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

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.

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

región y sociedad ◽

10.22198/rys.2016.67.a803 ◽

2016 ◽

Vol 28 (67) ◽

Cited By ~ 1

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.

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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

Harm Reduction Journal ◽

10.1186/s12954-021-00510-7 ◽

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.

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Barriers and Facilitators of HIV and Hepatitis C Care Among People Who Inject Drugs in Nairobi, Kenya: A Qualitative Study with Peer Educators

10.21203/rs.3.rs-744969/v1 ◽

2021 ◽

Author(s):

Natasha Ludwig-Barron ◽

Brandon L Guthrie ◽

Loice Mbogo ◽

David Bukusi ◽

William Sinkele ◽

...

Keyword(s):

Hepatitis C ◽

Law Enforcement ◽

Harm Reduction ◽

People Who Inject Drugs ◽

Community Level ◽

Barriers And Facilitators ◽

Peer Educators ◽

Prevention Education ◽

Individual Level ◽

Policy Level

Abstract Background: In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of harm reduction specialists. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. Methods: We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. Results: Twenty peer educators participated, including six women, with 2 months to 6 years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including competing needs of addiction and misinterpreted symptoms; (b) network-level themes including social isolation and drug pusher interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. Conclusions : Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care that were described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.

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

International Journal of Drug Policy ◽

10.1016/j.drugpo.2017.05.012 ◽

2017 ◽

Vol 45 ◽

pp. 18-24 ◽

Cited By ~ 6

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

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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 ◽

10.1136/bmjopen-2018-023683 ◽

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.

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

Epidemiology and Infection ◽

10.1017/s0950268814000727 ◽

2014 ◽

Vol 143 (1) ◽

pp. 132-140 ◽

Cited By ~ 19

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.

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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 ◽

10.1136/bmjopen-2020-047511 ◽

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.

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Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs

BMC Public Health ◽

10.1186/s12889-020-09549-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Myrtille Prouté ◽

Sophie Le Coeur ◽

Métrey H. Tiv ◽

Timothée Dub ◽

Parinya Jongpaijitsakul ◽

...

Keyword(s):

Harm Reduction ◽

Addiction Treatment ◽

People Who Inject Drugs ◽

Civil Society Organizations ◽

Public Health Approach ◽

Minority Ethnic Group ◽

Respondent Driven Sampling ◽

Chiang Mai ◽

Chiang Mai Province ◽

Injection Practices

Abstract Background People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand. Methods We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening. Results One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26–40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7–28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6–40.4] had shared injection material. Only 26.6% [95% CI: 17.6–35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0–15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3–13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1–0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6–19.9]). Conclusion Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.

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Preferences and acceptability of law enforcement initiated referrals for people who inject drugs: a mixed methods analysis

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-020-00319-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Gabriella K. Olgin ◽

Annick Bórquez ◽

Pieter Baker ◽

Erika Clairgue ◽

Mario Morales ◽

...

Keyword(s):

Substance Use ◽

Mixed Methods ◽

Law Enforcement ◽

Harm Reduction ◽

Social Services ◽

People Who Inject Drugs ◽

Strong Support ◽

Substance Use Treatment ◽

Health And Social Services ◽

Service Referral

Abstract Background Law enforcement officers (LEOs) come into frequent contact with people who inject drugs (PWID). Through service referrals, LEOs may facilitate PWID engagement in harm reduction, substance use treatment, and other health and supportive services. Little is known about PWID and LEO attitudes and concerns about service referrals, however. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico. Methods We assessed service referral preferences and perceived likelihood of participation in health and social services, integrating data from structured questionnaires with 280 PWID and 306 LEOs, contextualized by semi-structured interviews and focus groups with 15 PWID and 17 LEOs enrolled in two parallel longitudinal cohorts in Tijuana, Mexico. Results Among potential service referral options, both PWID (78%) and LEOs (88%) most frequently cited assistance with drug- and alcohol-use disorders. Over half of PWID and LEOs supported including harm reduction services such as syringe service programs, overdose prevention, and HIV testing. The majority of PWID supported LEO referrals to programs that addressed basic structural needs (e.g. personal care [62%], food assistance [61%], housing assistance [58%]). However, the proportion of LEOs (30–45%) who endorsed these service referrals was significantly lower (p < 0.01). Regarding referral acceptability, 71% of PWID reported they would be very likely or somewhat likely to make use of a referral compared to 94% of LEOs reporting that they thought PWID would always or sometimes utilize them. These results were echoed in the qualitative analysis, although practical barriers to referrals emerged, whereby PWID were less optimistic that they would utilize referrals compared to LEOs. Conclusions We identified strong support for LEO service referrals among both LEO and PWID respondents, with the highest preference for substance use treatment. LEO referral programs offer opportunities to deflect PWID contact with carceral systems while facilitating access to health and social services. However, appropriate investments and political will are needed to develop an evidence-based (integrated) service infrastructure.

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