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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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Wagner KD, Lee L. Commentary on Rosen et al.: Attending to the unique needs of pregnant and parenting women at risk for overdose. Addiction 2023; 118:855-856. [PMID: 36823721 DOI: 10.1111/add.16161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Karla D Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, NV, USA
| | - Lisa Lee
- College of Health Sciences and Public Policy, Walden University, Minneapolis, MN, USA
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Prevalence and factors associated with hospitalisation for bacterial skin infections among people who inject drugs: The ETHOS Engage Study. Drug Alcohol Depend 2022; 237:109543. [PMID: 35772249 DOI: 10.1016/j.drugalcdep.2022.109543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed to determine the prevalence of hospitalisation for SSTIs among PWID, and identify similarities and differences in factors associated with hospitalisation for SSTIs versus non-bacterial harms related to injecting drug use. METHODS We performed cross-sectional analyses of baseline data from an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Logistic regression models were used to identify factors associated with self-reported hospitalisation for (1) SSTIs (abscess and/or cellulitis), and (2) non-bacterial harms related to injecting drug use (e.g., non-fatal overdose; hereafter referred to as non-bacterial harms), both together and separately. RESULTS 1851 participants who injected drugs in the previous six months were enrolled (67% male; 85% injected in the past month; 42% receiving opioid agonist treatment [OAT]). In the previous year, 40% (n = 737) had been hospitalised for drug-related causes: 20% (n = 377) and 29% (n = 528) of participants were admitted to hospital for an SSTI and non-bacterial harm, respectively. Participants who were female (adjusted odds ratio [aOR]: 1.53, 95% CI: 1.19-1.97) or homeless (aOR: 1.59, 95% CI: 1.16-2.19) were more likely to be hospitalised for an SSTI, but not a non-bacterial harm. Both types of hospitalisation were more likely among people recently released from prison. CONCLUSIONS Hospitalisation for SSTIs is common among PWID. Community-based interventions to prevent SSTIs and subsequent hospitalisation among PWID will require targeting of at-risk groups, including women, people experiencing homelessness, and incarcerated people upon prison release.
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Stewart A, West BS, Rafful C, Lazos K, Jain J, Gonzalez-Zuniga P, Rocha-Jimenez T. "I would rather do it myself": injection initiation and current injection patterns among women who inject drugs in Tijuana, Mexico. Harm Reduct J 2021; 18:105. [PMID: 34645473 PMCID: PMC8513336 DOI: 10.1186/s12954-021-00554-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) experience unique risks and adverse health outcomes related to injection initiation and patterns of injection drug use. However, there is limited information on injection initiation experiences and injection patterns among women and the protective strategies employed to limit injection-related harms, especially in low- and middle-income settings. Therefore, this study sought to explore injection initiation and current injection patterns (e.g., relying on someone else to inject) among women who inject drugs and engage in sex work in Tijuana, Mexico. METHODS Semistructured in-depth interviews were conducted with 30 WWID on the following topics: injection initiation, current injection patterns, places where women inject, and protective strategies (i.e., risk reduction). All interviews were audio-recorded, transcribed, and de-identified. An inductive thematic analysis was conducted to identify and compare common themes and patterns across participants. RESULTS The interviews revealed that the vast majority of study participants were first initiated by another person who injects drugs (PWID), often a male sexual partner. However, the majority of the women transitioned to become self-injectors in order to avoid risks associated with relying on others for injection, including overdose, interpersonal violence, sexual abuse, and wounds. Those who relied on others indicated that they would prefer to inject themselves without assistance from others if they were able to. CONCLUSIONS The narratives uncovered in this study reveal the importance of multiple risk environments in shaping perceived risks associated with injection drug use among women in Tijuana, Mexico. Specifically, the interviews elucidate the connection between interpersonal relationships with other PWID and protective strategies used to minimize risk and harm. These findings highlight the need for women-centered harm reduction programs to facilitate the development of safer drug use environments among WWID in Tijuana, Mexico.
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Affiliation(s)
- Allison Stewart
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Claudia Rafful
- Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
- Center on Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
| | | | - Jennifer Jain
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA
| | - Patricia Gonzalez-Zuniga
- Wound Clinic Tijuana, Tijuana, Mexico
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA.
- Society and Health Research Center, Faculty of Humanities, Universidad Mayor, Santiago de Chile, Chile.
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Tales of gender-based oppression and violence: Risks and vulnerabilities of women who inject drugs (WWID) in Dhaka, Bangladesh. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103144. [PMID: 33549468 DOI: 10.1016/j.drugpo.2021.103144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/03/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women who inject drugs (WWID) experience various complexities, risks and vulnerabilities attributed to unequal gendered power differentials. This article has aimed to explore the unequal gendered power dynamics that influence HIV risks and vulnerabilities among WWID in Dhaka, Bangladesh. METHODS This paper is based on an ethnographic study conducted from April 2018 to December 2019 in Dhaka, Bangladesh. This component of the study constituted 2500 h of extensive field observations, 15 in-depth interviews and five focus groups exclusively with WWID. We also interviewed 15 key-informants including programme managers, an academician and harm reduction service providers. Data were thematically analysed in relation to the four bases of gendered power theorised by gender scholars Pratto and Walker which include force, resource control, asymmetrical obligations and consensual ideologies. RESULTS The first base, "force", highlighted situations where WWID were compelled into risky injecting and sexual behaviours to avoid violent ramifications or losing their safety nets with intimate partners. The second base, "resource control", depicted unequal access to commodities where men exercised their dominance over money and drugs. The third base, "social obligations", depicted the propensity of WWID to obey their partners and clients, thus precipitating their risky behaviours. The fourth base, consensual ideologies, were linked to weakened negotiation powers of WWID, thus increasing their propensity to risky injecting and sexual behaviours alongside poly-drug use. Despite several instances of gender-based violence and oppression, WWID have fallen victim to gender-blind interventions, as demonstrated by study observations and anecdotes. CONCLUSION Gender-based violence and oppression were depicted as prominent driving forces exacerbating WWID's HIV risks and vulnerabilities. If these issues are overlooked, the HIV burden will continue permeating among WWID. Thus, stakeholders need to look beyond the lens of conventional harm reduction modalities and synergize evidence-based gendered dynamics to formulate a gender-responsive comprehensive service package for WWID.
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Ataiants J, Roth AM, Mazzella S, Lankenau SE. Circumstances of overdose among street-involved, opioid-injecting women: Drug, set, and setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102691. [PMID: 32086154 PMCID: PMC7302961 DOI: 10.1016/j.drugpo.2020.102691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Current discourses about the causes of the overdose crisis largely focus on the harmful effects of drugs. Prior research, however, indicates that drug use experience is shaped by complex interactions of drugs with physiological and mental "sets" of people who use drugs and the wider social and physical "setting." Zinberg's "drug, set, and setting" theoretical framework was applied to identify patterns in circumstances leading up to women's overdose. METHODS In-depth semi-structured interviews were conducted with 29 opioid-injecting street-involved women, clients of a Philadelphia harm reduction program. Qualitative analysis with deductive and inductive coding was utilized to examine transcripts for theory-driven and emerging themes. RESULTS Ten out of 29 women attributed their overdose to "drugs," reporting the unpredictable quality of street opioids, concurrent use of benzodiazepines, or chasing the "high." Thirteen women reported "set" as a type of circumstance where their emotional states were affected by a "good" or "bad" day, leading them to unusual drug consumption practices. Six women described "setting" type of circumstances where their overdose was preceded by a recent change in context, such as release from prison, which prompted unsafe drug use to address physiological or psychological dependence on drugs. CONCLUSION While all overdoses result from the pharmacological action of drugs, some overdoses were triggered by circumstances occurring in women's set or setting. Overdose prevention policies should embrace not only individual-level behavioral interventions, but also structural measures to address stress, social isolation, and risky drug use contexts that plague the lives of street-involved women who inject opioids.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
| | - Silvana Mazzella
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA 19134, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104, USA
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A good “doctor” is hard to find: Assessing uncredentialed expertise in assisted injection. Soc Sci Med 2019; 237:112446. [DOI: 10.1016/j.socscimed.2019.112446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
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Malaguti A, Sani F, Stephens BP, Ahmad F, Dugard P, Dillon JF. Change in injecting behaviour among people treated for hepatitis C virus: The role of intimate partnerships. J Viral Hepat 2019; 26:65-72. [PMID: 30260560 DOI: 10.1111/jvh.13009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Injecting behaviour in people who inject drugs is the main risk factor for hepatitis C virus (HCV) infection. Psychosocial factors such as having a partner who injects drugs and living with other drug users have been associated with increases in injecting risk behaviour. This study aimed to investigate changes in injecting behaviour during treatment for HCV infection whilst exploring the role of psychosocial factors on patients' injecting behaviour. Eradicate-C was a single-centred clinical trial (ISRCTN27564683) investigating the effectiveness of HCV treatment within the injecting drug-using population between 2012 and 2017. A total of 94 participants completed up to 24 weeks of treatment, with social and behavioural measures taken at different intervals throughout treatment. Data for 84 participants were analysed retrospectively to explore mechanisms of potential behavioural changes which had occurred during treatment. Injecting frequency reduced significantly between baseline (week 1) and every 4-weekly interval until week 26. Not being on opiate substitution therapy (OST) was associated with a statistically significant decrease in injecting frequency, χ2 (1) = 10.412, P = 0.001, as was having a partner who also used drugs, in particular when that partner was also on treatment for HCV infection, Z = -2.312, P = 0.021. Treating a hard-to-reach population for HCV infection is not only possible, but also bears health benefits beyond treatment of HCV alone. Enrolling couples on HCV treatment when partners are sero-concordant has shown enhanced benefits for reduction in injecting behaviour. Implications for practice are discussed.
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Affiliation(s)
- Amy Malaguti
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK.,Adult Psychological Therapies Service, NHS Tayside, Dundee, UK.,Sexual Health and Blood Borne Virus Managed Care Network, Public Health Directory, NHS Tayside, Kings Cross Hospital, Dundee, UK.,School of Medicine, University of Dundee, Dundee, UK
| | - Fabio Sani
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK
| | - Brian P Stephens
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Farsana Ahmad
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Pat Dugard
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, UK
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Reynolds GL, Fisher DG. A latent class analysis of alcohol and drug use immediately before or during sex among women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:179-188. [PMID: 30359095 DOI: 10.1080/00952990.2018.1528266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alcohol and drug use by women is related to high-risk sexual practices and protective behaviors. OBJECTIVES To determine sexual risk and protective behaviors using information about women's drug use immediately before or during sex. METHODS Latent class analysis using PROC LCA in SAS software was used to determine classes of women using both past 30-day drug use and before or during sex. Participants were recruited from a community-based research site located in a low socio-economic area of Los Angeles County and completed the Risk Behavior Assessment, which elicits information on drug and sex risk behaviors. RESULTS The Risk Behavior Assessment and HIV and sexually transmitted infections testing was obtained on 812 women. Five distinct groups were identified by PROC LCA: An Abstinent group comprised of 26% of participants; an Alcohol and Marijuana group (16%); an Amphetamine group (11%); a No Sex-with-Alcohol group (37%); and a Poly Drug group (11%). Multinomial logistic regression revealed that sexual behaviors and condom use were different across the five groups: The Alcohol and Marijuana group had a higher odds of vaginal intercourse, while the No Sex-with-Alcohol group was most likely to use condoms for vaginal intercourse. The Poly Drug group had the highest risk for anal intercourse while the Amphetamine and Poly Drug groups had high proportions of women with injection-drug using and men-who-have-sex-with-men sexual partners. CONCLUSION Identifying women based on drug use immediately before or during sex can help providers understand prevention and risk-reduction practices and interventions for drug-using women.
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Affiliation(s)
- Grace L Reynolds
- a Department of Health Care Administration , California State University , Long Beach , CA , USA.,b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA
| | - Dennis G Fisher
- b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA.,c Psychology Department , California State University , Long Beach , CA , USA
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Guise A, Horyniak D, Melo J, McNeill R, Werb D. The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis. Addiction 2017; 112:2098-2111. [PMID: 28734128 PMCID: PMC5673537 DOI: 10.1111/add.13957] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 07/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. METHODS We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. RESULTS From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. CONCLUSIONS Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Division of Health and Social Care, King’s College London, Addison House, Guy’s campus, London, UK
| | - Danielle Horyniak
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne VIC 3004, Australia,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne VIC 3004, Australia
| | - Jason Melo
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA
| | - Ryan McNeill
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia Canada,Division of AIDS, Department of Medicine, University of British Columbia, 2775 Laurel St, Vancouver, British Columbia Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,International Centre for Science in Drug Policy, St. Michael’s Hospital, 30 Bond St, Toronto, Canada
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Loeliger KB, Biggs ML, Young R, Seal DW, Beckwith CG, Kuo I, Gordon MS, Altice FL, Ouellet LJ, Cunningham WE, Young JD, Springer SA. Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium. AIDS Behav 2017; 21:2945-2957. [PMID: 28188460 DOI: 10.1007/s10461-017-1722-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.
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Staton M, Strickland JC, Tillson M, Leukefeld C, Webster JM, Oser CB. Partner Relationships and Injection Sharing Practices among Rural Appalachian Women. Womens Health Issues 2017; 27:652-659. [PMID: 28882550 DOI: 10.1016/j.whi.2017.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The role of relationships in initiating and maintaining women's risk behaviors has been established. However, understanding factors that may underlie partner relationships and women's risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women's risky injection practices as a function of relationship power perception. METHODS Female participants were recruited from three rural jails in the Appalachian region. Women were selected randomly, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs during the year before entering jail (n = 199). MAIN FINDINGS Approximately three-quarters (76%) reported having a recent main male sexual partner with a history of injection drug use. Although having a risky partner independently increased the likelihood of women reporting shared injection practices, perceptions of relationship power significantly moderated the effect on shared needle (adjusted odds ratio, 0.02; 95% CI, 0.003-0.23; p = .001) and shared works (adjusted odds ratio, 0.17; 95% CI, 0.03-0.95; p = .04) use. CONCLUSIONS This interaction indicated that, for women who inject drugs with a recent injecting male partner, greater perception of relationship power was associated with a decreased likelihood of shared injection practices. Implications for clinical assessment and intervention are discussed.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky.
| | - Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - J Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carrie B Oser
- Department of Sociology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky
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Syringe Sharing Among a Prospective Cohort of Street-Involved Youth: Implications for Needle Distribution Programs. AIDS Behav 2017; 21:2717-2725. [PMID: 28409267 DOI: 10.1007/s10461-017-1762-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The sharing of previously used syringes is associated with the transmission of Hepatitis C and HIV. This longitudinal study examines syringe borrowing and syringe lending within a prospective cohort of street-involved youth in Vancouver, Canada. From September 2005 to May 2014, data were collected from the At-Risk Youth Study, a cohort of street-involved youth age 14-26 at enrollment, and analyzed using generalized estimating equations. Among 505 participants, 142 (28.1%) reported syringe borrowing and 132 (26.1%) reported syringe lending during the study period. In separate multivariable analyses, having difficulty finding clean needles and homelessness were significantly associated with syringe borrowing (Adjusted Odds Ratio (AOR) = 2.28, 95% CI 1.66-3.12 and AOR = 1.52, CI 1.05-2.21, respectively) and syringe lending (AOR = 1.89, 95% CI 1.32-2.71 and AOR = 1.65, 95% CI 1.11-2.44, respectively) (all p values < 0.05). Findings highlight gaps in syringe access for vulnerable young injectors and suggest that service delivery for youth may be suboptimal. Further examination of how needle distribution efforts might be improved to better meet the needs of young people is warranted.
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Staton M, Ciciurkaite G, Havens J, Tillson M, Leukefeld C, Webster M, Oser C, Peteet B. Correlates of Injection Drug Use Among Rural Appalachian Women. J Rural Health 2017; 34:31-41. [PMID: 28685884 DOI: 10.1111/jrh.12256] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/01/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU. METHODS This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting. RESULTS Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices. CONCLUSIONS This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Gabriele Ciciurkaite
- Department of Sociology, Social Work and Anthropology, Utah State University, Logan, Utah
| | - Jennifer Havens
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Martha Tillson
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carl Leukefeld
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Matthew Webster
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carrie Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky
| | - Bridgette Peteet
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
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Weissman J, Kanamori M, Dévieux JG, Trepka MJ, De La Rosa M. HIV Risk Reduction Interventions Among Substance-Abusing Reproductive-Age Women: A Systematic Review. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:121-140. [PMID: 28467160 PMCID: PMC5536169 DOI: 10.1521/aeap.2017.29.2.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
HIV/AIDS is one of the leading causes of death among reproductive-age women throughout the world, and substance abuse plays a major role in HIV infection. We conducted a systematic review, in accordance with the 2015 Preferred Items for Reporting Systematic Reviews and Meta-analysis tool, to assess HIV risk-reduction intervention studies among reproductive-age women who abuse substances. We initially identified 6,506 articles during our search and, after screening titles and abstracts, examining articles in greater detail, and finally excluding those rated methodologically weak, a total of 10 studies were included in this review. Studies that incorporated behavioral skills training into the intervention and were based on theoretical model(s) were the most effective in general at decreasing sex and drug risk behaviors. Additional HIV risk-reduction intervention research with improved methodological designs is warranted to determine the most efficacious HIV risk-reduction intervention for reproductive-age women who abuse substances.
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Affiliation(s)
- Jessica Weissman
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mariano Kanamori
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
| | - Jessy G Dévieux
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mary Jo Trepka
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
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16
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Carroll JJ, Ngure K, Heffron R, Curran K, Mugo NR, Baeten JM. Gendered differences in the perceived risks and benefits of oral PrEP among HIV-serodiscordant couples in Kenya. AIDS Care 2016; 28:1000-6. [PMID: 26754017 DOI: 10.1080/09540121.2015.1131972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is effective for preventing HIV among HIV-serodiscordant heterosexual couples. Gender roles may influence perceived personal and social risks related to HIV-prevention behaviors and may affect use of PrEP. In this study, interviews and focus groups were conducted with 68 individuals from 34 mutually disclosed serodiscordant heterosexual partnerships in Thika, Kenya. Sociocultural factors that affect adherence to PrEP were explored using grounded analysis. Three factors were identified, which shape perceptions of PrEP: gendered power dynamics and control over decision-making in the household; conflicts between risk-reduction strategies and male sexual desire; culture-bound definitions of women's work. Adherence to PrEP in the Partners PrEP Study was high; however, participants articulated conflicting interests related to PrEP in connection with traditional gender roles. The successful delivery of PrEP will require understanding of key social factors, particularly related to gender and dyadic dynamics around HIV serostatus.
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Affiliation(s)
- Jennifer J Carroll
- a Department of Epidemiology , University of Washington , Seattle , Washington , USA.,b Department of Anthropology , University of Washington , Seattle , Washington , USA
| | - Kenneth Ngure
- c Department of Global Health , University of Washington , Seattle , Washington , USA.,e Jomo Kenyatta University of Agriculture and Technology , Nairobi , Kenya
| | - Renee Heffron
- a Department of Epidemiology , University of Washington , Seattle , Washington , USA.,c Department of Global Health , University of Washington , Seattle , Washington , USA
| | - Kathryn Curran
- a Department of Epidemiology , University of Washington , Seattle , Washington , USA
| | - Nelly R Mugo
- f Kenya Medical Research Institute , Nairobi , Kenya
| | - Jared M Baeten
- a Department of Epidemiology , University of Washington , Seattle , Washington , USA.,c Department of Global Health , University of Washington , Seattle , Washington , USA.,d Department of Medicine , University of Washington , Seattle , Washington , USA
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Syvertsen JL, Ohaga S, Agot K, Dimova M, Guise A, Rhodes T, Wagner KD. An ethnographic exploration of drug markets in Kisumu, Kenya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:82-90. [PMID: 26838470 DOI: 10.1016/j.drugpo.2016.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use. METHODS Our exploratory study of injection drug use was conducted in Kisumu from 2013 to 2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein. RESULTS Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya. CONCLUSIONS We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Margarita Dimova
- Department of Politics and International Studies, SOAS, Thornhaugh Street, Russell Square, London, England WC1H 0XG, United Kingdom
| | - Andy Guise
- Division of Global Public Health, University of California, San Diego, Central Research Services Facility (CRSF), La Jolla, CA 92093-0507, USA; London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. MS 0274, Reno, NV 89557, USA
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18
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Wickersham JA, Loeliger KB, Marcus R, Pillai V, Kamarulzaman A, Altice FL. Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:98-110. [PMID: 26636885 DOI: 10.3109/00952990.2015.1101467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. OBJECTIVES To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. METHODS A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. RESULTS Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. CONCLUSION Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.
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Affiliation(s)
- Jeffrey A Wickersham
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Kelsey B Loeliger
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA
| | - Ruthanne Marcus
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA
| | - Veena Pillai
- c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Adeeba Kamarulzaman
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Frederick L Altice
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
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19
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Armenta RF, Roth AM, Wagner KD, Strathdee SA, Brodine SK, Cuevas-Mota J, Munoz FA, Garfein RS. Prevalence and Correlates of the Use of Prefilled Syringes Among Persons Who Inject Drugs in San Diego, CA. J Urban Health 2015; 92:1081-91. [PMID: 26382653 PMCID: PMC4675744 DOI: 10.1007/s11524-015-9988-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Persons who inject drugs (PWID) are at increased risk for blood-borne virus (BBV) infections and overdose resulting from high-risk injecting practices. Studies of prefilled syringe use ([PFSU] using a syringe that already contained drug solution when it was obtained by the user), an injection practice previously described in Eastern Europe, suggest that it increases susceptibility to BBV. However, little is known about this practice in the USA. Data were obtained from an ongoing cohort study of PWID to determine the prevalence and assess correlates of PFSU in San Diego, CA. Baseline interviews assessed socio-demographics and drug use behaviors. Logistic regression was used to identify factors independently associated with ever using a prefilled syringe (yes/no). Participants (n = 574) were predominately males (73.9%) and white (50.9%) with a mean age of 43.4 years (range 18-80); 33.3% reported ever using prefilled syringes, although only 4.9% reported use in the past 6 months. In multivariable analyses, PFSU was independently associated with ever having a rushed injection due to police presence [adjusted odds ratio (AOR) = 2.51, 95% CI 1.66, 3.79], ever being in prison (AOR = 1.80, 95% CI 1.23, 2.63), injecting most often in public versus private places in the past 6 months (AOR = 1.66, 95% CI 1.11, 2.48), and injecting drugs in Mexico (AOR = 1.70, 95% CI 1.16, 2.49). Results indicate that a history of PFSU is common and associated with environmental factors that may also increase risk for adverse health outcomes. Studies are needed to better understand PFSU in order to develop interventions to prevent adverse outcomes associated with their use.
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Affiliation(s)
- Richard F Armenta
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA.,Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Alexis M Roth
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Stephanie K Brodine
- Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Fatima A Munoz
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA.
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20
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Women Who Use or Inject Drugs: An Action Agenda for Women-Specific, Multilevel, and Combination HIV Prevention and Research. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S182-90. [PMID: 25978486 DOI: 10.1097/qai.0000000000000628] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Women account for more than half of all individuals living with HIV globally. Despite increasing drug and HIV epidemics among women, women who use drugs are rarely found in research, harm reduction programs, or drug and HIV treatment and care. Women who use drugs continue to face challenges that increase their vulnerability to HIV and other comorbidities because of high rates of gender-based violence, human rights violations, incarceration, and institutional and societal stigmatization. This special issue emphasizes how the burdens of HIV, drug use, and their co-occurring epidemics affect women in a global context. Articles included focus on the epidemiologies of HIV and hepatitis C virus and other comorbidities; HIV treatment, prevention, and care; and policies affecting the lives of women who use drugs. This issue also highlights the state of the science of biomedical and behavioral research related to women who use drugs. The final article highlights the major findings of articles covered and presents a call to action regarding needed research, treatment, and preventive services for women who use drugs. To address these needs, we advocate for women-specific thinking and approaches that consider the social, micro, and macro contexts of women's lives. We present a women-specific risk environment framework that reflects the unique lives and contexts of women who use drugs and provides a call to action for intervention, prevention, and policies.
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21
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Scheidell J, Khan M, Clifford L, Dunne E, Keen II. L, Latimer W. Gender differences in planning ability and hepatitis C virus among people who inject drugs. Addict Behav 2015; 47:33-7. [PMID: 25863005 DOI: 10.1016/j.addbeh.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/20/2015] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) is primarily spread through risky injection practices, including sharing needles, cookers, cottons, rinse water, and the practice of backloading. An important aspect of harm reduction for people who inject drugs (PWID) is to identify factors that contribute to safer injection. Planning ability may influence risky injection practices and gender differences in factors that drive injection practices indicate a need to examine associations between planning and injection behaviors in men versus women. Data from the NEURO-HIV Epidemiologic Study was restricted to those who had ever injected in their lifetime (n=456). Impaired planning ability was assessed with the Tower of London and defined as a standardized total excess move score below the 10th percentile. We used logistic regression to estimate the gender-specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between impaired planning, each injection practice, and biologically-confirmed HCV. Impaired planning ability was associated with sharing needles (AOR=2.93, 95% CI: 1.33, 6.47), cookers (AOR=3.13, 95% CI: 1.22, 8.02), cottons (AOR=2.89, 95% CI: 1.23, 6.78), rinse water (AOR=2.43, 95% CI: 1.15, 5.14), and backloading (AOR=2.68, 95% CI: 1.26, 5.70) and HCV (AOR=3.42, 95% CI: 1.03, 11.38) among men. Planning ability was not significantly associated with the injection behaviors or HCV among women, suggesting that other factors likely contribute to risky injection practices. Interventions to promote harm reduction among PWID should ascertain and strengthen planning ability. Women may have additional barriers to practicing safe injection beyond impaired planning abilities, which should also be addressed.
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An evaluation of high-risk behaviors among female drug users based on Health Belief Model. J Med Life 2015; 8:36-43. [PMID: 28316663 PMCID: PMC5348937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives. Because of the physiological nature of the female reproductive system, women are susceptible to infectious diseases, especially STD and AIDS. Addiction and high-risk behaviors also grow danger of these diseases. The reason of this paper was to examine high-risk behaviors among female drug users based on the Health Belief Model. Methods. Participants of this study were 106 female drug users aged 18 years and older; by the undermost level of literacy skills and been involved in sexual relationships. They came to Drop-In-Centers (DIC) in Tehran, the capital of Iran. Data study was controlled by using a logistic reflux investigation and Pearson correlation analysis. Results. The conclusion showed that women's overall awareness was moderate. There were a considerable relationship among awareness and years old (p=0.006), awareness and education (p> 0.0001), and awareness and conjugal situation (p=0.062). Perceived sensitivity and severity were clearly compared by education level (p=0.007) and (p=0.014), respectively. Mean scores of perceived benefits and perceived severity of high-risk behaviors were estimated to be superior to other components. Conclusion. Awareness and perceived susceptibility must be raised regarding the educational schedule, which is according to the health belief model in the addiction field, to reduce perceived barriers to risky behavior prevention of women who use drugs.
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Puri N, DeBeck K, Feng C, Kerr T, Rieb L, Wood E. Gender influences on hepatitis C incidence among street youth in a Canadian setting. J Adolesc Health 2014; 55:830-4. [PMID: 25240449 PMCID: PMC4254041 DOI: 10.1016/j.jadohealth.2014.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Few studies have examined gender-based differences in the risk of hepatitis C virus (HCV) infection among street-involved youth. We compared rates of HCV infection among male and female street-involved youth in a Canadian setting. METHODS The At-Risk Youth Study is a prospective cohort of drug-using street-involved youth. Study recruitment and follow-up occurred in Vancouver, Canada, between September 2005 and November 2011. Eligible participants were illicit drug-using youth aged 14-26 years at enrollment, recruited by street-based outreach. We evaluated rates of HCV antibody seroconversion, measured every 6 months during study follow-up, and used Cox proportional hazards regression to compare risk factors for HCV incidence between male and female street youth. RESULTS Among 512 HCV-seronegative youth contributing 836 person-years of follow-up, 56 (10.9%) seroconverted to HCV. Among female participants, the incidence density of HCV infection was 10.9 per 100 person-years, and in males, it was 5.1 per 100 person-years (p = .009). In multivariate analyses, female gender was independently associated with a higher rate of HCV seroconversion (adjusted hazard ratio, 2.01; 95% confidence interval, 1.18-3.44). Risk factors were similar in gender-stratified analyses and included heroin injection and crystal methamphetamine injection, although syringe sharing was only associated with HCV incidence among males. CONCLUSIONS Among street-involved youth in this setting, females had double the incidence of HCV seroconversion demonstrating the need for gender-focused HCV prevention interventions for this population.
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Affiliation(s)
- Nitasha Puri
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Launette Rieb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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El-Bassel N, Gilbert L, Terlikbayeva A, Beyrer C, Wu E, Shaw SA, Ma X, Chang M, Hunt T, Ismayilova L, Primbetova S, Rozental Y, Zhussupov B. HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: implications for HIV prevention, research, and policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:1195-203. [PMID: 24556208 PMCID: PMC5859567 DOI: 10.1016/j.drugpo.2013.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. METHODS This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. RESULTS The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). CONCLUSION Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.
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Affiliation(s)
- Nabila El-Bassel
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
| | - Louisa Gilbert
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7141, Baltimore, MD 21205, United States
| | - Elwin Wu
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Stacey A Shaw
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Xin Ma
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Mingway Chang
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Tim Hunt
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Leyla Ismayilova
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, United States
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Yelena Rozental
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Baurzhan Zhussupov
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
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Abstract
We reviewed papers published during the past 18 months (2012-2013) focusing on micro-social contexts of gender and power inequalities as drivers of HIV risks among people who inject drugs (PWID) in intimate heterosexual relationships. Although there has been a proliferation of social and behavioral research on the micro-social contexts of drug injection in heterosexual intimate relationships, there is still a gap in knowledge of these issues, particularly in low- and middle-income countries. Research has identified couple-based approaches for PWID in intimate relationships as an effective HIV prevention strategy to address micro-social contexts driving HIV risks. While HIV incidence has declined in many countries, prevalence remains at troubling levels among PWID and transmission from PWID to their sex partners is increasing in many parts of the world. HIV prevention among drug-using couples must address the importance of the relationship dyad and micro-social contexts.
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Abstract
PURPOSE OF REVIEW We reviewed the studies published in 2012-2013 that focused on re-emerging and emerging injection and noninjection drug use trends driving HIV risk behaviors and transmission in some parts of the world. RECENT FINDINGS Although HIV incidence has declined in many countries, HIV epidemics remain at troubling levels among key drug-using populations, including females who inject drugs (FWIDs), FWIDs who trade sex, sex partners of people who inject drugs, young people who inject drugs, and people who use noninjection drugs in a number of low-income and middle-income countries such as in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa. SUMMARY HIV epidemics occur within the contexts of global economic and political forces, including poverty, human rights violations, discrimination, drug policies, trafficking, and other multilevel risk environments. Trends of injection and noninjection drug use and risk environments driving HIV epidemics in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa call for political will to improve HIV and substance use service delivery, access to combination HIV prevention, and harm reduction programs.
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Wagner KD, Armenta RF, Roth AM, Maxwell JC, Cuevas-Mota J, Garfein RS. Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Drug Alcohol Depend 2014; 141:99-106. [PMID: 24916748 PMCID: PMC4114932 DOI: 10.1016/j.drugalcdep.2014.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/22/2014] [Accepted: 05/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Use of synthetic cathinones (SC) and cannabimimetics (i.e., "THC homologues" [TH]) is associated with adverse health effects. We investigated the epidemiology of synthetic drug use among a cohort of injection drug users (IDUs) in San Diego, California. METHODS We used logistic regression analysis to identify correlates of SC and TH use among 485 IDUs enrolled from June 2012 to September 2013. RESULTS Seven percent of participants reported ever using SC and 30% reported ever using TH. In multivariate logistic regression, age and recent hospitalization were significantly associated with odds of SC use (Adjusted Odds Ratio [AOR] 0.93, 95% Confidence Interval [C.I.] 0.90, 0.97; and AOR 2.34 95% C.I. 1.00, 5.49, respectively) and TH use (AOR 0.96, 95% C.I. 0.94, 0.98; and AOR 2.62, 95% C.I. 1.47, 4.68, respectively). Use of methamphetamine (AOR 9.35, 95% C.I. 1.20, 72.79) and club drugs in the past six months (AOR 3.38, 95% C.I. 1.17, 9.76) were significantly associated with SC use. Being on probation/parole (AOR 2.42, 95% C.I. 1.44, 4.07), initiating injection drug use with stimulants (AOR 1.89 95% C.I. 1.13, 3.16), and past six-month marijuana (AOR 9.22, 95% C.I. 4.49, 18.96) and prescription drug use (AOR 1.98, 95% C.I. 1.20, 3.27) were significantly associated with TH use. CONCLUSIONS A considerable proportion of IDU use synthetic drugs and may experience harms associated with their use. Findings have implications for criminal justice system management. Prevention efforts should emphasize the risks associated with rapidly changing synthetic formulations, and the potential harms associated with polydrug use.
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Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States.
| | - Richard F Armenta
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Alexis M Roth
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Jane C Maxwell
- The Center for Social Work Research, School of Social Work, The University of Texas at Austin, 1 University Station D3510, Austin, TX 78712, United States
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
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