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McCormick KA, Stanton MC, Ali SB. A Mixed Methods Analysis of Southern HIV Service Organizations' Implementation of Harm Reduction to Address the HIV and Opioid Syndemic. J Behav Health Serv Res 2024; 51:44-56. [PMID: 37697180 DOI: 10.1007/s11414-023-09859-y] [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: 08/08/2023] [Indexed: 09/13/2023]
Abstract
Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.
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Affiliation(s)
- Katie A McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204, USA
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Beck McGreevy P, Wood S, Thomson E, Burmeister C, Spence H, Pelletier J, Giesinger W, McDougall J, McLeod R, Hutchison A, Lock K, Norton A, Barker B, Urbanoski K, Slaunwhite A, Nosyk B, Pauly B. Doing community-based research during dual public health emergencies (COVID and overdose). Harm Reduct J 2023; 20:135. [PMID: 37715202 PMCID: PMC10504762 DOI: 10.1186/s12954-023-00852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
Meaningful engagement and partnerships with people who use drugs are essential to conducting research that is relevant and impactful in supporting desired outcomes of drug consumption as well as reducing drug-related harms of overdose and COVID-19. Community-based participatory research is a key strategy for engaging communities in research that directly affects their lives. While there are growing descriptions of community-based participatory research with people who use drugs and identification of key principles for conducting research, there is a gap in relation to models and frameworks to guide research partnerships with people who use drugs. The purpose of this paper is to provide a framework for research partnerships between people who use drugs and academic researchers, collaboratively developed and implemented as part of an evaluation of a provincial prescribed safer supply initiative introduced during dual public health emergencies (overdose and COVID-19) in British Columbia, Canada. The framework shifts from having researchers choose among multiple models (advisory, partnership and employment) to incorporating multiple roles within an overall community-based participatory research approach. Advocacy by and for drug users was identified as a key role and reason for engaging in research. Overall, both academic researchers and Peer Research Associates benefited within this collaborative partnerships approach. Each offered their expertise, creating opportunities for omni-directional learning and enhancing the research. The shift from fixed models to flexible roles allows for a range of involvement that accommodates varying time, energy and resources. Facilitators of involvement include development of trust and partnering with networks of people who use drugs, equitable pay, a graduate-level research assistant dedicated to ongoing orientation and communication, technical supports as well as fluidity in roles and opportunities. Key challenges included working in geographically dispersed locations, maintaining contact and connection over the course of the project and ensuring ongoing sustainable but flexible employment.
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Affiliation(s)
- Phoenix Beck McGreevy
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Shawn Wood
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Erica Thomson
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Charlene Burmeister
- PWLLE Stakeholder Engagement Lead, Professionals for Ethical Engagement of Peers (PEEP), BC Centre for Disease Control, Provincial Health Services Authority, Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Heather Spence
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Josh Pelletier
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Willow Giesinger
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Jenny McDougall
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Rebecca McLeod
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Abby Hutchison
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Kurt Lock
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alexa Norton
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Barker
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- School of Public Health and Social Policy, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Amanda Slaunwhite
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Health Evaluation and Outcome Sciences, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
- School of Nursing, University of Victoria, Box 1700 Stn CSC, Victoria, BC, Canada.
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Khan MR, Hoff L, Elliott L, Scheidell JD, Pamplin JR, Townsend TN, Irvine NM, Bennett AS. Racial/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City. Harm Reduct J 2023; 20:24. [PMID: 36841763 PMCID: PMC9959933 DOI: 10.1186/s12954-023-00736-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/12/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Drug overdose mortality is rising precipitously among Black people who use drugs. In NYC, the overdose mortality rate is now highest in Black (38.2 per 100,000) followed by the Latinx (33.6 per 100,000) and white (32.7 per 100,000) residents. Improved understanding of access to harm reduction including naloxone across racial/ethnic groups is warranted. METHODS Using data from an ongoing study of people who use illicit opioids in NYC (N = 575), we quantified racial/ethnic differences in the naloxone care cascade. RESULTS We observed gaps across the cascade overall in the cohort, including in naloxone training (66%), current possession (53%) daily access during using and non-using days (21%), 100% access during opioid use (20%), and complete protection (having naloxone and someone who could administer it present during 100% of opioid use events; 12%). Naloxone coverage was greater in white (training: 79%, possession: 62%, daily access: 33%, access during use: 27%, and complete protection: 13%, respectively) and Latinx (training: 67%, possession: 54%, daily access: 22%, access during use: 24%, and complete protection: 16%, respectively) versus Black (training: 59%, possession: 48%, daily access:13%, access during use: 12%, and complete protection: 8%, respectively) participants. Black participants, versus white participants, had disproportionately low odds of naloxone training (OR 0.40, 95% CI 0.22-0.72). Among participants aged 51 years or older, Black race (versus white, the referent) was strongly associated with lower levels of being trained in naloxone use (OR 0.20, 95% CI 0.07-0.63) and having 100% naloxone access during use (OR 0.34, 95% CI 0.13-0.91). Compared to white women, Black women had 0.27 times the odds of being trained in naloxone use (95% CI 0.10-0.72). CONCLUSIONS There is insufficient protection by naloxone during opioid use, with disproportionately low access among Black people who use drugs, and a heightened disparity among older Black people and Black women.
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Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Lee Hoff
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Luther Elliott
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY USA
| | - Joy D. Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - John R. Pamplin
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY USA
| | - Tarlise N. Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
| | - Natalia M. Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY USA
- Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY USA
- Center for Anti-Racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, NY USA
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Montaque HDG, Christenson E, Spector A, Wogen J, McDonald M, Weeks MR, Li J, Dickson-Gomez J. Mechanisms for Expanding Harm Reduction for Opioid Use in Suburban and Rural U.S. Settings. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221108694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The availability and adoption of Syringe Services Programs (SSPs) depends heavily on the towns and counties charged with implementing and sustaining these programs. Suburban and rural areas especially lack the community and political support for SSPs. We examined key informant in-depth interview data among professionals providing harm reduction services as well as some health department directors, doctors, and law enforcement officers from a three-state (Connecticut, Kentucky, and Wisconsin) study. Results revealed the challenges and emerging solutions for expanding harm reduction services in suburban and rural areas. Additional comparisons of experiences of those working in urban areas were highlighted. Overall, there were widespread similarities in challenges across the three states for providing harm reduction services in rural and suburban settings. Findings revealed potential directions to address the identified barriers and community-supported ideas to improve harm reduction efforts.
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Affiliation(s)
| | - Erika Christenson
- Center of Excellence in Women’s Health, Boston Medical Center/BUSM, Boston, MA, USA
| | - Antoinette Spector
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jenifer Wogen
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Madelyn McDonald
- SEED (Small business Education and Entrepreneurial Development), Office of Extramural Research, National Institutes of Health, Bethesda, MD, USA
| | | | - Jianghong Li
- Institute for Community Research, Hartford, CT, USA
| | - Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Wauwatosa, WI, USA
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Jackson LA, Dechman M, Mathias H, Gahagan J, Morrison K. Safety and danger: Perceptions of the implementation of harm reduction programs in two communities in Nova Scotia, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:360-371. [PMID: 34060676 DOI: 10.1111/hsc.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/28/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
People who use substances (PWUS), and specifically individuals who use injection drugs and/or smoke crack cocaine, experience risks which harm reduction programmes can help reduce. Prior to implementing harm reduction programmes, however, it is critical to understand how programme users and others in the community perceive the programmes as their perceptions may influence implementation. A mixed-methods study asked PWUS and key informants about their perceptions of implementing five harm reduction programmes in their communities, including perceptions of the advantages of the programmes, where best to locate them, and community support. Questionnaires were administered to 160 PWUS, and qualitative interviews were conducted with 11 purposefully sampled key informants. Data were collected in one medium-size and one small-size community/municipality in Nova Scotia, Canada, during 2017-2018. SPSS was used to generate descriptive statistics and means from the quantitative data, and the qualitative data were analysed for key themes using thematic analysis. Both PWUS and key informants perceived numerous advantages of the harm reduction programmes, but some key informants suggested that there might be potential opposition to the implementation of additional needle distribution and disposal programmes in some locations and potential opposition to safer consumption sites. Further research is needed to understand why these programmes were viewed as potentially generating opposition, but findings suggest that a key factor is the association of the programmes with 'danger' because the programmes are directly linked with criminalized drug use. In contrast, the three other programmes are linked to 'safety' because naloxone saves lives, peer navigation programmes support access to existing programmes and detoxification programmes are associated with safety through the reduction/elimination of drug use. Legalization/decriminalization of drugs might help to change the association of some programmes with 'danger' and therefore help support the implementation of harm reduction programmes that appear to be perceived by some as linked to danger.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Margaret Dechman
- School of Arts and Social Sciences, Cape Breton University, Sydney, Nova Scotia, Canada
| | - Holly Mathias
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kirk Morrison
- Department of Sociology, Brock University, St. Catharines, Ontario, Canada
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Salazar ZR, Vincent L, Figgatt MC, Gilbert MK, Dasgupta N. Research led by people who use drugs: centering the expertise of lived experience. Subst Abuse Treat Prev Policy 2021; 16:70. [PMID: 34544478 PMCID: PMC8454046 DOI: 10.1186/s13011-021-00406-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Research collaborations between people who use drugs (PWUD) and researchers are largely underutilized, despite the long history of successful, community-led harm reduction interventions and growing health disparities experienced by PWUD. PWUD play a critical role in identifying emerging issues in the drug market, as well as associated health behaviors and outcomes. As such, PWUD are well positioned to meaningfully participate in all aspects of the research process, including population of research questions, conceptualization of study design, and contextualization of findings. MAIN BODY We argue PWUD embody unparalleled and current insight to drug use behaviors, including understanding of novel synthetic drug bodies and the dynamics at play in the drug market; they also hold intimate and trusting relationships with other PWUD. This perfectly situates PWUD to collaborate with researchers in investigation of drug use behaviors and development of harm reduction interventions. While PWUD have a history of mistrust with the medical community, community-led harm reduction organizations have earned their trust and are uniquely poised to facilitate research projects. We offer the North Carolina Survivors Union as one such example, having successfully conducted a number of projects with reputable research institutions. We also detail the fallacy of meaningful engagement posed by traditional mechanisms of capturing community voice. As a counter, we detail the framework developed and implemented by the union in hopes it may serve as guidance for other community-led organizations. We also situate research as a mechanism to diversify the job opportunities available to PWUD and offer a real-time example of the integration of these principles into public policy and direct service provision. CONCLUSION In order to effectively mitigate the risks posed by the fluid and volatile drug market, research collaborations must empower PWUD to play meaningful roles in the entirety of the research process. Historically, the most effective harm reduction interventions have been born of the innovation and heart possessed by PWUD; during the current overdose crisis, there is no reason to believe they will not continue to be.
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Affiliation(s)
- Zach R Salazar
- North Carolina Survivors Union, 1116 Grove Street, Greensboro, NC, 27403, USA.
| | - Louise Vincent
- North Carolina Survivors Union, 1116 Grove Street, Greensboro, NC, 27403, USA
| | - Mary C Figgatt
- Injury Prevention Research Center, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Nabarun Dasgupta
- Injury Prevention Research Center, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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Syvertsen JL, Pollini RA. Syringe access and health harms: Characterizing "landscapes of antagonism" in California's Central Valley. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 75:102594. [PMID: 31775079 DOI: 10.1016/j.drugpo.2019.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sterile syringe access reduces injection-related health harms, yet access in the U.S. remains grossly inadequate. In California, syringe services programs (SSPs) are authorized mainly at the local level, and many communities remain underserved. State law also allows, but does not require, non-prescription syringe sales at pharmacies, but participation is low. We draw on the theoretical concept of "landscapes of antagonism" to examine how discordance between state and local decision-making contributes to uneven syringe access and health harms in California's Central Valley, where injection rates are high. METHODS Our study took place in Fresno and Kern counties. We draw on participant observation and qualitative interviews with individuals who inject drugs and key informants to examine issues around syringe access. RESULTS Overall, 8 key informants represented harm reduction, medical, and faith-based organizations. Among 46 people who inject drugs, mean age was 39 (range: 20-65), 37% were female, and 37% self-identified as Latino. About half of individuals at each site had ever successfully purchased from pharmacies, but limited locations and perceived judgement from pharmacy staff posed common barriers. There was no SSP in Kern County due to political opposition; Fresno's SSP has been run by volunteers for more than 20 years despite opposition, and recently gained authorization. Reflecting this disparity, all but two individuals in Fresno accessed syringes from the SSP, whereas only one person in Kern had ever been to an SSP. To fill gaps in access in both sites, individuals obtained syringes that were often already used from diabetics, friends, and people on the street, sharing and reusing syringes at dangerously high rates. CONCLUSION Landscapes of antagonism create syringe access inequities that threaten to exacerbate disease transmission and other health harms. Our study raises questions about accountability for the health of people who use drugs and suggests a need for political action.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, University of California, Riverside, 900 University Ave, 1320B Watkins Hall, Riverside, CA 92521, United States.
| | - Robin A Pollini
- School of Medicine, Department of Behavioral Medicine and Psychiatry, School of Public Health, Department of Epidemiology, West Virginia University, PO Box 9151, 3606 Collins Ferry Road, Suite 201, Morgantown, WV 26506, United States; Pacific Institute of Research and Evaluation, 11720 Beltsville Dr #900, Beltsville, MD 20705, United States
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Syringe Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm Reduction Coalition. Curr HIV/AIDS Rep 2019; 15:276-282. [PMID: 29740734 DOI: 10.1007/s11904-018-0397-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Syringe access programs (SAPs) are cornerstone harm reduction interventions for combatting the national opioid epidemic. The goal of this paper is to describe effective advocacy strategies for enacting syringe decriminalization legislation to foster the expansion of SAPs in high-need areas amidst political opposition. RECENT FINDINGS Decades or research shows that SAPs prevent the transmission of HIV among people who inject drugs (PWID) and are a cost-effective tool for linking PWID to medical care, health education, and social services. In the USA, state laws criminalizing distribution and possession of syringes impede the expansion of SAPs into areas where they are sorely needed. In 2016, North Carolina became the first state to legalize SAPs with a Republican super majority. This paper distills strategies for community organizations seeking to advance syringe decriminalization legislation in politically conservative states with histories of prioritizing punitive sanctions over public health responses to drug use.
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Khan S, Bernier A, Dapp D, Fortier E, Krajden M, King A, Grebely J, Sagan SM, Cooper CL, Crawley AM. 6th Canadian Symposium on Hepatitis C Virus: Delivering a cure for hepatitis C infection—What are the remaining gaps? CANADIAN LIVER JOURNAL 2018; 1:94-105. [DOI: 10.3138/canlivj.1.2.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/25/2022]
Abstract
Estimates are that more than 250,000 people in Canada are chronically infected with hepatitis C virus (HCV), and many more are unaware of their infection status. If untreated, chronic HCV infection can lead to cirrhosis and subsequent complications such as hepatocellular carcinoma. The Canadian Network on Hepatitis C, supported by the Public Health Agency of Canada and the Canadian Institutes of Health Research, has been committed to the scientific study of chronic hepatitis C and to supporting the advocacy work to improve diagnosis and access to HCV care in Canada. Although the treatment of HCV infection has been greatly advanced with direct-acting antivirals, with cure rates as high as 95%, many challenges remain in the implementation of HCV care. These issues include the lack of an effective vaccine, infection screening, treatment failure or resistance, post-cure health issues, limitations of treatment access despite increased provincial subsidization, complex needs of at-risk populations (ie, injection drug users, societal obstacles). At the 6th Canadian Symposium on HCV in March 2017, the theme “Delivering a Cure for Hepatitis C Infection: What Are the Remaining Gaps?” provided a framework in which basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada could showcase how they are working to address these ongoing challenges.
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Affiliation(s)
- Sarwat Khan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Bernier
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Dustin Dapp
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Fortier
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mel Krajden
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandra King
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Grebely
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Selena M Sagan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Curtis L Cooper
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
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10
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Eversman MH. "We want a living solution": views of harm reduction programs in black US Communities. J Ethn Subst Abuse 2016; 14:187-207. [PMID: 25984958 DOI: 10.1080/15332640.2014.976803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Illicit drug use in the US remains concerning, with injection drug use linked to transmission of blood-borne diseases as HIV/AIDS; persons of color, including Black Americans, experience disproportionately higher transmission rates. Harm reduction programs such as methadone and needle- and syringe-exchange (NEP/SEP) are empirically demonstrated to reduce HIV transmission, yet are believed largely opposed by Black communities. Using interview data from 21 service providers of substance abuse and related service organizations located in and/or serving predominantly populations of color, this study explored perceptions of harm reduction programming for illicit drugs and race in the US. Criticizing each program for unique reasons, respondents deemed them largely inadequate and inappropriate responses to community drug problems. While some believed these programs worsen Black communities, others believed they are becoming more accepted there. Views were informed by racial dynamics surrounding drugs in society, burdens borne by program host communities, and racialized stereotypes of drug use.
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11
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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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12
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McCann E, Temenos C. Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policy. Health Place 2015; 31:216-23. [DOI: 10.1016/j.healthplace.2014.12.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 11/12/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022]
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13
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Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Perlman DC, Hagan H, Dauria EF, Cooper HLF. A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City. Subst Use Misuse 2014; 49:783-92. [PMID: 24502371 PMCID: PMC4451113 DOI: 10.3109/10826084.2014.880176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983-2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed.
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Affiliation(s)
- Don C Des Jarlais
- 1Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, New York, USA
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14
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Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Hagan H, Cooper HLF, Perlman DC. Combined HIV prevention, the New York City condom distribution program, and the evolution of safer sex behavior among persons who inject drugs in New York City. AIDS Behav 2014; 18:443-51. [PMID: 24271348 DOI: 10.1007/s10461-013-0664-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Examine long term sexual risk behaviors among persons who inject drugs (PWID) in New York City following implementation of "combined" prevention programming, including condom social marketing. Quantitative interviews and human immunodeficiency virus (HIV) testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs 1990-2012. Data were analyzed by four time periods corresponding to the cumulative implementation of HIV prevention interventions. 7,132 subjects were recruited from 1990 to 2012; little change in sexual behavior occurred among HIV seronegative subjects, while HIV seropositive subjects reported significant decreases in being sexually active and significant increases in consistent condom use. HIV transmission risk (being HIV positive and engaging in unprotected sex) declined from 14 % in 1990-1995 to 2 % in 2007-2012 for primary sexual partners and from 6 to 1 % for casual partners. Cumulative implementation of combined prevention programming for PWID was associated with substantial decreases in sexual risk behavior among HIV seropositives.
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Affiliation(s)
- D C Des Jarlais
- Beth Israel Medical Center, The Baron Edmond de Rothschild Chemical Dependency Institute, 160 Water Street, New York, NY, 10038, USA,
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15
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Abstract
Emphasizing the reduction of risk over the cessation of drug use, needle exchange in the United States is often condemned for coddling its participants. Declining the punitive measures or unwavering teleology of criminal justice and drug treatment approaches, harm-reduction measures in general are faulted by naysayers for their refusal to establish clear normative boundaries for behavior modification. This article will seek to subvert such critiques by describing the ways in which disciplinary technologies suffused one needle exchange program in New York City. Drawing upon 1 year of participant observation at "Bronx Harm Reduction," this article will consider how the "minor procedures" of disciplinary power first characterized by Foucault (1977) worked to shape and organize different user bodies in needle exchange; it will further employ the work of Mitchell Dean to reflect upon the connections between program-level "technologies of agency" and government-led "technologies of performance." While conceding the overarching disciplinary transformation of late harm reduction, this article is specifically interested in the ramifications of this trajectory within one specific time and place. Namely, it postulates that attempts to "raise the bar" within a low-threshold program may serve to alienate or explicitly exclude certain service users.
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16
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Deren S, Hagan H, Friedman S, Des Jarlais DC, Perlman D, Gwadz M, Cleland C, Osborne A, Lunievicz J. Current and emerging research needs in studying the NYC HIV-drug use epidemic. Subst Use Misuse 2011; 46:316-9. [PMID: 21303251 PMCID: PMC4455883 DOI: 10.3109/10826084.2011.523324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As we begin the fourth decade of the epidemic, it is clear that, as demonstrated by the articles in this Special Issue, much has been learned about factors contributing to the decline in HIV prevalence among drug users in New York. However, there are a number of outstanding research questions that remain or are emerging. Following is a summary of some of the topics requiring further research. While this summary does not represent a comprehensive list, it is based on many of the questions raised in the articles in this Special Issue and identifies some of the directions to be investigated during the next decade.
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Affiliation(s)
- Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, New York, USA.
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