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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Romo E, Stopka TJ, Jesdale BM, Wang B, Mazor KM, Friedmann PD. Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States. Harm Reduct J 2024; 21:23. [PMID: 38282000 PMCID: PMC10822149 DOI: 10.1186/s12954-023-00916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). METHODS Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. RESULTS Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). CONCLUSIONS Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
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Affiliation(s)
- Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical, Worcester, MA, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate, Springfield, MA, USA
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Ibragimov U, Livingston MD, Young AM, Feinberg J, Korthuis PT, Akhtar WZ, Jenkins WD, Crane HM, Westergaard RP, Nance R, Miller WC, Bresett J, Khoury D, Hurt CB, Go VF, Nolte K, Cooper HLF. Correlates of Recent HIV Testing Among People Who Inject Drugs in Rural Areas: A Multi-site Cross-Sectional Study, 2018-2020. AIDS Behav 2024; 28:59-71. [PMID: 37515742 PMCID: PMC10823036 DOI: 10.1007/s10461-023-04140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
The Rural Opioid Initiative surveyed 2693 people who inject drugs (PWID) in eight rural U.S. areas in 2018-2020 about self-reported HIV testing in the past 6 months. Correlates of interest included receipt of any drug-related services, incarceration history, and structural barriers to care (e.g., lack of insurance, proximity to syringe service programs [SSP]). Overall, 20% of participants reported receiving an HIV test within the past 6 months. Multivariable generalized estimating equations showed that attending substance use disorder (SUD) treatment (OR 2.11, 95%CI [1.58, 2.82]), having health insurance (OR 1.42, 95%CI [1.01, 2.00]) and recent incarceration (OR 1.49, 95%CI [1.08, 2.04]) were positively associated with HIV testing, while experiencing a resource barrier to healthcare (inability to pay, lack of transportation, inconvenient hours, or lack of child care) had inverse (OR 0.73, 95%CI [0.56, 0.94]) association with HIV testing. We found that the prevalence of HIV testing among rural PWID is low, indicating an unmet need for testing. While SUD treatment or incarceration may increase chances for HIV testing for rural PWID, other avenues for expanding HIV testing, such as SSP, need to be explored.
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Affiliation(s)
- Umedjon Ibragimov
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA.
- Emory University, 1518 Clifton RD, GCR 558, Atlanta, GA, USA.
| | - Melvin D Livingston
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry and Medicine/Infectious Diseases, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Wajiha Z Akhtar
- Population Health Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Carbondale, IL, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Robin Nance
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - John Bresett
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Carbondale, IL, USA
- Department of Public Health, Southern Illinois University at Carbondale, Carbondale, IL, USA
| | | | - Christopher B Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Hannah L F Cooper
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA
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4
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Duong M, Delcher C, Freeman PR, Young A, Cooper H. Attitudes toward pharmacy-based HCV/HIV testing among people who use drugs in rural Kentucky. J Rural Health 2022; 38:93-99. [PMID: 33666274 PMCID: PMC8418619 DOI: 10.1111/jrh.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Rural areas of the United States have experienced outbreaks of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among people who use drugs (PWUD). Pharmacy-based interventions may play a crucial role in prevention and entry into care, especially when traditional health care access is limited. The willingness of rural PWUD to use pharmacies for HIV/HCV-related services remains unknown. The purpose of this study was to describe the factors associated with the perceived likelihood of participating in free pharmacy-based HIV and HCV testing among PWUD living in rural Kentucky. METHODS Baseline data from the CARE2HOPE study in five Appalachian counties in eastern Kentucky were used. Participants were recruited using respondent-driven sampling and completed interviewer-administered surveys. Guided by the Andersen and Newman Framework of Health Services Utilization, we examined distributions and correlates of items regarding willingness to participate in free pharmacy-based HIV/HCV testing using logistic regression. Analyses included individuals who reported being HIV (N = 304) or HCV (N = 185) negative. FINDINGS Seventy-five percent of PWUD reported being "very likely" to participate in free pharmacy-based HIV testing and 80% for HCV testing. Two factors were associated with being less willing to participate in free HIV testing: PWUD who previously tested for HIV (OR: 0.47, CI: 0.25-0.88) and PWUD who obtained a high school diploma or equivalent compared to those who completed less (OR: 0.50, CI: 0.26-0.99). CONCLUSION Free pharmacy-based HIV and HCV testing was invariably acceptable among most of the rural PWUD in our sample, suggesting that pharmacies might be acceptable testing venues for this population.
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Affiliation(s)
- Michelle Duong
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Chris Delcher
- Department of Pharmacy Practice & Science, University of Kentucky, Lexington, Kentucky
| | - Patricia R. Freeman
- Department of Pharmacy Practice & Science, University of Kentucky, Lexington, Kentucky
| | - April Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Hannah Cooper
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia
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Wise A, Kianian B, Chang HH, Linton S, Wolfe ME, Smith J, Tempalski B, Jarlais DD, Ross Z, Semaan S, Wejnert C, Broz D, Cooper HLF. Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103264. [PMID: 33990058 PMCID: PMC11091490 DOI: 10.1016/j.drugpo.2021.103264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
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Affiliation(s)
- Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Behzad Kianian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E Wolfe
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, USA
| | - Don Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ezell JM, Ompad DC, Walters S. How urban and rural built environments influence the health attitudes and behaviors of people who use drugs. Health Place 2021; 69:102578. [PMID: 33964805 DOI: 10.1016/j.healthplace.2021.102578] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of "stigma zoning," defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA; Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
| | - Danielle C Ompad
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, USA; Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Green TC, Stopka T, Xuan Z, Davis TC, Boggis J, Irwin AN, Gray M, Hartung DM, Bratberg J. Examining nonprescription syringe sales in Massachusetts and Rhode Island community pharmacies. J Am Pharm Assoc (2003) 2021; 61:e237-e241. [PMID: 33820716 PMCID: PMC8827136 DOI: 10.1016/j.japh.2021.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
Background: The role pharmacies play in addressing the opioid crisis and drug-related risks such as injection drug use is evolving. Estimating the prevalence of injection drug use at the community level is challenging because of the stigma of drug use. Many community pharmacies sell nonprescription sterile syringes; thus, pharmacy-level sales of injection equipment may be an indicator of drug-related harms and unmet needs of high-risk populations. Objectives: To describe, compare, and assess the convergent validity of staff-reported nonprescription syringe (NPS) sales volume and NPS administrative sales data from community pharmacies in Massachusetts (MA) and Rhode Island (RI). Methods: This study employed both prospective cross-sectional survey data collection and utilization of administrative pharmacy sales data. Between November 2017 and January 2018, we administered a telephone-based survey to estimate average weekly NPS type and volume for 191 chain pharmacies (CVS Health) located in communities experiencing fatal opioid overdoses above the state’s 2015 annual median rate. For the same time period, we obtained NPS sales data from surveyed pharmacies and all CVS Health pharmacies in the 2 states. We calculated Spearman correlations to assess convergence of average weekly volume between pharmacy staff reports and sales data. Results: All pharmacies responded to the survey. Most (98.4%) pharmacies surveyed sold NPS, but 42.0% reported running out of stock monthly or more frequently. Pharmacy staff tended to under-report syringe sales. Staff-reported weekly NPS sales volume was 67,922 versus 70,962 syringes from administrative pharmacy sales data. Spearman correlation between reported and actual NPS sales was 0.40 (95% CI 0.27e0.51). Conclusion: The counts of administrative pharmacy syringe sales data in MA and RI indicate high need, substantial volume, and notable access at community pharmacies. Future research should use NPS sales data rather than self-report data to track emerging trends and tailor local responses.
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Affiliation(s)
- Traci C. Green
- Correspondence: Traci C. Green, PhD, MSc, Professor and Director, Opioid Policy Research Collaborative, Heller School for Social Policy and Management, Brandeis University, 415 South Main St., MS035, Waltham MA 02454. (T.C. Green)
| | - Thomas Stopka
- Department of Community Health, Tufts University School of Medicine, Tufts University, Boston, MA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, MA
| | - Tyler C. Davis
- Pharmacy Professional Practice Standards, CVS Health, Woonsocket, RI
| | - Jesse Boggis
- Heller School for Social Policy & Management at Brandeis University, Brandeis University, Waltham, MA
| | - Adriane N. Irwin
- Oregon State University College of Pharmacy, Oregon State University, Corvallis, OR
| | | | - Daniel M. Hartung
- Oregon State University College of Pharmacy, Oregon State University, Corvallis, OR
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI
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Cooper HL, Cloud DH, Freeman PR, Fadanelli M, Green T, Van Meter C, Beane S, Ibragimov U, Young AM. Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102701. [PMID: 32223985 PMCID: PMC7529684 DOI: 10.1016/j.drugpo.2020.102701] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Buprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. METHODS In this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. RESULTS Twelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a "Drug Enforcement Administration (DEA) cap" on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. CONCLUSIONS Initiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.
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Affiliation(s)
| | - David H Cloud
- Emory University Rollins School of Public Health, Atlanta GA
| | | | | | - Travis Green
- University of Kentucky College of Public Health, Lexington KY
| | | | - Stephanie Beane
- Emory University Rollins School of Public Health, Atlanta GA
| | | | - April M Young
- University of Kentucky College of Public Health, Lexington KY
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Nassau T, Al-Tayyib A, Robinson WT, Shinefeld J, Brady KA. The Impact of Syringe Services Program Policy on Risk Behaviors Among Persons Who Inject Drugs in 3 US Cities, 2005-2015. Public Health Rep 2020; 135:138S-148S. [PMID: 32735193 PMCID: PMC7407040 DOI: 10.1177/0033354920930137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. METHODS PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. RESULTS From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P < .001), increased significantly from 32.0% to 50.5% in New Orleans (P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). CONCLUSIONS The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.
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Affiliation(s)
- Tanner Nassau
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Alia Al-Tayyib
- 47804 Denver Health and Hospital Authority, Denver Public Health, Denver, CO, USA
| | - William T Robinson
- 51530 School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, USA
- STD/HIV Program, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Jennifer Shinefeld
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kathleen A Brady
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
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10
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Whiteman A, Burnett J, Handanagic S, Wejnert C, Broz D. Distance matters: The association of proximity to syringe services programs with sharing of syringes and injecting equipment - 17 U.S. cities, 2015. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102923. [PMID: 32920424 DOI: 10.1016/j.drugpo.2020.102923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/22/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) have effectively limited the spread of HIV and hepatitis C (HCV) among people who inject drugs (PWID). Access to SSPs has been shown to reduce injection risk behaviors but the relationship between distance to an SSP and likelihood of sharing injection equipment is not well known. METHODS We analyzed a sample of 8,392 PWID from 17 U.S. cities recruited through the National HIV Behavioral Surveillance (NHBS) system in 2015. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated from log-linked Poisson regression to explore associations between injecting equipment sharing in the past 12 months and distance to the nearest SSP. RESULTS Regardless of SSP use, respondents who lived in zip codes further than the city-specific mean distance to nearest SSP were more likely to report sharing behavior. Among PWID who had not reported using an SSP in the previous 12 months, distributive sharing (aPR=1.13 95% CI=1.05, 1.21), receptive sharing (aPR=1.15, 95% CI=1.06, 1.24), and injection equipment sharing (aPR=1.08, 95% CI=1.03, 1.13) were more prevalent among residents who resided further than the average distance to the nearest SSP. CONCLUSIONS Greater distance to an SSP was associated with increased sharing behaviors. Improved access to an SSP and subsequent decreases in sharing behaviors could reduce transmission of HIV and HCV among PWID. Accessibility should be taken into account when planning provision of SSPs.
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Affiliation(s)
- Ari Whiteman
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-46, Atlanta, GA, 30329, USA; Oak Ridge Institute for Science and Education, Atlanta, GA, USA.
| | - Janet Burnett
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-46, Atlanta, GA, 30329, USA
| | - Senad Handanagic
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-46, Atlanta, GA, 30329, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-46, Atlanta, GA, 30329, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-46, Atlanta, GA, 30329, USA
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11
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Naserirad M, Beulaygue IC. Accessibility of Needle and Syringe Programs and Injecting and Sharing Risk Behaviors in High Hepatitis C Virus Prevalence Settings. Subst Use Misuse 2020; 55:900-908. [PMID: 31918611 DOI: 10.1080/10826084.2019.1710210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Access to healthcare services is a basic human right. Objective: The main purpose of this study is to assess the association between accessibility of needle and syringe programs (NSP) and injecting and sharing risk behaviors. Methods: A cross-sectional study employed respondent-driving sampling (RDS) to recruit a sample of 634 people who inject drugs (PWID) from three provinces, Golestan, Ardabil, and Sistan and Baluchestan, in Iran between November 2018 and February 2019. Participants completed a questionnaire based on the WHO Drug Injecting Study Phase II survey. Results: Participants reported their accessibility of NSP services as low (6%), middle (19%), and high (75%) in the past 2 months at the time of the survey. PWID who had increased access to NSP services were less likely to report utilization of used cooker (aOR = 1.40; CI 95% 0.99-1.82), cotton (aOR = 1.30; CI 95% 0.79-1.81), and water (aOR = 1.07; CI 95% 0.89-1.26), receptive needle/syringe sharing (aOR= 1.86, 95% CI 1.69-2.03), and distributive needle/syringe sharing (aOR= 1.09, 95% CI 0.81-1.37). Conclusions/Importance: There is evidence of inequality in PWID's access to health care as they relate to the prevention of HCV transmission. An understanding of both the social determinants and prevention of injecting and sharing risk behaviors seeks to connect HCV risk reduction within the context of human rights and vulnerability.
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Affiliation(s)
- Mohsen Naserirad
- Department of Sociology, Faculty of Social Sciences, University of Tehran, Tehran, Iran.,Centre de Recherche, Médecine, Sciences, Santé, Santé Mentale, Société, École des Hautes Études en Sciences Sociales, Paris, France
| | - Isabelle C Beulaygue
- Center for Promise, Wheelock College of Education and Human Development, Boston University, Boston, Massachusetts, USA
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12
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Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Ross Z, Cooper HLF. Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history. Harm Reduct J 2019; 16:53. [PMID: 31477150 PMCID: PMC6721211 DOI: 10.1186/s12954-019-0326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. METHODS A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. RESULTS Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. DISCUSSION Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
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Affiliation(s)
- D C Des Jarlais
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
| | - C McKnight
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - K Arasteh
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - J Feelemyer
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA
| | - H L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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13
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Cao Y, Stewart K, Wish E, Artigiani E, Sorg MH. Determining spatial access to opioid use disorder treatment and emergency medical services in New Hampshire. J Subst Abuse Treat 2019; 101:55-66. [PMID: 31174714 DOI: 10.1016/j.jsat.2019.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/14/2019] [Accepted: 03/29/2019] [Indexed: 01/04/2023]
Abstract
This research presents an analysis of spatial access to both opioid use disorder treatment facilities and emergency medical services in New Hampshire during 2015-2016, a period during which there was a steep increase in unintentional overdoses involving fentanyl. For this research, spatial access was computed using the enhanced two-step floating catchment area model combined with the Huff model to assess access across New Hampshire and gives attention to supply-side parameters that can impact spatial access. The model is designed to measure access to healthcare services for opioid use disorder patients offered at treatment centers or from buprenorphine treatment practitioners, as well as from emergency medical services across New Hampshire. A composite index of accessibility is proposed to represent overall access to these different treatment services for opioid use disorder patients. Geospatial determinants of spatial access included street network distances, driving times and distance decay relationships, while other key factors were services availability and population demand. Among the towns with the highest composite access scores, approximately 40% were metropolitan locations while 16% were rural towns. The insights from this research showed that for this period, while the opioid crisis was impacting many towns in New Hampshire, high levels of access to treatment services were not uniform across the state. When comparing the access results with data on the towns of residence for individuals who died from unintentional overdoses involving fentanyl during 2015 and 2016, estimates found that approximately 40% of the towns were not estimated to be in the highest class of access to treatment services at the time. This research provides information for local public health officials to support planning strategies to address opioid use disorder treatment access in high-risk regions.
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Affiliation(s)
- Yanjia Cao
- Center for Geospatial Information Science, University of Maryland, College Park, MD 20742, United States of America; Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States of America.
| | - Kathleen Stewart
- Center for Geospatial Information Science, University of Maryland, College Park, MD 20742, United States of America; Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States of America
| | - Eric Wish
- Center for Substance Abuse Research, University of Maryland, College Park, MD 20740, United States of America
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, MD 20740, United States of America
| | - Marcella H Sorg
- Margaret Chase Smith Policy Center, University of Maine, Orono, ME 04469, United States of America
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O’Keefe D, Wilkinson A, Aitken C, Dietze P. Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia. PLoS One 2018; 13:e0209280. [PMID: 30550588 PMCID: PMC6294429 DOI: 10.1371/journal.pone.0209280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/02/2022] Open
Abstract
Distance to health services is known to be negatively associated with usage and needle and syringe programs (NSPs) for people who inject drugs (PWID) are no different. Australia has a mixture of NSP modalities (primary or secondary fixed-site NSPs), which may present unique barriers to access. In this study, we explore 1) the effect of distance to NSPs on individual-level needle and syringe coverage, and 2) differences in coverage dependent on NSP modality. Using data from 219 PWID in an ongoing cohort study in Melbourne, Australia, we measured the straight-line distance from participants’ residence to their nearest primary or secondary fixed-site NSP. We analysed the relationship between geographical distance and coverage via regression analysis. The median distance to any type of NSP was 1872 metres. Regardless of service type, 52% of participants lived within 2 kms of a fixed-site NSP and 87% lived within 5 kms. We found no association between distance to NSPs and syringe coverage or a significant difference in coverage by nearest service type. Our findings suggest that the number and distribution of NSPs in Melbourne, Australia caters adequately for the population of PWID.
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Affiliation(s)
- Daniel O’Keefe
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Anna Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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15
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DeCuir J, Lovasi GS, El-Sayed A, Lewis CF. The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs. Drug Alcohol Depend 2018; 183:184-191. [PMID: 29288913 PMCID: PMC5927611 DOI: 10.1016/j.drugalcdep.2017.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/25/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility. METHODS Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior. RESULTS Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source. CONCLUSIONS PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas.
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Affiliation(s)
- Jennifer DeCuir
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, New York, NY, 10032, USA.
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16
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Rudolph A, Tobin K, Rudolph J, Latkin C. Web-Based Survey Application to Collect Contextually Relevant Geographic Data With Exposure Times: Application Development and Feasibility Testing. JMIR Public Health Surveill 2018; 4:e12. [PMID: 29351899 PMCID: PMC5797287 DOI: 10.2196/publichealth.8581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background Although studies that characterize the risk environment by linking contextual factors with individual-level data have advanced infectious disease and substance use research, there are opportunities to refine how we define relevant neighborhood exposures; this can in turn reduce the potential for exposure misclassification. For example, for those who do not inject at home, injection risk behaviors may be more influenced by the environment where they inject than where they live. Similarly, among those who spend more time away from home, a measure that accounts for different neighborhood exposures by weighting each unique location proportional to the percentage of time spent there may be more correlated with health behaviors than one’s residential environment. Objective This study aimed to develop a Web-based application that interacts with Google Maps application program interfaces (APIs) to collect contextually relevant locations and the amount of time spent in each. Our analysis examined the extent of overlap across different location types and compared different approaches for classifying neighborhood exposure. Methods Between May 2014 and March 2017, 547 participants enrolled in a Baltimore HIV care and prevention study completed an interviewer-administered Web-based survey that collected information about where participants were recruited, worked, lived, socialized, injected drugs, and spent most of their time. For each location, participants gave an address or intersection which they confirmed using Google Map and Street views. Geographic coordinates (and hours spent in each location) were joined to neighborhood indicators by Community Statistical Area (CSA). We computed a weighted exposure based on the proportion of time spent in each unique location. We compared neighborhood exposures based on each of the different location types with one another and the weighted exposure using analysis of variance with Bonferroni corrections to account for multiple comparisons. Results Participants reported spending the most time at home, followed by the location where they injected drugs. Injection locations overlapped most frequently with locations where people reported socializing and living or sleeping. The least time was spent in the locations where participants reported earning money and being recruited for the study; these locations were also the least likely to overlap with other location types. We observed statistically significant differences in neighborhood exposures according to the approach used. Overall, people reported earning money in higher-income neighborhoods and being recruited for the study and injecting in neighborhoods with more violent crime, abandoned houses, and poverty. Conclusions This analysis revealed statistically significant differences in neighborhood exposures when defined by different locations or weighted based on exposure time. Future analyses are needed to determine which exposure measures are most strongly associated with health and risk behaviors and to explore whether associations between individual-level behaviors and neighborhood exposures are modified by exposure times.
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Affiliation(s)
- Abby Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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17
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Ghaddar A, Nassar K, Elsoury G. Barriers to Access to Sterile Syringes as Perceived by Pharmacists and Injecting Drug Users: Implications for Harm Reduction in Lebanon. Subst Use Misuse 2017; 52:1420-1428. [PMID: 28430013 DOI: 10.1080/10826084.2017.1284235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Access to sterile syringes to injecting drug users (IDU) reduces sharing behavior and prevents the transmission of HIV. OBJECTIVES To describe the barriers to access to sterile syringes for IDUs in Lebanon from the perspectives of pharmacists and IDUs. METHODS in this qualitative study conducted in Lebanon, data were collected from 72 syringe purchase tests at pharmacies, 64 interviewees with pharmacists and 2 focus groups with injecting drug users. Two independent researchers analyzed the verbatim transcripts. RESULTS Results revealed that pharmacists often deny access to sterile syringes to IDUs who are frequently stigmatized and intimidated at pharmacies. While no large gender differences in pharmacists' attitudes and practices were observed, inequalities in syringe access were noticed with men IDUs more often denied purchase. Pharmacists had several barriers to sell syringes to IDUs including fear of disease spread, increased drug use, inappropriately discarded syringes, staff and customer safety, and business concerns. IDUs had several challenges to purchase syringes including stigmatization, intimidation, physical harassment, concern to reveal identity, fear of arrest and syringe price abuse. CONCLUSIONS Identifying the barriers to and facilitators of access to sterile syringes to IDUs is important to guide the development of efficient policies. Findings implicate the importance of empowering IDUs to purchase syringes at pharmacies through reducing the negative attitude towards IDUs and strengthening pharmacists' role in the promotion of health of IDUs. Findings also suggest that the habit of syringe sharing would decrease if the legal and cultural barriers to access are reduced.
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Affiliation(s)
- Ali Ghaddar
- a Observatory of Public Policies and Health , Beirut , Lebanon.,b Department of Biomedical Sciences , Lebanese International University , Beirut , Lebanon
| | - Karine Nassar
- c Soins Infirmiers et Developement Communitaire , Beirut , Lebanon
| | - Ghadier Elsoury
- a Observatory of Public Policies and Health , Beirut , Lebanon.,b Department of Biomedical Sciences , Lebanese International University , Beirut , Lebanon
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18
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Rudolph AE, Bazzi AR, Fish S. Ethical considerations and potential threats to validity for three methods commonly used to collect geographic information in studies among people who use drugs. Addict Behav 2016; 61:84-90. [PMID: 27249807 DOI: 10.1016/j.addbeh.2016.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/23/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Analyses with geographic data can be used to identify "hot spots" and "health service deserts", examine associations between proximity to services and their use, and link contextual factors with individual-level data to better understand how environmental factors influence behaviors. Technological advancements in methods for collecting this information can improve the accuracy of contextually-relevant information; however, they have outpaced the development of ethical standards and guidance, particularly for research involving populations engaging in illicit/stigmatized behaviors. Thematic analysis identified ethical considerations for collecting geographic data using different methods and the extent to which these concerns could influence study compliance and data validity. METHODS In-depth interviews with 15 Baltimore residents (6 recruited via flyers and 9 via peer-referral) reporting recent drug use explored comfort with and ethics of three methods for collecting geographic information: (1) surveys collecting self-reported addresses/cross-streets, (2) surveys using web-based maps to find/confirm locations, and (3) geographical momentary assessments (GMA), which collect spatiotemporally referenced behavioral data. RESULTS Survey methods for collecting geographic data (i.e., addresses/cross-streets and web-based maps) were generally acceptable; however, participants raised confidentiality concerns regarding exact addresses for illicit/stigmatized behaviors. Concerns specific to GMA included burden of carrying/safeguarding phones and responding to survey prompts, confidentiality, discomfort with being tracked, and noncompliance with study procedures. Overall, many felt that confidentiality concerns could influence the accuracy of location information collected for sensitive behaviors and study compliance. CONCLUSIONS Concerns raised by participants could result in differential study participation and/or study compliance and questionable accuracy/validity of location data for sensitive behaviors.
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19
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Nonprescription syringe sales: Resistant pharmacists' attitudes and practices. Drug Alcohol Depend 2016; 166:45-50. [PMID: 27423213 DOI: 10.1016/j.drugalcdep.2016.06.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine barriers to nonprescription syringe sales (NPSS) in pharmacies by examining resistant pharmacists' willingness to provide syringes to people who inject drugs (PWID) and their current practices for provision or refusal. METHODS Qualitative, semi-structured, in-depth interviews with community pharmacists in California, Kansas, Mississippi, and New Jersey. Participants include seventeen community pharmacists who expressed ethical concerns about providing syringes drawn from a larger sample of 71 community pharmacists participating in a study of ethical decision-making. Analysis captures pharmacists' descriptions of their experiences providing syringes to suspected PWID. RESULTS Pharmacists who identified syringes as a key ethical issue exhibited significant ambivalence about providing syringes to PWID. Most of these pharmacists were aware of harm reduction logics, but endorsed them to varying degrees. Moral concerns about supplying PWID with syringes were mediated by law and organizational policy. Many pharmacists who considered syringes an ethical challenge allayed their concerns by creating informal policy and engaging in deterrence practices designed to dissuade PWID from coming to the pharmacy. CONCLUSIONS As heroin abuse rates continue to rise, pharmacists are undoubtedly integral allies in the fight to prevent the spread of communicable diseases like HIV/AIDS and Hepatitis C. Education should be aimed at identifying barriers to NPSS resulting from resistant pharmacists' attitudes and practices. Increased education paired with favorable law and organizational policy and decentralization of syringe provision could increase access to clean needles and decrease public health risks.
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20
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O'Keefe D, Scott N, Aitken C, Dietze P. Individual-level needle and syringe coverage in Melbourne, Australia: a longitudinal, descriptive analysis. BMC Health Serv Res 2016; 16:411. [PMID: 27542604 PMCID: PMC4992312 DOI: 10.1186/s12913-016-1668-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/12/2016] [Indexed: 12/23/2022] Open
Abstract
Background Coverage is used as one indicator of needle and syringe program (NSP) effectiveness. At the individual level, coverage is typically defined as an estimate of the proportion of a person who injects drugs’ (PWID) injecting episodes that utilise a sterile syringe. In this paper, we explore levels of individual syringe coverage and its changes over time. Methods Data were extracted from 1889 interviews involving 502 participants drawn from the Melbourne drug user cohort study (MIX). We asked questions relating to participants syringe acquisition, distribution and injecting frequency within the two weeks before interview. We created a dichotomous coverage variable that classified participants as sufficiently (≥100 %) covered if all their injecting episodes utilised at least one sterile syringe, and insufficiently (<100 %) covered if not. We categorised participants as “consistently covered” if they were sufficiently covered across interviews; as “consistently uncovered” if they were insufficiently covered across interviews; and “inconsistently covered” if they oscillated between coverage states. Chi-square statistics tested proportions of insufficient coverage across sub-groups using broad demographic, drug use and service utilisation domains. Logistic regression tested predictors of insufficient coverage and inconsistently covered categorisation. Results Across the sample, levels of insufficient coverage were substantial (between 22–36 % at each interview wave). The majority (50 %) were consistently covered across interviews, though many (45 %) were inconsistently covered. We found strong statistical associations between insufficient coverage and current hepatitis C virus (HCV) infection (RNA+). Current prescription of opioid substitution therapy (OST) and using NSPs as the main source of syringe acquisition were protective against insufficient coverage. Conclusion Insufficient coverage across the sample was substantial and mainly driven by those who oscillated between states of coverage, suggesting the presence of temporal factors. We recommend a general expansion of NSP services and OST prescription to encourage increases in syringe coverage. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel O'Keefe
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Nick Scott
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Campbell Aitken
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
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21
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Linton SL, Cooper HLF, Kelley ME, Karnes CC, Ross Z, Wolfe ME, Chen YT, Friedman SR, Des Jarlais D, Semaan S, Tempalski B, Sionean C, DiNenno E, Wejnert C, Paz-Bailey G. Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States. Ann Epidemiol 2016; 26:619-630.e2. [PMID: 27576908 DOI: 10.1016/j.annepidem.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States. METHODS PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment). RESULTS Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.21-4.17; P = .011), and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex (AOR = 1.02, 95% CI = 1.00-1.04; P = .046). Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex (AOR = 0.93, 95% CI = 0.88-1.00; P = .038). CONCLUSIONS Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mary E Kelley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Conny C Karnes
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY
| | - Mary E Wolfe
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yen-Tyng Chen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY
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Campbell ANC, Des Jarlais D, Hannah C, Braunstein S, Tross S, Kersanske L, Borges C, Pavlicova M, Jefferson K, Newville H, Weaver L, Wolff M. Antiretroviral medication treatment for all HIV-infected individuals: a protocol using innovative multilevel methodologies to evaluate New York City's universal ART policy among problem substance users. BMC Health Serv Res 2016; 16:341. [PMID: 27485435 PMCID: PMC4971753 DOI: 10.1186/s12913-016-1554-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of "treatment as prevention," in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The "ART for ALL" (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use. METHODS/DESIGN The AFA Study is informed by two complementary frameworks: Glasgow and colleagues' RE-AIM model, a multi-level framework developed to guide the evaluation of implementation of new policies, and Bronfrenbrenner's ecological systems model, which conceptualizes the bi-directional interplay between people and their environment. Using multi-level data and mixed methods, the primary aims of the AFA Study are to assess rates of viral load suppression, using the NYC HIV Surveillance Registry, within 12 months of HIV diagnosis with (a) yearly cohorts of high-risk-to-transmit, difficult-to-treat, substance using patients recruited from NYC Sexually Transmitted Disease clinics and a large detoxification unit and (b) yearly cohorts of all newly HIV diagnosed people in NYC. Further goals include (c) recruiting cross-sectional samples of HIV/AIDS service providers to assess ART initiation with problem substance users and d) examining geographic factors that influence rates of viral load suppression. An Implementation Collaborative Board meets regularly to guide study procedures and interpret results. DISCUSSION The AFA Study has the unique strength of accessing and analyzing data at multiple levels using mixed methodology, taking advantage of NYC DOHMH biomedical surveillance data. If successful, others may benefit from lessons learned to inform local and state policies to improve the health of PLWH and further reduce HIV transmission.
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Affiliation(s)
- Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY 10032 USA
| | - Don Des Jarlais
- Icahn School of Medicine at Mount Sinai, 39 Broadway, 5th Floor, New York, NY 10006 USA
| | - Cooper Hannah
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Room 568, Atlanta, GA 30322 USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Susan Tross
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Laura Kersanske
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Christine Borges
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101 USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th Floor, #637, New York, NY 10032 USA
| | - Kevin Jefferson
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Room 568, Atlanta, GA 30322 USA
| | - Howard Newville
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Laurel Weaver
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
| | - Margaret Wolff
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s Hospital, 1111 Amsterdam Avenue, 11th Floor, New York, NY 10025 USA
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Cooper HLF, Linton S, Kelley ME, Ross Z, Wolfe ME, Chen YT, Zlotorzynska M, Hunter-Jones J, Friedman SR, Des Jarlais DC, Tempalski B, DiNenno E, Broz D, Wejnert C, Paz-Bailey G. Risk Environments, Race/Ethnicity, and HIV Status in a Large Sample of People Who Inject Drugs in the United States. PLoS One 2016; 11:e0150410. [PMID: 26974165 PMCID: PMC4790920 DOI: 10.1371/journal.pone.0150410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/13/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We analyzed relationships between place characteristics and being HIV-negative among black, Latino, and white people who inject drugs (PWID) in the US. METHODS Data on PWID (N = 9077) were from the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance. Administrative data were analyzed to describe the 968 ZIP codes, 51 counties, and 19 metropolitan statistical areas (MSAs) where they lived. Multilevel multivariable models examined relationships between place characteristics and HIV status. Exploratory population attributable risk percents (e-PAR%s) were estimated. RESULTS Black and Latino PWID were more likely to be HIV-negative if they lived in less economically disadvantaged counties, or in MSAs with less criminal-justice activity (i.e., lower drug-related arrest rates, lower policing/corrections expenditures). Latino PWID were more likely to be HIV-negative in MSAs with more Latino isolation, less black isolation, and less violent crime. E-PAR%s attributed 8-19% of HIV cases among black PWID and 1-15% of cases among Latino PWID to place characteristics. DISCUSSION Evaluations of structural interventions to improve economic conditions and reduce drug-related criminal justice activity may show evidence that they protect black and Latino PWID from HIV infection.
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Affiliation(s)
- Hannah L. F. Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Sabriya Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Mary E. Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY 14850, United States of America
| | - Mary E. Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Maria Zlotorzynska
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Josalin Hunter-Jones
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
| | - Samuel R. Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23 Street, 4 Fl, New York, NY 10010, United States of America
| | - Don C. Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, 5 floor, New York, NY 10006, United States of America
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23 Street, 4 Fl, New York, NY 10010, United States of America
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS-E46), Atlanta, GA 30333, United States of America
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS-E46), Atlanta, GA 30333, United States of America
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS-E46), Atlanta, GA 30333, United States of America
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS-E46), Atlanta, GA 30333, United States of America
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Friedman SR, Tempalski B, Brady JE, West BS, Pouget ER, Williams LD, Des Jarlais DC, Cooper HLF. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:11-6. [PMID: 27198555 DOI: 10.1016/j.drugpo.2016.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
Abstract
This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
| | - Barbara Tempalski
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Joanne E Brady
- NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814 USA
| | - Brooke S West
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093-0507, USA
| | - Enrique R Pouget
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Leslie D Williams
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Don C Des Jarlais
- Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai., 39 Broadway, Suite 530, New York, NY 10006, USA
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
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Abstract
Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. The geometric point distance estimation technique was used to calculate the mean walking distance PWID traveled from the centroid point of their zip code of home residence to the mobile exchange site where they accessed SEP services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by year. The results of this research suggest that the distance DC PWID traveled to access SEP services remained relatively constant (approximately 2.75 mi) from 2003 to 2008, but increased to just over 4 mi in 2010. This research provides support for expanding SEP operations such that PWID have increased access to their services. Increasing SEP accessibility may help resolve unmet needs among injectors.
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Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs. Epidemiol Infect 2016; 144:1683-700. [PMID: 26753627 DOI: 10.1017/s0950268815003180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events ('risk acts'), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
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27
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Cooper HLF, Linton S, Kelley ME, Ross Z, Wolfe ME, Chen YT, Zlotorzynska M, Hunter-Jones J, Friedman SR, Des Jarlais D, Semaan S, Tempalski B, DiNenno E, Broz D, Wejnert C, Paz-Bailey G. Racialized risk environments in a large sample of people who inject drugs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:43-55. [PMID: 26342272 PMCID: PMC4715941 DOI: 10.1016/j.drugpo.2015.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/27/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. METHODS As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. RESULTS Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). CONCLUSION PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
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Affiliation(s)
- Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Sabriya Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY 14850, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Maria Zlotorzynska
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Josalin Hunter-Jones
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA
| | - Don Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th floor, New York, NY 10038, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
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Cooper HLF, West B, Linton S, Hunter-Jones J, Zlotorzynska M, Stall R, Wolfe ME, Williams L, Hall HI, Cleland C, Tempalski B, Friedman SR. Contextual Predictors of Injection Drug Use Among Black Adolescents and Adults in US Metropolitan Areas, 1993-2007. Am J Public Health 2015; 106:517-26. [PMID: 26691126 DOI: 10.2105/ajph.2015.302911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults. METHODS For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960-1969) and urban renewal funding (1949-1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models. RESULTS Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated. CONCLUSIONS Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults.
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Affiliation(s)
- Hannah L F Cooper
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Brooke West
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Sabriya Linton
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Josalin Hunter-Jones
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Maria Zlotorzynska
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Ron Stall
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Mary E Wolfe
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Leslie Williams
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - H Irene Hall
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Charles Cleland
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Barbara Tempalski
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Samuel R Friedman
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
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Strathdee SA, Arredondo J, Rocha T, Abramovitz D, Rolon ML, Patiño Mandujano E, Rangel MG, Olivarria HO, Gaines T, Patterson TL, Beletsky L. A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes. BMJ Open 2015; 5:e008958. [PMID: 26260350 PMCID: PMC4538275 DOI: 10.1136/bmjopen-2015-008958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/25/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre-post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. OBJECTIVES Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). METHODS/ANALYSIS ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N = ∼ 1200), we will administer one 3 h PEP course to groups of 20-50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. ETHICS/DISSEMINATION Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. TRIAL REGISTRATION NUMBER NCT02444403.
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Affiliation(s)
- Steffanie A Strathdee
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jaime Arredondo
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Teresita Rocha
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniela Abramovitz
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Maria Luisa Rolon
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Xochicalco University, Tijuana, Baja California, Mexico
| | | | - Maria Gudelia Rangel
- U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico
| | | | - Tommi Gaines
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Thomas L Patterson
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Beletsky
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Jordan AE, Des Jarlais DC, Arasteh K, McKnight C, Nash D, Perlman DC. Incidence and prevalence of hepatitis c virus infection among persons who inject drugs in New York City: 2006-2013. Drug Alcohol Depend 2015; 152:194-200. [PMID: 25891230 PMCID: PMC4458155 DOI: 10.1016/j.drugalcdep.2015.03.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatitis C virus infection is a source of significant preventable morbidity and mortality among persons who inject drugs (PWID). We sought to assess trends in hepatitis C virus (HCV) infection among PWID from 2006 to 2013 in New York City (NYC). METHODS Annual cross-sectional surveys of PWID entering a large drug abuse treatment program were performed. Risk behavior questionnaires were administered, and HIV and HCV testing were conducted. Comparisons were made with prior prevalence and incidence estimates in 1990-1991 and 2000-2001 reflecting different periods of combined prevention and treatment efforts. RESULTS HCV prevalence among PWID (N: 1535) was 67% (95% CI: 66-70%) during the study period, and was not significantly different from that observed in 2000-2001. The estimated HCV incidence among new injectors (persons injecting for ≤6 years) during 2006-2013 was 19.5/100 PYO (95% CI: 17-23) and did not differ from that observed in 2000-2001 (18/100 PYO, 95% CI: 14-23/100). CONCLUSIONS Despite the expansion of combined prevention programming between 2000-2001 and 2006-2013, HCV prevalence remained high. Estimated HCV incidence among new injectors also remained high, and not significantly lower than in 2000-2001, indicating that expanded combined prevention efforts are needed to control the HCV epidemic among PWID in NYC.
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Affiliation(s)
- Ashly E. Jordan
- The Graduate Center at the City University of New York, 365 Fifth
Avenue, New York, New York 10016 USA,Center for Drug Use and HIV Research, New York, New York USA
| | - Don C. Des Jarlais
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Kamyar Arasteh
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Courtney McKnight
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Denis Nash
- City University of New York, Hunter College, 2180 Third Avenue, New
York, New York 10035 USA
| | - David C. Perlman
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, 120 East 16 Street, New York,
NY 10003 USA
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Gibson BA, Ghosh D, Morano JP, Altice FL. Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations. Health Place 2014; 28:153-66. [PMID: 24853039 DOI: 10.1016/j.healthplace.2014.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/23/2014] [Accepted: 04/26/2014] [Indexed: 01/08/2023]
Abstract
We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.
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Affiliation(s)
- Britton A Gibson
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Debarchana Ghosh
- University of Connecticut, Department of Geography, Storrs, CT, USA.
| | - Jamie P Morano
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; University of Malaya, Centre of Excellence on Research in AIDS (CERiA), Kuala Lumpur, Malaysia
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Kori N, Roth AM, Lozada R, Vera A, Brouwer KC. Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:525-32. [PMID: 24418632 DOI: 10.1016/j.drugpo.2013.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/08/2013] [Accepted: 12/06/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substance use and HIV are growing problems in the Mexico-U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an 'HIV incidence hotspot,' consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot. METHODS From 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV 'hotspot'. RESULTS Of 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors independently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14-2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67-6.38), deportation (AOR 1.58; 95%CI 1.18-2.12), active syphilis (AOR 3.03; 95%CI 1.63-5.62), needle sharing (AOR 0.57; 95%CI 0.42-0.78), various police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13-2.03), and health insurance status (AOR 0.53; 95%CI 0.33-0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2-30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08-6.93), injecting inside (AOR 5.26; 95%CI 1.54-17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56-15.15), prior HIV testing (AOR 2.45; 95%CI 1.04-5.81), and health insurance status (AOR 0.12; 95%CI 0.03-0.59). CONCLUSION While drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.
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Affiliation(s)
- Nana Kori
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA; Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Drive, San Diego, CA 92182-4162, USA
| | - Alexis M Roth
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA
| | - Remedios Lozada
- Pro-COMUSIDA, Niños héroes 697, Oficina 1 y 6, Zona Norte, Tijuana 22000, Baja California, Mexico
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA
| | - Kimberly C Brouwer
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA.
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Janulis P. Pharmacy nonprescription syringe distribution and HIV/AIDS: a review. J Am Pharm Assoc (2003) 2013; 52:787-97. [PMID: 23229966 DOI: 10.1331/japha.2012.11136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize current research findings on pharmacy nonprescription syringe distribution to prevent the spread of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) among injection drug users (IDUs), including research on pharmacist attitudes and behavior, drug user attitudes and behavior, and the health impact on HIV/AIDS risk behavior. DATA SOURCES Data were collected using PubMed and PsycINFO through July 2011. Search terms used were pharmacist or pharmacy and syringe or syringe exchange or needle or needle exchange. Two journals (Journal of Urban Health and Journal of the American Pharmacists Association) with a high number of hits were manually inspected. Reference sections for each article also were examined. STUDY SELECTION Studies were included if they examined attitudes toward, experiences with, or the impact of pharmacy nonprescription syringe distribution for the purpose of preventing the spread of HIV/AIDS among IDUs in the United States. Studies were excluded that mentioned these topics in passing or did not report empirical results. DATA SYNTHESIS 47 studies were identified that met the inclusion criteria. Studies included a diverse range of perspectives, including pharmacist viewpoints, IDU attitudes, and evaluations. CONCLUSION According to the available literature, many pharmacists express willingness to sell and report selling syringes to customers without a prescription. IDUs show willingness to use pharmacies to obtain syringes. Finally, pharmacy syringe sale and the legalization of this practice appear to have a positive impact on HIV risk behavior. Accordingly, the nonprescription sale of syringe should be promoted. However, the literature remains incomplete and future research is required.
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Affiliation(s)
- Patrick Janulis
- Department of Psychology, Michigan State University, East Lansing, USA.
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Wood W. Harm reduction: A canadian perspective. Ment Health Clin 2013. [DOI: 10.9740/mhc.n183647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wende Wood
- Education Pharmacist, Ontario Pharmacists Association
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35
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Werb D, Kerr T, Buxton J, Shoveller J, Richardson C, Montaner J, Wood E. Patterns of injection drug use cessation during an expansion of syringe exchange services in a Canadian setting. Drug Alcohol Depend 2013; 132:535-40. [PMID: 23642315 PMCID: PMC3762907 DOI: 10.1016/j.drugalcdep.2013.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/21/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Needle and syringe programmes (NSPs) have been shown to reduce HIV risk among people who inject drugs (IDUs). However, concerns remain that NSPs delay injecting cessation. METHODS Individuals reporting injection drug use in the past six months in the greater Vancouver area were enrolled in the Vancouver Injection Drug Users Study (VIDUS). Annual estimates of the proportion of IDU reporting injecting cessation were generated. Generalized estimating equation (GEE) analysis was used to assess factors associated with injecting cessation during a period of NSP expansion. RESULTS Between May 1996 and December 2010, the number of NSP sites in Vancouver increased from 1 to 29 (P<0.001). The estimated proportion of participants (n=2710) reporting cessation increased from 2.4% (95% confidence interval [CI]: 0.0-7.0%) in 1996 to 47.9% (95% CI: 46.8-48.9%) in 2010 (P<0.001). In a multivariate GEE analysis, the authors observed an association between increasing calendar year and increased likelihood of injecting cessation (Adjusted Odds Ratio=1.17, 95% CI: 1.15, 1.19, P<0.001). CONCLUSION The proportion of IDU reporting injecting cessation increased during a period of NSP expansion, implying that increased NSP availability did not delay injection cessation. These results should help inform community decisions on whether to implement NSPs.
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Affiliation(s)
- Dan Werb
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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36
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Crawford ND, Amesty S, Rivera AV, Harripersaud K, Turner A, Fuller CM. Randomized, community-based pharmacy intervention to expand services beyond sale of sterile syringes to injection drug users in pharmacies in New York City. Am J Public Health 2013; 103:1579-82. [PMID: 23865644 DOI: 10.2105/ajph.2012.301178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Structural interventions may help reduce racial/ethnic disparities in HIV. In 2009 to 2011, we randomized pharmacies participating in a nonprescription syringe access program in minority communities to intervention (pharmacy enrolled and delivered HIV risk reduction information to injection drug users [IDUs]), primary control (pharmacy only enrolled IDUs), and secondary control (pharmacy did not engage IDUs). Intervention pharmacy staff reported more support for syringe sales than did control staff. An expanded pharmacy role in HIV risk reduction may be helpful.
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Affiliation(s)
- Natalie D Crawford
- Robert Wood Johnson Health and Society Scholars program, Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
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Des Jarlais DC, McCarty D, Vega WA, Bramson H. HIV infection among people who inject drugs: the challenge of racial/ethnic disparities. AMERICAN PSYCHOLOGIST 2013; 68:274-85. [PMID: 23688094 PMCID: PMC3710402 DOI: 10.1037/a0032745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs.
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Affiliation(s)
- Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10038, USA.
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Abstract
Discussions of drug policy tend not to consider whether the stated goals of policies are an accurate statement of what they are meant to do and also may not consider the fact that what benefits some people may harm others. We explore these issues and present an agenda for research in this area that, while not eliminating these difficulties, both illuminates them and can help guide actors toward more effective action.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institutes, Inc, New York, NY 10010, USA.
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39
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Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs. Curr Opin HIV AIDS 2012; 7:354-61. [PMID: 22498481 DOI: 10.1097/coh.0b013e328353d990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.
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40
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Brouwer KC, Rusch ML, Weeks JR, Lozada R, Vera A, Magis-Rodríguez C, Strathdee SA. Spatial Epidemiology of HIV among Injection Drug Users in Tijuana, Mexico. ACTA ACUST UNITED AC 2012; 102:1190-1199. [PMID: 23606753 DOI: 10.1080/00045608.2012.674896] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The northwest border city of Tijuana is Mexico's fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006-2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score -6.173; p < 0.001), with a 16 km2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July-December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs.
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Affiliation(s)
- Kimberly C Brouwer
- University of California San Diego School of Medicine, La Jolla, California, USA
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41
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Cooper H, Des Jarlais D, Ross Z, Tempalski B, Bossak BH, Friedman SR. Spatial access to sterile syringes and the odds of injecting with an unsterile syringe among injectors: a longitudinal multilevel study. J Urban Health 2012; 89:678-96. [PMID: 22585448 PMCID: PMC3535144 DOI: 10.1007/s11524-012-9673-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the U.S.A., these interventions--and specifically SEP site locations--remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995-2006). Annual measures of spatial access to syringes in each UHF district (N = 42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N = 4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in >75% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.
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Affiliation(s)
- Hannah Cooper
- Rollins School of Public Health at Emory University, Atlanta, GA, USA.
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42
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Cooper HL, Des Jarlais DC, Tempalski B, Bossak BH, Ross Z, Friedman SR. Drug-related arrest rates and spatial access to syringe exchange programs in New York City health districts: combined effects on the risk of injection-related infections among injectors. Health Place 2011; 18:218-28. [PMID: 22047790 DOI: 10.1016/j.healthplace.2011.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
Abstract
Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors' risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs' protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs.
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Affiliation(s)
- Hannah Lf Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Room 526, Atlanta, GA 30322, USA.
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