Homelessness, HIV testing, and the reach of public health efforts for people who inject drugs, San Francisco, California

2021 ◽  
Vol 221 ◽  
pp. 108560
Author(s):  
Wilson Vincent ◽  
Jess Lin ◽  
Danielle Veloso ◽  
Desmond Miller ◽  
Willi McFarland
Keyword(s):  
Public Health ◽  
Hiv Testing ◽  
San Francisco ◽  
People Who Inject Drugs

scholarly journals Plasma virome and the risk of blood-borne infection in persons with substance use disorder

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Abraham J. Kandathil ◽  
Andrea L. Cox ◽  
Kimberly Page ◽  
David Mohr ◽  
Roham Razaghi ◽  
...  
Keyword(s):  
Public Health ◽  
San Francisco ◽  
People Who Inject Drugs ◽  
Health Resources ◽  
Bloodborne Pathogens ◽  
The Public ◽  
Innovative Methods ◽  
Pathogenic Virus ◽  
Pathogenic Viruses ◽  
Bloodborne Viruses

AbstractThere is an urgent need for innovative methods to reduce transmission of bloodborne pathogens like HIV and HCV among people who inject drugs (PWID). We investigate if PWID who acquire non-pathogenic bloodborne viruses like anelloviruses and pegiviruses might be at greater risk of acquiring a bloodborne pathogen. PWID who later acquire HCV accumulate more non-pathogenic viruses in plasma than matched controls who do not acquire HCV infection. Additionally, phylogenetic analysis of those non-pathogenic virus sequences reveals drug use networks. Here we find first in Baltimore and confirm in San Francisco that the accumulation of non-pathogenic viruses in PWID is a harbinger for subsequent acquisition of pathogenic viruses, knowledge that may guide the prioritization of the public health resources to combat HIV and HCV.

scholarly journals Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Barbara Tempalski ◽  
Leslie D. Williams ◽  
Brooke S. West ◽  
Hannah L. F. Cooper ◽  
Stephanie Beane ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Resource Availability ◽  
People Who Inject Drugs ◽  
Census Data ◽  
Poverty Rate ◽  
Community Action ◽  
Historical Change ◽  
Treatment Coverage ◽  
Over Time

Abstract Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.

Complaint-Oriented “Services”: Shelters as Tools for Criminalizing Homelessness

2021 ◽  
Vol 693 (1) ◽  
pp. 264-283
Author(s):  
Chris Herring
Keyword(s):  
Public Health ◽  
San Francisco ◽  
Homeless People ◽  
Public Spaces ◽  
Health Initiatives ◽  
Public Health Initiatives

This article argues that the expansion of shelter and welfare provisions for the homeless can lead to increased criminalization of homeless people in public spaces. First, I document how repression of people experiencing homelessness by the police in San Francisco neighborhoods increased immediately after the opening of new shelters. Second, I reveal how shelter beds are used as a privileged tool of the police to arrest, cite, and confiscate property of the unhoused, albeit in the guise of sanitary and public health initiatives. I conclude by considering how shelters increasingly function as complaint-oriented “services,” aimed at addressing the interests of residents, businesses, and politicians, rather than the needs of those unhoused.

scholarly journals 448. Disproportionate Burden of COVID-19 on Latinx Residents among Hospitalized Patients at San Francisco’s Public Health Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S292-S292
Author(s):  
Vivek Jain ◽  
Lillian B Brown ◽  
Carina Marquez ◽  
Luis Rubio ◽  
Natasha Spottiswoode ◽  
...  
Keyword(s):  
Public Health ◽  
African American ◽  
San Francisco ◽  
Ethnic Disparities ◽  
Food Service ◽  
Lengths Of Stay ◽  
Hospital Deaths ◽  
Health Hospital ◽  
Disproportionate Burden ◽  
Overall Mortality

Abstract Background San Francisco implemented one of the earliest shelter-in-place public health mandates in the U.S., with flattened curves of diagnoses and deaths. We describe demographics, clinical features and outcomes of COVID-19 patients admitted to a public health hospital in a high population-density city with an early containment response. Methods We analyzed inpatients with COVID-19 admitted to San Francisco General Hospital (SFGH) from 3/5/2020–5/11/2020. SFGH serves a network of &gt;63,000 patients (32% Latinx/24% Asian/19% African American/19% Caucasian). Demographic and clinical data through 5/18/2020 were abstracted from hospital records, along with ICU and ventilator utilization, lengths of stay, and in-hospital deaths. Results Of 157 admitted patients, 105/157 (67%) were male, median age was 49 (range 19-96y), and 127/157 (81%) of patients with COVID-19 were Latinx. Crowded living conditions were common: 60/157 (38%) lived in multi-family shared housing, 12/1578 (8%) with multigenerational families, and 8/157 (5%) were homeless living in shelters. Of 102 patients with ascertained occupations, most had frontline essential jobs: 23% food service, 14% construction/home maintenance, and 10% cleaning. Overall, 86/157 (55%) of patients lived in neighborhoods home to majority Latinx and African-American populations. Overall, 45/157 (29%) of patients needed ICU care, and 26/157 (17%) required mechanical ventilation; 20/26 (77%) of ventilated patients were successfully extubated, and 137/157 (87%) were discharged home. Median hospitalization duration was 4 days (IQR, 2–10), and only 6/157 (4%) patients died in hospital. Conclusion In San Francisco, where early COVID-19 mitigation was enacted, we report a stark, disproportionate COVID-19 burden on Latinx patients, who accounted for 81% of hospitalizations despite making up only 32% of the patient base and 15% of San Francisco’s total population. Latinx inpatients frequently lived in high-density settings, increasing household risk, and frequently worked essential jobs, potentially limiting the opportunity to effectively distance from others. We also report here favorable clinical outcomes and low overall mortality. However, an effective COVID-19 response must urgently address racial and ethnic disparities. Disclosures All Authors: No reported disclosures

scholarly journals Advancing population and public health ethics regarding HIV testing: a scoping review

2013 ◽  
Vol 24 (3) ◽  
pp. 283-295 ◽  
Author(s):  
Rod Knight ◽  
Jean Shoveller ◽  
Devon Greyson ◽  
Thomas Kerr ◽  
Mark Gilbert ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Testing ◽  
Scoping Review ◽  
Public Health Ethics ◽  
Health Ethics ◽  
Population And Public Health

scholarly journals Unsafe Injection Is Associated with Higher HIV Testing after Bayesian Adjustment for Unmeasured Confounding

2020 ◽  
Vol 23 (12) ◽  
pp. 848-855
Author(s):  
Soodabeh Navadeh ◽  
Ali Mirzazadeh ◽  
Willi McFarland ◽  
Phillip Coffin ◽  
Mohammad Chehrazi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
San Francisco ◽  
Expert Opinion ◽  
Bias Analysis ◽  
Hiv Knowledge ◽  
Persons Who Inject Drugs ◽  
Adjusted Risk ◽  
Unmeasured Confounder ◽  
Unsafe Injection ◽  
Insufficient Knowledge

Background: To apply a novel method to adjust for HIV knowledge as an unmeasured confounder for the effect of unsafe injection on future HIV testing. Methods: The data were collected from 601 HIV-negative persons who inject drugs (PWID) from a cohort in San Francisco. The panel-data generalized estimating equations (GEE) technique was used to estimate the adjusted risk ratio (RR) for the effect of unsafe injection on not being tested (NBT) for HIV. Expert opinion quantified the bias parameters to adjust for insufficient knowledge about HIV transmission as an unmeasured confounder using Bayesian bias analysis. Results: Expert opinion estimated that 2.5%–40.0% of PWID with unsafe injection had insufficient HIV knowledge; whereas 1.0%–20.0% who practiced safe injection had insufficient knowledge. Experts also estimated the RR for the association between insufficient knowledge and NBT for HIV as 1.1-5.0. The RR estimate for the association between unsafe injection and NBT for HIV, adjusted for measured confounders, was 0.96 (95% confidence interval: 0.89,1.03). However, the RR estimate decreased to 0.82 (95% credible interval: 0.64, 0.99) after adjusting for insufficient knowledge as an unmeasured confounder. Conclusion: Our Bayesian approach that uses expert opinion to adjust for unmeasured confounders revealed that PWID who practice unsafe injection are more likely to be tested for HIV – an association that was not seen by conventional analysis.

scholarly journals Integrating Routine HIV Testing into a Public Health STD Clinic

2006 ◽  
Vol 121 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Doug Campos-Outcalt ◽  
Tom Mickey ◽  
Jonathan Weisbuch ◽  
Robert Jones
Keyword(s):  
Public Health ◽  
Hiv Testing ◽  
Routine Hiv Testing
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