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Mars SG, Koester KA, Ondocsin J, Mars V, Mars G, Ciccarone D. 'The High Five Club': Social Relations and Perspectives on HIV-Related Stigma During an HIV Outbreak in West Virginia. Cult Med Psychiatry 2023; 47:329-349. [PMID: 35199277 PMCID: PMC8865492 DOI: 10.1007/s11013-022-09769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior ('grid') or degree of group allegiance/individual autonomy ('group'). Accordingly, we would expect that perceptions about HIV, including stigma, correspond with individuals' grid/group attributes. To explore this, we conducted qualitative interviews with people who inject drugs (PWID) recruited from a WV syringe service program. This paper focuses on our unexpected findings on stigma during a coinciding HIV outbreak. PWID living homeless identified as belonging to a 'street family'. Its members were mutually distrustful and constrained by poverty and drug dependence but despite their conflicts, reported openness between each other about HIV + status. Interviewees living with HIV perceived little enacted stigma from peers since the local outbreak. Contrasting stigmatizing attitudes were attributed to the town's mainstream society. The 'High Five' (Hi-V) Club, expressing defiance towards stigmatizing behavior outside the street family, epitomized the tensions between a desire for solidary and mutual support and a fatalistic tendency towards division and distrust. Fatalism may hinder cooperation, solidarity and HIV prevention but may explain perceived reductions in stigma.
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Affiliation(s)
- Sarah G Mars
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA.
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Jeff Ondocsin
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
| | - Valerie Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Gerald Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU3E, San Francisco, CA, 94143, USA
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Guy D, Doran J, White TM, van Selm L, Noori T, Lazarus JV. The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review. Front Psychiatry 2022; 13:951682. [PMID: 36090369 PMCID: PMC9459118 DOI: 10.3389/fpsyt.2022.951682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION People who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population. METHODS We systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review. RESULTS Our search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers. CONCLUSIONS To improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.
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Affiliation(s)
- Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,National Infection Service, UK Health Security Agency, London, United Kingdom.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Lefoka MH, Netangaheni TR. A plea of those who are affected most by HIV: The utterances by women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34476973 PMCID: PMC8424706 DOI: 10.4102/phcfm.v13i1.2416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/11/2022] Open
Abstract
Background Nyaope injecting practice brought the field of Human Immunodeficiency Virus (HIV) prevention and Substance Use Disorder (SUD) together. It is complex and requires multidisciplinary approach. Women who use drugs face individual, social, and structural factors that fuel their vulnerability to contract HIV, and other blood-borne infections. Women Who Inject Drugs (WWID) are a subpopulation that is neglected from HIV prevention and SUD treatment interventions, and are hardly the subject of surveys. In order to fully address the HIV epidemic among WWID it is imperative that they become part of the process of finding solutions. Aim This study explored the strategies to curb HIV incidence among Women Who Inject Nyaope (WWIN), residing in City of Tshwane Municipality, Gauteng Province. Setting The research was conducted within COSUP. COSUP was considered more appropriate as it is a harm reduction based organisation. Methods The study utilised the qualitative research approach. Semi structured interviews were conducted with 24 women with a history of injecting Nyaope aged between 19 to 35 years. The data was analysed using thematic data analysis. Results Health intervention, economic intervention and educational intervention was stressed as key strategies to curb HIV among WWIN. Needle exchange programmes, condom distribution, PrEP, HIV Testing and Counselling, employment opportunities, support groups and awareness campaigns if implemented, can yield positive outcomes in curbing HIV among WWID. Conclusion Mechanisms to curb HIV among WWIN exist, and when implemented, they have the potential to address high HIV incidence among women who inject Nyaope.
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Affiliation(s)
- Moganki H Lefoka
- Department of Sociology, Faculty of Human Sciences, University of South Africa, Pretoria.
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Oro-facial opportunistic infections and related pathologies in HIV patients: A comprehensive review. Dis Mon 2021; 67:101170. [PMID: 33618831 DOI: 10.1016/j.disamonth.2021.101170] [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: 11/20/2022]
Abstract
Among all the viral infections, acquired immunodeficiency syndrome (AIDS) is considered as one of the most morbid infections caused by the human immunodeficiency virus (HIV). The prime reason for the pathogenesis is the profound immunosuppression that leads to lethal opportunistic infections (OI), neurological disorders, unexpected malignancies and pathologies of the orofacial region. Patients with OI whose HIV status is unknown have shown a mortality rate higher than those with known HIV status. Among HIV-associated infections, orofacial lesions contribute a major proportion of the OI attributed to the plethora of micro-organisms present in the oral cavity. Apart from serious clinical manifestations, opportunistic infections also lead to significant impairment of quality of life. These lesions not only indicate the HIV infection but also among the clinical manifestations, which often occur early in the course of disease. World Health Organization has also provided policies for treatment/prevention of oral lesions, strengthening the promotion and care of oral health in HIV/AIDS patients. The present review provides comprehensive information about orofacial OI in HIV/AIDS patients and emphasis was also given to the malignancies associated with EB and HTLV virus.
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Smith M, Elliott L, Hutchinson SJ, Metcalfe R, Flowers P, McAuley A. Perspectives on pre-exposure prophylaxis for people who inject drugs in the context of an hiv outbreak: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103033. [PMID: 33249313 DOI: 10.1016/j.drugpo.2020.103033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/10/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is an ongoing HIV outbreak amongst people who inject drugs (PWID) in Glasgow, Scotland, and one response which has not yet been widely implemented is the provision of Pre-exposure prophylaxis (PrEP). PrEP is the use of HIV anti-retrovirals prior to HIV infection to provide a barrier to infection. This has been shown to be effective amongst various at-risk populations in preventing HIV spread. The present study aimed to explore views of PWID who might benefit from PrEP provision and Service Providers working with PWID to understand will to use PrEP and literacy of PrEP, contributing to the development of a PrEP service. METHODS A qualitative approach was taken, with semi structured interviews conducted in Glasgow at two third sector service sites. 11 Service Providers and 21 PWID participated in the study. Data was analysed thematically. RESULTS Participants, both PWID and Service Providers, were keen to engage with PrEP and perceived substantial potential benefits of PrEP for this population. Potential barriers to engagement were identified as a lack of health literacy, motivation, and self-ascribed risk, as well as the overwhelming unpredictability of substance use. Participants wanted PrEP to be provided within already existing structures, particularly community pharmacies, and for promotion and provision to involve peers. CONCLUSION This sample reported willingness to engage with PrEP, and suggested there is a specific need amongst PWID for PrEP. However, PWID have specific lived experienced contexts and needs, and are burdened by social and economic marginalisation and inequality at every level. This contrasts them from other populations currently being provided with PrEP, and must be considered in the development of provision.
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Affiliation(s)
- Matt Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK G4 0BA.
| | - Lawrie Elliott
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK G4 0BA
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK G4 0BA; Health Protection Scotland, Meridian Court, Glasgow, UK, G4 0BA
| | - Rebecca Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK G4 0BA; NHS Greater Glasgow and Clyde, Sandyford Sexual Health Service, Glasgow, UK G3 7NB
| | - Paul Flowers
- School of Psychological Sciences & Health Room, Graham Hills Building, 40 George Street, Glasgow, G1 1QE
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK G4 0BA; Health Protection Scotland, Meridian Court, Glasgow, UK, G4 0BA
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Lefoka MH, Netangaheni TR. A plea of those who are affected most by HIV: The utterances by women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng. Afr J Prim Health Care Fam Med 2020. [DOI: 10.4102/phcfm.v12i1.2416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Wachamo D, Bonja F. Magnitude of Opportunistic Infections and Associated Factors Among HIV-Positive Adults on ART at Selected Public Hospitals in Sidama National Regional State, Southern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:479-487. [PMID: 33061659 PMCID: PMC7532037 DOI: 10.2147/hiv.s265274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
Background Opportunistic infections are late complications of HIV infection due to the depletion of the immune system. It is a major public health problem and high morbidity AIDS patients die of AIDS-related infections in developing countries like Ethiopia. Identification of opportunistic infections (OIs) is important to develop a specific intervention. Therefore, the aim of this study was to assess the burden and associated factors of opportunistic infections. Methods A facility-based cross-sectional study was conducted on 420 randomly selected HIV/AIDS patients taking anti-retroviral therapy. Data were collected from selected hospitals in Sidama Regional State based on population proportion to size. Data were collected by a pre-tested questionnaire and a pre-tested checklist from the medical records of patients. Data were entered and analyzed for descriptive and logistic regression models by SPSS v.23. The result declared as statistically significant at p < 0.05. Results The magnitude of opportunistic infections was 39.6%. Major identified OIs were oral candidiasis 23.2%, recurrent bacterial pneumonia 21.5%, herpes zoster 6.3%, and pulmonary tuberculosis 6.0%. The magnitude of opportunistic associated with older age [AOR=3.50, 95% CI:1.85, 6.61], no formal education [AOR=4.54, 95% CI:1.81, 11.37], initial CD4 count less than 200 cells/mm3 [AOR=3.10, 95% CI:1.61, 5.96], who interrupt ART medicines [AOR=3.21, 95% CI:1.86, 5.56] and khat chewing [AOR=4.24, 95% CI:2.07, 8.68] when compared to their counterparts. Conclusion The overall magnitude of opportunistic infections was high when compared with other studies. Health officials and clinicians need to give attention to the strengthening of the provision if ART with prophylaxis on early stage and adherence, implementation of the TB/HIV collaboration activity, and early initiation of ART to reduce opportunistic infections.
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Affiliation(s)
- Demelash Wachamo
- Department of Public Health, Hawassa College of Health Sciences, Hawassa, South Nations and Nationalities Peoples' Region, Ethiopia
| | - Fisseha Bonja
- Department of Medical Laboratory, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Goldstein NS, Seymour EC, Carter-Davis JB. A Model for Increasing Access to Preexposure Prophylaxis (PrEP) Services in the Substance Use Population. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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PRE-EXPOSURE PROPHYLAXIS FOR HIV PREVENTION
IN THOSE WITH SUBSTANCE USE DISORDERS. ACTA ACUST UNITED AC 2018. [DOI: 10.26634/jnur.8.2.14022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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No one left behind: how are we doing in the roll-out of PrEP as part of combination HIV prevention? J Int AIDS Soc 2016; 19:21364. [PMID: 27760690 PMCID: PMC5071753 DOI: 10.7448/ias.19.7.21364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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11
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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