No description available.

The purpose of this qualitative research study was to understand the facilitators and/or barriers to safer drug use and sexual practices among a sample of young female injection drug users (IDUs) who live in small towns/rural communities in Cape Breton, Nova Scotia. This study examined how economic status, relationships, social roles, small town/rural living, and stigma function as facilitators and/or barriers to safer practices. Eight female IDUs aged 20-31, living in small towns/rural communities in Cape Breton, engaged in face-to-face, semi-structured interviews. The women described what day-to-day life is like for female IDUs living in small towns/rural communities. They spoke about managing drug addiction, their understanding of safer and unsafe injection drug use and risky and safer sexual practices, as well as their experiences with services/supports. The information obtained from this study will help to inform harm reduction policy and program initiatives.

This dissertation examines the influence of love and other emotions on sexual and drug-related HIV risk among female sex workers who inject drugs and their intimate, non-commercial partners in Tijuana, Mexico. My work on a public health study along the Mexico-U.S. border and independent ethnographic research in Tijuana suggests the importance of emotions in shaping sex workers' relationships and health risks. Love is a universal human emotional experience embodied within broader cultural, social, and economic contexts. A growing body of cross-cultural research suggests that modern relationships have transformed to emphasize love and emotional intimacy over moral or kinship obligations. Particularly in contexts of risk and uncertainty, intimate relationships provide emotional security. Drug-using couples may engage in unprotected sex or even needle sharing to convey notions of love and trust and help sustain emotional unity, but such acts also place partners at heightened risk for HIV. For female sex workers in Tijuana who endure poverty, marginality, and an increased risk of contracting HIV, establishing and maintaining emotional bonds with intimate partners may be of paramount importance. Yet little is known about how female sex workers' intimate male partners shape their HIV risk perceptions and practices. Moreover, male partners' perspectives are critically absent in HIV prevention strategies. This dissertation is nested within Proyecto Parejas, a study of the social context and epidemiology of HIV among sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. Through semi-structured and ethnographic interviews, photo elicitation interviews, and participant observation, I got to know seven of the couples in Tijuana who are enrolled in Parejas. I examine their relationships through the lens of critical phenomenology, which combines concern with experience, emotions, and subjectivity with political economy perspectives that argue sex work, drug use, and HIV/AIDS is not randomly distributed but historically and structurally produced. My work suggests that female sex workers and their intimate partners experience their relationships in gradations of love and emotional content. These relationships hold significant meaning in both partners' lives for emotional and material reasons, and shape each partner's HIV risk within and outside of the relationships. Couples choose not to use condoms with each other, often to define themselves as a couple. Sex outside of the relationship occurs for economic and culturally conditioned reasons, but does not necessarily diminish the meaning of the primary relationship. Motivations and ability to use condoms with clients and outside partners are context dependent and, in order to preserve trust and unity, sexual risks are typically not discussed. Partners share drugs and syringes with each other as a sign of care within a context of scarce material resources. Emotionally close couples tend to confine their sharing within the relationship, whereas less close couples also share with friends and family in more social forms of drug use. Given their vulnerability within a milieu of poverty, social marginalization, and discrimination, love alone cannot explain the HIV risk that female sex workers and their partners face. Nevertheless, emotions are significant factors in both risk taking and risk management. This study encourages researchers, practitioners, and policy makers to consider the affective dimensions of HIV risk within sex workers' intimate relationships as an integral part of a multi-level strategy to address each partner's health and wellbeing.

INTRODUCTION: Despite rising hepatitis C virus (HCV) incidence in the United States in recent years among young adults, little data describe HCV testing in youth. My objective was to characterize the HCV care cascade in adolescents and emerging adults in a large US sample and to describe the association between diagnosed substance use disorders (SUDs) and HCV testing. METHODS: In this retrospective cohort study, I describe HCV care cascade outcomes for youth 13–21 years old seen at least once from 1/2012–9/2017 at an OCHIN-participating federally qualified health center. Using electronic health record data, I analyzed odds of HCV testing by number of concurrent diagnosed SUDs associated with HCV risk (those associated with injection or intranasal use: opioids, amphetamines, and cocaine). RESULTS: Among 269,124 youth who met inclusion criteria, (54.7% female, 62.5% non-white, mean age [SD] at testing 18.5 [2.2] years), 6812 (2.5%) were tested for HCV antibody, 122/6812 (1.8%) of those tested were anti-HCV positive, and of anti-HCV positive youth, 75.4% had additional diagnostic testing. Only 1 had documented HCV treatment. Each additional HCV risk-associated SUD was associated with higher odds of HCV testing, particularly in younger (OR 9.12, 95% CI 6.78, 12.4 in 13–15 year-olds, and OR 8.37, 95% CI 7.48, 9.36 in 16–18 year-olds) compared with older youth (OR 3.9, 95% CI 3.59, 4.24 in 19–21 year-olds). CONCLUSION: This study highlights important gaps in recommended HCV testing during the current opioid crisis. As the first step in the care cascade, addressing missed testing opportunities is critical for reducing hepatitis C burden. / 2020-09-28T00:00:00Z

Background: Rural people who inject drugs (PWID) have been disproportionately affected by the ongoing hepatitis C virus (HCV) epidemic. Methods: Using data from a cross-sectional study of PWID from rural New Hampshire, Vermont, and Massachusetts, we evaluated the potential for syringe services programs (SSPs) to lower the risk of HCV infection among rural PWID via their influence on the physical and social environment. The specific aims were to evaluate: 1) the association of spatial proximity to the nearest SSP with HCV seroprevalence and injection risk behaviors; 2) the association of indirect SSP use (secondary syringe exchange) with HCV seroprevalence and injection risk behaviors; and to 3) explore PWIDs’ perceptions and experiences with obtaining injection supplies, injection risk behaviors, and HCV. Results: Living farther from an SSP was associated with a higher prevalence of HCV seropositivity and injection risk behaviors. Indirect SSP use was weakly and imprecisely associated with lower prevalence of injection risk behaviors, while direct SSP and pharmacy use were both associated with a higher prevalence of HCV seropositivity and injection risk behaviors. Participants described sharing syringes in response to limited access to syringe sources. Syringe sharing behavior was influenced by perceptions of HCV risk, HCV status, and emotions of trust and intimacy. Conclusion: Spatial proximity to an SSP and direct use of an SSP may lower the risk of HCV infection among rural PWID. HCV prevention efforts in rural New England need to address syringe access and cultivate the perception that HCV is a serious but preventable risk.

New survey data indicate that injection drug users (IDU) in Victoria, BC who share syringes do so with a single person. These partnerships pose an obvious health risk to IDU, as blood borne illnesses are transmitted through the sharing of injection equipment. Here we formulate an ordinary di erential equation (ODE) model of pair formation and separation. Susceptible-infectious (SI) disease dynamics are built into this model so as to describe the syringe-mediated transmission of human immune de ciency virus (HIV) and hepatitis C virus (HCV) among IDU. We utilize a novel parameter estimation approach, and t the distribution of partnership durations observed in Victoria. The basic reproduction number is derived, and its qualitative behavior explored with both analytical and numerical techniques.

Of the 3.5 million persons infected with chronic HCV in the United States, the African American population is the largest racial group with chronic HCV. Disparities in access to care and treatment involve a complex set of individual, interpersonal, socioeconomic, and environmental factors that influence the course of HCV infection in the African American population, resulting in poorer outcomes and survival. Drawing upon both the theory of reasoned action and the theory of planned behavior, this study was conducted to determine whether the seeking of health care by HCV-positive African Americans and the responses of health care providers to HCV-positive African Americans had improved since 2008 following the introduction of new treatment options, as compared to other HCV-positive racial/ethnic groups, using secondary data analyses with survey datasets from the National Health and Nutrition Examination Survey, 2005-2012. Using chi-square test of difference and logistic regression analyses, the study did not identify a statistically significant relationship between health care seeking behavior and responses from health care providers for HCV-positive African Americans before (2005-2008) and after (2009-2012) the introduction of new treatment options as compared to other HCV-positive racial/ethnic groups. Given the ongoing development of new and improved drugs to treat HCV infection, further research might focus on the HCV-infected population as a whole to ascertain whether differences exist as compared to earlier therapies before 2013. This study may drive social change within the health care community by raising awareness of the risks of HCV infection resulting in less provider bias and the introduction of resources into the African American and underserved communities that will improve outcomes and reduce barriers to care.

Background: Injecting drug use is one of the most risky forms of substance use that carries risks for individuals and society. The Czech Republic is one of the countries where the prevalence of injecting drug use is high and increasing. The available data show that learning to inject has, among other things, a social character. Exploring these social circumstances, as well as the personal experiences of people who inject drugs, can be a tool for designing and implementing appropriate prevention interventions. One of these effective interventions is the Break the Cycle method, which refers to the initiation of injecting as a phenomenon that can be transmitted to inexperienced persons on the basis of social learning. Reducing the assistance of experienced persons in the initiation of injection to inexperienced persons, reducing injection in front of inexperienced persons, and refusing to discuss the benefits of injection with inexperienced persons can have a positive impact on the incidence of injection use in the Czech population. Aims and Methods: The aim of this study is to provide information on the essential phenomena related to the initiation of injection drug use and to explore the experience of clients of the Prague contact centre with their initiation of injection use and their experiences...

No description available.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.