scholarly journals Drug use practices among people who inject drugs in a context of drug market changes: Challenges for optimal coverage of harm reduction programs

2017 ◽  
Vol 45 ◽  
pp. 18-24 ◽  
Author(s):  
Élise Roy ◽  
Nelson Arruda ◽  
Pascale Leclerc ◽  
Carole Morissette ◽  
Caty Blanchette ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Drug Market ◽  
Market Changes

scholarly journals High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lisa J. Messersmith ◽  
Rose Adjei ◽  
Jennifer Beard ◽  
Angela R. Bazzi ◽  
Joel J. Earlywine ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Population Size ◽  
Sex Workers ◽  
People Who Inject Drugs ◽  
Syringe Sharing ◽  
Unsafe Sex ◽  
Lack Of Information ◽  
Sex With Men ◽  
Major Drug

Abstract Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

scholarly journals Impact of drug consumption rooms on risk practices and access to care in people who inject drugs in France: the COSINUS prospective cohort study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023683
Author(s):  
Marc Auriacombe ◽  
Perrine Roux ◽  
Laélia Briand Madrid ◽  
Sébastien Kirchherr ◽  
Charlotte Kervran ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
Drug Use ◽  
Harm Reduction ◽  
Access To Care ◽  
Social Services ◽  
People Who Inject Drugs ◽  
Drug Consumption ◽  
Risk Practices ◽  
The Impact

IntroductionThe high prevalence of hepatitis C and the persistence of HIV and hepatitis C virus (HCV) risk practices in people who inject drugs (PWID) in France underlines the need for innovative prevention interventions. The main objective of this article is to describe the design of the COSINUS cohort study and outline the issues it will explore to evaluate the impact of drug consumption rooms (DCR) on PWID outcomes. Secondary objectives are to assess how DCR (a) influence other drug-related practices, such as the transition from intravenous to less risky modes of use, (b) reduce drug use frequency/quantity, (c) increase access to treatment for addiction and comorbidities (infectious, psychiatric and other), (d) improve social conditions and (e) reduce levels of violence experienced and drug-related offences. COSINUS will also give us the opportunity to investigate the impact of other harm reduction tools in France and their combined effect with DCR on reducing HIV-HCV risk practices. Furthermore, we will be better able to identify PWID needs.Methods and analysisEnrollment in this prospective multi-site cohort study started in June 2016. Overall, 680 PWID in four different cities (Bordeaux, Marseilles, Paris and Strasbourg) will be enrolled and followed up for 12 months through face-to-face structured interviews administered by trained staff to all eligible participants at baseline (M0), 3 month (M3), 6 month (M6) and 12 month (M12) follow-up visits. These interviews gather data on socio-demographic characteristics, past and current drug and alcohol consumption, drug-use related practices, access to care and social services, experience of violence (as victims), offences, other psychosocial issues and perception and needs about harm reduction interventions and services. Longitudinal data analysis will use a mixed logistic model to assess the impact of individual and structural factors, including DCR attendance and exposure to other harm reduction services, on the main outcome (HIV-HCV risk practices).Ethics and disseminationThis study was reviewed and approved by the institutional review board of the French Institute of Medical Research and Health (opinion number: 14–166). The findings of this cohort study will help to assess the impact of DCR on HIV-HCV risk practices and other psycho-social outcomes and trajectories. Moreover, they will enable health authorities to shape health and harm reduction policies according to PWID needs. Finally, they will also help to improve current harm reduction and therapeutic interventions and to create novel ones.

Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking

2014 ◽  
Vol 143 (1) ◽  
pp. 132-140 ◽  
Author(s):  
V. D. HOPE ◽  
J. McVEIGH ◽  
A. MARONGIU ◽  
M. EVANS-BROWN ◽  
J. SMITH ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Site ◽  
People Who Inject Drugs ◽  
Open Wound ◽  
Factors Associated ◽  
Risks Factors ◽  
And Performance ◽  
Performance Enhancing Drugs ◽  
Performance Enhancing

SUMMARYPeople who inject drugs are vulnerable to infections and injuries at injection sites, but these have rarely been studied in those injecting image- and performance-enhancing drugs (IPEDs). This study examined the factors associated with reported symptoms of injection site infections and injuries in IPED injectors. Of the 366 male IPED injectors surveyed, 42% reported ever having redness, swelling and tenderness (36% in the preceding year), and 6·8% had ever had an abscess or open wound at an injection site. Having these symptoms was associated with a range of factors related to drug use and healthcare utilization. One sixth (17%) of those reporting redness, tenderness and swelling had ever sought treatment, as had the majority (76%) of those reporting an abscess, sore or open wound. Most common sources of advice were emergency clinics and General Practitioners. Interventions are needed to support access to appropriate injecting equipment and provide targeted harm reduction advice.

scholarly journals Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047511
Author(s):  
Katrina Bouzanis ◽  
Siddharth Joshi ◽  
Cynthia Lokker ◽  
Sureka Pavalagantharajah ◽  
Yun Qiu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Infectious Diseases ◽  
Harm Reduction ◽  
Bacterial Infections ◽  
People Who Inject Drugs ◽  
Integrative Review ◽  
Future Research ◽  
Structural Factors ◽  
Health Programmes

ObjectivesPeople who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID.DesignThis study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada.ResultsThis study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction.ConclusionsThese results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care.PROSPERO registration numberCRD42020142947.

scholarly journals Personas que se inyectan drogas en Hermosillo, Sonora. Metodología para su registro

2016 ◽  
Vol 28 (67) ◽  
Author(s):  
Angélica Ospina-Escobar
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Population Size ◽  
Addiction Treatment ◽  
People Who Inject Drugs ◽  
Hiv Transmission ◽  
Multiplier Methods ◽  
Qualitative And Quantitative ◽  
Treatment Services ◽  
Mixed Approach

Resumen: conocer el tamaño de las poblaciones es fundamental para estimar universos de necesidad, planear intervenciones y evaluarlas. La estigmatización y criminalización del uso de drogas en México hace que las personas que se las inyectan sean difíciles de alcanzar, sin embargo tienen derecho a la salud, y el Estado está obligado a garantizarla, lo que incluye diseñar acciones efectivas para prevenir el sida. En Hermosillo, Sonora, el peso de la trasmisión del virus de inmunodeficiencia humana por drogas inyectadas ha ganado relevancia en la última década, no obstante, se desconoce el tamaño de la población que se inyecta drogas. En este artículo se describe detalladamente cómo se construye una aproximación mixta de metodologías cualitativas y cuantitativas para estimar el tamaño de dicha población en Hermosillo, y se ofrecen recomendaciones para mejorar los sistemas para registrarla en los servicios de tratamiento de adicciones, y cómo potenciar las intervenciones comunitarias de reducción de daños en la ciudad.Palabras clave: métodos multiplicadores; métodos mixtos; personas que se inyectan drogas; reducción de daños; Hermosillo.Abstract: having estimations of the size of populations is critical to estimate universes of need, plan and evaluate interventions. Stigmatization and criminalization of drug use in Mexico makes pwid constitute a hard-to-reach population; however, they have a right to health and it is an obligation of the State to guarantee it, which includes designing effective actions to prevent aids. In Hermosillo, Sonora, the weight of hiv transmission via injecting drug use has gained prominence in the last decade; nevertheless, there are no estimations of pwid population size. In this paper we describe in detail how to build a mixed approach combining qualitative and quantitative techniques to estimate the population size of pwid in Hermosillo. We present recommendations to improve pwid registration systems in addiction treatment services and how to improve community harm reduction interventions in the city.Key words: multiplier methods; mixed methods; people who inject drugs; harm reduction; Hermosillo.

scholarly journals Research led by people who use drugs: centering the expertise of lived experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zach R. Salazar ◽  
Louise Vincent ◽  
Mary C. Figgatt ◽  
Michael K. Gilbert ◽  
Nabarun Dasgupta
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Critical Role ◽  
Drug Market ◽  
Research Process ◽  
Medical Community ◽  
People Who Use Drugs ◽  
Main Body ◽  
Research Collaborations ◽  
History Of

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.

scholarly journals Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Pieter Baker ◽  
Jaime Arredondo ◽  
Annick Borquez ◽  
Erika Clairgue ◽  
Maria L. Mittal ◽  
...  
Keyword(s):  
Law Enforcement ◽  
Drug Use ◽  
Harm Reduction ◽  
Addiction Treatment ◽  
People Who Inject Drugs ◽  
Police Training ◽  
Prevalence Ratio ◽  
Crime Reduction ◽  
High Drug ◽  
Addiction Services

Abstract Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration: NCT02444403.

scholarly journals Young and invisible: an explanatory model for service engagement by people who inject drugs in India

2021 ◽  
Author(s):  
Lakshmi Ganapathi ◽  
Aylur K Srikrishnan ◽  
Clarissa Martinez ◽  
Gregory M Lucas ◽  
Shruti H Mehta ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Opioid Dependence ◽  
People Who Inject Drugs ◽  
Structured Interview ◽  
Explanatory Model ◽  
List Type ◽  
Structural Factors ◽  
Injection Initiation ◽  
Service Engagement

ABSTRACTIntroductionThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤ 30 years of age), who are hard to engage in services. We assessed perspectives of young PWID across three Indian cities representing historic and emerging drug use epidemics to guide development of youth-specific services.MethodsWe conducted focus group discussions (FGDs) with PWID (ages 18-35 years) and staff at venues offering services to PWID in three cities (Aizawl and Imphal, Northeast India and Amritsar, Northwest India). A semi-structured interview guide was used to elicit participants’ narratives on injection initiation experiences, motivating factors and barriers to seeking harm-reduction services, service-delivery gaps, and recommendations to promote engagement.Thematic analysis was used to develop an explanatory model for engagement for each temporal stage across the injection continuum: (a) pre-injection initiation, (b) peri-injection initiation and (c) established injection behavior.Results43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the pre-injection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low risk perception resulted in low motivation to seek services.Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.ConclusionsDevelopment of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm-reduction services.STRENGTHS AND LIMITATIONSThe findings in this study represent some of the first qualitative data to explore engagement with services, specifically among young PWID in India.The study was conducted in multiple cities representing older and emerging injection drug use epidemics. The inclusion of multiple cities adds strength to the findings.We did not recruit adolescent PWID due to constraints rendered by laws pertaining to informed consent in India.Although all PWID we recruited had initiated injection in adolescence or young adulthood, the preponderance of older PWID in our study limits the conclusions we can draw about the needs of adolescent PWID.

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