report seeing a physician in the subsequent follow-up period. Daily use of injection drugs was positively associated with reporting perceived mistreatment. These findings demonstrate the implications of negative health care interactions in a population that must consistently engage with the health care system, and the need for stigma-reducing educational interventions for health care professionals.
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Affiliation(s)
- Laura Jaibat
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
| | - Sanjana Mitra
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane Loh
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
| | - Hudson Reddon
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
- Division of social medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada.
- Division of social medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Lee E, Piñeros J, Williams LD, Mackesy-Amiti ME, Molina Y, Boodram B. Network ethnic homophily and injection equipment sharing among Latinx and White non-Latinx people who inject drugs. J Ethn Subst Abuse 2023:1-20. [PMID: 36853193 PMCID: PMC10460831 DOI: 10.1080/15332640.2023.2181259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Latinx people who inject drugs (PWID) are less likely to engage in injection equipment sharing, but are more vulnerable to injection drug use (IDU)-related morbidity and mortality than Whites. Identifying subgroups of Latinx PWID who do engage in equipment sharing and likely bear the brunt of this health burden is a priority. Ethnic disparities may reflect contextual drivers, including injection networks. Latinx PWID with low ethnic homophily (the proportion of individuals with the same ethnic background) may be more likely to share equipment due to forced distancing from health-protective ethnocultural resources and power imbalances within injection networks. The current study offers a framework and examines how associations between network ethnic homophily and injection equipment sharing differ among 74 Latinx and 170 non-Latinx White PWID in the Chicagoland area (N = 244). Latinx had less homophilous than non-Latinx Whites (p <.001). Ethnic homophily was protective for equipment sharing among Latinx (OR = 0.17, 95%CI [0.77, 0.04], p = .02), but not non-Latinx Whites (OR = 1.66, 95%CI [0.40, 6.93], p = .49). Our findings implicate the need for targeted cultured interventions that focus on Latinx PWID who are more vulnerable to morbidity and mortality, potentially due to less access to ethnic peers.
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Affiliation(s)
- Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Juliet Piñeros
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Mary-Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Yamilé Molina
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
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Linton SL, Jarlais DCD, Ornstein JT, Kasman M, Hammond R, Kianian B, Smith JC, Wolfe ME, Ross Z, German D, Flynn C, Raymond HF, Klevens RM, Spencer E, Schacht JM, Finlayson T, Paz-Bailey G, Wejnert C, Cooper HLF. An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103194. [PMID: 33812133 PMCID: PMC8608566 DOI: 10.1016/j.drugpo.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
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Affiliation(s)
- Sabriya L Linton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Don C Des Jarlais
- College of Global Public Health, New York University, New York City, NY, USA
| | - Joseph T Ornstein
- School of Public and International Affairs, The University of Georgia, Athens, GA, USA
| | - Matt Kasman
- Brookings Institution, District of Columbia, USA
| | - Ross Hammond
- Brookings Institution, District of Columbia, USA
| | - Behzad Kianian
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Justin C Smith
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mary E Wolfe
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, USA
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colin Flynn
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | | | | | - Emma Spencer
- Florida Department of Health, Tallahassee, FL, USA
| | | | | | | | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Arasteh K, Des Jarlais DC, Feelemyer J, McKnight C. Hepatitis C incidence and prevalence among Puerto Rican people who use drugs in New York City. Glob Public Health 2020; 15:1789-1799. [DOI: 10.1080/17441692.2020.1768276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kamyar Arasteh
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Don C. Des Jarlais
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Jonathan Feelemyer
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Courtney McKnight
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
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Linton SL, Cooper HLF, Chen YT, Khan MA, Wolfe ME, Ross Z, Des Jarlais DC, Friedman SR, Tempalski B, Broz D, Semaan S, Wejnert C, Paz-Bailey G. Mortgage Discrimination and Racial/Ethnic Concentration Are Associated with Same-Race/Ethnicity Partnering among People Who Inject Drugs in 19 US Cities. J Urban Health 2020; 97:88-104. [PMID: 31933055 PMCID: PMC7010885 DOI: 10.1007/s11524-019-00405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Racial/ethnic homophily in sexual partnerships (partners share the same race/ethnicity) has been associated with racial/ethnic disparities in HIV. Structural racism may partly determine racial/ethnic homophily in sexual partnerships. This study estimated associations of racial/ethnic concentration and mortgage discrimination against Black and Latino residents with racial/ethnic homophily in sexual partnerships among 7847 people who inject drugs (PWID) recruited from 19 US cities to participate in CDC's National HIV Behavioral Surveillance. Racial/ethnic concentration was defined by two measures that respectively compared ZIP code-level concentrations of Black residents to White residents and Latino residents to White residents, using the Index of Concentration at the Extremes. Mortgage discrimination was defined by two measures that respectively compared county-level mortgage loan denial among Black applicants to White applicants and mortgage loan denial among Latino applicants to White applicants, with similar characteristics (e.g., income, loan amount). Multilevel logistic regression models were used to estimate associations. Interactions of race/ethnicity with measures of racial/ethnic concentration and mortgage discrimination were added to the final multivariable model and decomposed into race/ethnicity-specific estimates. In the final multivariable model, among Black PWID, living in ZIP codes with higher concentrations of Black vs. White residents and counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Latino residents was associated with lower odds of homophily among Black PWID. Among Latino PWID, living in ZIP codes with higher concentrations of Latino vs. White residents and counties with higher mortgage discrimination against Latino residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Black residents was associated with lower odds of homophily among Latino PWID. Among White PWID, living in ZIP codes with higher concentrations of Black or Latino residents vs. White residents was associated with lower odds of homophily, but living in counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Racial/ethnic segregation may partly drive same race/ethnicity sexual partnering among PWID. Future empirical evidence linking these associations directly or indirectly (via place-level mediators) to HIV/STI transmission will determine how eliminating discriminatory housing policies impact HIV/STI transmission.
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Affiliation(s)
- Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Yen-Tyng Chen
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, 837 S Maryland Avenue, Chicago, IL, 60637, USA
| | - Mohammed A Khan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Wolfe
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 209 N Aurora St, 2nd Floor, Ithaca, NY, 14850, USA
| | - Don C Des Jarlais
- College of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc, 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc, 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
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West BS. Social Networks of Substance-Using Populations: Key Issues and Promising New Approaches for HIV. Curr HIV/AIDS Rep 2019; 16:48-56. [PMID: 30659477 PMCID: PMC6420834 DOI: 10.1007/s11904-019-00425-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This paper presents recent literature on substance using networks and HIV, highlighting renewed and emerging themes in the field. The goal is to draw attention to research that holds considerable promise for advancing our understanding of the role of networks in shaping behaviors, while also providing critical information for the development of interventions, programs, and policies to reduce HIV and other drug-related harms. RECENT FINDINGS Recent research advances our understanding of networks and HIV, including among understudied populations, and provides new insight into how risk environments shape the networks and health of substance-using populations. In particular, the integration of network approaches with molecular epidemiology, research on space and place, and intervention methods provides exciting new avenues of investigation. Continued advances in network research are critical to supporting the health and rights of substance-using populations and ensuring the development of high-impact HIV programs and policies.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
- Division of Infectious Diseases and Global Public Health in the School of Medicine, University of California San Diego, San Diego, CA, USA.
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