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Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103750. [PMID: 35667193 PMCID: PMC10024805 DOI: 10.1016/j.drugpo.2022.103750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. METHODS We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. RESULTS A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and Poly-Victimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. CONCLUSION Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan.
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Treloar C, Hopwood M, Drysdale K, Lea T, Holt M, Dowsett GW, Aggleton P, Bryant J. Stigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103229. [PMID: 33774423 DOI: 10.1016/j.drugpo.2021.103229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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McKenzie KC, Mishori R, Ferdowsian H. Twelve tips for incorporating the study of human rights into medical education. MEDICAL TEACHER 2020; 42:871-879. [PMID: 31314624 DOI: 10.1080/0142159x.2019.1623384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In order for patients to be adequately cared for by clinicians, an awareness and acknowledgement of the factors that affect their well-being, including adherence to internationally recognized human rights, should be part of the professional education of all health care professionals. Worldwide conflicts, which have led to record forced global displacement, and ongoing international human rights violations have had profound effects on the health and well-being of millions of patients. Trainees early in their careers should be educated about these and related population-level issues that affect the health of their patients, so they can better care and advocate for their patients and communities throughout their careers.
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Affiliation(s)
| | - Ranit Mishori
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Hope Ferdowsian
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Stangl AL, Singh D, Windle M, Sievwright K, Footer K, Iovita A, Mukasa S, Baral S. A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know? BMC Infect Dis 2019; 19:209. [PMID: 30832599 PMCID: PMC6399958 DOI: 10.1186/s12879-019-3692-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. Methods We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003–28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS’ key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. Results Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. Conclusion Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection. Electronic supplementary material The online version of this article (10.1186/s12879-019-3692-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA.
| | - Devaki Singh
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Michael Windle
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kirsty Sievwright
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Katherine Footer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Alexandrina Iovita
- Human Rights Division, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Stella Mukasa
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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van Dijk AJ, Herrington V, Crofts N, Breunig R, Burris S, Sullivan H, Middleton J, Sherman S, Thomson N. Law enforcement and public health: recognition and enhancement of joined-up solutions. Lancet 2019; 393:287-294. [PMID: 30663598 DOI: 10.1016/s0140-6736(18)32839-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/20/2017] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
Abstract
Public security and law enforcement have a crucial but often largely unacknowledged role in protecting and promoting public health. Although the security sector is a key partner in many specific public health programmes, its identity as an important part of the public health endeavour is rarely recognised. This absence of recognition has resulted in a generally inadequate approach to research and investigation of ways in which law enforcement, especially police at both operational and strategic levels, can be effectively engaged to actively promote and protect public health as part of a broader multisectoral public health effort. However, the challenge remains to engage police to consider their role as one that serves a public health function. The challenge consists of overcoming the continuous and competitive demand for police to do so-called policing, rather than serve a broader public health function-often derogatively referred to as social work. This Series paper explores the intersect between law enforcement and public health at the global and local levels and argues that public health is an integral aspect of public safety and security. Recognition of this role of public health is the first step towards encouraging a joined-up approach to dealing with entrenched social, security, and health issues.
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Affiliation(s)
- Auke J van Dijk
- Police of the Netherlands, The Hague, Amsterdam, Netherlands
| | | | - Nick Crofts
- Centre for Law Enforcement and Public Health, Amsterdam, Netherlands; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Robert Breunig
- Crawford School of Public Policy, Australian National University, Canberra, ACT, Australia
| | - Scott Burris
- Center for Public Health Law Research, Temple University, Philadelphia, PA, USA
| | - Helen Sullivan
- Crawford School of Public Policy, Australian National University, Canberra, ACT, Australia
| | | | - Susan Sherman
- Department of Health, Behavior and Society, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas Thomson
- Centre for Public Health and Human Rights, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Nossal Institute for Global Health, Baltimore, MD, USA
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Marotta PL, Gilbert L, Terlikbayeva A, Wu E, El-Bassel N. Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:96-106. [PMID: 30219718 PMCID: PMC6340710 DOI: 10.1016/j.drugpo.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/15/2018] [Accepted: 07/16/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The criminalization of drug use leads to high rates of drug crime convictions for engaging in injection drug use behaviors, introducing barriers to HIV prevention and drug treatment for PWID. Females (FWID) face unique vulnerabilities to HIV compared to males (MWID) in Kazakhstan. This study examined sex differences in associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, and conviction for a drug crime in a sample of people who inject drugs (PWID) in Almaty, Kazakhstan. METHODS Analyses were performed on baseline data from 510 PWID and stratified by males (MWID) (329) and females (FWID) (181) from Kazakhstan in a couples-focused HIV prevention intervention. Logistic regression analyses using mixed effects (AOR) examined associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, drug use severity, drug treatment history and conviction for a drug crime. RESULTS About three quarters of PWID reported drug crime conviction (73.92%, n = 377). HCV infection was associated with increased odds of drug crime conviction for FWID (AOR = 4.35, CI95 = 1.83-10.31, p < .01) and MWID (AOR = 3.62, CI95 = 1.09-12.07, p < .01). HIV transmission knowledge was associated with increased odds of conviction for MWID (AOR = 1.19, CI95 = 1.00-1.41, p < .05). Injection drug risk knowledge was associated with lower odds of conviction (AOR = .75, CI95 = .59-.94, p < .05) for FWID. Receptive syringe sharing (AOR = 3.48, CI95 = 1.65-7.31, p < .01), splitting drug solutions (AOR = 4.12, CI95 = 1.86-7.31, p < .05), and injecting with more than two partners (AOR = 1.89, CI95 = 1.06-3.34, p < .05) was associated with increased odds of conviction for FWID. Receptive syringe or equipment sharing with intimate partners was associated with conviction for both MWID (AOR = 1.90, CI95 = 1.03-3.92, p < .05) and FWID (AOR = 1.95, CI95 = 1.02-3.70, p < .05). For FWID, injection drug use in public spaces was associated with conviction (AORME = 3.25, CI95 = 1.31-7.39, p < .01). Drug use severity was associated with increased odds of conviction for FWID (AOR = 1.29, CI95 = 1.09-1.53, p < .001) and MWID (AOR = 1.24, CI95 = 1.09-1.41, p < .001). Ever receiving drug treatment was associated with conviction for MWID (AOR = 2.31, CI95 = 1.32-4.12, p < .01). CONCLUSION High-risk behaviors, HCV infection and more severe substance use disorders are associated with drug crime conviction for PWID, particularly FWID. Structural interventions are necessary to increase the engagement of PWID with drug crime convictions in HIV prevention and substance abuse treatment.
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Affiliation(s)
| | - Louisa Gilbert
- Columbia University, United States; Global Research Center of Central Asia, Kazakhstan; Social Intervention Group, United States
| | | | - Elwin Wu
- Columbia University, United States; Global Research Center of Central Asia, Kazakhstan; Social Intervention Group, United States
| | - Nabila El-Bassel
- Columbia University, United States; Global Research Center of Central Asia, Kazakhstan; Social Intervention Group, United States
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Dawson L, Strathdee SA, London AJ, Lancaster KE, Klitzman R, Hoffman I, Rose S, Sugarman J. Addressing ethical challenges in HIV prevention research with people who inject drugs. JOURNAL OF MEDICAL ETHICS 2018; 44:149-158. [PMID: 27114469 PMCID: PMC6367727 DOI: 10.1136/medethics-2015-102895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 05/15/2023]
Abstract
Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.
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Affiliation(s)
- Liza Dawson
- Division of AIDS, NIH/NIAID, Bethesda, Maryland, USA
| | | | | | | | | | - Irving Hoffman
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott Rose
- Family Health International, Durham, North Carolina, USA
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Michel L, Des Jarlais DC, Thi HD, Hai OKT, Minh KP, Peries M, Vallo R, Tuyet TNT, Thi GH, Le Sao M, Feelemyer J, Hai VV, Moles JP, Laureillard D, Nagot N. Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions. Drug Alcohol Depend 2017; 179:198-204. [PMID: 28800503 PMCID: PMC5911921 DOI: 10.1016/j.drugalcdep.2017.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. METHODS A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. RESULTS Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. CONCLUSION Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.
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Affiliation(s)
- Laurent Michel
- CESP/Inserm1018, Pierre Nicole Centre, French Red Cross, 27 Pierre Nicole Street, 75005, Paris, France.
| | - Don C. Des Jarlais
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Huong Duong Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Oanh Khuat Thi Hai
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Khuê Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Marianne Peries
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Roselyne Vallo
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Thanh Nham Thi Tuyet
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Mai Le Sao
- Departement of mental health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Jonathan Feelemyer
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Vinh Vu Hai
- Infectious Diseases Department, Viet Tiep Hospital, So 1, duong Nha Thuong, Le Chan, Hai Phong, Viet Nam
| | - Jean-Pierre Moles
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Didier Laureillard
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Infectious Diseases Department, Caremeau University Hospital, Prefessor Robert Debré Place, 30900 Nîmes, France
| | - Nicolas Nagot
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Department of Medical Information, University Hospital of Montpellier, 34090, Montpellier, France
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Klingemann J. The rights of drug treatment patients: Experience of addiction treatment in Poland from a human rights perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 43:67-73. [PMID: 28231439 DOI: 10.1016/j.drugpo.2017.01.015] [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] [Received: 09/26/2016] [Revised: 12/13/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug dependence is a recognized medical condition and therefore, right to health applies in the same way to drug dependence as it does to any other health condition. The human rights in patient care framework - which refers to the application of basic human rights principles in the delivery of health care services - was used to explore the experiences of equality in the dignity and rights protected by Polish law within four different specialist drug treatment settings in Poland. The views of patients and staff were examined and compared. METHODS Focus group interviews were conducted in 12 drug treatment facilities: three inpatient therapeutic communities, three outpatient programs, three opioid substitution programs and three harm reduction programs (drop-in/needle exchange/support). Interviews were conducted with a total of 43 staff and 73 patients. All interviews were audio-recorded with participants' prior consent and transcribed verbatim. Data were analysed according to the problem-centred interview methodology, using CAQDA. RESULTS Patients described instances of abuse of their rights regarding dignity, privacy, confidentiality, personalized treatment, and respect of patient's time, right to information and to complain. Those accounts were complemented by the perspective of professionals working in drug treatment. Patients of Polish opioid substitution programs reported experiencing more humiliation and disenfranchisement than patients in other drug treatment settings. CONCLUSION Drug testing and control, fuelled by prejudices of health professionals, are leading to discriminatory practices in substitution treatment and damaging the chances of therapeutic success. The concept of epistemic injustice illuminates the reasons behind discrimination against patients on opioid substitution programs, who are seen as continuously sick and their illness perceived as a mark of moral, social and epistemic failure.
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Affiliation(s)
- Justyna Klingemann
- Department of Studies on Alcohol and Drug Dependence, Institute of Psychiatry and Neurology, 9 Sobieskiego Str., 02-957 Warsaw, Poland.
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McNeil R, Kerr T, Coleman B, Maher L, Milloy MJ, Small W. Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative. AIDS Behav 2017; 21:402-409. [PMID: 27351192 DOI: 10.1007/s10461-016-1470-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV Treatment as Prevention (TasP) initiatives promote antiretroviral therapy (ART) access and optimal adherence (≥95 %) to produce viral suppression among people living with HIV (PLHIV) and prevent the onward transmission of HIV. ART treatment interruptions are common among PLHIV who use drugs and undermine the effectiveness of TasP. Semi-structured interviews were conducted with 39 PLHIV who use drugs who had experienced treatment ART interruptions in a setting with a community-wide TasP initiative (Vancouver, Canada) to examine influences on these outcomes. While study participants attributed ART interruptions to "treatment fatigue," our analysis revealed individual, social, and structural influences on these events, including: (1) prior adverse ART-related experiences among those with long-term treatment histories; (2) experiences of social isolation; and, (3) breakdowns in the continuity of HIV care following disruptive events (e.g., eviction, incarceration). Findings reconceptualise 'treatment fatigue' by focusing attention on its underlying mechanisms, while demonstrating the need for comprehensive structural reforms and targeted interventions to optimize TasP among drug-using PLHIV.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bill Coleman
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
| | - Lisa Maher
- Kirby Institute of Infection and Immunity, UNSW Australia, Sydney, Australia
| | - M J Milloy
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Gooden L, Metsch LR, Pereyra MR, Malotte CK, Haynes LF, Douaihy A, Chally J, Mandler RN, Feaster DJ. Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups. AIDS Behav 2016; 20:1893-906. [PMID: 26837631 PMCID: PMC4970956 DOI: 10.1007/s10461-016-1300-6] [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: 10/22/2022]
Abstract
HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).
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Affiliation(s)
- Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA
| | - C Kevin Malotte
- Department of Health Science, California State University, Long Beach, CA, USA
| | - Louise F Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack Chally
- Johns Hopkins University, Baltimore, MD, USA
- EMMES Corporation, Inc., Rockville, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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12
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Souleymanov R, Kuzmanović D, Marshall Z, Scheim AI, Mikiki M, Worthington C, Millson MP. The ethics of community-based research with people who use drugs: results of a scoping review. BMC Med Ethics 2016; 17:25. [PMID: 27129927 PMCID: PMC4850694 DOI: 10.1186/s12910-016-0108-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Drug user networks and community-based organizations advocate for greater, meaningful involvement of people with lived experience of drug use in research, programs and services, and policy initiatives. Community-based approaches to research provide an opportunity to engage people who use drugs in all stages of the research process. Conducting community-based participatory research (CBPR) with people who use drugs has its own ethical challenges that are not necessarily acknowledged or supported by institutional ethics review boards. We conducted a scoping review to identify ethical issues in CBPR with people who use drugs that were documented in peer-reviewed and grey literature. Methods The search strategy focused on three areas; community-based research, ethical issues, and drug use. Searches of five academic databases were conducted in addition to a grey literature search, hand-searching, and consultation with organizational partners and key stakeholders. Peer reviewed literature and community reports published in English between 1985 and 2013 were included, with initial screening conducted by two reviewers. Results The search strategy produced a total of 874 references. Twenty-five references met the inclusion criteria and were included in our thematic analysis. Five areas were identified as important to the ethics of CBPR with people who use drugs: 1) participant compensation, 2) drug user perspectives on CBPR, 3) peer recruitment and representation in CBPR, 4) capacity building, and 5) participation and inclusion in CBPR. Conclusions We critically discuss implications of the emerging research in this field and provide suggestions for future research and practice.
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Affiliation(s)
- Rusty Souleymanov
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, ON, M5S 1V4, Canada.
| | - Dario Kuzmanović
- Joint Centre for Bioethics, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Zack Marshall
- Division of Community Health & Humanities, Health Sciences Centre, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON, N6A 5C1, Canada
| | - Mikiki Mikiki
- Harm Reduction Peer Street Outreach Coordinator, Queen West Central Toronto Community Health Centre, 168 Bathurst Street, Toronto, ON, M5V 2R4, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, HSD building, Victoria, BC, V8W 2Y2, Canada
| | - Margaret Peggy Millson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
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Meier BM, Gelpi A, Kavanagh MM, Forman L, Amon JJ. Employing human rights frameworks to realize access to an HIV cure. J Int AIDS Soc 2015; 18:20305. [PMID: 26568056 PMCID: PMC4644771 DOI: 10.7448/ias.18.1.20305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/21/2015] [Accepted: 10/08/2015] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The scale of the HIV pandemic - and the stigma, discrimination and violence that surrounded its sudden emergence - catalyzed a public health response that expanded human rights in principle and practice. In the absence of effective treatment, human rights activists initially sought to protect individuals at high risk of HIV infection. With advances in antiretroviral therapy, activists expanded their efforts under international law, advocating under the human right to health for individual access to treatment. DISCUSSION As a clinical cure comes within reach, human rights obligations will continue to play a key role in political and programmatic decision-making. Building upon the evolving development and implementation of the human right to health in the global response to HIV, we outline a human rights research agenda to prepare for HIV cure access, investigating the role of human rights law in framing 1) resource allocation, 2) international obligations, 3) intellectual property and 4) freedom from coercion. CONCLUSIONS The right to health is widely recognized as central to governmental, intergovernmental and non-governmental responses to the pandemic and critical both to addressing vulnerability to infection and to ensuring universal access to HIV prevention, treatment, care and support. While the advent of an HIV cure will raise new obligations for policymakers in implementing the right to health, the resolution of past debates surrounding HIV prevention and treatment may inform claims for universal access.
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Affiliation(s)
- Benjamin Mason Meier
- Department of Public Policy, University of North Carolina, Chapel Hill, NC, USA;
| | - Adriane Gelpi
- Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA
| | - Matthew M Kavanagh
- Department of Political Science, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Joseph J Amon
- Health and Human Rights Division, Human Rights Watch, New York, NY, USA
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14
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Michel L, Lions C, Van Malderen S, Schiltz J, Vanderplasschen W, Holm K, Kolind T, Nava F, Weltzien N, Moser A, Jauffret-Roustide M, Maguet O, Carrieri PM, Brentari C, Stöver H. Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern. BMC Public Health 2015; 15:1093. [PMID: 26507505 PMCID: PMC4624386 DOI: 10.1186/s12889-015-2421-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 10/16/2015] [Indexed: 01/13/2023] Open
Abstract
Background Prisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations. Methods Following the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison. Results A majority of prisons answered in Austria (100 %), France (66 %) and Denmark (58 %), half in Belgium (50 %) and few in Italy (17 %), representing 100, 74, 89, 47 and 23 % coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (p = 0.08). Conclusions Using a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.
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Affiliation(s)
- Laurent Michel
- Inserm U1178, Paris, France. .,Univ Paris-Sud and Univ Paris Descartes, UMRS1178, Paris, France. .,Centre Pierre Nicole, French Red Cross, Paris, France.
| | - Caroline Lions
- Inserm U912 (SESSTIM), Marseille, France. .,Univ Aix Marseille, IRD, UMR-S912, Marseille, France. .,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
| | | | - Julie Schiltz
- Department of Special Education, Ghent University, Ghent, Belgium.
| | | | - Karina Holm
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
| | - Torsten Kolind
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
| | | | | | | | | | | | - Patrizia M Carrieri
- Inserm U912 (SESSTIM), Marseille, France. .,Univ Aix Marseille, IRD, UMR-S912, Marseille, France. .,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
| | | | - Heino Stöver
- University of Applied Sciences, Frankfurt, Germany.
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15
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Wolfe D, Luhmann N, Harris M, Momenghalibaf A, Albers E, Byrne J, Swan T. Human rights and access to hepatitis C treatment for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1072-80. [PMID: 26232055 DOI: 10.1016/j.drugpo.2015.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/26/2015] [Accepted: 05/12/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND People who inject drugs (PWID) achieve adherence to and outcomes from hepatitis C virus (HCV) treatment comparable to other patients. Nonetheless, this population has been excluded from treatment by regulation or practice. Approval of safer and more effective oral HCV medicines should offer greater treatment options for PWID, although high medicine prices have led to continued treatment rationing and exclusion in developed countries. In middle-income countries (MICS), treatment is largely unavailable and unaffordable for most PWID. METHODS Human rights analysis, with its emphasis on the universal and interconnected nature of the economic, social and political spheres, offers a useful framework for HCV treatment reform. Using peer-reviewed and grey literature, as well as community case reports, we discuss barriers to treatment, correlate these barriers to rights violations, and highlight examples of community advocacy to increase treatment for PWID. RESULTS Structural drivers of lack of treatment access for PWID include stigma in health settings; drug use status as a criterion for treatment exclusion; requirements for fees or registration by name as a drug user prior to treatment initiation; and incarceration/detention in prisons and rehabilitation centers where treatment is unavailable. High medicine prices force further exclusion of PWID, with cost containment masked as concern about treatment adherence. These barriers correlate to multiple rights violations, including of the rights to privacy; non-discrimination; health; freedom of information; fair trial; and freedom from cruel, inhuman and degrading treatment. CONCLUSIONS Needed reforms include decriminalization of drug use, possession of drugs and drug injecting equipment; removal of exclusionary or discriminatory treatment protocols; approaches to strengthen links between health providers and increase participation of PWID in treatment design and implementation; and measures to increase transparency in government/pharmaceutical company negotiations and reduce treatment price.
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Affiliation(s)
- D Wolfe
- Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA.
| | - N Luhmann
- Médecins Du Monde, 62 Rue Marcadet, Paris 75018, France
| | - M Harris
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - A Momenghalibaf
- Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA
| | - E Albers
- International Network of People who Use Drugs, Unit 2C05, South Bank Technopark 90 London Road, London SE1 6LN, United Kingdom
| | - J Byrne
- Australian Injecting and Illicit Drug Users League, GPO Box 1552, Canberra ACT 2601, Australia
| | - T Swan
- Treatment Action Group, 261 5th Avenue #2110, New York, NY 10016, USA
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Wickersham JA, Azar MM, Cannon CM, Altice FL, Springer SA. Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen (RODS). JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:12-26. [PMID: 25559628 PMCID: PMC4435561 DOI: 10.1177/1078345814557513] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Rapid Opioid Dependence Screen (RODS) is an 8-item measure of opioid dependence designed for quick, targeted screening in clinical and research settings. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, criteria, the RODS has an average administration of less than 2 minutes and can easily be administered as a stand-alone instrument or as part of a comprehensive interview. This study reports on the initial validation of the RODS among a sample of 97 newly incarcerated, HIV-positive individuals. Using the Mini International Neuropsychiatric Interview as the primary measure of opioid dependence, the RODS showed good-to-strong sensitivity (.97), specificity (.76), positive predictive value (.69), and negative predictive value (.98), while concordance analysis revealed moderate diagnostic agreement (κ = .67). Psychometric properties revealed strong internal consistency (α = .92) and inter-item correlations (.66 to .87).
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Affiliation(s)
- Jeffrey A Wickersham
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Marwan M Azar
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | - Frederick L Altice
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Sandra A Springer
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
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Strathdee SA, Beletsky L, Kerr T. HIV, drugs and the legal environment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26 Suppl 1:S27-32. [PMID: 25265900 DOI: 10.1016/j.drugpo.2014.09.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs' behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs' risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.
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Affiliation(s)
| | - Leo Beletsky
- Northeastern University School of Law and Bouvé College of Health Sciences, Boston, USA
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18
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Underhill K. Legal and ethical values in the resolution of research-related disputes: how can IRBS respond to participant complaints? J Empir Res Hum Res Ethics 2014; 9:71-82. [PMID: 24572085 DOI: 10.1525/jer.2014.9.1.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Under US federal regulations, participants providing informed consent must receive information regarding whom to contact in case of a research-related injury or complaint. Although informed consent processes routinely direct participants to contact institutional review boards (IRBs) with questions or concerns, there has been little empirical study of the ways in which IRBs act to resolve participants' research-related complaints. This article explores available literature on participant complaints, considers the responsibilities of IRBs in dispute resolution, and outlines a research agenda. As a case study, this review considers disputes arising from HIV/AIDS research, focusing on novel issues arising from biomedical HIV prevention trials.
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van Griensven F, Phanuphak N, Srithanaviboonchai K. Biomedical HIV prevention research and epidemic control in Thailand: two sides of the same coin. Sex Health 2014; 11:180-99. [PMID: 25000363 DOI: 10.1071/sh13119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/10/2014] [Indexed: 02/04/2023]
Abstract
For a country with a moderate adult HIV prevalence of just over 1% in 2012, Thailand is widely perceived as having made some extraordinary contributions to the global management of the HIV/AIDS pandemic. It has been promoted as a model of effective HIV control and applauded for its leadership in providing access to antiretroviral treatment. Thailand has also received international recognition for its contribution to biomedical HIV prevention research, which is generally perceived as exceptional. In this paper, Thailand's global role model function as an example of effective HIV/AIDS control and high-quality biomedical HIV prevention research is re-evaluated against the background of currently available data and more recent insights. The results indicate that Thailand's initial response in raising the level of the political significance of HIV/AIDS was indeed extraordinary, which probably prevented a much larger epidemic from occurring. However, this response transpired in unusual extraconstitutional circumstances and its effectiveness declined once the country returned to political normalcy. Available data confirm the country's more than exceptional contribution to biomedical HIV prevention research. Thailand has made a huge contribution to the global management and control of the HIV/AIDS pandemic.
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Affiliation(s)
- Frits van Griensven
- Thai Red Cross AIDS Research Center, 104 Rajadamri Road, Patumwan, Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Thai Red Cross AIDS Research Center, 104 Rajadamri Road, Patumwan, Bangkok 10330, Thailand
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang Chiang Mai 50200, Thailand
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20
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Malta M, Ralil da Costa M, Bastos FI. The Paradigm of Universal Access to HIV-Treatment and Human Rights Violation: How Do We Treat HIV-Positive People Who Use Drugs? Curr HIV/AIDS Rep 2013; 11:52-62. [DOI: 10.1007/s11904-013-0196-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Treloar C, valentine K. Examining structural violence in opioid pharmacotherapy treatment in Australia: Sweating the “small stuff” in a liberal paradise. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e11-3. [DOI: 10.1016/j.drugpo.2013.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
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22
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Izenberg JM, Bachireddy C, Soule M, Kiryazova T, Dvoryak S, Altice FL. High rates of police detention among recently released HIV-infected prisoners in Ukraine: implications for health outcomes. Drug Alcohol Depend 2013; 133:154-60. [PMID: 23769160 PMCID: PMC3786010 DOI: 10.1016/j.drugalcdep.2013.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ukraine's HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention of PWID not resulting in a formal charge or imprisonment is common, but its prevalence and impact on health are not known. METHOD HIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression. RESULTS Detention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031). CONCLUSIONS HIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.
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Affiliation(s)
- Jacob M. Izenberg
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Chethan Bachireddy
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Michael Soule
- Massachussetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | | | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Bailey TC, Sugarman J. Social justice and HIV vaccine research in the age of pre-exposure prophylaxis and treatment as prevention. Curr HIV Res 2013; 11:473-80. [PMID: 24033297 PMCID: PMC4084567 DOI: 10.2174/1570162x113116660054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/05/2013] [Accepted: 07/11/2013] [Indexed: 11/22/2022]
Abstract
The advent of pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) as means of HIV prevention raises issues of justice concerning how most fairly and equitably to apportion resources in support of the burgeoning variety of established HIV treatment and prevention measures and further HIV research, including HIV vaccine research. We apply contemporary approaches to social justice to assess the ethical justification for allocating resources in support of HIV vaccine research given competing priorities to support broad implementation of HIV treatment and prevention measures, including TasP and PrEP. We argue that there is prima facie reason to believe that a safe and effective preventive HIV vaccine would offer a distinct set of ethically significant benefits not provided by current HIV treatment or prevention methods. It is thereby possible to justify continued support for HIV vaccine research despite tension with priorities for treatment, prevention, and other research. We then consider a counter-argument to such a justification based on the uncertainty of successfully developing a safe and effective preventive HIV vaccine. Finally, we discuss how HIV vaccine research might now be ethically designed and conducted given the new preventive options of TasP and PrEP, focusing on the ethically appropriate standard of prevention for HIV vaccine trials.
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Affiliation(s)
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics and Division of Infectious Diseases, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
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24
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Gruskin S, Ferguson L, Alfven T, Rugg D, Peersman G. Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment. J Int AIDS Soc 2013; 16:18000. [PMID: 23621903 PMCID: PMC3638120 DOI: 10.7448/ias.16.1.18000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 02/03/2013] [Accepted: 03/14/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. METHODS Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. RESULTS Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention. CONCLUSIONS Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.
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Affiliation(s)
- Sofia Gruskin
- Programme on Global Health and Human Rights, Institute for Global Health, University of Southern California, Los Angeles, CA, USA.
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Csete J, Wolfe D. Viral transmission linked to injecting illicit drugs: finding the best medicine. Future Virol 2013. [DOI: 10.2217/fvl.12.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Joanne Csete
- Global Drug Policy Program, Open Society Foundation, Millbank Tower, 21–24 Millbank, London SW1P 4QP, UK.
| | - Daniel Wolfe
- International Harm Reduction Development Program, Open Society Foundation, 400 W. 59 Street, New York, NY 10019, USA
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Fu JJ, Bazazi AR, Altice FL, Mohamed MN, Kamarulzaman A. Absence of antiretroviral therapy and other risk factors for morbidity and mortality in Malaysian compulsory drug detention and rehabilitation centers. PLoS One 2012; 7:e44249. [PMID: 23028508 PMCID: PMC3445567 DOI: 10.1371/journal.pone.0044249] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/31/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature. METHODS We evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals. RESULTS Approximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis. Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release. Fourteen percent of participants reported suicidal ideation over the previous two weeks. CONCLUSION We identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality. Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health.
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Affiliation(s)
- Jeannia J. Fu
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America
- Centre of Excellence for Research in AIDS (CERiA), University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alexander R. Bazazi
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America
- Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, United States of America
- Centre of Excellence for Research in AIDS (CERiA), University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Frederick L. Altice
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America
- Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, United States of America
- Centre of Excellence for Research in AIDS (CERiA), University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * E-mail:
| | | | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America
- Centre of Excellence for Research in AIDS (CERiA), University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Affiliation(s)
- Joseph J. Amon
- Health and Human Rights Division, Human Rights Watch, New York, NY 10118-3299, USA
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Terzian AS, Bodach SD, Wiewel EW, Sepkowitz K, Bernard MA, Braunstein SL, Shepard CW. Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City. PLoS One 2012; 7:e29679. [PMID: 22291892 PMCID: PMC3265470 DOI: 10.1371/journal.pone.0029679] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 12/02/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL). METHODS/PRINCIPAL FINDINGS Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average. CONCLUSIONS/SIGNIFICANCE Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.
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Affiliation(s)
- Arpi S Terzian
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America.
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Human rights abuses, ethics, and the protection of subjects when conducting research on intravenous drug users in China. J Acquir Immune Defic Syndr 2011; 57:e29-31. [PMID: 21709453 DOI: 10.1097/qai.0b013e318215de81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moran M, Khawaja M, Khoshnood K, Ramahi T, Inhorn MC. Violent conflict and population health in the Middle East. Glob Public Health 2011; 6:467-71. [PMID: 24735466 DOI: 10.1080/17441692.2011.578581] [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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Volkmann T, Lozada R, Anderson CM, Patterson TL, Vera A, Strathdee SA. Factors associated with drug-related harms related to policing in Tijuana, Mexico. Harm Reduct J 2011; 8:7. [PMID: 21477299 PMCID: PMC3080292 DOI: 10.1186/1477-7517-8-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/08/2011] [Indexed: 11/18/2022] Open
Abstract
Objective To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. Methods IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling and underwent questionnaires and testing for HIV (human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Results Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. Conclusions IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs.
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Affiliation(s)
- Tyson Volkmann
- 9500 Gilman Drive, MC-0507, La Jolla, California, 92093-0507, USA.
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Lambert EY, Normand JL, Volkow ND. Prevention and treatment of HIV/AIDS among drug-using populations: a global perspective. J Acquir Immune Defic Syndr 2010; 55 Suppl 1:S1-4. [PMID: 21045592 PMCID: PMC3074297 DOI: 10.1097/qai.0b013e3181f9c120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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