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Urbanoski KA, van Roode T, Selfridge M, Hogan KC, Fraser J, Lock K, McGreevy PB, Burmeister C, Barker B, Slaunwhite A, Nosyk B, Pauly B. Access and barriers to safer supply prescribing during a toxic drug emergency: a mixed methods study of implementation in British Columbia, Canada. Subst Abuse Treat Prev Policy 2024; 19:44. [PMID: 39285270 PMCID: PMC11406709 DOI: 10.1186/s13011-024-00625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 09/03/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND In March 2020, British Columbia, Canada, introduced prescribed safer supply involving the distribution of pharmaceutical grade alternatives to the unregulated toxic drug supply. Prior research has demonstrated positive impacts on overdose mortality, but with limited reach to people who use substances. Objectives of this study were to (1) identify barriers to accessing safer supply prescribing among people who use substances; and (2) determine whether and how barriers differed between people with and without prescriptions, and between urban and rural settings. METHODS We conducted a participatory mixed-methods study guided by the Consolidated Framework for Implementation Research. Participants (≥ 19 years old) had received a safer supply prescription or were seeking one (survey n = 353; interviews n = 54). RESULTS Participants who had a prescription were more likely to be living in a large urban centre, compared to medium/smaller centres and rural areas (78.5% vs. 65.8%, standardized mean difference = 0.286). Participants who did not have a prescription were more likely to report an array of structural, interpersonal, and health-related barriers (compared to those who had a prescription). In interviews, participants linked experiences of barriers to stigma and criminalization, low availability of services, lack of information and prescribers, not being able to get what they need, and anxieties, worries and doubts stemming from personal circumstances. There were no notable differences between large urban centres and medium/smaller centres and rural areas in the presence of specific types of barriers. CONCLUSIONS Findings demonstrate restricted access to safer supply prescribing outside of large urban centres and provide future targets for enhancing implementation. Attention is needed to promote equity and counter systemic barriers in the implementation of responses to the ongoing toxic drug emergency.
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Affiliation(s)
- Karen A Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada.
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, V8W 2Y2, Canada.
| | - Thea van Roode
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - Marion Selfridge
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - Katherine C Hogan
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - James Fraser
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - Kurt Lock
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Phoenix Beck McGreevy
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - Charlene Burmeister
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Brittany Barker
- First Nations Health Authority, 540-757 West Hastings St, Vancouver, BC, V6C 1A1, Canada
| | - Amanda Slaunwhite
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Public and Population Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr., Burnaby, BC, V5A 1S6, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
- School of Nursing, University of Victoria, Victoria, BC, V8W 2Y2, Canada
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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gazzola MG, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2024; 56:530-540. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [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] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | | | | | | | - Lindsay M. S. Oberleitner
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Xiaoying Zheng
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Nancy S. Redeker
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Declan T. Barry
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
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Li D, Song A. Drug use disorder and family politics evolution: How can Chinese PWUD families quit drugs? J Ethn Subst Abuse 2024; 23:586-611. [PMID: 36107825 DOI: 10.1080/15332640.2022.2119186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Family plays an essential role in drug-related behavior. Based on a case study of the Lin family, whose members have all taken drugs for almost 20 years but have now completed community rehabilitation, in this study, we attempted to reveal the specific operating mechanisms of the family during the process of rehabilitation. In the analysis process, we divided the drug-use history of this family into three stages from a diachronic dimension: promote-disorder-control; we used family politics as the theoretical framework. During the drug-use promotion stage (1990-1999), all members began to use drugs. During the disorder stage (2000-2017), the Lin family members consistently relapsed intermittently due to the brutal effects of social forces and the lack of family order. Finally, in the control stage (2018-2021), the Lin family established a new family order and completed rehabilitation. The establishment process produced changes in the family politics structure, including a shift in the center of power and the decision-making patterns. Additionally, we found that the interweaving of love and power was another key trait of family politics, embodied in behavior regulation, resource sharing, and maintaining dignity among members, which further consolidated the establishment of the new family order. The results of our analysis of endogenous family change both enrich the abstract concept of family support in addiction recovery and present the potential a family has in recovery.
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Affiliation(s)
- Dong Li
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
| | - Apei Song
- Faculty of Law and Justice, School of Law, Society, and Criminology, University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Qifu Social Work Service Center, Xiamen, China
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4
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Broady TR, Valerio H, Alavi M, Wheeler A, Silk D, Martinello M, Conway A, Milat A, Dunlop A, Murray C, Henderson C, Amin J, Read P, Marks P, Degenhardt L, Stevens A, Prain B, Hayllar J, Reid D, Montebello M, Wade A, Christmass M, Cock V, Dore GJ, Treloar C, Grebely J. Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104468. [PMID: 38795465 DOI: 10.1016/j.drugpo.2024.104468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Heather Valerio
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Anna Conway
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Camperdown, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Murray
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | | | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annabelle Stevens
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Bianca Prain
- Centre for Population Health, NSW Health, New South Wales, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Mark Montebello
- North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexandra Wade
- Mid North Coast Local Health District, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Araujo Chaveron L, Pham TTP, Nguyen BT, Tran TH, Le NTH, Pham TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Nguyen TA, Taieb F, Madec Y. Injecting drug use increases the risk of death in HIV patients on antiretroviral therapy in Vietnam. AIDS Care 2024; 36:631-640. [PMID: 37339000 DOI: 10.1080/09540121.2023.2224549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic remains a major public health issue worldwide. In Vietnam, the HIV epidemic is essentially driven by people who inject drugs (PWID). This study aims to compare mortality and loss to follow-up (LTFU) between PWID and other patients. From June 2017 to April 2018, HIV-infected adults were enrolled in a prospective cohort from time of ART initiation in six provinces of North Vietnam. The end date was July 2020. Mortality and LTFU were described using competing-risk survival models. Factors associated with mortality and with LTFU were identified using Cox models with a competing-risk approach. Of the 578 participants, 261 (45.2%) were PWID and almost exclusively male. 49 patients died, corresponding to a mortality rate (95% confidence interval (CI)) of 3.7 (2.8-4.9) per 100 person-months, and 79 were lost to follow-up, corresponding to a rate (95% CI) of 6.0 (4.8-7.4) per 100 person-months. PWID were at higher risk of death but not of LTFU. Overall, LTFU was high in both groups. Latecomers to clinical visits were more at risk of both death and LTFU. Therefore, this should be a warning to clinical teams and preventive actions taken in these patients.Trial registration: ClinicalTrials.gov identifier: NCT03249493..
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Affiliation(s)
- Lucia Araujo Chaveron
- EHESP French School of Public Health, Paris, France
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
| | - Tram Thi Phuong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thang Hong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Ministry of Health, Vietnam Administration of HIV/AIDS Control (VAAC), Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
| | - Tuan Anh Nguyen
- HIV and AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
- Institut Pasteur, Department of international affairs, Université de Paris, Paris, France
| | - Yoann Madec
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
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Mlunde LB, Saalim K, Mbwambo JK, Kiwia P, Fitch E, Manyama W, Rugemalila I, Clay S, Lambdin BH, Stelmach RD, Bann C, Nyblade L. Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania. Harm Reduct J 2024; 21:65. [PMID: 38491349 PMCID: PMC10941424 DOI: 10.1186/s12954-024-00965-4] [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] [Received: 09/05/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND HIV prevalence among people who use drugs (PWUD) in Tanzania is 4-7 times higher than in the general population, underscoring an urgent need to increase HIV testing and treatment among PWUD. Drug use stigma within HIV clinics is a barrier to HIV treatment for PWUD, yet few interventions to address HIV-clinic drug use stigma exist. Guided by the ADAPT-ITT model, we adapted the participatory training curriculum of the evidence-based Health Policy Plus Total Facility Approach to HIV stigma reduction, to address drug use stigma in HIV care and treatment clinics (CTCs). METHODS The first step in the training curriculum adaptation process was formative research. We conducted 32 in-depth interviews in Dar es Salaam, Tanzania: 18 (11 men and 7 women) with PWUD living with HIV, and 14 with a mix of clinical [7] and non-clinical [7] CTC staff (5 men and 9 women). Data were analyzed through rapid qualitative analysis to inform initial curriculum adaptation. This initial draft curriculum was then further adapted and refined through multiple iterative steps of review, feedback and revision including a 2-day stakeholder workshop and external expert review. RESULTS Four CTC drug use stigma drivers emerged as key to address in the curriculum adaptation: (1) Lack of awareness of the manifestations and consequences of drug use stigma in CTCs (e.g., name calling, ignoring PWUD and denial of care); (2) Negative stereotypes (e.g., all PWUD are thieves, dangerous); (3) Fear of providing services to PWUD, and; (4) Lack of knowledge about drug use as a medical condition and absence of skills to care for PWUD. Five, 2.5-hour participatory training sessions were developed with topics focused on creating awareness of stigma and its consequences, understanding and addressing stereotypes and fears of interacting with PWUD; understanding drug use, addiction, and co-occurring conditions; deepening understanding of drug use stigma and creating empathy, including a panel session with people who had used drugs; and working to create actionable change. CONCLUSION Understanding context specific drivers and manifestations of drug use stigma from the perspective of PWUD and health workers allowed for ready adaptation of an existing evidence-based HIV-stigma reduction intervention to address drug use stigma in HIV care and treatment clinics. Future steps include a pilot test of the adapted intervention.
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Affiliation(s)
- Linda B Mlunde
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Jessie K Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Pfiriael Kiwia
- Kimara Peer Educators and Health Promoters, Dar es Salaam, Tanzania
| | | | | | | | - Sue Clay
- 3C Regional Consultants, Lusaka, Zambia
| | | | | | - Carla Bann
- RTI International, Research Triangle Park, NC, USA
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Katayama M, Fujishiro S, Sugiura K, Konishi J, Inada K, Shirakawa N, Matsumoto T. Stigmatized attitudes of medical staff toward people who use drugs and their determinants in Japanese medical facilities specialized in addiction treatment. Neuropsychopharmacol Rep 2023; 43:576-586. [PMID: 37814500 PMCID: PMC10739075 DOI: 10.1002/npr2.12380] [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] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023] Open
Abstract
AIM Stigma within healthcare settings significantly impact the lives of people who use drugs (PWUD). Given the lack of quantitative data on stigma toward PWUD in healthcare settings and the unknown factors that contribute to it in the Japanese context, this study aimed to investigate the current status of stigma toward PWUD and its determinants. METHODS We conducted a survey in five specialized addiction medical facilities across three prefectures in Japan. The survey included questions related to stigmatizing attitudes toward PWUD, knowledge about illicit drug use, and personal and professional interactions with PWUD. RESULTS A substantial portion of respondents rejected the notion that drug addiction can be overcome through sheer willpower or attributed it solely to moral failings. However, the majority still considered them untrustworthy and viewing drug use as unacceptable and incomprehensible. Many respondents perceived PWUD as dangerous, despite the limited occurrence of hostile behavior from PWUD in clinical practice. A considerable proportion of respondents did not seek support for their own or their relatives' drug-related issues, and less than half had collaborated with recovered PWUD, which serves as potential indicators of reduced stigma. While healthcare professionals recognized that involving law enforcement does not contribute to the recovery of PWUD, a considerable number still believed it was necessary to report them to the authorities. CONCLUSION Healthcare professionals in specialized addiction medical facilities demonstrate strong stigmatizing attitudes toward PWUD. Comprehensive educational programs and large-scale awareness campaigns are necessary to address and mitigate stigma in this context.
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Affiliation(s)
- Munenori Katayama
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
- Department of Drug Dependence ResearchInstitute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - So Fujishiro
- Aichi Prefectural Mental Health and Welfare CenterNagoyaJapan
| | - Kanna Sugiura
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
| | - Jun Konishi
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
| | - Ken Inada
- Department of Psychiatry, School of MedicineKitasato UniversitySagamiharaJapan
| | | | - Toshihiko Matsumoto
- Department of Drug Dependence ResearchInstitute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
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Mlunde LB, Hirschhorn LR, Nyblade L, Rothrock NE, Mbugi EV, Moskowitz JT, Kaaya S, Hawkins C, Leyna G, Mbwambo JK. Translation and cultural adaptation of drug use stigma and HIV stigma measures among people who use drugs in Tanzania. PLoS One 2023; 18:e0292642. [PMID: 37856437 PMCID: PMC10586607 DOI: 10.1371/journal.pone.0292642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION People who use drugs (PWUD) experience stigma from multiple sources due to their drug use. HIV seroprevalence for PWUD in Tanzania is estimated to range from 18 to 25%. So, many PWUD will also experience HIV stigma. Both HIV and drug use stigma have negative health and social outcomes, it is therefore important to measure their magnitude and impact. However, no contextually and linguistically adapted measures are available to assess either HIV or drug use stigma among PWUD in Tanzania. In response, we translated and culturally adapted HIV and drug use stigma measures among Tanzanian PWUD and described that process in this study. METHODS This was a cross-sectional study. We translated and adapted existing validated stigma measures by following a modified version of Wild's ten steps for translation and adaptation. We also added new items on stigmatizing actions that were not included in the original measures. Following translation and back translation, we conducted 40 cognitive debriefs among 19 PWUD living with and 21 PWUD not living with HIV in Dar es Salaam to assess comprehension of the original and new items. For challenging items, we made adaptations and repeated cognitive debriefs among ten new PWUD participants where half of them were living with HIV. RESULTS Most of the original items (42/54, 78%), response options and all items with new 12 stigmatizing actions were understood by participants. Challenges included response options for a few items; translation to Swahili; and differences in participants' interpretation of Swahili words. We made changes to these items and the final versions were understood by PWUD participants. CONCLUSION Drug use and HIV stigma measures can successfully be translated and culturally adapted among Tanzanian PWUD living with and without HIV. We are currently conducting research to determine the stigma measures' psychometric properties and we will report the results separately.
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Affiliation(s)
- Linda B. Mlunde
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Laura Nyblade
- Health Practice, RTI, International, Washington, DC, United States of America
| | - Nan E. Rothrock
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Erasto V. Mbugi
- Department of Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Department of Medicine, Feinberg School of Medicine Northwestern University, Chicago, Illinois, United States of America
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K. Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Nagot N, Binh NT, Hong TT, Vinh VH, Quillet C, Vallo R, Huong DT, Hai Oanh KT, Thanh NTT, Rapoud D, Quynh BTN, Nguyen DQ, Feelemyer J, Michel L, Vickerman P, Fraser H, Weiss L, Lemoine M, Lacombe K, Des Jarlais D, Khue PM, Moles JP, Laureillard D. A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100801. [PMID: 37693880 PMCID: PMC10485672 DOI: 10.1016/j.lanwpc.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 09/12/2023]
Abstract
Background Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam. Methods Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks. Findings Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2-7). Interpretation Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries. Funding France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
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Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Nguyen Thanh Binh
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Tran Thi Hong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vu Hai Vinh
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | | | - Delphine Rapoud
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Bach Thi Nhu Quynh
- Department of Molecular Biology, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Duc Quang Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laurence Weiss
- Université de Paris Cité, Department of Clinical Immunology, Hôpital Hôtel Dieu AP-HP, Paris, France
| | - Maud Lemoine
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Karine Lacombe
- Sorbonne Université Inserm IPLESP, Hôpital St Antoine AP-HP, Paris, France
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, USA
| | - Pham Minh Khue
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean Pierre Moles
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
- Infectious and Tropical Diseases Department, Caremeau University Hospital, Nîmes, France
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10
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Dumchev K, Guo X, Ha TV, Djoerban Z, Zeziulin O, Go VF, Sarasvita R, Metzger DS, Latkin CA, Rose SM, Piwowar-Manning E, Richardson P, Hanscom B, Lancaster KE, Miller WC, Hoffman IF. Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial. BMC Infect Dis 2023; 23:319. [PMID: 37170118 PMCID: PMC10173611 DOI: 10.1186/s12879-023-08201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
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Affiliation(s)
- Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran Viet Ha
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zubairi Djoerban
- Depts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Oleksandr Zeziulin
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine
| | - Vivian F Go
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl A Latkin
- Dept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott M Rose
- Science Facilitation Department, Durham, North Carolina, FHI 360, USA
| | | | - Paul Richardson
- Dept. of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Dept. of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Loh J, Buxton J, Kaida A, Voon P, Grant C, Milloy MJ. Estimating the prevalence and correlates of pain among people living with HIV who use unregulated drugs in a Canadian setting. J Opioid Manag 2023; 19:225-237. [PMID: 37145925 PMCID: PMC10811581 DOI: 10.5055/jom.2023.0778] [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: 05/07/2023]
Abstract
Although prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and people who use unregulated drugs (PWUD), pain and its possible links to substance use patterns and engagement in HIV treatment remains poorly characterized. We sought to evaluate the prevalence and correlates of pain among a cohort of PLWH who use un-regulated drugs. Between December 2011 and November 2018, 709 participants were recruited, and data were analyzed using generalized linear mixed-effects (GLMM). At baseline, 374 (53 percent) individuals reported moderate-to-extreme pain in the previous 6 months. In a multivariable model, pain was significantly associated with nonmedical prescrip-tion-opioid use (adjusted odds ratio (AOR) = 1.63, 95 percent confidence interval (CI): 1.30-2.05), nonfatal overdose (AOR = 1.46, 95 percent CI: 1.11-1.93), self-managing pain (AOR = 2.25, 95 percent CI: 1.94-2.61), requesting pain medication in the previous 6 months (AOR = 2.01, 95 percent CI: 1.69-2.38), and ever being diagnosed with a mental illness (AOR = 1.47, 95 percent CI: 1.11-1.94). Establishing accessible pain management interventions that address the complex intersection of pain, drug use, and HIV-infection has potential to improve quality of life outcomes among this population.
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Affiliation(s)
- Jane Loh
- British Columbia Centre on Substance Use, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pauline Voon
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Department of Medicine, University of British Columbia, Vancouver, Canada
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12
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Lefrancois LH, Nguyen BT, Pham TTP, Le NTH, Dao HTT, Tran TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Pham TH, Nguyen TA, Taieb F, Madec Y. Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients. PLoS One 2023; 18:e0281857. [PMID: 36802388 PMCID: PMC9942987 DOI: 10.1371/journal.pone.0281857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID. METHODS Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART. RESULTS Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001). CONCLUSIONS Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care. TRIAL REGISTRATION Clinical Trial Number: NCT03249493.
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Affiliation(s)
- Louise H. Lefrancois
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
| | - Binh Thanh Nguyen
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Thi Phuong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huyen Thi Thanh Dao
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
| | - Thang Hong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
- Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
- * E-mail:
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13
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Dopelt K, Davidovitch N, Davidov N, Plot I, Boas H, Barach P. "As if we are branded with the mark of Cain": stigma, guilt, and shame experienced by COVID-19 survivors in Israel - a qualitative study. CURRENT PSYCHOLOGY 2023:1-14. [PMID: 36684454 PMCID: PMC9838295 DOI: 10.1007/s12144-023-04241-9] [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] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Stigma is associated with harmful health outcomes, and it fuels social and health inequalities. It can undermine social cohesion and encourage social exclusion of groups, which may contribute to secrecy about disease symptoms, avoidance of disease testing and vaccination, and further spread of a contagious illness. Stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose a threat to effective interpersonal and social relationships. In this qualitative study, we delved into the stigmatization experiences of twenty COVID-19 recovered patients during the COVID-19 first wave, using in-depth semi-structured interviews conducted during November 2020. Using thematic analysis, we found that the process of stigmatization was all-encompassing, from the stage of diagnosis throughout the duration of the disease and the recovery phases. On the basis of the data, we hypothesized that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging and insidious effects during infectious disease pandemics such as COVID-19, and reduce infectious disease-related stigma. Interventions should address provision of emotional support frameworks for the victims of stigmatization and discrimination that accompany the COVID-19 pandemic and future pandemics. This study was conducted in the early days of the COVID-19 pandemic, when uncertainty about the disease was high and fear of contamination fueled high levels of stigmatization against those who became ill with Covid-19.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nikol Davidov
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Ira Plot
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Hagai Boas
- Department of Politics and Governance, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Van Leer Jerusalem Institute, Jerusalem, Israel
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA USA
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14
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Tran HV, Filipowicz TR, Landrum KR, Nong HTT, Tran TTT, Pence BW, Go VF, Le GM, Nguyen MX, Verhey R, Chibanda D, Ho HT, Gaynes BN. Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study. AIDS Res Ther 2022; 19:63. [PMID: 36517849 PMCID: PMC9753276 DOI: 10.1186/s12981-022-00491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stigma around human immunodeficiency virus (HIV), injection drug use (IDU), and mental health disorders can be co-occurring and have different impacts on the well-being of people living with HIV (PWH) who use drugs and have mental health disorders. This stigma can come from society, health professionals, and internalized stigma. A person who has more than one health condition can experience overlapping health-related stigma and levels of stigma which can prevent them from receiving necessary support and healthcare, serving to intensify their experience with stigma. This study investigates HIV, drug use, and mental health stigmas in three dimensions (social, internalized, and professional) around PWH on methadone maintenance treatment (MMT) who have common mental disorders (CMDs) including depression, anxiety, and stress-related disorders in Hanoi, Vietnam.Please check and confirm whether corresponding author's email id is correctly identified.The cooresponding author's email is correct METHODS: We conducted semi-structured, in-depth interviews (IDIs) (n = 21) and two focus group discussions (FGDs) (n = 10) with PWH receiving MMT who have CMD symptoms, their family members, clinic health care providers, and clinic directors. We applied thematic analysis using NVIVO software version 12.0, with themes based on IDI and FGD guides and emergent themes from interview transcripts. RESULTS The study found evidence of different stigmas towards HIV, IDU, and CMDs from the community, family, health care providers, and participants themselves. Community and family members were physically and emotionally distant from patients due to societal stigma around illicit drug use and fears of acquiring HIV. Participants often conflated stigmas around drug use and HIV, referring to these stigmas interchangeably. The internalized stigma around having HIV and injecting drugs made PWH on MMT hesitant to seek support for CMDs. These stigmas compounded to negatively impact participants' health. CONCLUSIONS Strategies to reduce stigma affecting PWH on MMT should concurrently address stigmas around HIV, drug addiction, and mental health. Future studies could explore approaches to address internalized stigma to improve self-esteem, mental health, and capacities to cope with stigma for PWH on MMT. TRIAL REGISTRATION NCT04790201, available at clinicaltrials.gov.
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Affiliation(s)
- Ha V. Tran
- The University of North Carolina-Vietnam Office, Hanoi, Vietnam
| | - Teresa R. Filipowicz
- grid.410711.20000 0001 1034 1720Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Kelsey R. Landrum
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha T. T. Nong
- The University of North Carolina-Vietnam Office, Hanoi, Vietnam
| | - Thuy T. T. Tran
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Brian W. Pence
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Vivian F. Go
- grid.410711.20000 0001 1034 1720Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Giang M. Le
- grid.56046.310000 0004 0642 8489Center for Research and Training in HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Minh X. Nguyen
- grid.56046.310000 0004 0642 8489Epidemiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Ruth Verhey
- grid.56046.310000 0004 0642 8489Epidemiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Dixon Chibanda
- grid.13001.330000 0004 0572 0760Department of Psychiatry & Research Support Centre, University of Zimbabwe, Harare, Zimbabwe ,grid.8991.90000 0004 0425 469XLondon School of Hygiene & Tropical Medicine, London, UK
| | - Hien T. Ho
- grid.448980.90000 0004 0444 7651Faculty of Clinical Medicine, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bradley N. Gaynes
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam ,grid.410711.20000 0001 1034 1720Department of Psychiatry, University of North Carolina, Chapel Hill, USA
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Pollack TM, Duong HT, Nhat Vinh DT, Phuong DT, Thuy DH, Nhung VTT, Uyen NK, Linh VT, Van Truong N, Le Ai KA, Ninh NT, Nguyen A, Canh HD, Cosimi LA. A pretest-posttest design to assess the effectiveness of an intervention to reduce HIV-related stigma and discrimination in healthcare settings in Vietnam. J Int AIDS Soc 2022; 25 Suppl 1:e25932. [PMID: 35818864 PMCID: PMC9274370 DOI: 10.1002/jia2.25932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Stigma and discrimination are important barriers to HIV epidemic control. We implemented a multi‐pronged facility‐level intervention to reduce stigma and discrimination at health facilities across three high‐burden provinces. Key components of the intervention included measurement of stigma, data review and use, participatory training of healthcare workers (HCWs), and engagement of people living with HIV and key populations in all stigma reduction activities. Methods From July 2018 to July 2019, we assessed HIV‐related stigma and discrimination among patients and HCWs at 10 facilities at baseline and 9 months following an intervention. A repeated measures design was used to assess the change in stigma and discrimination among HCWs and a repeated cross‐sectional design assessed the change in stigma and discrimination experienced by PLHIV. HCWs at target facilities were invited at random and PLHIV were recruited when presenting for care during the two assessment periods. McNemar's test was used to compare paired proportions among HCWs, and chi‐square test was used to compare proportions among PLHIV. Mixed models were used to compare outcomes before and after the intervention. Results Semi‐structured interviews were conducted with 649 and 652 PLHIV prior to and following the intervention, respectively. At baseline, over the previous 12 months, 21% reported experiencing discrimination, 16% reported self‐stigma, 14% reported HIV disclosure without consent and 7% had received discriminatory reproductive health advice. Nine months after the intervention, there was a decrease in reported stigma and discrimination across all domains to 15%, 11%, 7% and 3.5%, respectively (all p‐values <0.05). Among HCWs, 672 completed the pre‐ and post‐intervention assessment. At baseline, 81% reported fear of HIV infection, 69% reported using unnecessary precautions when caring for PLHIV, 44% reported having observed other staff discriminate against PLHIV, 54% reported negative attitudes towards PLHIV and 41% felt uncomfortable working with colleagues living with HIV. The proportions decreased after the intervention to 52%, 34%, 32%, 35% and 24%, respectively (all p‐values <0.05). Conclusions A multi‐pronged facility‐level intervention was successful at reducing healthcare‐associated HIV‐related stigma in Vietnam. The findings support the scale‐up of this intervention in Vietnam and highlight key components potentially applicable in other settings.
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Affiliation(s)
- Todd M Pollack
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Hao Thi Duong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Baylor College of Medicine, Houston, Texas, USA
| | | | - Do Thi Phuong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Do Huu Thuy
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | | | - Vuong The Linh
- Binh Duong Center for Disease Control, Binh Duong, Vietnam
| | | | - Kim Anh Le Ai
- Thai Nguyen Center for Disease Control, Thai Nguyen, Vietnam
| | | | - Asia Nguyen
- Division of Global HIV and TB, Center for Global Health, United States Centers for Disease Control and Prevention Vietnam, Hanoi, Vietnam
| | - Hoang Dinh Canh
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Lisa A Cosimi
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Vervoort D, An KR, Elbatarny M, Tam DY, Quastel A, Verma S, Connelly KA, Yanagawa B, Fremes SE. Dealing with the epidemic of endocarditis in people who inject drugs. Can J Cardiol 2022; 38:1406-1417. [PMID: 35691567 DOI: 10.1016/j.cjca.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-sided IE compared to those with non-IDU-IE and a majority are a result of S. aureus. While most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part related to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons but also infectious disease specialists, drug addiction experts, social workers, neurologists and/or neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns such as overdoses. In this review, we describe the pathophysiological, clinical, surgical, social, and ethical characteristics of IDU-IE and the management thereof. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Quastel
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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17
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Sun J, Mehta SH, Astemborski J, Piggott DA, Genberg BL, Woodson-Adu T, Benson EM, Thomas DL, Celentano DD, Vlahov D, Kirk GD. Mortality among people who inject drugs: a prospective cohort followed over three decades in Baltimore, MD, USA. Addiction 2022; 117:646-655. [PMID: 34338374 PMCID: PMC10572098 DOI: 10.1111/add.15659] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS During the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV/AIDS, the prescription opioid crisis and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban US city. DESIGN Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE). SETTING Baltimore, MD, USA from 1988 to 2018. PARTICIPANTS A total of 5506 adult PWIDs (median age at baseline 37 years). MEASUREMENTS Mortality was identified by linkage to National Death Index-Plus (NDI-Plus) and categorized into HIV/infectious disease (HIV/ID) deaths, overdose and violence-related (drug-related) deaths and chronic disease deaths. Person-time at risk accrued from baseline and ended at the earliest of death or study period. All-cause and cause-specific mortality were calculated annually. The Fine & Gray method was used to estimate the subdistribution hazards of cause-specific deaths accounting for competing risks. FINDINGS Among 5506 participants with 84 226 person-years of follow-up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV/ID deaths, 24.4% drug-related deaths and 33.3% chronic disease deaths. Age-standardized all-cause mortality increased from 23 to 45 per 1000 person-years from 1988 to 1996, declined from 1996 to 2014, then trended upward to 2018. HIV/ID deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic disease deaths increased continuously as the cohort aged. Drug-related deaths declined until 2011, but increased more than fourfold by 2018. HIV/HCV infection and active injecting were independently associated with HIV/ID and drug-related deaths. Female and black participants had a higher risk of dying from HIV/ID deaths and a lower risk of dying from drug-related deaths than male and non-black participants. CONCLUSIONS Deaths in Baltimore, MD, USA attributable to HIV/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug-related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Damani A Piggott
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tanita Woodson-Adu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eve-Marie Benson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Vlahov
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Yale School of Nursing, Orange, CT, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Le SM, Trouiller P, Duong TH, Khuat THO, Pham MK, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, Nham TTT, Hoang TG, Feelemyer J, Vu HV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs. Drug Alcohol Rev 2022; 41:697-705. [PMID: 34786755 PMCID: PMC10150937 DOI: 10.1111/dar.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. METHODS We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. RESULTS CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. DISCUSSION AND CONCLUSIONS The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
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Affiliation(s)
- Sao M Le
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Thi H Duong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi H O Khuat
- Supporting Community Development Initiatives, Hanoi, Vietnam
| | - Minh K Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Thuy L Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Quang D Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Thi G Hoang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hai V Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Hong Q Doan
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, Nîmes, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
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19
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Li C, Hu M, Yang T, Shao X, Zheng D. Correlates of stigma for poststroke patients: A meta-analysis. J Clin Nurs 2022; 32:1952-1962. [PMID: 35181955 DOI: 10.1111/jocn.16250] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/27/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
AIMS A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients. BACKGROUND Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life. DESIGN A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines. REVIEW METHODS Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis. RESULTS Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma. CONCLUSIONS The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.
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Affiliation(s)
- Chen Li
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Mingyue Hu
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China
| | - Tao Yang
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Xinmei Shao
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Dongxiang Zheng
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
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20
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Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100337. [PMID: 35024661 PMCID: PMC8669310 DOI: 10.1016/j.lanwpc.2021.100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding : This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
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Key Words
- ANRS, French Agency for Research on AIDS and Viral Hepatitis
- CBO, community-based organization
- CGI, clinical global impression scale
- DRIVE, Drug-Related Infections in ViEtnam
- EQ5D5L, 5 levels/5 dimensions EuroQol instrument
- HIV, human immunodeficiency virus
- LMICs, low-middle income countries
- MINI, MINI international neuropsychiatric interview
- MMT, methadone maintenance treatment
- NIDA, National Institute on Drug Abuse
- PHQ, patient health questionnaire
- PWID, people who inject drugs
- RDS, respondent driven sampling
- SCDI, Supporting Community Development Initiatives
- VND, Vietnamese dong
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21
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Anderson NC, Kesten JM, Ayres R, Hickman M, Amlôt R, Michie S, Lorencatto F. Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs: A qualitative study with service users and providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103437. [PMID: 34600415 DOI: 10.1016/j.drugpo.2021.103437] [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] [Received: 02/25/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England). METHODS Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. RESULTS The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination. CONCLUSIONS The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries.
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Affiliation(s)
- Niall C Anderson
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK.
| | - Joanna M Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK; NIHR Applied Research Collaboration West (ARC West), Bristol, BS1 2NT, UK
| | | | - Matthew Hickman
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK
| | - Richard Amlôt
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Health Protection Agency, Public Health England, Bristol, BS1 6EH, UK; Health Protection Research Unit in Emergency Preparedness and Response, Public Health England, Salisbury, SP4 0JG, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
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22
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Damas J, Storm M, Pandey LR, Marrone G, Deuba K. Prevalence of HIV, Hepatitis C and its related risk behaviours among women who inject drugs in the Kathmandu Valley, Nepal: a cross-sectional study. Ther Adv Infect Dis 2021; 8:20499361211062107. [PMID: 34881024 PMCID: PMC8646840 DOI: 10.1177/20499361211062107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: People who inject drugs (PWID) are at great risk of HIV and Hepatitis C Virus (HCV). In order to properly design interventions and develop programmes for women who inject drugs, this study assessed the prevalence of HIV, Hepatitis B, Hepatitis C, and syphilis and its risk behaviours among women who inject drugs in the Kathmandu Valley, Nepal. Methods: Through modified network sampling in three districts in the Kathmandu Valley, Nepal, this cross-sectional study enrolled a total of 160 women who inject drugs. Participants’ serum samples were tested for HIV, HCV, Hepatitis B virus (HBV) and syphilis and risk behaviours were assessed through a structured questionnaire. Primary outcome variables were HIV, HCV, HBV and syphilis prevalence, and secondary outcome variables were sharing needles in the past month and using condom in last sexual intercourse. Stepwise logistic regression was used to determine micro- and macroenvironmental factors associated with secondary outcomes. Results: The prevalence of HIV, HCV, and HBV was 8.8%, 21.3%, and 1.9%, respectively. HIV-HCV co-infection rate was 5.6%. Fifteen percent of women who inject drugs reported transactional sex for drugs or money. One in four women who inject drugs (27.5%) reported that they were imprisoned or detained for drug related reasons. In multivariable analysis, women living with HIV who inject drugs were almost four times more likely to use a previously used needle/syringe than women who inject drugs who were HIV negative (aOR: 4.2 CI: 1.1-15.9, p = 0.03), but were almost four times more likely to use a condom during sexual intercourse (aOR: 3.5 CI: 1.1-28.9, p = 0.03). Enrolment in family planning was the main determinant for using condoms in last sexual intercourse (aOR 4.9 CI: 1.6-16.7, p = 0.006). Participants with access to HIV test and counselling (HTC) services were less likely to share needles (aOR: 0.3, 95% CI: 0.1–0.8, p = 0.01). Conclusion: Prevalence of HIV and HCV is high among women who inject drugs in Kathmandu valley of Nepal. Women who inject drugs enrolled in national programmes such as family planning and HTC were positively associated with condom use, and less likely to share needles.
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Affiliation(s)
- José Damas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Margrethe Storm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lok Raj Pandey
- National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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23
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Stockton MA, Mughal AY, Bui Q, Greene MC, Pence BW, Go V, Gaynes BN. Psychometric performance of the perceived stigma of substance abuse scale (PSAS) among patients on methadone maintenance therapy in Vietnam. Drug Alcohol Depend 2021; 226:108831. [PMID: 34225222 PMCID: PMC9830006 DOI: 10.1016/j.drugalcdep.2021.108831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) and patients on methadone maintenance therapy (MMT) face severe stigma and discrimination. However, there are limited measures assessing stigma towards individuals with substance use disorders or MMT patients, particularly in Vietnam, and few studies have examined the psychometric properties of existing measures. This study aims to examine the performance of the eight-item Perceived Stigma of Substance Abuse Scale (PSAS), created in the United States, among a population of MMT patients in Vietnam. METHODS A cross-sectional survey was conducted among 400 adult patients enrolled in an urban MMT clinic. Substance use stigma was measured using the PSAS. We conducted confirmatory factor analysis (CFA) and assessed construct validity, reliability and known-group validity. RESULTS The original eight-item scale was unidimensional, but yielded mixed goodness-of-fit indicators. Ultimately, dropping two items and allowing the errors of the items related to childcare to correlate improved the goodness-of-fit indicators. (RMSEA = 0.025; CFI = 0.999; and SRMR = 0.018). The shortened scale demonstrated acceptable reliability (Cronbach's α = 0.766). The mean stigma scores were significantly higher among individuals not working, but did not significantly vary by length of time in MMT, marital status, education attainment, HIV status, depression, concurrent injection drug use or missed methadone dose. CONCLUSIONS The shortened six-item scale demonstrated good construct validity and acceptability reliability, but it did not demonstrate many a priori hypothesized known-group validity associations. Further research should consider a mixed-methods validation approach.
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Affiliation(s)
- Melissa A. Stockton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 630 W 168th St, New York, NY, 10032, USA,New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA,Corresponding author: (MAS)
| | - Anisa Y. Mughal
- The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Quynh Bui
- The UNC Vietnam Office, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Yen Hoa Ward, Cau Giay District, Hanoi
| | - M. Claire Greene
- Columbia University Mailman School of Public Health, Program on Forced Migration, Heilbrunn Department of Population and Family Health, 722 W 168th St, New York, NY, 10032, USA
| | - Brian W. Pence
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Epidemiology Department, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry, 333 S Columbia St, Chapel Hill, NC 27516, USA
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24
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Huang CL, Tsai IJ, Lin WC, Ho IK, Wang RY, Lee CWS. Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study. Adv Ther 2021; 38:2908-2919. [PMID: 33559050 DOI: 10.1007/s12325-021-01633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT. METHODS A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups. RESULTS During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable. CONCLUSION MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.
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Affiliation(s)
- Chieh-Liang Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - I-Ju Tsai
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Chi Lin
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ing-Kang Ho
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ruey-Yun Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cynthia Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan.
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
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Do M, Ho HT, Dinh HT, Le HH, Truong TQ, Dang TV, Nguyen DD, Andrinopoulos K. Intersecting Stigmas among HIV-Positive People Who Inject Drugs in Vietnam. Health Serv Insights 2021; 14:11786329211013552. [PMID: 33994794 PMCID: PMC8107921 DOI: 10.1177/11786329211013552] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
HIV-related stigma remains a barrier to ART adherence among people living with
HIV (PLWH) globally. People who inject drugs (PWID) may face additional stigma
related to their behavior or identity; yet, there is little understanding of how
these stigmas may co-exist and interact among these key populations. This study
aims to explore the existence of multiple dimensions of HIV-related stigma, and
how they may intersect with stigma related to drug injection. The study took
place in Vietnam, where the HIV epidemic is concentrated among 3 key population
groups; of those, PWID account for 41% of PLWH. The vast majority (95%) of PWID
in Vietnam are male. Data came from in-depth interviews with 30 male PWID
recruited from outpatient clinics, where they had been receiving ART
medications. Deductive, thematic analysis was employed to organize stigma around
the 3 dimensions: enacted, anticipated, and internalized stigma. Findings showed
that HIV- and drug use-related stigma remained high among participants. All 3
stigma dimensions were prevalent and perceived to come from different sources:
family, community, and health workers. Stigmas related to HIV and drug injection
intersected among these individuals, and such intersection varied widely across
types of stigma. The study revealed nuanced perceptions of stigma among this
marginalized population. It is important for future studies to further
investigate the influence of each dimension of stigma, and their interactive
effects on HIV and behavioral outcomes among PWID.
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Affiliation(s)
- Mai Do
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hien Thi Ho
- Faculty of Clinical Medicine, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha Thu Dinh
- Faculty of Social and Behavioural Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha Hai Le
- At the time of the study, Dr. Le was with Hanoi University of Public Health, Hanoi, Vietnam
| | - Tien Quang Truong
- Faculty of Social and Behavioural Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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Lin Y, Li C, Wang L, Jiao K, Ma W. The mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake among three key populations in China. AIDS Res Ther 2021; 18:8. [PMID: 33766062 PMCID: PMC7992327 DOI: 10.1186/s12981-021-00334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background Peer education and HIV risk perception are related to HIV testing uptake among key populations. We aimed to examine the association between peer education, HIV risk perception, and HIV testing uptake, as well as to evaluate the mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake. Methods We conducted a cross-sectional survey among 1188 HIV-uninfected or unknown participants from populations of men who have sex with men (MSM), female sex workers (FSWs), and drug users (DUs) in seven cities of China. Partial correlation analysis and regression analysis were employed to examine the associations among peer education, HIV risk perception, and HIV testing uptake. Mediation analysis was conducted to assess whether HIV risk perception mediated the hypothesized association. Results Receiving peer education was associated with higher odds of HIV testing uptake among MSM, FSWs and DUs. Perceiving risk of HIV infection was associated with higher odds of HIV testing uptake among MSM and DUs. Among MSM, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 0.53, 95% CI 0.07 to 1.21), and by high risk perception of HIV (indirect effect: 0.50, 95% CI 0.01 to 1.17). Among DUs, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 1.80, 95% CI 0.57 to 3.45). Conclusions Participants who received peer education tended to perceive their risk of HIV infection, which in turn was associated with increased HIV testing uptake among MSM and DUs. Therefore, in addition to peer education interventions, more report about HIV epidemic and risk assessment should also be scaled up to enhance HIV risk perception among key populations.
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Eng CW, Tuot S, Chann N, Chhoun P, Mun P, Yi S. Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study. BMJ Open 2021; 11:e045282. [PMID: 33653761 PMCID: PMC7929833 DOI: 10.1136/bmjopen-2020-045282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia. DESIGN Cross-sectional study. SETTING Twelve major provinces with a high burden of HIV and drug use in Cambodia. PARTICIPANTS This study included 1677 PWUD recruited using a peer-based social network recruitment method. Participants' selection criteria included being at least 18 years old and using any illicit drugs via any administration routes in the past 12 months. PRIMARY OUTCOME MEASURE Recent HIV testing, defined as having an HIV test in the past 6 months. RESULTS The median age of the participants was 28 (IQR 22-34) years, and 56.6% were men. The prevalence of lifetime and recent HIV testing was 70.7% and 42.9%, respectively. After adjustment in multivariable logistic regression analysis, recent HIV testing remained positively associated with being female (adjusted OR (AOR) 1.55, 95% CI 1.18 to 2.04) or third gender identity (AOR 2.06, 95% CI 1.11 to 3.80), having ever been to a drug rehabilitation centre (AOR 1.60, 95% CI 1.13 to 2.29), having used any HIV services in the past 6 months (AOR 7.37, 95% CI 5.61 to 9.69), having received HIV education in the past 3 months (AOR 3.40, 95% CI 2.63 to 4.40) and having self-perception of higher HIV risk (AOR 1.81, 95% CI 1.19 to 2.73). CONCLUSIONS Recent HIV test uptake among PWUD in Cambodia was suboptimal. This study highlights the roles of outreach HIV education and services in promoting regular HIV testing among PWUD. Strengthening the coordinated effort of government agencies and local civil society organisations to prioritise expanding community-based peer-driven interventions to reach out to this hidden population is warranted.
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Affiliation(s)
- Chee Wen Eng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
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28
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Scott D. Stigma in place: Black gay men's experiences of the rural South. Health Place 2021; 68:102515. [PMID: 33515909 DOI: 10.1016/j.healthplace.2021.102515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability-sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.
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Affiliation(s)
- Darius Scott
- Department of Geography, Dartmouth College Hanover, New Hampshire, 03755, USA.
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Thu Trang N, Jauffret-Roustide M, Minh Giang L, Visier L. How to be self-reliant in a stigmatising context? Challenges facing people who inject drugs in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102913. [PMID: 32855011 PMCID: PMC8118722 DOI: 10.1016/j.drugpo.2020.102913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigma works to reinforce dominant social values. The meaning of stigma is therefore not static but dependant on the regime in power. Taking into account the significant socioeconomic changes that took place in Vietnam over the last thirty years, this study explores the meaning of stigma directed at Vietnamese people who inject drugs in different social spheres. METHODS This qualitative study was conducted as part of an evaluation of a peer outreach program that distributes harm-reduction supplies and information, and provides treatment referral assistance to people who inject drugs in Haiphong, Vietnam. We conducted ethnographic field observations with peer outreach workers, home visits, and 54 in-depth interviews with participants in 2017 and 2018. Grounded theory led our theoretical sampling and analysis. RESULTS Stigma towards people who inject drugs seems to centre on the ability to be self-reliant rather than on drug-using behaviours. Participants described how their families and neighbours expressed expectations that they should manage their substance use issues by themselves, without considering the barriers they face in the job market. Participants interpret stigma directed at them in terms of poverty rather than drug use. As a result, they sometimes engage in illegal income-generating activities to pursue financial autonomy and to regain their social status. CONCLUSION People who inject drugs were struggling to conform to social expectations of self-reliance with limited support to realise it. Effective interventions must consider the many facets and challenges individuals encounter in their daily lives.
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Affiliation(s)
- Nguyen Thu Trang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam.
| | - Marie Jauffret-Roustide
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Le Minh Giang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Laurent Visier
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
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30
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Reported Low Uptake of HCV Testing among People Who Inject Drugs in Urban Vietnam. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3701379. [PMID: 33274205 PMCID: PMC7700019 DOI: 10.1155/2020/3701379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/26/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
Background HCV testing is an important first step for treatment and prevention, particularly for those who are highly vulnerable to HCV infection such as people who inject drugs (PWID). In settings where direct-acting antiretroviral medicines are becoming more available, limited information exists about who and where to target to increase the prevalence of HCV testing among PWID. This study is aimed at understanding the prevalence of HCV testing uptake and its determinants of medical services and risk behaviors. Methods From February 2016 to April 2017, a sample of 509 PWID was interviewed using a structured questionnaire on their history of HCV testing, confirmation, services using in the previous year as well as HCV-related knowledge, and risk behaviors. Multiple logistic regression identified factors associated with ever being tested for HCV before enrollment in the program. Results Approximately 33% reported ever testing for HCV. Most cited sources of testing are public hospitals and general clinics (68.9%) and outpatient clinics (18.9%). Having ever tested for HCV was positively associated with accessing health services within the prior 12 months (aOR = 2.25; 95% CI 1.11-4.58), being currently enrolled in a methadone treatment program (aOR = 2.35; 95% CI 1.34-4.08), and/or on ART treatment (aOR = 2.30; 95% CI 1.30-4.08). Those who ever delayed in seeking healthcare services for any reason were less likely to get tested for HCV (aOR = 0.54; 95% CI 0.35-0.84). Conclusion HCV testing prevalence is low among PWID in Hanoi despite a very high prevalence of HCV infection. To improve the cascade of HCV testing, it is critical that intervention programs scale up linkages among methadone, outpatient clinics, and HCV services, take steps to reduce stigma and discrimination in both community and, especially, in health care settings, and increase awareness of HCV for PWID by integrating HCV into routine counseling at health care services.
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Abstract
Stigma poses considerable challenges to the mental health of people living with HIV who use drugs (PLHWUD). In this study, we explored factors related to different types of stigma (perceived and internalized) attached to layered stigmatizing characters (HIV and drug use) and their mental health influences on PLHWUD. The study used baseline data of an ongoing randomized controlled trial among 241 PLHWUD recruited between March and December 2018 in Vietnam. A structural equation model was used to assess the relationships among different types and layers of stigma and mental health status. Both perceived and internalized drug-related stigma measures were significantly higher than their corresponding HIV-related stigma. HIV-related stigma was negatively associated with mental health status; however, we did not find a significant relationship between drug-related stigma and mental health. Tailored intervention strategies in consideration of types and layers of stigma are needed to address stigma-related challenges faced by PLHWUD.
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Yang S, Gao B, Gu J, Gong Y, Yu B, Han J, Dong P, Jia P, Yang S. Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study. Medicine (Baltimore) 2020; 99:e19963. [PMID: 32541447 PMCID: PMC7302679 DOI: 10.1097/md.0000000000019963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.
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Affiliation(s)
- Shifan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou
| | - Yi Gong
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jiayu Han
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peijie Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
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Feasibility of dried blood spots for HIV viral load monitoring in decentralized area in North Vietnam in a test-and-treat era, the MOVIDA project. PLoS One 2020; 15:e0230968. [PMID: 32271796 PMCID: PMC7145146 DOI: 10.1371/journal.pone.0230968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Access to HIV viral load is crucial to efficiently monitor patients on antiretroviral treatment (ART) and prevent HIV drug resistance acquisition. However, in some remote settings, access to viral load monitoring is still complex due to logistical and financial constraints. Use of dried blood spots (DBS) for blood collection could overcome these difficulties. This study aims to describe feasibility and operability of DBS use for routine viral load monitoring. Methods From June 2017 to April 2018, HIV-infected adults who initiated ART were enrolled in a prospective cohort in 43 clinical sites across 6 provinces in North Vietnam. Following national guidelines, the first viral load monitoring was planned 6 months after ART initiation. DBS were collected at the clinical site and sent by post to a central laboratory in Hanoi for viral load measurement. Results Of the 578 patients enrolled, 537 were still followed 6 months after ART initiation, of which DBS was collected for 397 (73.9%). The median (inter quartile range) delay between DBS collection at site level and reception at the central laboratory was 8 (6–19) days and for 70.0% viral load was measured ≤30 days after blood collection. The proportion of patients with viral load ≥1000 copies/mL at the 6 month evaluation was 15.9% (n = 59). Of these, a DBS was collected again to confirm virological failure in 15 (24.4%) of which virological failure was confirmed in 11 (73.3%). Conclusion Delay of DBS transfer to the central laboratory was acceptable and most viral loads were measured in ≤30 days, in-line with routine follow-up. However, the level of DBS coverage and the proportion of patients in failure for whom a confirmatory viral load was available were suboptimal, indicating that integration of viral load monitoring in the field requires, among other things, careful training and strong involvement of the local teams. The proportion of patients experiencing virological failure was in line with other reports; interestingly those who reported being non-adherent and those with a low BMI were more at risk of failure.
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Bayat AH, Mohammadi R, Moradi-Joo M, Bayani A, Ahounbar E, Higgs P, Hemmat M, Haghgoo A, Armoon B. HIV and drug related stigma and risk-taking behaviors among people who inject drugs: a systematic review and meta-analysis. J Addict Dis 2020; 38:71-83. [PMID: 32186479 DOI: 10.1080/10550887.2020.1718264] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The impact of HIV-related stigma on people living with HIV has been well documented, but there have been few studies examining how drug-related stigma impacts risk-taking in the lives of people who inject drugs (PWID). This meta-analysis aimed to determine HIV and drug-related stigma and the association it has with risk-taking behaviors among PWID. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in March 2019. After reviewing for any study duplicates the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. After a detailed assessment, a total of 14 studies containing 13,689 participants met the eligibility criteria. Among the potential risk factors: employment status, depression and sharing injecting paraphernalia had a significant relationship with HIV and drug stigma among PWIDs respectively (OR = 0.78, 95%CI = 0.62-0.98), (OR = 1.84, 95%CI = 1.45-2.33) and (OR = 2.20, 95%CI = 1.84-1.63). Illicit drug use related stigma was found to be associated with several concurrent effects. The impact of stigma should be considered in the development of drug use prevention strategies. Perceived stigma is correlated with numerous negative consequences in other populations including people living with HIV/AIDS. These data suggest this could also be generalized to people who inject drugs because it seems that individuals with internalized stigma experience drug dependence, reduced comfort in seeking help from services and higher rates of depression.
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Affiliation(s)
- Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Moradi-Joo
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amin Haghgoo
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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35
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Le TA, Nguyen TA, Dang AD, Nguyen CT, Phan HT, Vu GT, Nguyen THT, Latkin CA, Ho CSH, Ho RCM, Tran BX, Ying J, Zhang MWB. Preferences for methadone clinics among drug users in Vietnam: a comparison between public and private models. Harm Reduct J 2020; 17:1. [PMID: 31906957 PMCID: PMC6945541 DOI: 10.1186/s12954-019-0355-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background Methadone maintenance treatment (MMT) has been proven to be effective in treating opioid dependence. In Vietnam, MMT services are provided primarily by public clinics, with only one private MMT clinic established in recent years. Assessing the preferences of patients for different MMT models is important in evaluating the feasibility of these models. This study measured the preferences of drug users enrolling in public and private MMT clinics in Vietnam and examines the related factors of these preferences. Methods A cross-sectional study was performed on 395 participants at 3 methadone clinics in Nam Dinh. Data about the preferences for MMT models and sociodemographic characteristics of participants were collected. Exploratory factor analysis was employed to explore the construct validity of the questionnaire. The chi-square test and Mann-Whitney test were used for analyzing demographic characteristics and preferences of participants. Multivariate logistic regression identified factors associated with participants’ preferences. Results Half the participants received MMT treatment in a private facility (49.4%). Two preference dimensions were defined as “Availability and convenience of service” and “Competencies of clinic and health professionals”. Self-employed patients were more likely to consider these two dimensions when choosing MMT models. Only 9.9% of participants chose “Privacy” as one of the evaluation criteria for an MMT facility. Compared to public clinics, a statistically higher percentage of patients in the private clinic chose the attitudes of health workers as the reason for using MMT service (34.7% and 7.6% respectively). Mean score of satisfaction towards MMT services was 8.6 (SD = 1.0), and this score was statistically higher in a public facility, compared to the private facility (8.7 and 8.4 respectively). Conclusions The study highlighted patterns of patient preferences towards MMT clinics. Compared to the public MMT model, the private MMT model may need to enhance their services to improve patient satisfaction.
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Affiliation(s)
- Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Pharmacoeconomics and Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jiangbo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Melvyn W B Zhang
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Stringer KL, Mukherjee T, McCrimmon T, Terlikbayeva A, Primbetovac S, Darisheva M, Hunt T, Gilbert L, El-Bassel N. Attitudes towards people living with HIV and people who inject drugs: A mixed method study of stigmas within harm reduction programs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:27-36. [PMID: 30981165 PMCID: PMC6550278 DOI: 10.1016/j.drugpo.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/16/2019] [Accepted: 02/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND High levels of stigma towards people who inject drugs (PWID) and people living with HIV (PLWH) exist in Kazakhstan, yet little is known about the role of stigma in harm reduction service settings. In this paper, we use a mixed method design to explore and describe the actionable drivers and facilitators of stigma among harm reduction service providers. Additionally, we describe the manifestations of stigma among PWID who are living with HIV (PWID/LWH), and the impact that stigma has on harm reduction and healthcare service utilization. METHODS Eight focus groups with 57 PWID/LWH were convened between March 2016 and July 2016 to describe manifestations of stigma from the perspective of syringe exchange program (SEP) clients. Additionally, we surveyed 80 nurses, social workers, outreach workers, and providers of HIV care at SEPs between January 2017 and July 2017 to assess stigmatizing attitudes among staff within the SEP environment. Joint displays were used to integrate quantitative and qualitative data. RESULTS The actionable drivers of stigma identified in this study include negative opinions and moral judgements towards PWID/LWH. Facilitators identified included stigmatization as a social norm within the service provision environment, a lack of awareness of anti-discrimination policies, and lack of enforcement of anti-discrimination policies. Qualitative findings highlight manifestations of stigma in which PWID/LWH experienced denial of services, perceived negative attitudes, and avoidance from service provision staff. PWID/LWH also described segregation in healthcare settings, the use of unnecessary precautions by providers, and unauthorized disclosure of HIV status. CONCLUSIONS This paper highlights the urgent need to address stigma in the harm reduction and HIV service settings in Kazakhstan. These findings have implications for informing an actionable model for stigma reduction for providers who deliver services to PWID/LWH in Kazakhstan. Drivers, facilitators, and manifestations of stigma are multifaceted and addressing them will require a multilevel approach.
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Affiliation(s)
| | - Trena Mukherjee
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, United States
| | - Tara McCrimmon
- Columbia University, Department of Social Work, New York, NY, United States
| | | | | | | | - Timothy Hunt
- Columbia University, Department of Social Work, New York, NY, United States
| | - Louisa Gilbert
- Columbia University, Department of Social Work, New York, NY, United States
| | - Nabila El-Bassel
- Columbia University, Department of Social Work, New York, NY, United States
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Kwan TH, Wong NS, Lee SS. Participation pattern of methadone users and its association with social connection and HIV status: Analyses of electronic health records data. PLoS One 2019; 14:e0216727. [PMID: 31071182 PMCID: PMC6508728 DOI: 10.1371/journal.pone.0216727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background HIV spread in injecting drug users (IDU) occurs efficiently between individuals within their social networks. While methadone maintenance treatment has long known to be effective in combating HIV transmission in IDU, the impacts of one’s social connections and HIV status have not been well characterised. A study was conducted with the objective of differentiating the pattern of treatment participation between HIV-positive and negative methadone users and to understand its association with social connections with peers. Methods Attendance data in one calendar year were extracted from a territory-wide electronic clinical record database of over 8000 methadone users attending 19 clinics in Hong Kong, a city with a relatively low HIV prevalence in injecting drug users. A case-control design was used by matching HIV positive methadone users with HIV negative controls. A temporal-social co-occurrence approach was adopted to construct a social network. Multiple logistic regression and network-based analyses were conducted. Results In 2016, a total of 8332 methadone users had attended a clinic at least once, giving 1694016 attendance records that were included in the study. Some 432 methadone, 54 of whom HIV positive, were included in the case-control analyses. Multivariable logistic regression model showed that HIV-positive status was associated with drug injection history (adjusted odds ratio [aOR] 2.28, 95% confidence interval [95% CI] 1.19–4.38), not working fulltime (aOR 3.34, 95% CI 1.15–9.72), ethnic minority (aOR 2.59, 95% CI 1.33–5.02) and minimum daily dose of at least 20mg (aOR 3.64, 95% CI 1.08–12.26). Those having connections with other peers were older (aOR 1.02, 95% CI 1.00–1.04), had a higher mode dose (aOR 1.03, 95% CI 1.02–1.04) and had been admitted to methadone programme for longer time (aOR 1.07, 95% CI 1.02–1.13). Among those with connections, HIV-negative users did not have more connections (median degree centrality 21.00 vs 34.50, p = 0.26) but the network structure was stronger (clustering coefficient 0.65 vs 0.53, p = 0.03). Conclusion The weak and sparse linkages may explain the generally low HIV prevalence and incidence in opioid-dependent persons in Hong Kong. Social support could play a constructive role in harm reduction and ethnic minority community-based organisations could help and reinforce treatment adherence.
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Affiliation(s)
- Tsz Ho Kwan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
- * E-mail:
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Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, Mitchell EMH, Nelson LRE, Sapag JC, Siraprapasiri T, Turan J, Wouters E. Stigma in health facilities: why it matters and how we can change it. BMC Med 2019; 17:25. [PMID: 30764806 PMCID: PMC6376713 DOI: 10.1186/s12916-019-1256-2] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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Affiliation(s)
- Laura Nyblade
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Melissa A. Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, 2103 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Kayla Giger
- RTI International, 701 13th ST NW, Suite 750, Washington, DC, USA
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, Zambart, P.O. Box 50697, Lusaka, Zambia
| | - Maria L. Ekstrand
- Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549 USA
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, India
| | - Roger Mc Lean
- Health Economics Unit, Centre for Health Economics, Faculty of Social Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Kortenaerkade 12, 2518 AX The Hague, Netherlands
| | - La Ron E. Nelson
- University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, M5T 1B8 Canada
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Taweesap Siraprapasiri
- Department of Disease Control, Ministry of Public Health of the Government of Thailand, Tivanond Road, Nonthaburi, 11000 Thailand
| | - Janet Turan
- Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
- Behavioral and Community Sciences Core, UAB Center for AIDS Research (CFAR), Birmingham, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, B-2000 Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, PO Box 399, Bloemfontein, 9300 South Africa
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BDL. Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. Harm Reduct J 2019; 16:3. [PMID: 30621699 PMCID: PMC6325714 DOI: 10.1186/s12954-018-0276-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2016, drug overdose deaths exceeded 64,000 in the United States, driven by a sixfold increase in deaths attributable to illicitly manufactured fentanyl. Rapid fentanyl test strips (FTS), used to detect fentanyl in illicit drugs, may help inform people who use drugs about their risk of fentanyl exposure prior to consumption. This qualitative study assessed perceptions of FTS among young adults. METHODS From May to September 2017, we recruited a convenience sample of 93 young adults in Rhode Island (age 18-35 years) with self-reported drug use in the past 30 days to participate in a pilot study aimed at better understanding perspectives of using take-home FTS for personal use. Participants completed a baseline quantitative survey, then completed a training to learn how to use the FTS. Participants then received ten FTS for personal use and were asked to return 2-4 weeks later to complete a brief quantitative and structured qualitative interview. Interviews were transcribed, coded, and double coded in NVivo (Version 11). RESULTS Of the 81 (87%) participants who returned for follow-up, the majority (n = 62, 77%) used at least one FTS, and of those, a majority found them to be useful and straightforward to use. Positive FTS results led some participants to alter their drug use behaviors, including discarding their drug supply, using with someone else, and keeping naloxone nearby. Participants also reported giving FTS to friends who they felt were at high risk for fentanyl exposure. CONCLUSION These findings provide important perspectives on the use of FTS among young adults who use drugs. Given the high level of acceptability and behavioral changes reported by study participants, FTS may be a useful harm reduction intervention to reduce fentanyl overdose risk among this population. TRIAL REGISTRATION The study protocol is registered with the US National Library of Medicine, Identifier NCT03373825, 12/24/2017, registered retrospectively. https://clinicaltrials.gov/ct2/show/NCT03373825?id=NCT03373825&rank=1.
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Affiliation(s)
- Jacqueline E Goldman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Kobe A Periera
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Maxwell S Krieger
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Thi Thanh Huong N, Thi Hau N, Van Chau N, Trung Tan L, Thi Minh Tam N, Gray R, O’Connell KA, Neukom J. Perceived barriers and facilitators to uptake of HIV testing services among people who inject drugs in Vietnam. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1448473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ngo Thi Thanh Huong
- Population Services International (PSI)/Vietnam, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội, Vietnam
| | - Nguyen Thi Hau
- Community Peer Researcher, Hai Bà Trưng, Hà Nội, Vietnam
| | | | - Le Trung Tan
- Community Peer Researcher, Phu Luong, Thai Nguyen, Vietnam
| | - Nguyen Thi Minh Tam
- Vietnam Authority of HIV/AIDS Control, Ministry of Health Head, Dept. of Health Organisation and Management, Hanoi Medical University, Hanoi, Vietnam
| | - Rob Gray
- Independent Consultants, Population Services International, Washington DC, USA
| | | | - Josselyn Neukom
- Population Services International (PSI)/Vietnam, Phạm Đình Hổ, Hai Bà Trưng, Hà Nội, Vietnam
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