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Bruce V, Eldredge J, Leyva Y, Mera J, English K, Page K. Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada. Epidemiol Rev 2019; 41:158-167. [PMID: 31781749 PMCID: PMC7305812 DOI: 10.1093/epirev/mxz015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/02/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022] Open
Abstract
American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%-67.60%) and Indigenous populations (2.28%-90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.
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Affiliation(s)
- Veronica Bruce
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jonathan Eldredge
- Health Sciences Library and Informatics Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Office of Research, Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jorge Mera
- Cherokee Nation Health Services, Tahlequah, Oklahoma
| | - Kevin English
- and Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc, Albuquerque, New Mexico
| | - Kimberly Page
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Fraser H, Mukandavire C, Martin NK, Hickman M, Cohen MS, Miller WC, Vickerman P. HIV treatment as prevention among people who inject drugs - a re-evaluation of the evidence. Int J Epidemiol 2018; 46:466-478. [PMID: 27524816 DOI: 10.1093/ije/dyw180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 01/01/2023] Open
Abstract
Background Population-level associations between community measures of HIV viral load and HIV incidence have been interpreted as evidence for HIV anti-retroviral treatment (ART) as prevention among people who inject drugs (PWID). However, investigation of concurrent HCV and HIV incidence trends allows examination of alternative explanations for the fall in HIV incidence. We estimate the contribution of ART and reductions in injecting risk for reducing HIV incidence in Vancouver between 1996 and 2007. Methods A deterministic model of HIV and HCV transmission among PWID was calibrated to the baseline (1996) HIV and HCV epidemic among PWID in Vancouver. While incorporating parameter uncertainty, the model projected what levels of ART protection and decreases in injecting risk could reproduce the observed reduction in HIV and HCV incidence for 1996-2007, and so what impact would have been achieved with just ART or just reductions in injecting risk. Results Model predictions suggest the estimated reduction (84%) in HCV incidence for 1996-2007 required a 59% (2.5-97.5 percentile range 49-76%) reduction in injecting risk, which accounted for nine-tenths of the observed decrease in HIV incidence; the remainder was achieved with a moderate ART efficacy for reducing sexual HIV infectivity (70%, 51-89%) and an uncertain ART efficacy for reducing injection-related HIV infectivity (44%, 0-96%). Despite this uncertainty, projections suggest that the decrease in injecting risk reduced HIV incidence by 76% (63-85%) and ART further reduced HIV incidence by 8% (2-19%), or on its own by 3% (-34-37%). Conclusions Observed declines in HIV incidence in Vancouver between 1996 and 2007 should be seen as a success for intensive harm reduction, whereas ART probably played a small role.
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Affiliation(s)
- Hannah Fraser
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Natasha K Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Global Public Health, University of California San Diego, CA, USA and
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Myron S Cohen
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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3
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Bird Y, Lemstra M, Rogers M, Moraros J. Third-world realities in a first-world setting: A study of the HIV/AIDS-related conditions and risk behaviors of sex trade workers in Saskatoon, Saskatchewan, Canada. SAHARA J 2017; 13:152-61. [PMID: 27616600 PMCID: PMC5642440 DOI: 10.1080/17290376.2016.1229213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The transmission and prevalence of Human Immunodeficiency Virus (HIV) among those employed as sex trade workers (STW) is a major public health concern. The present study describes the self-reported responses of 340 STW, at-risk for contracting HIV. The participants were recruited by selective targeting between 2009 and 2010 from within the Saskatoon Health Region (SHR), Saskatchewan, Canada. As of 2012, the SHR has the highest incidence rate of positive test reports for HIV in Canada, at more than three times the national average (17.0 vs. 5.9 per 100,000 people). Additionally, the epidemiology of HIV/AIDS in the SHR is different from that seen elsewhere in Canada (still mostly men having sex with men and Caucasians), with its new HIV cases predominantly associated with injection drug use and Aboriginal cultural status. The purpose of this study was to (a) describe the demographic and socio-economic characteristics of the STW in the SHR, (b) identify their significant life events, self-reported problems, knowledge, attitudes, behaviors, self-efficacy, and barriers regarding HIV, and (c) determine the significant independent risk indicators for STW self-reporting a chance of greater than 50% of becoming infected with HIV/AIDS. The majority of the study participants were females, who were never married, of Aboriginal descent, without a high school diploma, and had an annual income of less than $10,000. Using multivariate regression analysis, four significant independent risk indicators were associated with STW reporting a greater that 50% chance of acquiring HIV/AIDS, including experiencing sexual assault as a child, injecting drugs in the past four weeks, being homeless, and a previous Chlamydia diagnosis. These findings provide important evidence of the essential sexual and drug-related vulnerabilities associated with the risk of HIV infection among STW and offer insight into the design and implementation of effective and culturally sensitive public health intervention and prevention efforts. To be most effective, it is recommended that such intervention and prevention initiatives: (1) use specifically tailored community-based outreach to high risk STW who are drug users and link them with appropriate drug treatment and HIV/AIDS prevention and treatment services, (2) provide free and confidential, routine HIV counseling and testing in substance abuse programs, and (3) build capacity among the local, Aboriginal NGOs so as to address with cultural sensitivity both the drug and HIV-related risk factors prevalent among this vulnerable population.
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Affiliation(s)
- Yelena Bird
- a MD, PhD, MPH, is an Assistant Professor at the School of Public Health, University of Saskatchewan , Saskatchewan , Canada
| | - Mark Lemstra
- b DrPH, PhD, is an Adjunct Professor at the School of Public Health, University of Saskatchewan , Saskatchewan , Canada
| | - Marla Rogers
- c BA, MPA, is a Researcher at the College of Medicine, University of Saskatchewan , Saskatchewan , Canada
| | - John Moraros
- d MD, PhD, MPH, is an Associate Professor at the School of Public Health, University of Saskatchewan , Saskatchewan , Canada
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Urbanoski KA. Need for equity in treatment of substance use among Indigenous people in Canada. CMAJ 2017; 189:E1350-E1351. [PMID: 29109207 DOI: 10.1503/cmaj.171002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Karen A Urbanoski
- Centre for Addictions Research of BC; School of Public Health and Social Policy, University of Victoria, Victoria, BC
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Conyers LM, Richardson LA, Datti PA, Koch LC, Misrok M. A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:475-490. [PMID: 29068719 DOI: 10.1521/aeap.2017.29.5.475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.
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Affiliation(s)
- Liza M Conyers
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | | | - Mark Misrok
- National Working Positive Coalition, New York, New York
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Ti L, Fast D, Small W, Kerr T. Perceptions of a drug prevention public service announcement campaign among street-involved youth in Vancouver, Canada: a qualitative study. Harm Reduct J 2017; 14:3. [PMID: 28086787 PMCID: PMC5237277 DOI: 10.1186/s12954-017-0132-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/04/2017] [Indexed: 11/15/2022] Open
Abstract
Background Due to the popularity of public service announcements (PSAs), as well as the broader health and social harms associated with illicit drug use, this study sought to investigate how drug prevention messages found in the Government of Canada’s DrugsNot4Me campaign were understood, experienced, and engaged with among a group of street-involved young people in Vancouver, Canada. Methods Qualitative interviews were conducted with 25 individuals enrolled in the At-Risk Youth Study, and a thematic analysis was conducted. Results Findings indicate that the campaign’s messages neither resonated with “at-risk youth”, nor provided information or resources for support. In some cases, the messaging exacerbated the social suffering experienced by these individuals. Conclusions This study underscores the importance of rigorous evaluation of PSAs and the need to consider diverting funds allocated to drug prevention campaigns to social services that can meaningfully address the structural drivers of drug-related harms among vulnerable youth populations.
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Affiliation(s)
- Lianlian Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Communication, Simon Fraser University, K9671-8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - William Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 11300-8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Krüsi A, McNeil R, Moore D, Small W. 'Because I've been extremely careful': HIV seroconversion, responsibility, citizenship and the neo-liberal drug-using subject. HEALTH RISK & SOCIETY 2016; 19:58-73. [PMID: 28989321 DOI: 10.1080/13698575.2016.1245850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this article we examine how injection drug users who do not attribute their HIV infection to engaging in HIV risk behaviours take up and critique discourses of individual responsibility and citizenship relating to HIV risk and HIV prevention. We draw on data from a study in Vancouver, Canada (2006 - 2009) in which we interviewed individuals living with HIV who had a history of injection drug use. In this paper we focus on 6 cases studies of participants who did not attribute their HIV infection to engaging in HIV risk behaviours. We found that in striving to present themselves as responsible HIV citizens who did not engage in HIV risk behaviours, these participants drew on individually-focused HIV prevention discourses. By identifying themselves in these ways, they were able to present themselves as 'deserving' HIV citizens and avoid the blame associated with being HIV positive. However, in rejecting the view that they and their risk behaviours were to blame for their HIV infection and by developing an explanation that drew on broader social, structural and historical factors, these individuals were developing a tentative critique of the importance of individual responsibility in HIV transmission as opposed to dangers of infection from the socio-economic environment. By framing the risk of infection in environmental rather than individual risk-behaviour terms these individuals redistributed responsibility to reflect the social-structural realities of their lives. In this article we reflect on the implications of these findings for public health measures such as risk prevention messages. We note that it is important that such messages are not restricted to individual risk prevention but also include a focus of broader shared responsibilities of HIV.
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Affiliation(s)
- Andrea Krüsi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,School of Population and Public Health; Faculty of Medicine; University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - David Moore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Rogers MR, Lemstra ME, Moraros JS. Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:548-55. [PMID: 26720823 PMCID: PMC4679163 DOI: 10.1177/070674371506001205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. METHODS Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. RESULTS The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. CONCLUSIONS Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.
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Affiliation(s)
- Marla Rochelle Rogers
- Research Study Coordinator, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Mark Edgar Lemstra
- Adjunct Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - John Simeon Moraros
- Assistant Professor, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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10
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Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S100-9. [PMID: 25978476 DOI: 10.1097/qai.0000000000000623] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. RESULTS Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. CONCLUSIONS There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.
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Pottie K, Medu O, Welch V, Dahal GP, Tyndall M, Rader T, Wells G. Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review. BMJ Open 2014; 4:e006859. [PMID: 25510889 PMCID: PMC4267075 DOI: 10.1136/bmjopen-2014-006859] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure. DESIGN Cochrane systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction. DATA SELECTION We included controlled studies that compared rapid VCT with conventional testing among people at risk for HIV exposure. DATA EXTRACTION Two reviewers extracted data. We used Cochrane risk of bias tool and GRADE criteria: risk of bias, inconsistency, indirectness, imprecision and publication bias. For observational studies we used the Newcastle-Ottawa Scale. We used the PRISMA-Equity reporting guideline. RESULTS From 2441 articles, we included 8 randomised controlled trials and 5 observational studies. Rapid VCT was associated with a threefold increase in HIV-testing uptake (relative risk (RR)=2.95 95% CI 1.69 to 5.16) and a twofold increase in the receipt of test results (RR=2.14, 95% CI 1.08 to 4.24). Women accepted testing more often than men in rapid VCT arm, but no differences in effect for age or socioeconomic status. Observational studies also showed rapid VCT led to higher rates of uptake of testing. Heterogeneity was high. A cluster-randomised trial reported an 11% reduction in HIV incidence in intervention communities (RR=0.89, 95% CI=0.63 to 1.24) over 3 years trial. CONCLUSIONS Rapid VCT in health facilities and communities was associated with a large increase in HIV-testing uptake and receipt of results. This has implications for WHO guidelines. The routine use of rapid VCT may also help avoid human rights violations among marginalised populations where testing may occur without informed consent and where existing stigma may create barriers to testing.
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Affiliation(s)
- Kevin Pottie
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
- Ottawa Hospital Research Institute, The Ottawa Hospital
| | - Olanrewaju Medu
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Welch
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Govinda P Dahal
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Canada Foundation for Nepal, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
| | - Tamara Rader
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - George Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital
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Hadland SE, DeBeck K, Kerr T, Feng C, Montaner JS, Wood E. Prescription opioid injection and risk of hepatitis C in relation to traditional drugs of misuse in a prospective cohort of street youth. BMJ Open 2014; 4:e005419. [PMID: 25052173 PMCID: PMC4120401 DOI: 10.1136/bmjopen-2014-005419] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Despite dramatic increases in the misuse of prescription opioids, the extent to which their intravenous injection places drug users at risk of acquiring hepatitis C virus (HCV) remains unclear. We sought to compare risk of HCV acquisition from injection of prescription opioids to that from other street drugs among high-risk street youth. DESIGN Prospective cohort study. SETTING Vancouver, British Columbia, Canada from September 2005 to November 2011. PARTICIPANTS The At-Risk Youth Study (ARYS) is a prospective cohort of drug-using adolescents and young adults aged 14-26 years. Participants were recruited through street-based outreach and snowball sampling. PRIMARY OUTCOME MEASURE HCV antibody seroconversion, measured every 6 months during follow-up. Risk for seroconversion from injection of prescription opioids was compared with injection of other street drugs of misuse, including heroin, cocaine or crystal methamphetamine, using Cox proportional hazards regression controlling for age, gender and syringe sharing. RESULTS Baseline HCV seropositivity was 10.6%. Among 512 HCV-seronegative youth contributing 860.2 person-years of follow-up, 56 (10.9%) seroconverted, resulting in an incidence density of 6.5/100 person-years. In bivariate analyses, prescription opioid injection (HR=3.48; 95% CI 1.57 to 7.70) predicted HCV seroconversion. However, in multivariate modelling, only injection of heroin (adjusted HR=4.56; 95% CI 2.39 to 8.70), cocaine (adjusted HR=1.88; 95% CI 1.00 to 3.54) and crystal methamphetamine (adjusted HR=2.91; 95% CI 1.57 to 5.38) remained independently associated with HCV seroconversion, whereas injection of prescription opioids did not (adjusted HR=0.94; 95% CI 0.40 to 2.21). CONCLUSIONS Although misuse of prescription opioids is on the rise, traditional street drugs still posed the greatest threat of HCV transmission in this setting. Nonetheless, the high prevalence and incidence of HCV among Canadian street youth underscore the need for evidence-based drug prevention, treatment and harm reduction interventions targeting this vulnerable population.
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Affiliation(s)
- Scott E Hadland
- Division of Adolescent & Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cindy Feng
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- University of Saskatchewan, School of Public Health, Saskatoon, Saskatchewan, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Ward J, Costello-Czok M, Willis J, Saunders M, Shannon C. So far, so good: Maintenance of prevention is required to stem HIV incidence in Aboriginal and Torres Strait Islander communities in Australia. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:267-279. [PMID: 24846489 DOI: 10.1521/aeap.2014.26.3.267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Indigenous people globally remain resilient yet vulnerable to the threats of HIV. Although Australian Aboriginal and Torres Strait Islander peoples experience the worst health status of any identifiable group in Australia, with a standardized morbidity rate three times that of non-Indigenous Australians, the Australian response to HIV has resulted in relatively low and stable rates of HIV infection among Australia's Indigenous peoples. This paper examines the reasons for the success of HIV prevention efforts. These include early recognition by Indigenous peoples of the potential effect that HIV could have on their communities; the supply of health hardware (needle and syringe programs and condoms); the development and implementation of culturally-appropriate health promotion messages such as the internationally-recognized Condoman campaign; the inclusion of dedicated Aboriginal and Torres Strait Islander Sexual Health Workers in communities; and an inclusive policy and partnership approach. Furthermore, the efforts of peak Aboriginal health organizations including NACCHO and its member services and Indigenous programs in peak mainstream organizations like AFAO and its member organizations, have all contributed to prevention success. Efforts need to be maintained however to ensure an escalated epidemic does not occur, particularly among heterosexual people, especially women, and people who inject drugs. New ideas are required as we enter a new era of HIV prevention within the context of the new paradigm of treatment as prevention, and getting to zero new infections.
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Hull M, Giguère P, Klein M, Shafran S, Tseng A, Côté P, Poliquin M, Cooper C. [Not Available]. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2014; 25:39-62. [PMID: 24634688 PMCID: PMC3950988 DOI: 10.1155/2014/921314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
HISTORIQUE : De 20 % à 30 % des Canadiens qui vivent avec le VIH sont co-infectés par le virus de l’hépatite C (VHC), lequel est responsable d’une morbidité et d’une mortalité importantes. La prise en charge du VIH et du VHC est plus complexe en raison de l’évolution accélérée de la maladie hépatique, du choix et des critères d’initiation de la thérapie antirétrovirale et du traitement anti-VHC, de la prise en charge de la santé mentale et des toxicomanies, des obstacles socioéconomiques et des interactions entre les nouvelles thérapies antivirales à action directe du VHC et les antirétroviraux OBJECTIF : Élaborer des normes nationales de prise en charge des adultes co-infectés par le VHC et le VIH dans le contexte canadien. MÉTHODOLOGIE : Le Réseau canadien pour les essais VIH des Instituts de recherche en santé du Canada a réuni un groupe d’experts possédant des compétences cliniques en co-infection par le VIH et le VHC pour réviser les publications à jour ainsi que les lignes directrices et les protocoles en place. Après une vaste sollicitation afin d’obtenir des points de vue, le groupe de travail a approuvé des recommandations consensuelles, qu’il a caractérisées au moyen d’une échelle de qualité des preuves fondée sur la classe (bienfaits par rapport aux préjudices) et sur la catégorie (degré de certitude). RÉSULTATS : Toutes les personnes co-infectées par le VIH et le VHC devraient subir une évaluation en vue de recevoir un traitement du VHC. Les personnes qui ne sont pas en mesure d’entreprendre un traitement du VHC devraient être soignées pour le VIH afin de ralentir l’évolution de la maladie hépatique. La norme de traitement du VHC de génotype 1 est un régime comprenant de l’interféron pégylé et de la ribavirine dosée en fonction du poids, associés à un inhibiteur de la protéase du VHC. Pour les génotypes 2 ou 3, une bithérapie classique est recommandée pendant 24 semaines s’il y a clairance virologique à la semaine 4 ou, pour les génotypes 2 à 6, à 48 semaines. On peut envisager de reporter le traitement chez les personnes ayant une maladie hépatique légère. Le VIH ne devrait pas être considéré comme un obstacle à la transplantation hépatique chez les patients co-infectés. EXPOSÉ : Les recommandations ne se substituent pas au jugement clinique personnel.
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Affiliation(s)
- Mark Hull
- Université de la Colombie-Britannique, British Columbia Centre for Excellence in VIH/AIDS, Vancouver (Colombie-Britannique)
| | - Pierre Giguère
- L’Institut de recherche de l’Hôpital d’Ottawa, Ottawa (Ontario)
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Shea B, Aspin C, Ward J, Archibald C, Dickson N, McDonald A, Penehira M, Halverson J, Masching R, McAllister S, Smith LT, Kaldor JM, Andersson N. HIV diagnoses in indigenous peoples: comparison of Australia, Canada and New Zealand. Int Health 2013; 3:193-8. [PMID: 24038370 DOI: 10.1016/j.inhe.2011.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In industrial countries, a number of factors put indigenous peoples at increased risk of HIV infection. National surveillance data between 1999 and 2008 provided diagnoses for Aboriginal and Torres Strait Islanders (Australia), First Nations, Inuit and Métis (Canada excluding Ontario and Quebec) and Māori (New Zealand). Each country provided similar data for a non-indigenous comparison population. Direct standardisation used the 2001 Canadian Aboriginal male population for comparison of five-year diagnosis rates in 1999-2003 and 2004-2008. Using the general population as denominators, we report diagnosis ratios for presumed heterosexual transmission, men who have sex with men (MSM) and intravenous drug users (IDU). Age standardised HIV diagnosis rates in indigenous peoples in Canada in 2004-2008 (178.1 and 178.4/100 000 for men and women respectively) were higher than in Australia (48.5 and 12.9/100 000) and New Zealand (41.9 and 4.3/100 000). Higher HIV diagnosis rates related to heterosexual contact among Aboriginal peoples, especially women, in Canada confirm a widening epidemic beyond the conventional risk groups. This potential of a generalised epidemic requires urgent attention in Aboriginal communities; available evidence can inform policy and action by all stakeholders. Although less striking in Australia and New Zealand, these findings may be relevant to indigenous peoples in other countries.
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Minichiello V, Rahman S, Hussain R. Epidemiology of sexually transmitted infections in global indigenous populations: data availability and gaps. Int J STD AIDS 2013; 24:759-68. [PMID: 24052012 DOI: 10.1177/0956462413481526] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Socioeconomic and health disadvantage is widespread within and across indigenous communities in the world, leading to differentials in morbidity and mortality between indigenous and non-indigenous populations. Sexually transmitted infections (STIs), including HIV/AIDS, among indigenous populations are an emerging public health concern. The focus of this paper is on examining the STI epidemiology in indigenous communities in various parts of the world utilizing a range of data sources. Most of the STI research on global indigenous communities has concentrated on developed countries, neglecting more than half the world's indigenous people in the developing countries. This has resulted in major gaps in data at global level for STIs and HIV/AIDS among indigenous populations. Available data show that the prevalence of STIs is increasing among the indigenous communities and in several instances, the rates of these infections are higher than among non-indigenous populations. However, HIV still remains low when compared with the rates of other STIs. The paper argues that there is an urgent need to collect more comprehensive and reliable data at the global level across various indigenous communities. There is also an opportunity to reverse current trends in STIs through innovative, evidence-based and culturally appropriate targeted sexual health programmes.
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Affiliation(s)
- Victor Minichiello
- The Australian Research Centre in Sex, Health and Society, School of Public Health & Human Biosciences, La Trobe University, Melbourne, Australia
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Housing instability among people who inject drugs: results from the Australian needle and syringe program survey. J Urban Health 2013; 90:699-716. [PMID: 22733170 PMCID: PMC3732681 DOI: 10.1007/s11524-012-9730-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
High rates of substance dependence are consistently documented among homeless people, and are associated with a broad range of negative outcomes among this population. Investigations of homelessness among drug users are less readily available. This study examined the prevalence and correlates of housing instability among clients of needle syringe programs (NSPs) via the Australian NSP Survey, annual cross-sectional seroprevalence studies among NSP attendees. Following self-completion of a brief, anonymous survey and provision of a capillary blood sample by 2,396 NSP clients, multivariate logistic regressions identified the variables independently associated with housing instability. Nineteen percent of ANSPS participants reported current unstable housing, with primary ('sleeping rough'; 5 %), secondary (staying with friends/relatives or in specialist homelessness services; 8 %), and tertiary (residential arrangements involving neither secure lease nor private facilities; 6 %) homelessness all evident. Extensive histories of housing instability were apparent among the sample: 66 % reported at least one period of sleeping rough, while 77 % had shifted between friends/relatives (73 %) and/or resided in crisis accommodation (52 %). Participants with a history of homelessness had cycled in and out of homelessness over an average of 10 years; and one third reported first being homeless before age 15. Compared to their stably housed counterparts, unstably housed participants were younger, more likely to be male, of Indigenous Australian descent, and to report previous incarceration; they also reported higher rates of key risk behaviors including public injecting and receptive sharing of injecting equipment. The high prevalence of both historical and current housing instability among this group, particularly when considered in the light of other research documenting the many adverse outcomes associated with this particular form of disadvantage, highlights the need for increased supply of secure, affordable public housing in locations removed from established drug markets and serviced by health, social, and welfare support agencies.
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RETIRED: Chapter 5 First Nations, Inuit, and Métis Women’s Sexual and Reproductive Health. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:S28-S32. [DOI: 10.1016/s1701-2163(15)30705-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tu D, Belda P, Littlejohn D, Pedersen JS, Valle-Rivera J, Tyndall M. Adoption of the chronic care model to improve HIV care: in a marginalized, largely aboriginal population. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:650-657. [PMID: 23766052 PMCID: PMC3681456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes. DESIGN Multisite, prospective, interventional cohort study. SETTING Two urban community health centres in Vancouver and Prince George, BC. PARTICIPANTS Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites. INTERVENTION Systematic implementation of the CCM during an 18-month period. MAIN OUTCOME MEASURES Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period. RESULTS Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up. CONCLUSION Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an "infectious disease" approach to a "chronic disease management" approach to HIV care for marginalized populations is strongly recommended.
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Affiliation(s)
- David Tu
- Vancouver Native Health Society, 449 Hastings St E, Vancouver, BC V6A 1P5, Canada.
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Boyd S, NAOMI Patients Association. Yet they failed to do so: recommendations based on the experiences of NAOMI research survivors and a call for action. Harm Reduct J 2013; 10:6. [PMID: 23594923 PMCID: PMC3646696 DOI: 10.1186/1477-7517-10-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 04/01/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This article highlights the experiences of a unique group. In January 2011, Dave Murray organized a group of participants from the North American Opiate Medication Initiative (NAOMI) heroin-assisted treatment clinical trials from 2005 to 2008 in the Downtown Eastside of Vancouver (DTES), B.C., Canada. The NAOMI Patients Association (NPA) is an independent group that currently meets every Saturday in the DTES. Currently, all members of the NPA are former participants in the heroin stream of the clinical trial. The NPA offers support, education, and advocacy to its members. METHODS Drawing on brainstorming sessions and focus groups that were conducted in the summer of 2011, this paper highlights the experiences of NPA members in their own words. RESULTS The findings provide a lens to understand how becoming a research subject for the NAOMI trial impacted the lives of NPA members, both positive and negative. The NPA members discuss ethics, consent, recommendations for future HAT programs and studies, and ongoing advocacy.
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Affiliation(s)
- Susan Boyd
- Studies in Policy & Practice, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Jozaghi E, Andresen MMA. Should North America's first and only supervised injection facility (InSite) be expanded in British Columbia, Canada? Harm Reduct J 2013; 10:1. [PMID: 23414093 PMCID: PMC3599963 DOI: 10.1186/1477-7517-10-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 02/11/2013] [Indexed: 11/20/2022] Open
Abstract
Background This article reports qualitative findings from a sample of 31 purposively chosen injection drug users (IDUs) from Vancouver, Surrey and Victoria, British Columbia interviewed to examine the context of safe injection site in transforming their lives. Further, the purpose is to determine whether the first and only Supervised injection facility (SIF) in North America, InSite, needs to be expanded to other cities. Methods Semi-structured qualitative interviews were conducted in a classical anthropological strategy of conversational format as drug users were actively involved in their routine activities. Purposive sampling combined with snowball sampling techniques was employed to recruit the participants. Audio recorded interviews were transcribed verbatim and analyzed thematically using NVivo 9 software. Results Attending InSite has numerous positive effects on the lives of IDUs including: saving lives, reducing HIV and HCV risk behavior, decreasing injection in public, reducing public syringe disposal, reducing use of various medical resources and increasing access to nursing and other primary health services. Conclusions There is an urgent need to expand the current facility to cities where injection drug use is prevalent to reduce overdose deaths, reduce needle sharing, reduce hospital emergency care, and increase safety. In addition, InSite’s positive changes have contributed to a cultural transformation in drug use within the Downtown Eastside and neighboring communities.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, B,C, V5A 1S6, Burnaby, Canada.
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Hull M, Klein M, Shafran S, Tseng A, Giguère P, Côté P, Poliquin M, Cooper C. CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian guidelines for management and treatment of HIV/hepatitis C coinfection in adults. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2013; 24:217-38. [PMID: 24489565 PMCID: PMC3905006 DOI: 10.1155/2013/781410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV-HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens. OBJECTIVE To develop national standards for the management of HCV-HIV coinfected adults in the Canadian context. METHODS A panel with specific clinical expertise in HIV-HCV co-infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality-of-evidence scale. RESULTS All HIV-HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight-based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2-6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients. DISCUSSION Recommendations may not supersede individual clinical judgement.
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Affiliation(s)
- Mark Hull
- University of British Columbia, British Columbia Centre for Excellent in HIV/AIDS, Vancouver, British Columbia
| | | | | | | | | | - Pierre Côté
- Clinique médicale du Quartier Latin, Montréal, Quebec
| | - Marc Poliquin
- Clinique médicale du Quartier Latin, Montréal, Quebec
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Wood E, Kerr T. Commentary on Des Jarlais et al. (2012): are ethnic disparities in drug policy-related harms relevant to the addiction medicine community? Addiction 2012; 107:2096-8. [PMID: 23167645 DOI: 10.1111/j.1360-0443.2012.04072.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
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Lemstra M, Rogers M, Thompson A, Moraros J, Buckingham R. Risk indicators associated with injection drug use in the Aboriginal population. AIDS Care 2012; 24:1416-24. [DOI: 10.1080/09540121.2011.650678] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Mark Lemstra
- a School of Public Health , University of Saskatchewan , Saskatoon , Canada
| | - Marla Rogers
- a School of Public Health , University of Saskatchewan , Saskatoon , Canada
| | - Adam Thompson
- b Health and Family Services , Saskatoon Tribal Council , Saskatoon , Canada
| | - John Moraros
- a School of Public Health , University of Saskatchewan , Saskatoon , Canada
| | - Robert Buckingham
- a School of Public Health , University of Saskatchewan , Saskatoon , Canada
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Lang K, El-Aneed A, Berenbaum S, Dell CA, Wright J, McKay ZT. Qualitative assessment of crisis services among persons using injection drugs in the city of Saskatoon. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.606350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reddon H, Wood E, Tyndall M, Lai C, Hogg R, Montaner J, Kerr T. Use of North America's first medically supervised safer injecting facility among HIV-positive injection drug users. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:412-422. [PMID: 22010805 PMCID: PMC3799861 DOI: 10.1521/aeap.2011.23.5.412] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of this study was to examine supervised injecting facility (SIF) use among a cohort of 395 HIV-positive injection drug users (IDUs) in Vancouver, Canada. The correlates of SIF use were identified using generalized estimating equation analyses. In multivariate analyses, frequent SIF use was associated with homelessness (adjusted odds ratio [AOR] = 1.90), daily heroin injection (AOR = 1.56), and daily cocaine injection (AOR = 1.59). The reasons given for not using the SIF included a preference for injecting at home and already having a safe place to inject. The SIF services most commonly used were needle exchange and nursing services. The SIF appears to have attracted a high-risk subpopulation of HIV-positive IDUs; this coverage perhaps could be extended with the addition of HIV-specific services such as disease monitoring and the provision of antiretroviral therapy.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver
| | - Mark Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver
| | - Calvin Lai
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver
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Marshall BDL, Shoveller JA, Wood E, Patterson TL, Kerr T. Difficulty accessing syringes mediates the relationship between methamphetamine use and syringe sharing among young injection drug users. AIDS Behav 2011; 15:1546-53. [PMID: 21197598 PMCID: PMC3180618 DOI: 10.1007/s10461-010-9876-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22–27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.
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Affiliation(s)
- Brandon D. L. Marshall
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jean A. Shoveller
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Thomas L. Patterson
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0680 USA
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Monette LE, Rourke SB, Gibson K, Bekele TM, Tucker R, Greene S, Sobota M, Koornstra J, Byers S, Marks E, Bacon J, Watson JR, Hwang SW, Ahluwalia A, Dunn JR, Guenter D, Hambly K, Bhuiyan S. Inequalities in determinants of health among Aboriginal and Caucasian persons living with HIV/AIDS in Ontario: results from the Positive Spaces, Healthy Places Study. Canadian Journal of Public Health 2011. [PMID: 21714322 DOI: 10.1007/bf03404900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario. METHODS We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity. RESULTS Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity. CONCLUSION Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
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Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting. J Emerg Med 2011; 43:236-43. [PMID: 21719229 DOI: 10.1016/j.jemermed.2011.05.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/21/2010] [Accepted: 05/20/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive injection drug users (IDUs) are known to be at risk for multiple medical problems that may necessitate emergency department (ED) use; however, the relative contribution of HIV disease vs. injection-related complications has not been well described. OBJECTIVES We examined factors associated with ED use among a prospective cohort of HIV-positive IDUs in a Canadian setting. METHODS We enrolled HIV-positive IDUs into a community-recruited prospective cohort study. We modeled factors associated with the time to first ED visit using Cox regression to determine factors independently associated with ED use. In sub-analyses, we examined ED diagnoses and subsequent hospital admission rates. RESULTS Between December 5, 2005 and April 30, 2008, 428 HIV-positive IDUs were enrolled, among whom the cumulative incidence of ED use was 63.7% (95% confidence interval [CI] 59.1-68.3%) at 12 months after enrollment. Factors independently associated with time to first ED visit included: unstable housing (hazard ratio [HR] 1.5; 95% CI 1.1-2.0) and reporting being unable to obtain needed health care services (HR 2.2; 95% CI 1.2-4.1), whereas CD4 count and viral load were non-significant. Skin and soft tissue infections accounted for the greatest proportion of ED visits (17%). Of the 2461 visits to the ED, 419 (17%) were admitted to the hospital. CONCLUSIONS High rates of ED use were observed among HIV-positive IDUs, a behavior that was predicted by unstable housing and limited access to primary care. Factors other than HIV infection seem to be driving ED use among this population in the post-highly active antiretroviral therapy era.
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Kucirka LM, Sarathy H, Govindan P, Wolf JH, Ellison TA, Hart LJ, Montgomery RA, Ros RL, Segev DL. Risk of window period HIV infection in high infectious risk donors: systematic review and meta-analysis. Am J Transplant 2011; 11:1176-87. [PMID: 21366859 PMCID: PMC3110509 DOI: 10.1111/j.1600-6143.2010.03329.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The OPTN defines high risk donors (HRDs), colloquially known as 'CDC high risk donors', as those thought to carry an increased risk of HIV window period (WP) infection prior to serologic detectability. However, the true risk of such infection remains unknown. To quantify the risk of WP infection in each HRD behavior category, we performed a systematic review and meta-analysis of studies of HIV prevalence and incidence. Of 3476 abstracts reviewed, 27 eligible studies of HIV infection in HRD populations were identified. Pooled HIV incidence estimates were calculated for each category of HRD behavior and used to calculate the risk of WP HIV infection. Risks ranged from 0.09-12.1 per 10 000 donors based on WP for ELISA and 0.04-4.9 based on nucleic acid testing (NAT), with NAT reducing WP risk by over 50% in each category. Injection drug users had the greatest risk of WP infection (4.9 per 10 000 donors by NAT WP), followed by men who have sex with men (4.2:10 000), commercial sex workers (2.7:10 000), incarcerated donors (0.9:10 000), donors exposed to HIV through blood (0.6:10 000), donors engaging in high-risk sex (0.3:10 000) and hemophiliacs (0.035:10 000). These estimates can help inform patient and provider decision making regarding HRDs.
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Affiliation(s)
- Lauren M. Kucirka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harini Sarathy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joshua H. Wolf
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trevor A. Ellison
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robert A. Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. Lorie Ros
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
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Lemstra M, Rogers M, Thompson A, Moraros J, Buckingham R. Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:358-66. [PMID: 21756450 DOI: 10.1177/070674371105600607] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100,000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours. METHODS From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR. RESULTS Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10,000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment. CONCLUSIONS This study found that depressive symptomatology was strongly associated with injection drug use.
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Affiliation(s)
- Mark Lemstra
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan.
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Milloy MJ, Kerr T, Buxton J, Rhodes T, Guillemi S, Hogg R, Montaner J, Wood E. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis 2011; 203:1215-21. [PMID: 21459814 DOI: 10.1093/infdis/jir032] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although some studies have identified impressive clinical gains for incarcerated HIV-seropositive injection drug users (IDUs) undergoing antiretroviral therapy (ART), the effect of incarceration on adherence to ART remains undetermined. METHODS We used data from a long-term community-recruited cohort of HIV-seropositive IDUs, including comprehensive ART dispensation records, in a setting where HIV care is free. We estimated the relationship between the cumulative burden of incarceration, measured longitudinally, and the odds of < 95% adherence to ART, with use of multivariate modeling. RESULTS From 1996 through 2008, 490 IDUs were recruited and contributed 2220 person-years of follow-up; 271 participants (55.3%) experienced an incarceration episode, with the number of incarcerations totaling 1156. In a multivariate model, incarceration had a strong dose-dependent effect on the likelihood of nonadherence to ART: 1-2 incarceration events (adjusted odds ratio [AOR], 1.49; 95% confidence interval [95% CI], 1.03-2.05), 3-5 events (AOR, 2.48; 95% CI, 1.62-3.65), and > 5 events (AOR, 3.11; 95% CI, 1.86-4.95). CONCLUSIONS Among HIV-seropositive IDUs receiving ART, an increasing burden of incarceration was associated with poorer adherence in a dose-dependent fashion. Our findings support improved adherence support for HIV-seropositive IDUs experiencing incarceration.
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Affiliation(s)
- M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Monette LE, Rourke SB, Gibson K, Bekele TM, Tucker R, Greene S, Sobota M, Koornstra J, Byers S, Marks E, Bacon J, Watson JR, Hwang SW, Ahluwalia A, Dunn JR, Guenter D, Hambly K, Bhuiyan S. Inequalities in determinants of health among Aboriginal and Caucasian persons living with HIV/AIDS in Ontario: results from the Positive Spaces, Healthy Places Study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:215-9. [PMID: 21714322 PMCID: PMC6974182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 12/04/2010] [Indexed: 03/29/2024]
Abstract
OBJECTIVES Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario. METHODS We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity. RESULTS Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity. CONCLUSION Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
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Affiliation(s)
| | - Sean B. Rourke
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - Katherine Gibson
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Tsegaye M. Bekele
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Ruthann Tucker
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Saara Greene
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Faculty of Social Sciences, McMaster University, Toronto, ON Canada
- Fife House, Toronto, ON Canada
| | - Michael Sobota
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- AIDS Thunder Bay, Thunder Bay, ON Canada
| | - Jay Koornstra
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Bruce House, Ottawa, ON Canada
| | | | - Elisabeth Marks
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - James R. Watson
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | | | - James R. Dunn
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Health, Aging & Society, McMaster University, Hamilton, ON Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | | | - Shafi Bhuiyan
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Positive Spaces, Healthy Places Team
- Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON Canada
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Faculty of Social Sciences, McMaster University, Toronto, ON Canada
- Fife House, Toronto, ON Canada
- AIDS Thunder Bay, Thunder Bay, ON Canada
- Bruce House, Ottawa, ON Canada
- AIDS Niagara, St. Catharines, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Health, Aging & Society, McMaster University, Hamilton, ON Canada
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
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Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet 2011; 377:1429-37. [PMID: 21497898 DOI: 10.1016/s0140-6736(10)62353-7] [Citation(s) in RCA: 315] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Overdose from illicit drugs is a leading cause of premature mortality in North America. Internationally, more than 65 supervised injecting facilities (SIFs), where drug users can inject pre-obtained illicit drugs, have been opened as part of various strategies to reduce the harms associated with drug use. We sought to determine whether the opening of an SIF in Vancouver, BC, Canada, was associated with a reduction in overdose mortality. METHODS We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city. FINDINGS Of 290 decedents, 229 (79·0%) were male, and the median age at death was 40 years (IQR 32-48 years). A third (89, 30·7%) of deaths occurred in city blocks within 500 m of the SIF. The fatal overdose rate in this area decreased by 35·0% after the opening of the SIF, from 253·8 to 165·1 deaths per 100,000 person-years (p=0·048). By contrast, during the same period, the fatal overdose rate in the rest of the city decreased by only 9·3%, from 7·6 to 6·9 deaths per 100,000 person-years (p=0·490). There was a significant interaction of rate differences across strata (p=0·049). INTERPRETATION SIFs should be considered where injection drug use is prevalent, particularly in areas with high densities of overdose. FUNDING Vancouver Coastal Health, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research.
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Duncan KC, Reading C, Borwein AM, Murray MCM, Palmer A, Michelow W, Samji H, Lima VD, Montaner JSG, Hogg RS. HIV incidence and prevalence among aboriginal peoples in Canada. AIDS Behav 2011; 15:214-27. [PMID: 20799061 DOI: 10.1007/s10461-010-9792-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.
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Affiliation(s)
- Katrina C Duncan
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Nowgesic E. Addressing HIV/AIDS among Aboriginal People using a Health Status, Health Determinants and Health Care Framework: A Literature Review and Conceptual Analysis. CANADIAN JOURNAL OF ABORIGINAL COMMUNITY-BASED HIV/AIDS RESEARCH 2010; 3:35-46. [PMID: 27398110 PMCID: PMC4935527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES (1) To describe the Human Immunodeficiency Virus (HIV) infection among Aboriginal populations using a mixed methods approach (i.e. quantitative and qualitative methods); (2) to examine the individual-level and community-level relationships between HIV/AIDS, health determinants, and health care (e.g. diagnosis, access to treatment and health services planning); and (3) to explore innovative solutions to address HIV/AIDS among Aboriginal populations based upon research and infrastructure (e.g. partnerships, data sources and management, health indicators and culture) and policy (i.e. self-determination of Aboriginal Peoples). METHODS Literature review and conceptual analysis using a health status, health determinants and health care framework. RESULTS In comparison to non-Aboriginal persons, HIV infection is higher among Aboriginal persons, is more directly attributable to unique risk factors and socio-demographic characteristics, and yields more adverse health outcomes. Culture, poverty and self-determination are determinants of health for Aboriginal populations. Aboriginal people have inadequate primary care and, in particular, specialist care. It is necessary to include traditional Aboriginal approaches and culture when addressing Aboriginal health while understanding competing paradigms between modern medicine and Aboriginal traditions. CONCLUSION There is a need for self-determination of Aboriginal Peoples in order to improve the health of Aboriginal communities and those living with HIV/AIDS. Research and policy affecting Aboriginal people should be of the highest quality and based upon Aboriginal community relevance and involvement.
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Marshall BDL, Kerr T, Qi J, Montaner JSG, Wood E. Public injecting and HIV risk behaviour among street-involved youth. Drug Alcohol Depend 2010; 110:254-8. [PMID: 20456875 PMCID: PMC2905504 DOI: 10.1016/j.drugalcdep.2010.01.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/02/2010] [Accepted: 01/06/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although street-involved youth who inject illicit drugs are known to be at an increased risk of HIV and other adverse health outcomes, little is known about public injecting among this population and how injecting in public environments may impact HIV risk behaviour. METHODS We used data derived from a study of 560 street-involved youth in Vancouver, Canada to examine the factors associated with injecting in public environments among youth who reported injecting drugs in the past 6 months. RESULTS At baseline, 162 (28.9%) reported injecting drugs in the past 6 months. Among injectors, the 124 (76.5%) participants who reported injecting in public were more likely to be homeless (odds ratio [OR]=6.39, p<0.001), engage in unprotected intercourse (OR=3.09, p=0.004), deal drugs (OR=2.26, p=0.032), smoke crack cocaine (OR=3.00, p=0.005), inject heroin (OR=3.48, p=0.001), drop used syringes outdoors (OR=8.44, p<0.001), share syringes (OR=4.43, p=0.004), and were less likely to clean injection sites >75% of the time (OR=0.36, p=0.008). The majority (62.1%) reported feeling rushed while injecting in public. CONCLUSIONS Youth who inject in public are significantly more likely to engage in sexual and injection-related risk behaviour. Given the known elevated rates of HIV infection and other harms among this population, youth-focused interventions that target both sexual and drug-related risks associated with public drug-using environments are in urgent need of evaluation.
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Affiliation(s)
- Brandon DL Marshall
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Jiezhi Qi
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Julio SG Montaner
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Shaw SY, Deering KN, Jolly AM, Wylie JL. Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users. Harm Reduct J 2010; 7:16. [PMID: 20642835 PMCID: PMC2911412 DOI: 10.1186/1477-7517-7-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 07/19/2010] [Indexed: 12/15/2022] Open
Abstract
Background Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada. Methods Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression. Results A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3). Interpretation High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations.
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Affiliation(s)
- Souradet Y Shaw
- Centre for Global Public Health, University of Manitoba, R070 Med Rehab Bldg 771 McDermot Avenue, Winnipeg, Manitoba R3E 0T6, Canada.
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Methadone use among HIV-positive injection drug users in a Canadian setting. J Subst Abuse Treat 2010; 39:174-9. [PMID: 20598827 DOI: 10.1016/j.jsat.2010.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/22/2010] [Accepted: 05/03/2010] [Indexed: 11/21/2022]
Abstract
We examined methadone maintenance therapy (MMT) use among HIV-positive injection drug users (IDU) in Vancouver. Among 353 participants, 199 (56.3%) were on MMT at baseline, and 48 initiated MMT during follow-up. Female gender (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI] = 1.14-2.62) and antiretroviral therapy use (AOR = 2.04, 95% CI = 1.46-2.86) were positively associated with MMT use, whereas frequent heroin injection (AOR = 0.34, 95% CI = 0.23-0.50), public injection (AOR = 0.76, 95% CI = 0.59-0.97), syringe borrowing (AOR = 0.54, 95% CI = 0.32-0.90), and nonfatal overdose (AOR = 0.58, 95% CI = 0.36-0.92) were negatively associated with MMT use. The rate of discontinuation of MMT was 12.46 (95% CI = 8.28-18.00) per 100 person years. Frequent heroin use (adjusted hazards ratio = 4.49, 95%CI = 1.81-11.13) was positively associated with subsequent discontinuation of MMT. These findings demonstrate the benefits of MMT among HIV-positive IDU and the need to improve access to and retention in MMT.
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Rachlis B, Lloyd-Smith E, Small W, Tobin D, Stone D, Li K, Wood E, Kerr T. Harmful microinjecting practices among a cohort of injection drug users in vancouver Canada. Subst Use Misuse 2010; 45:1351-66. [PMID: 20509739 PMCID: PMC3782079 DOI: 10.3109/10826081003767643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We sought to identify factors associated with harmful microinjecting practices in a longitudinal cohort of IDU. METHODS Using data from the Vancouver Injection Drug Users Study (VIDUS) between January 2004 and December 2005, generalized estimating equations (GEE) logistic regression was performed to examine sociodemographic and behavioral factors associated with four harmful microinjecting practices (frequent rushed injecting, frequent syringe borrowing, frequently injecting with a used water capsule, frequently injecting alone). RESULTS In total, 620 participants were included in the present analysis. Our study included 251 (40.5%) women and 203 (32.7%) self-identified Aboriginal participants. The median age was 31.9 (interquartile range: 23.4-39.3). GEE analyses found that each harmful microinjecting practice was associated with a unique profile of sociodemographic and behavioral factors. DISCUSSION We observed high rates of harmful microinjecting practices among IDU. The present study describes the epidemiology of harmful microinjecting practices and points to the need for strategies that target higher risk individuals including the use of peer-driven programs and drug-specific approaches in an effort to promote safer injecting practices.
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Affiliation(s)
- Beth Rachlis
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Swe LA, Nyo KK, Rashid AK. Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study. Harm Reduct J 2010; 7:12. [PMID: 20515507 PMCID: PMC2890662 DOI: 10.1186/1477-7517-7-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 06/02/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most worrying medical and social problems throughout the world in recent years. Myanmar has one of the highest prevalence rates of HIV among the IDUs in the region. AIM The objective of the study was to determine the risk behaviours among HIV positive injecting drug users in Myanmar. METHODS A non matched case control study was conducted among 217 respondents registered with a non governmental organization's harm reduction center. 78 HIV positive IDUs were used as cases and 139 non HIV positive IDUs as controls. The study was conducted between April-May 2009. Data was analysed using SPSS version 15 and the study was ethically conducted. RESULTS Factors like age, marital status, age first used drugs, drug use expenditure, reason for drug use, age first used injection were found to be significant. Other risk factors found significantly associated with HIV among IDU were education (OR 2.3), location of respondent (OR 2.4) type of syringe first used (OR 5.1), sharing syringe at the first injection (OR 4.5) and failure of drug detoxification programme (OR 4.9). More HIV positive IDUs were returning used syringes in the centre (OR 3.3). CONCLUSIONS Prudent measures such as access to sterile syringes and continuous health education programmes among IDUs and their sexual partners are required to reduce high risk behaviours of IDUs in Myanmar.
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Affiliation(s)
- Lin A Swe
- Beneficial Partner Group, Myanmar. 30A 2 Inya Road. Kamayut Township, Yangon. Myanmar
| | - Kay K Nyo
- Department of Community Medicine, Faculty of Medicine, AIMST University, Jalan Bedong - Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia
| | - AK Rashid
- Department of Public Health Medicine, Penang Medical College, 4 Sepoy Lines, 10450 Georgetown, Penang, Malaysia
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Orchard TR, Druyts E, McInnes CW, Clement K, Ding E, Fernandes KA, Anema A, Lima VD, Hogg RS. Factors behind HIV testing practices among Canadian Aboriginal peoples living off-reserve. AIDS Care 2010; 22:324-31. [DOI: 10.1080/09540120903111510] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Treena R. Orchard
- a Faculty of Health Sciences , University of Western Ontario , Arthur and Sonia Labatt Health Sciences Building, London , ON , N6A 5B9 , Canada
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
| | - Eric Druyts
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
| | - Colin W. McInnes
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
| | - Ken Clement
- c Healing Our Spirit , British Columbia Aboriginal HIV/AIDS Society , 644-1979 Marine Drive, Vancouver , BC , V7P 3G1 , Canada
| | - Erin Ding
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
| | - Kimberly A. Fernandes
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
| | - Aranka Anema
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
- d Department of Medicine, Faculty of Medicine , University of British Columbia , 3300–950 West 10th Avenue, Vancouver , BC , V5Z 4E3 , Canada
| | - Viviane D. Lima
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
- d Department of Medicine, Faculty of Medicine , University of British Columbia , 3300–950 West 10th Avenue, Vancouver , BC , V5Z 4E3 , Canada
| | - Robert S. Hogg
- b British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , 608–1081 Burrard Street, V6Z 1Y6 , Vancouver , BC , Canada
- e Faculty of Health Sciences , Simon Fraser University , 8888 University Drive, Burnaby , BC , V5A 1S6 , Canada
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Fast D, Small W, Krüsi A, Wood E, Kerr T. 'I guess my own fancy screwed me over': transitions in drug use and the context of choice among young people entrenched in an open drug scene. BMC Public Health 2010; 10:126. [PMID: 20222984 PMCID: PMC2853507 DOI: 10.1186/1471-2458-10-126] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/12/2010] [Indexed: 12/04/2022] Open
Abstract
Background There is growing interest in describing the broader risk trajectories experienced by young people who use drugs - that is, in describing the sequences of drug use transitions experienced by youth in relation to evolving understandings of risk and harm. This study sought to examine young people's perspectives regarding the evolution of their drug use in the context of a local drug scene in Vancouver, Canada. Methods Semi-structured qualitative interviews with 38 individuals recruited from a cohort of young drug users known as the At-risk Youth Study (ARYS) were supplemented by ongoing ethnographic fieldwork (e.g., observations and informal conversations with youth) conducted within the same cohort population. Interviews were transcribed verbatim and a thematic analysis was conducted. Results The majority of youth characterized past transition events as non-exceptional, largely 'spur-of-the-moment' decisions motivated by evolving feelings of curiosity. At the same time, participants' reflections indicated that the social, structural and material contexts of drug scene entrenchment play a powerful role in shaping these decisions and transition experiences. Conclusions Importantly, as young people become increasingly entrenched in the local drug scene, drug use transitions seem to constitute increasingly relevant (and even 'inevitable') choices congruent with everyday lived experience. The implications of these findings for the development of meaningful interventions for youth are discussed.
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Affiliation(s)
- Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
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Shannon K, Kerr T, Marshall B, Li K, Zhang R, Strathdee SA, Tyndall MW, Montaner JGS, Wood E. Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a canadian setting. ACTA ACUST UNITED AC 2010; 164:61-5. [PMID: 20048243 DOI: 10.1001/archpediatrics.2009.241] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine whether there were differential rates of hepatitis C virus (HCV) incidence in injecting drug-using youths who did and did not report involvement in survival sex work. DESIGN Data were derived from 2 prospective cohort studies of injecting drug users (May 1, 1996, to July 31, 2007). Analyses were restricted to HCV antibody-negative youths who completed baseline and at least 1 follow-up assessment. SETTING Vancouver, British Columbia, Canada. PARTICIPANTS Of 3074 injecting drug users, 364 (11.8%) were youths (aged 14-24 years) with a median age of 21.3 years and a duration of injecting drug use of 3 years. Main Exposure Survival sex work involvement. MAIN OUTCOME MEASURE The Kaplan-Meier method and Cox proportional hazards regression were used to compare HCV incidence among youths who did and did not report survival sex work. RESULTS Baseline HCV prevalence was 51%, with youths involved in survival sex work significantly more likely to be HCV antibody positive (60% vs 44%; P = .002). In baseline HCV antibody-negative youths, the cumulative HCV incidence at 36 months was significantly higher in those involved in survival sex work (68.4% vs 38.8%; P < .001). The HCV incidence density was 36.8 (95% confidence interval [CI], 24.2-53.5) per 100 person-years in youths reporting survival sex work involvement at baseline compared with 14.1 (9.4-20.3) per 100 person-years in youths not reporting survival sex work. In multivariate Cox proportional hazards analyses, survival sex work was the strongest predictor of elevated HCV incidence (adjusted relative hazard, 2.30; 95% CI, 1.27-4.15). CONCLUSION This study calls attention to the critical need for evidence-based social and structural HCV prevention efforts that target youths engaged in survival sex work.
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Affiliation(s)
- Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada.
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Small D, Glickman A, Rigter G, Walter T. The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model. Harm Reduct J 2010; 7:1. [PMID: 20047690 PMCID: PMC2806876 DOI: 10.1186/1477-7517-7-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 01/04/2010] [Indexed: 11/11/2022] Open
Abstract
Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the syringe distribution model, showing that the distribution and retrieval of syringes can be separated with effective results. Further, the experience of IDUs is utilized, through paid employment, to provide a vulnerable population of people with clean syringes to prevent HIV and HCV.
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Affiliation(s)
- Dan Small
- PHS Community Services Society, 20 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
- Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Andrea Glickman
- Union of BC Indian Chiefs, 500 - 342 Water Street, Vancouver, BC, V6B 1B6, Canada
| | - Galen Rigter
- PHS Community Services Society, 20 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Thia Walter
- Life is not Enough Society, 42 Blood Alley Square, Vancouver BC, V6B 1C8, Canada
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Devries KM, Free CJ, Morison L, Saewyc E. Factors associated with pregnancy and STI among Aboriginal students in British Columbia. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2009; 100:226-30. [PMID: 19507728 PMCID: PMC6974225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 01/09/2009] [Indexed: 11/14/2023]
Abstract
BACKGROUND Aboriginal adolescents are more likely to become pregnant and contract an STI than other Canadian adolescents. This study provides some of the first data on factors associated with these outcomes among Aboriginal adolescents. METHODS A secondary analysis was conducted using 2003 data from a large cross-sectional survey of British Columbia secondary school students. 445 young women and 360 young men who identified as Aboriginal and reported ever having sex were included in analyses. Associations between self-reported pregnancy and STI and 11 exposure variables were examined using logistic regression. RESULTS Of young women, 10.6% reported a pregnancy; 10.5% of young men reported causing a pregnancy. An STI diagnosis was reported by 4.2% of young women and 3.9% of young men. In multivariate analyses for young men, ever having been sexually abused was the strongest consistent risk factor for causing a pregnancy (AOR = 4.30, 95% CI 1.64-11.25) and STI diagnosis (AOR = 5.58, 95% CI 1.61-19.37). For young women, abuse was associated with increased odds of pregnancy (AOR = 10.37, 95% CI 4.04-26.60) but not STI. Among young women, substance use was the strongest consistent risk factor for both pregnancy (AOR = 3.36, 95% CI 1.25-9.08) and STI (AOR = 5.27, 95% CI 1.50-18.42); for young men, substance use was associated with higher odds of STI (AOR = 4.60, 95% CI 1.11-19.14). Factors associated with decreased risk included community, school and family involvement. CONCLUSIONS Health care professionals, communities and policy-makers must urgently address sexual abuse and substance use. Exploring promotion of school and community involvement and family cohesion may be useful for sexual health interventions with Aboriginal students.
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Affiliation(s)
- Karen M Devries
- Gender Violence and Health Centre, LSHTM, London International Development Centre, 36 Gordon Square, London WC1H OPD.
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Shannon K, Strathdee SA, Shoveller J, Rusch M, Kerr T, Tyndall MW. Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy. Am J Public Health 2009; 99:659-65. [PMID: 19197086 PMCID: PMC2661482 DOI: 10.2105/ajph.2007.129858] [Citation(s) in RCA: 233] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the relationship between environmental-structural factors and condom-use negotiation with clients among female sex workers. METHODS We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of "hot spots" for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental-structural factors and being pressured by a client into unprotected sexual intercourse. RESULTS In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4.49), and servicing clients in cars or in public spaces (OR = 2.00; 95% CI = 1.65, 5.73). CONCLUSIONS Given growing global concern surrounding the failings of prohibitive sex-work legislation on sex workers' health and safety, there is urgent need for environmental-structural HIV-prevention efforts that facilitate sex workers' ability to negotiate condom use in safer sex-work environments and criminalize abuse by clients and third parties.
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Affiliation(s)
- Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
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McInnes CW, Druyts E, Harvard SS, Gilbert M, Tyndall MW, Lima VD, Wood E, Montaner JSG, Hogg RS. HIV/AIDS in Vancouver, British Columbia: a growing epidemic. Harm Reduct J 2009; 6:5. [PMID: 19265531 PMCID: PMC2662822 DOI: 10.1186/1477-7517-6-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 03/05/2009] [Indexed: 11/16/2022] Open
Abstract
The prevalence of HIV in Vancouver, British Columbia was subject to two distinct periods of rapid increase. The first occurred in the 1980s due to high incidence among men who have sex with men (MSM), and the second occurred in the 1990s due to high incidence among injection drug users (IDU). The purpose of this study was to estimate and model the trends in HIV prevalence in Vancouver from 1980 to 2006. HIV prevalence data were entered into the UNAIDS/WHO Estimation and Projection Package (EPP) where prevalence trends were estimated by fitting an epidemiological model to the data. Epidemic curves were fit for IDU, MSM, street-based female sex trade workers (FSW), and the general population. Using EPP, these curves were then aggregated to produce a model of Vancouver's overall HIV prevalence. Of the 505 000 people over the age of 15 that reside in Vancouver, 6108 (ranging from 4979 to 7237) were living with HIV in the year 2006, giving an overall prevalence of 1.21 percent (ranging from 0.99 to 1.43 percent). The subgroups of IDU and MSM account for the greatest proportion of HIV infections. Our model estimates that the prevalence of HIV in Vancouver is greater than one percent, roughly 6 times higher than Canada's national prevalence. These results suggest that HIV infection is having a relatively large impact in Vancouver and that evidence-based prevention and harm reduction strategies should be expanded.
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Affiliation(s)
- Colin W McInnes
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
| | - Eric Druyts
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Stephanie S Harvard
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Mark Gilbert
- Division of STI/HIV Prevention and Control, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Mark W Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
| | - Julio SG Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
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Marshall BDL, Kerr T, Livingstone C, Li K, Montaner JSG, Wood E. High prevalence of HIV infection among homeless and street-involved Aboriginal youth in a Canadian setting. Harm Reduct J 2008; 5:35. [PMID: 19019253 PMCID: PMC2607257 DOI: 10.1186/1477-7517-5-35] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 11/19/2008] [Indexed: 11/25/2022] Open
Abstract
Aboriginal people experience a disproportionate burden of HIV infection among the adult population in Canada; however, less is known regarding the prevalence and characteristics of HIV positivity among drug-using and street-involved Aboriginal youth. We examined HIV seroprevalence and risk factors among a cohort of 529 street-involved youth in Vancouver, Canada. At baseline, 15 (2.8%) were HIV positive, of whom 7 (46.7%) were Aboriginal. Aboriginal ethnicity was a significant correlate of HIV infection (odds ratio = 2.87, 95%CI: 1.02 – 8.09). Of the HIV positive participants, 2 (28.6%) Aboriginals and 6 (75.0%) non-Aboriginals reported injection drug use; furthermore, hepatitis C co-infection was significantly less common among Aboriginal participants (p = 0.041). These findings suggest that factors other than injection drug use may promote HIV transmission among street-involved Aboriginal youth, and provide further evidence that culturally appropriate and evidence-based interventions for HIV prevention among Aboriginal young people are urgently required.
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Affiliation(s)
- Brandon D L Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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