Aim: The aim of this master thesis was to explore contexts of initiation of substance use and to describe the social, physical and mental health situation of women injecting drug users (WIDU) in Tunisia. Relevance: In North Africa, people who inject drugs are an important risk group in the HIV epidemic. There is evidence that WIDU are even more vulnerable. However, in Arabic Muslim societies, rehabilitation, treatment for this subpopulation and research on this issue are scarce. Method: A qualitative study was conducted. Six in-depth interviews with WIDU in Tunis were recorded, transcribed and inductivelyanalyzed using thematic analysis. Findings: Four themes were identified. The first theme describes situation of women before dependence. Women were brought up within patriarchal cultural norms where they were victimized. The second theme is related to the circumstances of initiation of drug use characterized by the wish for escape and pursue of pleasures. The third theme describes the dependence, withdrawal and consequences on everyday life. Final and fourth theme is related to the way out of addiction. Conclusion and recommendations: The socio-ecological model and the gender relational theory helped to interpret the findings.WIDU in Tunisia suffer from marginalization and from social and health inequalities due to their gender and to their dependence. This puts them at a higher risk of violence, abuse, health hazards and blood-borne and HIV infections. Thus, awareness and policies should be designed in order to alleviate the stigma and bring services closer to this subpopulation.

There is a paucity of scientific evidence into the lived experience of people who have a history of injecting drug use and are living with leg ulceration. Portraying the true voice of injecting drug users (IDUs) through narrative means is a novelty in contemporary literature. The representation of the life and the person behind the leg ulcer, having experienced addiction, is original from a purist narrative perspective. This study, led from the perspective of a nurse-researcher leading in the field of wound management, offers a unique opportunity to gain a rare glimpse into the daily life of IDUs, as reported in their own words. The aim of this study was to explore the experience of injecting drug users living with leg ulceration using qualitative methodology. A naturalistic paradigm framed the design by allowing participants to control the data in an unrestricted an open manner without direct intrusion form the researcher. Qualitative methodology was central to collecting data on life experience and feelings. The ethics process detailed a rigorous application to explore the professional, ethical virtues from the perspective of an insider-outsider working with sensitive data in a marginalised population. Diaries were kept and recorded by participants over four weeks in their routine daily life; this was followed by semi-structured interviews. The diaries allowed a unique insight into the past, present and future of IDUs and how their ulcer affected their lives. The diaries also facilitated a means of reflection on themselves and their wounded body. The interviews offered an opportunity to explore in detail the diary entries and other stories participants wished to share. The study recruited twelve participants from leg ulcer clinics set in London; three women and nine men older than 18 years of age (median age of 52 years; range 35 - 62 years). Ten completed the data collection process; two of the participants, aged 61 and 62 years, were married. Gatekeepers working with IDUs with leg ulceration were central to the process of engagement and recruitment. Participants welcomed the design as an opportunity to voice and share their journey of living with an open wound. The findings revealed the detailed suffering participants endured living with their ulcer: pain, shame and stigma were clearly voiced in their narratives. The majority of participants had experienced some form of stigma during their life and this was exacerbated as they were drug users. The self-blame and punishment triggered by this felt stigma was a detriment to the health of participants. Those in contact with specialist wound care services saw a significant improvement in wound healing and this had a positive impact on their wellbeing and their overall outlook on life. Participants also voiced enacted-stigma experienced from encounters in health practice. These negative experiences exacerbated the self-stigma. Findings also portrayed the multiple characteristics and talents of participants including humour, art and resilience. This research contributes to science and practice by understanding the lives of IDUs living with leg ulceration. It provides a platform from which to engage both generalists and specialists who care for these patients and has the potential to influence medical and social policy-making and clinical practice in this field. By means of narrative inquiry, this study may challenge the conventional social stereotypes, the taboos and the stigma still experienced by this patient group in health care.

Australian and international literature provides strong evidence that intravenous use of psychostimulants increases the harms experienced by users, including heightening the risk of blood-borne virus (BBV) infection. The few Australian studies that include women who inject psychostimulants identify street-based sex work as the main method of income generation and highlight the harms that result from combining these practices. However, there has been little exploration into the way these practices are shaped by the environments in which they occur or the ways in which women manage these harms. This thesis aims to provide an in-depth exploration of the daily lives of women who inject psychostimulants and engage in street-based sex work in Kings Cross, Sydney. Over 18 months between 2005 and 2007, the author conducted ethnographic fieldwork with women who injected psychostimulants and engaged in street-based sex work in Kings Cross, Sydney. Data sources included observations recorded as fieldnotes and transcripts of in-depth interviews with 12 women. Thematic analysis of the data was employed with particular attention to the women???s shared narratives. Key findings of the thesis were that 1) the Kings Cross environment plays a prominent role in shaping the lives of women, their psychostimulant injecting and street-based sex work practices; 2) psychostimulant injecting reinforces the opportunistic nature of street-based sex work as the primary method of income generating for women, restricting the development of occupational norms; 3) synergies exist between the drug and sex markets in Kings Cross, increasing the harms associated with both injecting and street-based sex work practices; 4) public health messages relating to sharing of injecting equipment and condom use fail to account for contextually driven decision-making and risk prioritising; 5) women develop lay epidemiological understandings as they attempt to reconcile the public health messages with the lived reality. The value of these findings is in the insights they provide into the everyday lives of these women in Kings Cross that have not been documented previously and their potential for informing ???bottom-up??? rather than ???top down??? approaches to future policy, practice and research.

No description available.

Men who have sex with men (MSM) account for a majority of all men currently diagnosed with AIDS. MSM is also recognized as the largest risk category of all AIDS cases. Drug use has been shown to have a synergistic effect on the prevalence of HIV in the MSM population. The study aimed to examine the association between injection drug use, non-injection drug use, and non-drug use with sexual risk behaviors for HIV in men who have sex with men. Secondary, cross-sectional data procured from the National HIV Behavioral Surveillance System for the Atlanta Metropolitan Survey Area were used for the study. The study population was 960 participants. Using binary logistic regression analyses, the drug use categories were studied for unprotected intercourse, unprotected receptive anal intercourse and HIV status. Strong associations were seen independently for unprotected intercourse, unprotected receptive anal intercourse, and HIV status with injection and non injection drug use, but the association weakened for drug use categories when controlled for other independent factors. Taking into account current findings and findings from previous research, the importance of clinical significance over statistical significance was considered. Racial disparities were evident, in that, although the Black participants showed no increased odds for sexual risk factors or drug use, it had a higher odds for being HIV positive compared to Whites. Combining Viagra/Levitra with drugs was significantly associated with unprotected intercourse (AOR=1.9), and each individual drug showed a different degree of association with Viagra/Levitra. Further research is recommended to identify sub-populations at risk and appropriately allocate resources and channel programs and interventions.

The control of excessive water production in oil and gas producing wells is of increasing importance to the field operator, primarily when trying to maintain the survivability of a mature field from shut in. During the last two decades many chemicals have been studied and applied under the name of relative permeability modifier (RPM) to combat this problem. These chemicals were mostly bullheaded individually into the affected zones, consequently their application resulted in low to medium success, particularly in treating reservoirs suffering from matrix flow. It has been found that the disproportionate permeability reduction depends on the amount of polymer dispersed or absorbed by the porous rock. If single polymers are employed to treat excessive water production in a matrix reservoir they cannot penetrate deep into the formation rock because the polymer will start to build as a layer on the surface of the rock grains. As a result the placement of polymer into the formation will no be piston like and the dispersion over the rock pores will be uneven. To improve water shutoff technology a method of injecting chemicals sequentially is recommended provided that the chemical’s viscosity is increasing successively with the chemicals injected. / Experimentally confirmed, injecting chemicals sequentially provides better results for conformance control. The value of post treatment water mobility is conspicuously lowered by the method of applying injecting chemicals sequentially in comparison with the single chemical injection method. For instance, the residual resistance factor to water (Frrw) at the first cycle of brine flushing for this method is approximately five times higher than the Frrw obtained by injecting only one single chemical. Furthermore, for the second cycle of brine flushing Frrw is still higher by a ratio of about 2.5. In addition to this improvement residual resistance factor to oil Frro for this method is less than two which has been considered as the upper limit for conformance control in matrix reservoir. Accordingly injecting chemical sequentially can be applied for enhancing relative permeability modifier performance in matrix reservoir.

Recent advances in HIV antiretroviral therapy and the availability of prophylaxis for opportunistic infections, combined with the opportunity to prevent perinatal HIV infection, underscores the value of early diagnosis of HIV infection. HIV antibody home test kits offer individuals the opportunity to collect a blood sample, send it anonymously to a laboratory, and receive counseling and referral over the phone. Home HIV testing may reduce barriers to testing that have precluded individuals from learning their HIV serostatus, and if seropositive, from taking advantage of efficacious therapeutic and preventive regimens. This study employed a randomized-controlled prospective field trial design to determine if the availability of home testing increased HIV testing relative to traditional counseling and testing among injecting drug users in three HIV prevention/drug treatment contexts; methadone maintenance, hospital-based detoxification, and syringe exchange. Theoretical correlates to HIV testing were also evaluated. Multivariate analyses demonstrated that participants randomized to home testing were 2.2 times more likely than those randomized to traditional counseling and testing to test for HIV antibodies in this study after controlling for demographic, HIV risk, and theoretical variables. No differences were observed between testing methods with regard to obtaining HIV test results. The relationship between HIV testing and test type was moderated by drug treatment context and history of homeless, with home testing resulting in increased testing among methadone participants and persons without a history of homelessness. Analyses of theoretical variables suggested that prevention education stressing the benefits of HIV testing, personal risk of HIV infection, and efficacy of available treatments could increase HIV testing among injecting drug users. Participants randomized to home testing were more satisfied with testing and telephone-based counseling than were those receiving traditional testing and face-to-face counseling. Home testing was associated with increased testing perhaps due to reduced barriers to testing. To further reduce barriers to testing and to increase testing among injecting drug users, consideration should be given to incorporating oral fluid testing and rapid result capability in home test kits. Counseling could be made available as needed, delivered by telephone, and contingent upon the volitional control of the testing consumer.

Studien har gjorts mot bakgrund av den pågående diskussionen gällande införandet av sprutbytesverksamhet i Jönköpings län och vill till den diskussionen tillföra de skilda erfarenheterna som finns i fyra olika existerande sprutbytesprogrammen i Sverige, att jämföra likheter och skillnader i praxis och att relatera dessa erfarenheter till deras mål och resurser. Trots att lagen om sprutbyte trädde i kraft år 2006 är sprutbyte fortfarande ett kontroversiellt ämne i Sverige. I denna omtvistade form av preventiv verksamhet finns det dock en viktig del som gör ämnet mer relevant och det är de goda, sociala bieffekter som programmen medför. Dessa omnämns i studien som paramedicinsk vård. Metoden som ligger till grund för studien är kvalitativa, semistrukturerade intervjuer. Materialet har sedan analyserats för betydelsen av sitt innehåll och genom organisationsteori. Utgångspunkten är avhandlingar, vetenskapliga artiklar och litteratur i ämnet sprutbyte. Vid sprutbytesprogrammen i Sverige skiljer sig uppfattningarna åt gällande behovet och implementeringen av den paramedicinska vården i verksamheten. Likaså går åsikterna isär mellan de forskare, politiker och professionellt verksamma som intervjuats. En gemensam nämnare är dock synen på paramedicin i stort som något betydelsefullt för personer i aktivt missbruk, oavsett om det är landstinget eller socialtjänsten som bedriver den. Studiens konklusion blir således att denna form av verksamhet kräver ett holistiskt perspektiv av den vård som ska bedrivas. Samarbete utanför landstingens och kommunens gränser verkar gynnande. Landstinget har större inflytande än kommunen men kommunen har å andra sidan större resurser när det gäller paramedicinska vårdinsatser. I de landsting där eventuella sprutbytesverksamheter diskuteras kan studien ge exempel på goda respektive mindre goda paramedicinska insatser vid de program som idag är verksamma. / In light of the ongoing discussion regarding the possible introduction of needle exchange programs in Jönköping county, this study aims to compare similarities and differences in practice at four different needle exchange programs in Sweden and to relate these experiences to their objectives and resources. Despite the fact that the law of needle exchange entered into force 2006, needle exchange programs are still a controversial subject of discussion in Sweden. In this contested form of infection care there is an important part though which makes the subject more legitimate. That is the positive social side effects which come as a result of the programs. These effects are mentioned in the study as paramedic care. The method underlying the study is qualitative, semi structured interviews. The material has been analyzed for the relevance of its content and also through organization theory. The starting point is theses, scientific articles and literature on the subject of needle exchange. At the needle exchange programs in Sweden the perceptions regarding the need for and the implementation of paramedical care differs as well as the views of researchers, politicians and professionally active that we interviewed on the subject. A common denominator, however, is the perception of paramedical care at large as something significant for people in active addiction, whether it is the country council or the social services that engaged in it. The conclusion of the study is thus that this form of activities requires a holistic perspective of the care that should be conducted. Cooperation outside the county and municipal boundaries seems favorable. The county councils have more influence than the municipalities but the municipalities on the other hand have greater resources in terms of paramedical care efforts. In the county councils where any needle exchange activities are up for discussion this study could give examples on favorable and less favorable paramedical activities at programs that are currently active.

Background: Intravenous way of drug application is the most common between problem drug users at Prague. Due Mravčík et al. (2015), the estimate is, that there was a 15 700 intravenous drug users at Prague in 2014 (7 500 pervitin users, 2 500 heroin users and 5 700 buprenorphine users). And that they spend about 15,5 millions of syringes every year (Švůgerová, 2015). But the data in Annual report on drug situation 2014 says, there was only 2, 6 millions of syringes distributed (Mravčík et al., 2015). This means, that Prague intravenous drug users spend many more syringes, that are distributed by low-treshold services and pharmacies. That is a reason of charting of the behaviour of drug users in connection with application of addictive substance, especially how the consuption of injecting material is connected with single type of drug user. Aims: The main aim of the thesis is to find out the frequency of drug application in intravenous drug users and to estimate the total consumption of injecting materialial depended on single of users typology (used drugs, frequncy of contact with harm reduction services…) Research sample: The sample consists of 155 clients of harm reduction services at Prague (3 contact centers and 3 streetwork programs). All of the respondents stated the intravenous drug using in...

Bakgrund: Personer som injicerar droger riskerar att drabbas av allvarliga infektioner. Tidigare studier har visat att personal som möter personer i risk inte har tillräckligt med kunskap för att erbjuda hälsofrämjande insatser. Syfte:Att kartlägga personalens kunskap om infektioner som kan drabba personer som injicerar droger,samt undersöka om utbildnings intervention ökar personalens kunskap och motivation till preventiva samtal. Metod:Totalt genomfördes fem utbildningar med 26 deltagare från psykiatri-, och infektionsavdelning, samt ungdomsmottagning. Studien genomfördes med enkät före och en månad efter utbildning. Enkäten innehöll kunskapsfrågor och frågor om erfarenhet av preventionssamtal med personer i risk. Resultat:Studien visade att personalen saknade tillräcklig kunskap om smitta vid injektion av droger och att personer i risk inte i tillräcklig omfattning erbjöds information och stöd. Innan utbildning skulle enbart 60 % av personalen samtala om smitta vid injektion av droger om de fick frågor av personer i risk. Hinder för samtal uppgavs vara brist på kunskap och osäkerhet på hur frågorna skulle tas emot vid samtal. Personalens upplevda och faktiska kunskap visade på en signifikant förbättring efter utbildningsinterventionen (p&lt;0,001). Utbildningen upplevdes som relevant och 80 % av deltagarna önskade ytterligare utbildning i form av föreläsningar på arbetsplatsen och handledning av sakkunnig. Konklusion:För att kunna erbjuda personer som injicerar droger hälsofrämjande insatserkrävs att personal har tillgång till anpassad utbildningoch aktivt stödutifrån verksamhetensbehov / Background:People who inject drugs are at risk of contracting severe infections. Previous studies have shown that personnel meeting people at risk often lack sufficient knowledge to offer health promotion measures. Aims:This study aimed to investigate knowledge among personnel about infectious diseases contracted due to injecting drugs and determine whether educational intervention can increase knowledge and motivation for preventive communication. Methods:We administered a total of five courses to 26 healthcare workers employed in an infectious diseases department, psychiatric clinic, and youth counseling clinic. The study was conducted with questionnaires before and one month after completing the courses. The questionnaires included questions about disease facts, and workers’ experience regarding preventive conversations with people at risk. Results:The study revealed that respondent slacked sufficient knowledge about infections associated with injecting drugs, and that people at risk did not receive adequate information and support. Before education, only 60% of respondents would consider talking about infections contracted while injecting drugs if they got questions by persons at risk. Barriers to addressing such questions included lack of knowledge,and uncertainty about how the questions would be received. After the educational intervention, respondents perceived a significant improvement of knowledge (p&lt;0,001). They perceived the coursesas relevant,and 80% of participants wanted more lectures and expert guidance in the workplace. Conclusion:Providing health promotion to persons who inject drugs requires appropriate educationfor personnel,as well as active support adapted to their needs. / <p>ISBN 978-91-86739-82-9</p>