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Nguyen TQ, Roberts Lavigne LC, Brantner CL, Kirk GD, Mehta SH, Linton SL. Estimation of place-based vulnerability scores for HIV viral non-suppression: an application leveraging data from a cohort of people with histories of using drugs. BMC Med Res Methodol 2024; 24:21. [PMID: 38273277 PMCID: PMC10809603 DOI: 10.1186/s12874-023-02133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
The relationships between place (e.g., neighborhood) and HIV are commonly investigated. As measurements of place are multivariate, most studies apply some dimension reduction, resulting in one variable (or a small number of variables), which is then used to characterize place. Typical dimension reduction methods seek to capture the most variance of the raw items, resulting in a type of summary variable we call "disadvantage score". We propose to add a different type of summary variable, the "vulnerability score," to the toolbox of the researchers doing place and HIV research. The vulnerability score measures how place, as known through the raw measurements, is predictive of an outcome. It captures variation in place characteristics that matters most for the particular outcome. We demonstrate the estimation and utility of place-based vulnerability scores for HIV viral non-suppression, using data with complicated clustering from a cohort of people with histories of injecting drugs.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA.
| | | | | | | | | | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA
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2
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Lee E, Piñeros J, Williams LD, Mackesy-Amiti ME, Molina Y, Boodram B. Network ethnic homophily and injection equipment sharing among Latinx and White non-Latinx people who inject drugs. J Ethn Subst Abuse 2023:1-20. [PMID: 36853193 PMCID: PMC10460831 DOI: 10.1080/15332640.2023.2181259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Latinx people who inject drugs (PWID) are less likely to engage in injection equipment sharing, but are more vulnerable to injection drug use (IDU)-related morbidity and mortality than Whites. Identifying subgroups of Latinx PWID who do engage in equipment sharing and likely bear the brunt of this health burden is a priority. Ethnic disparities may reflect contextual drivers, including injection networks. Latinx PWID with low ethnic homophily (the proportion of individuals with the same ethnic background) may be more likely to share equipment due to forced distancing from health-protective ethnocultural resources and power imbalances within injection networks. The current study offers a framework and examines how associations between network ethnic homophily and injection equipment sharing differ among 74 Latinx and 170 non-Latinx White PWID in the Chicagoland area (N = 244). Latinx had less homophilous than non-Latinx Whites (p <.001). Ethnic homophily was protective for equipment sharing among Latinx (OR = 0.17, 95%CI [0.77, 0.04], p = .02), but not non-Latinx Whites (OR = 1.66, 95%CI [0.40, 6.93], p = .49). Our findings implicate the need for targeted cultured interventions that focus on Latinx PWID who are more vulnerable to morbidity and mortality, potentially due to less access to ethnic peers.
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Affiliation(s)
- Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Juliet Piñeros
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Mary-Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Yamilé Molina
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
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3
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Marotta PL, Stringer K, Beletsky L, West BS, Goddard-Eckrich D, Gilbert L, Hunt T, Wu E, El-Bassel N. Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019. Harm Reduct J 2021; 18:115. [PMID: 34789270 PMCID: PMC8600731 DOI: 10.1186/s12954-021-00565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.
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Affiliation(s)
- Phillip L Marotta
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
- School of Social Work, Columbia University, New York, NY, 10027, USA.
- Northeastern University, Boston, MA, 02115, USA.
| | - Kristi Stringer
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Leo Beletsky
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Brooke S West
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Dawn Goddard-Eckrich
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Louisa Gilbert
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Tim Hunt
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Elwin Wu
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Nabila El-Bassel
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
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4
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Jin C, Nwangwu-Ike N, Gant Z, Johnson Lyons S, Satcher Johnson A. Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017. Public Health Rep 2021; 137:525-536. [PMID: 33882743 PMCID: PMC9109533 DOI: 10.1177/00333549211007168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. METHODS We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau's American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. RESULTS We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had <high school diploma, the median annual household income was <$40 000, and ≥16% of the residents did not have health insurance or a health coverage plan. CONCLUSION To our knowledge, our study is the first large-scale, census tract-level study to describe SDH among PWID with diagnosed HIV in the United States. The findings of substantial disparities in SDH among people with HIV infection attributed to injection drug use should be further examined. Understanding the SDH among PWID is crucial to reducing disparities in HIV diagnoses in this population.
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Affiliation(s)
- Chan Jin
- ICF, Atlanta, GA, USA,Chan Jin, PhD, ICF, 2635 Century Pkwy NE,
Ste 1000, Atlanta, GA 30345, USA;
| | - Ndidi Nwangwu-Ike
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
| | - Zanetta Gant
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
| | - Shacara Johnson Lyons
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, GA, USA
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5
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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Millett GA, Honermann B, Jones A, Lankiewicz E, Sherwood J, Blumenthal S, Sayas A. White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses. AIDS Patient Care STDS 2020; 34:417-424. [PMID: 32833494 PMCID: PMC7585613 DOI: 10.1089/apc.2020.0155] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/ethnicity for various diseases, including HIV. This commentary documents differing HIV and COVID-19 outcomes and service delivery by race/ethnicity and the crucial role of racial segregation. Using publicly available Census data, we divide US counties into quintiles by percentage of non-Hispanic white residents and examine HIV diagnoses and COVID-19 per 100,000 population. HIV diagnoses decrease as the proportion of white residents increase across US counties. COVID-19 diagnoses follow a similar pattern: Counties with the highest proportion of white residents have the fewest cases of COVID-19 irrespective of geographic region or state political party inclination (i.e., red or blue states). Moreover, comparatively fewer COVID-19 diagnoses have occurred in primarily white counties throughout the duration of the US COVID-19 pandemic. Systemic drivers place racial minorities at greater risk for COVID-19 and HIV. Individual-level characteristics (e.g., underlying health conditions for COVID-19 or risk behavior for HIV) do not fully explain excess disease burden in racial minority communities. Corresponding interventions must use structural- and policy-level solutions to address racial and ethnic health disparities.
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Affiliation(s)
| | - Brian Honermann
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Austin Jones
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Elise Lankiewicz
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Jennifer Sherwood
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Susan Blumenthal
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Asal Sayas
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
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Ibragimov U, Beane S, Friedman SR, Komro K, Adimora AA, Edwards JK, Williams LD, Tempalski B, Livingston MD, Stall RD, Wingood GM, Cooper HLF. States with higher minimum wages have lower STI rates among women: Results of an ecological study of 66 US metropolitan areas, 2003-2015. PLoS One 2019; 14:e0223579. [PMID: 31596890 PMCID: PMC6785113 DOI: 10.1371/journal.pone.0223579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
Prior research has found that places and people that are more economically disadvantaged have higher rates and risks, respectively, of sexually transmitted infections (STIs). Economic disadvantages at the level of places and people, however, are themselves influenced by economic policies. To enhance the policy relevance of STI research, we explore, for the first time, the relationship between state-level minimum wage policies and STI rates among women in a cohort of 66 large metropolitan statistical areas (MSAs) in the US spanning 2003-2015. Our annual state-level minimum wage measure was adjusted for inflation and cost of living. STI outcomes (rates of primary and secondary syphilis, gonorrhea and chlamydia per 100,000 women) were obtained from the CDC. We used multivariable hierarchical linear models to test the hypothesis that higher minimum wages would be associated with lower STI rates. We preliminarily explored possible socioeconomic mediators of the minimum wage/STI relationship (e.g., MSA-level rates of poverty, employment, and incarceration). We found that a $1 increase in the price-adjusted minimum wage over time was associated with a 19.7% decrease in syphilis rates among women and with an 8.5% drop in gonorrhea rates among women. The association between minimum wage and chlamydia rates did not meet our cutpoint for substantive significance. Preliminary mediation analyses suggest that MSA-level employment among women may mediate the relationship between minimum wage and gonorrhea. Consistent with an emerging body of research on minimum wage and health, our findings suggest that increasing the minimum wage may have a protective effect on STI rates among women. If other studies support this finding, public health strategies to reduce STIs among women should include advocating for a higher minimum wage.
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Affiliation(s)
- Umedjon Ibragimov
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- * E-mail:
| | - Stephanie Beane
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Samuel R. Friedman
- National Development and Research Institutes Inc, New York, NY, United States of America
| | - Kelli Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States of America
| | - Barbara Tempalski
- National Development and Research Institutes Inc, New York, NY, United States of America
| | - Melvin D. Livingston
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ronald D. Stall
- Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Gina M. Wingood
- Department of Sociomedical Sciences, Columbia University, New York, NY, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Ross Z, Cooper HLF. Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history. Harm Reduct J 2019; 16:53. [PMID: 31477150 PMCID: PMC6721211 DOI: 10.1186/s12954-019-0326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. METHODS A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. RESULTS Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. DISCUSSION Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
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Affiliation(s)
- D C Des Jarlais
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
| | - C McKnight
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - K Arasteh
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - J Feelemyer
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA
| | - H L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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9
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Collins AB, Boyd J, Cooper HLF, McNeil R. The intersectional risk environment of people who use drugs. Soc Sci Med 2019; 234:112384. [PMID: 31254965 PMCID: PMC6719791 DOI: 10.1016/j.socscimed.2019.112384] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
Current conceptual models for examining the production of risk and harm (e.g. syndemics, 'risk environment') in substance use research have been fundamental in emphasizing broader environmental factors that shape health outcomes for people who use drugs (PWUD). However, the application of these frameworks in ways that highlight nuance and complexity has remained challenging, with much of this research focusing on select social positions (e.g. race, gender) and social-structural factors (e.g. poverty, drug policies). It is crucial that we move to better accounting for these relations in the context of substance use research to enhance equity in research and ensure understanding of diverse and complex needs. Building on the risk environment framework and complementary approaches, this article introduces the 'intersectional risk environment' as an approach to understanding the interconnected ways that social locations converge within the risk environment to produce or mitigate drug-related outcomes. This framework integrates a relational intersectional lens to examine how differential outcomes across populations of PWUD are produced in relation to social location and processes operating across social-structural dimensions. In doing so, the intersectional risk environment highlights how outcomes are products of processes and relations that are embodied, reflected, and challenged while situated within social, historical, and geographic contexts. Incorporating this framework into future research may improve understandings of health outcomes for PWUD and better orient structural interventions and public health approaches to address differential risks and experiences of PWUD.
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Affiliation(s)
- Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada; British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
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10
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Tempalski B, Cooper HLF, Kelley ME, Linton SL, Wolfe ME, Chen YT, Ross Z, Des Jarlais DC, Friedman SR, Williams LD, Semaan S, DiNenno E, Wejnert C, Broz D, Paz-Bailey G. Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas. AIDS Behav 2019; 23:318-335. [PMID: 29971735 PMCID: PMC6318077 DOI: 10.1007/s10461-018-2217-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC's 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sabriya L Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY, 14850, USA
| | - Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, Suite 530, New York, NY, 10006, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
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11
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Perlman DC, Jordan AE. The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions. Curr HIV/AIDS Rep 2018; 15:96-112. [PMID: 29460225 PMCID: PMC5884743 DOI: 10.1007/s11904-018-0390-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This article reviews the case for recognizing (1) the epidemics of opioid misuse, overdose, hepatitis C virus, and HIV as a syndemic and (2) the importance of examining and addressing structural factors in responses to this syndemic. We focus on the current syndemic in the US, but also consider data from other locations to highlight the issues existing and arising in various contexts. RECENT FINDINGS Advances in multi-level theory and statistical methods allow sound ecologic and multi-level analyses of the impact of structural factors on the syndemic. Studies of opioid misuse, overdoses, hepatitis C virus, and HIV demonstrate that area-level access to healthcare, medication-assisted treatment of opioid use disorders, sterile injection equipment, and overdose prevention with naloxone, as well as factors such as opioid marketing, income inequality, intensity of policing activities, and health care policies, are related to the prevalence of substance misuse, overdoses, infection risk, and morbidity. Structural variables can predict area-level vulnerability to the syndemic. The implementation of combined prevention and treatment interventions can control and reverse components of the syndemic. Recognizing and monitoring potent structural factors can facilitate the identification of areas at risk of vulnerability to the syndemic. Further, many structural factors are modifiable through intervention and policy to reduce structural vulnerability and create health-enabling environments. Evidence supports the immediate implementation of broader HCV and HIV testing and substance use screening, medication-assisted treatment, needle/syringe exchange programs, naloxone programs, increased population-level implementation of HCV treatment, and further attention to structural-level factors predicting, and contributing to, area-level vulnerability, such as degrees of opioid marketing, distribution, and prescribing.
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Affiliation(s)
- David C Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 350 East 17th St, 19th Floor, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research, New York, NY, 10003, USA.
| | - Ashly E Jordan
- Center for Drug Use and HIV Research, New York, NY, 10003, USA
- City University New York, Graduate School of Public Health and Health Policy, New York, NY, 10016, USA
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How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters? J Acquir Immune Defic Syndr 2017; 76:13-22. [PMID: 28797017 DOI: 10.1097/qai.0000000000001463] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and 2 HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters. METHODS Bivariate Local Moran's I evaluated geographical clustering in the association between social capital (participation in civic and social organizations, 2006, 2008, 2010) and [5-year (2007-2011) prevalence of late HIV diagnosis and linkage to HIV care] across Philadelphia, PA, census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (eg, racial composition) predict differences across clusters. RESULTS We identified 4 significant clusters (high social capital-high HIV/AIDS, low social capital-low HIV/AIDS, low social capital-high HIV/AIDS, and high social capital-low HIV/AIDS). Moran's I between social capital and late HIV diagnosis was (I = 0.19, z = 9.54, P < 0.001) and linkage to HIV care (I = 0.06, z = 3.274, P = 0.002). In multivariable analysis, median household income predicted differences across clusters, particularly where social capital was lowest and HIV burden the highest, compared with clusters with high social capital and lowest HIV burden. DISCUSSION The association between social participation and HIV care continuum outcomes cluster geographically in Philadelphia, PA. HIV prevention interventions should account for this phenomenon. Reducing geographic disparities will require interventions tailored to each continuum step and that address socioeconomic factors such as neighborhood median income.
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Marotta P. Exploring Relationships Between Delinquent Peer Groups, Participation in Delinquency, Substance Abuse, and Injecting Drug Use Among the Incarcerated: Findings From a National Sample of State and Federal Inmates in the United States. JOURNAL OF DRUG ISSUES 2017; 47:320-339. [PMID: 28966393 DOI: 10.1177/0022042617690234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The following study assesses the relationship between affiliating with delinquent peer groups, participation in delinquency, and several substance misuse and injecting drug use outcomes in a nationally representative sample of inmates in state and federal facilities in the United States. After controlling for potential confounders, affiliating with peers who engaged in deviant behaviors and participation in delinquency was associated with onset of alcohol and illicit drug use, substance dependence, alcohol dependence, types of substances used, and injecting drug use outcomes. Inmates who began engaging in delinquency at older ages reported initiating drug and alcohol use at older ages, and were less likely to meet the criteria for drug abuse or dependence, less likely to use substances daily or near daily, and less likely to report having ever injected or shared syringes. The implications of these findings for substance abuse, HIV, and crime prevention interventions are discussed.
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Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Tross S, Perlman D, Friedman S, Campbell A. Racial/Ethnic Disparities at the End of an HIV Epidemic: Persons Who Inject Drugs in New York City, 2011-2015. Am J Public Health 2017; 107:1157-1163. [PMID: 28520494 DOI: 10.2105/ajph.2017.303787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine whether racial/ethnic disparities persist at the "end of the HIV epidemic" (prevalence of untreated HIV infection < 5%; HIV incidence < 0.5 per 100 person-years) among persons who inject drugs (PWID) in New York City. METHODS We recruited 2404 PWID entering New York City substance use treatment in 2001 to 2005 and 2011 to 2015. We conducted a structured interview, and testing for HIV and herpes simplex virus 2 (HSV-2; a biomarker for high sexual risk). We estimated incidence by using newly diagnosed cases of HIV. Disparity analyses compared HIV, untreated HIV, HIV-HSV-2 coinfection, HIV monoinfection, and estimated HIV incidence among Whites, African Americans, and Latinos. RESULTS By 2011 to 2015, Whites, African Americans, and Latino/as met both criteria of our operational "end-of-the-epidemic" definition. All comparisons that included HIV-HSV-2-coinfected persons had statistically significant higher rates of HIV among racial/ethnic minorities. No comparisons limited to HIV monoinfected persons were significant. CONCLUSIONS "End-of-the-epidemic" criteria were met among White, African American, and Latino/a PWID in New York City, but elimination of disparities may require a greater focus on PWID with high sexual risk.
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Affiliation(s)
- Don C Des Jarlais
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Kamyar Arasteh
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Courtney McKnight
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Jonathan Feelemyer
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Susan Tross
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - David Perlman
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Samuel Friedman
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
| | - Aimee Campbell
- Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, and David Perlman are with Icahn School of Medicine at Mount Sinai, New York, NY. Susan Tross and Aimee Campbell are with Department of Psychiatry, Columbia University, New York. Samuel Friedman is with National Research and Development Institutes, New York
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Friedman SR, Tempalski B, Brady JE, West BS, Pouget ER, Williams LD, Des Jarlais DC, Cooper HLF. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:11-6. [PMID: 27198555 DOI: 10.1016/j.drugpo.2016.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
Abstract
This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
| | - Barbara Tempalski
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Joanne E Brady
- NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814 USA
| | - Brooke S West
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093-0507, USA
| | - Enrique R Pouget
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Leslie D Williams
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Don C Des Jarlais
- Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai., 39 Broadway, Suite 530, New York, NY 10006, USA
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
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