scholarly journals Substance use and HIV stage at entry into care among people with HIV

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Canada Parrish ◽  
Bridget M. Whitney ◽  
Robin M. Nance ◽  
Nancy Puttkammer ◽  
Paul Fishman ◽  
...  
Keyword(s):  
Substance Use ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Regression Models ◽  
Hiv Care ◽  
Hiv Disease ◽  
Methamphetamine Use ◽  
Early Entry ◽  
Timing Of Entry ◽  
The Impact

Abstract Background Information regarding the impact of substance use on the timing of entry into HIV care is lacking. Better understanding of this relationship can help guide approaches and policies to improve HIV testing and linkage. Methods We examined the effect of specific substances on stage of HIV disease at entry into care in over 5000 persons with HIV (PWH) newly enrolling in care. Substance use was obtained from the AUDIT-C and ASSIST instruments. We examined the association between early entry into care and substance use (high-risk alcohol, methamphetamine, cocaine/crack, illicit opioids, marijuana) using logistic and relative risk regression models adjusting for demographic factors, mental health symptoms and diagnoses, and clinical site. Results We found that current methamphetamine use, past and current cocaine and marijuana use was associated with earlier entry into care compared with individuals who reported no use of these substances. Conclusion Early entry into care among those with substance use suggests that HIV testing may be differentially offered to people with known HIV risk factors, and that individuals with substances use disorders may be more likely to be tested and linked to care due to increased interactions with the healthcare system.

scholarly journals Gender Differences in Smoking Among an Urban Emergency Department Sample

2019 ◽  
Vol 12 ◽  
pp. 1179173X1987913 ◽  
Author(s):  
Carol B Cunradi ◽  
Juliet Lee ◽  
Anna Pagano ◽  
Raul Caetano ◽  
Harrison J Alter
Keyword(s):  
Gender Differences ◽  
Emergency Department ◽  
Substance Use ◽  
Partner Violence ◽  
Regression Models ◽  
Food Insufficiency ◽  
Polysubstance Use ◽  
Same Gender ◽  
The Impact ◽  
Urban Emergency Department

Background: Urban emergency department (ED) patients have elevated smoking and substance use compared with the general population. We analyzed gender differences in smoking among an urban ED sample and assessed the contribution of substance use, demographic, and couple factors. Methods: We conducted a secondary analysis of data obtained from a cross-sectional, observational survey (N = 1037 participants) on drinking, drug use, and intimate partner violence (IPV). Gender-specific logistic regression models for current (past 30-day) smoking and multinomial regression models for smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10 CPD; heavier: >10 CPD) were estimated. Results: Smoking prevalence was higher among men than women (35.5% vs 18.9%; P < .001). Substance use (frequency of intoxication, marijuana, amphetamine, and cocaine use), demographic (food insufficiency, unemployment), and couple-related factors (having a spouse/partner who smoked, IPV involvement, being in a same-gender couple) were differentially associated with current smoking and level of intensity among men and women. Conclusions: Emergency department staff should consider the impact of polysubstance use, food insufficiency, unemployment, and whether both partners in the couple smoke when screening patients for smoking and formulating cessation treatment plans. Women in same-gender relationships and those who have experienced IPV involvement may require additional referral.

scholarly journals The Changing Demographics of Women Living with HIV/AIDS in Southern Alberta from 1982 to 2006

2012 ◽  
Vol 23 (2) ◽  
pp. e36-e40
Author(s):  
Liana Hwang ◽  
Jesse Raffa ◽  
Michael John Gill
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Care ◽  
Screening Methods ◽  
Newly Diagnosed ◽  
Female Population ◽  
Opt Out ◽  
Hiv Test ◽  
Southern Alberta ◽  
The Impact

INTRODUCTION: Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment.OBJECTIVE: To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening.METHODS: A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed.RESULTS: The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001).CONCLUSIONS: Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.

scholarly journals Emergency Room “Opt-Out” HIV Testing Pre- and During COVID-19 Pandemic in a Large Community Health System

2021 ◽  
Vol 20 ◽  
pp. 232595822110412
Author(s):  
Paula Eckardt ◽  
Jianli Niu ◽  
Sheila Montalvo
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Healthcare System ◽  
South Florida ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Testing Program ◽  
Large Community ◽  
Opt Out ◽  
The Impact

Background: South Florida has the highest HIV rates across the country. Emergency Rooms (ERs) are optimal clinical sites for the identification of people living with HIV. We aimed to evaluate the feasibility and yield of opt-out HIV testing among ER patients in a large community healthcare system in South Florida, and determine the impact of the COVID-19 pandemic on HIV testing. Methods: This was a retrospective study conducted in the Memorial Healthcare System, Hollywood, Florida. HIV test was offered on an “opt-out” basis to patients aged 16 years or older presenting to the ER of the Memorial Regional Hospital between July 2018 and August 2020. Number of ER visits, HIV testing offered, acceptance of HIV testing, tested positive for HIV infection and linkage to care were reviewed and analyzed. Results: A total of 105,264 (53.7%) patients of 196,110 ER visits were eligible for HIV testing and 39,261 (37.3%) completed HIV testing. Of those tested, 206 (0.5%) patients tested positive, with 54 (26.2%) new infected patients and 152 (73.8%) known infected patients who had not disclosed their status. 45 (60%) of 75 patients with known HIV infections who were not engaged in HIV care were successfully relinked into care after testing, and engagement in care increased from 50.7% pre-testing to 80.3% post-testing (p = 0.001). 45 (83.3%) of 54 newly diagnosed patients were successfully linked into care. During the COVID-19 pandemic, there was a significant reduction in both the ER visits and HIV tests as compared with the pre-pandemic period (p = 0.007 and p < 0.001, respectively). Conclusion: An “Opt-out” HIV testing program was successfully implemented in a community hospital ERs. The use of this strategy successfully identified patients with undiagnosed HIV infection and improved their engagement in HIV care. Given the impact of COVID-19 pandemic on the testing program, new strategies should develop to reduce service disruption and maintain the progress of “Opt-out” HIV testing.

scholarly journals Perspectives on Pain, Engagement in HIV Care, and Behavioral Interventions for Chronic Pain Among Older Sexual Minority Men Living with HIV and Chronic Pain: A Qualitative Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Samantha M McKetchnie ◽  
Corinne Beaugard ◽  
S Wade Taylor ◽  
Conall O’Cleirigh
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Hiv Care ◽  
Sexual Minority Men ◽  
Problematic Substance Use ◽  
Problematic Substance ◽  
Minority Men ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
The Impact

Abstract Objective and Methods The transition of HIV from an acute, fatal illness to a chronic health condition has shifted the treatment needs of people living with HIV (PLWH). PLWH, including sexual minority men (SMM), are living longer and are subject to health concerns often associated with aging. A major health concern of older SMM living with HIV who report problematic substance use is chronic pain. This qualitative analysis of 15 one-on-one interviews with older SMM living with HIV and chronic pain aimed to characterize this population’s experiences with pain, engagement in HIV care, and problematic substance use. This study was conducted in a community health center in Boston, MA. We also solicited suggestions for preferred intervention strategies. Results Three main themes emerged from the interview transcripts: 1) the impact of chronic pain and pain treatment on engagement in HIV clinical care; 2) the impact of substance use on chronic pain; and 3) response to interventions to address chronic pain and substance use. Conclusions These findings underscore the need for interventions that address the structural, physical, and psychological barriers to engagement in medical and self-care that affect older SMM living with HIV and chronic pain.

scholarly journals COVID/HIV Co-Infection: A Syndemic Perspective on What to Ask and How to Answer

2021 ◽  
Vol 9 ◽  
Author(s):  
Hailay Abrha Gesesew ◽  
Lillian Mwanri ◽  
Jacqueline H. Stephens ◽  
Kifle Woldemichael ◽  
Paul Ward
Keyword(s):  
Hiv Testing ◽  
Research Agenda ◽  
Digital Health ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Medical Mistrust ◽  
Theoretical Frameworks ◽  
The Impact

The present commentary explored the intersecting nature of the COVID-19 and HIV pandemics to identify a shared research agenda using a syndemic approach. The research agenda posits the following questions. Questions around HIV infection, transmission, and diagnosis include: (i) molecular, genetic, clinical, and environmental assessments of COVID-19 in people living with HIV, (ii) alternative options for facility-based HIV testing services such as self- and home-based HIV testing, and (iii) COVID-19 related sexual violence and mental health on HIV transmission and early diagnosis. These and related questions could be assessed using Biopsychosocial and socio-ecological models. Questions around HIV treatment include: (i) the effect of COVID-19 on HIV treatment services, (ii) alternative options for facility-based treatment provision such as community-based antiretroviral therapy groups, and (iii) equitable distribution of treatment and vaccines for COVID-19, if successful. Bickman's logic model and the social determinants of health framework could guide these issues. The impact of stigma, the role of leveraging lessons on sustained intra-behavioral change, the role of medical mistrust and conspiracy beliefs, and the role of digital health on integrated management of HIV care and spectrum of care of COVID-19 need assessment using several frameworks including Goffman's stigma framework, Luhmann's Trust theory, and Gidden's theory of structuration. In conclusion, the potential research agenda of this commentary encompasses a variety of research fields and disciplinary areas—clinicians, laboratory scientists, public health practitioners, health economists, and psychologists—, and suggests several theoretical frameworks to guide examination of complex issues comprehensively.

scholarly journals "I Used to be Scared to Even Like Stand Beside Somebody Who Had It": HIV Risk Behaviours and Perceptions among Indigenous People Who Use Drugs

2021 ◽  
Vol 12 (3) ◽  
pp. 1-21
Author(s):  
Jennifer Lavalley ◽  
Western Aboriginal Harm Reduction Society ◽  
Christopher Livingstone ◽  
Melissa Steinhauer ◽  
Ashley Goodman ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Indigenous People ◽  
Hiv Risk ◽  
Risk Perceptions ◽  
Treatment Options ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Knowledge ◽  
Community Based ◽  
Talking Circles

Objectives: In Canada, and elsewhere, Indigenous people who use illicit drugs and/or alcohol (WUID/A) experience a disproportionate burden of HIV-related harm. This study examined HIV risk perceptions and behaviours among Indigenous people WUID/A living in the Downtown Eastside (DTES) and the policies and practices that shape inequities and vulnerabilities for them in HIV testing and treatment. Further, we aimed to situate the vulnerabilities of Indigenous people WUID/A in HIV care within the context of wider structural inequality and generate recommendations for culturally relevant and safe HIV treatment options. Methods: This research employed an Indigenous-led community-based participatory approach using talking circles to explore experiences of Indigenous people living with HIV. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited participants’ experiences of HIV knowledge, testing, and treatment, and were audio-recorded and transcribed. Data were coded line-by-line and codes were organized into themes.  Results: Five key themes were identified via the talking circles: evolving HIV risk perceptions (e.g., HIV knowledge and testing, and “intentional exposure”); research as an avenue for HIV testing; HIV treatment and discussions about grief and loss; HIV-related stigma and discrimination; and the importance of culturally-relevant and safe HIV treatment options for Indigenous people WUID/A. Discussion: Our work reveals that Indigenous people WUID/A do not have adequate access to HIV knowledge and education, often limiting their ability to access HIV testing and supports. Participant stories revealed both internalized and community stigma and discrimination, which at times compromised connection with participants' home communities. Further, our findings point to a failure in the public health system to deliver accessible HIV information to Indigenous Peoples, hence, many participants have solely relied on participation in community-based research studies in the Downtown Eastside (DTES) for HIV education and knowledge. There is an urgent need for accessible, culturally safe, and community-based education and treatment options for Indigenous people WUID/A within HIV care.

Substance Use and Motivational Interviewing

2019 ◽  
pp. 105-114 ◽  
Author(s):  
Liu yi Lin ◽  
Linda R. Frank ◽  
Antoine Douaihy
Keyword(s):  
Substance Use ◽  
Motivational Interviewing ◽  
Substance Use Disorder ◽  
Integrated Approach ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Co Morbidity ◽  
Important Health ◽  
Living With Hiv ◽  
The Impact

People living with HIV (PLWH) who use drugs and alcohol are particularly likely to experience gaps across the HIV care continuum. People with co-occurring HIV and a substance use disorder face significant challenges in treatment. Substance use is well-known to be linked to important health behaviors and outcomes including adherence to antiretroviral and treatment, immunosuppression, and sexual risk behaviors. This chapter provides a review of the impact of substance use in PLWH and the role of motivational interviewing as part of an integrated approach to care of PLWH with co-occurring substance use disorders. The chapter concludes with a case example to illustrate the role that motivational interviewing can play the care of PLWH with a co-morbidity of substance use disorder.

scholarly journals Impact of Patient Navigators in Linkage to Care for HIV-Positive Patients in an Urban Emergency Department in Newark, NJ

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S420-S420
Author(s):  
Samuel Maldonado ◽  
Gregory Sugalski ◽  
Garry Closeil ◽  
Shobha Swaminathan
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Linkage To Care ◽  
Patient Navigators ◽  
Hiv Test ◽  
Routine Hiv Testing ◽  
The Impact ◽  
White Patients

Abstract Background Despite CDC recommendations, areas with high HIV prevalence have not implemented routine HIV testing, stating among other concerns, inability to effectively link them to care. We implemented a routine HIV testing program in the Emergency Department (ED) at University Hospital in Newark, NJ that had 46,164 visits from July 2015 to November 2016 and looked at the impact of patient navigators (PN) on linkage to care (LTC) rates. Methods This was a retrospective study of all patients newly diagnosed (ND) with HIV or previously positive (PP) but lost to follow-up (LTFU) in select areas of the ED from July 2015 to November 2016. We collected information on demographics, HIV risk factor, and looked at the impact of PN on LTC by comparing months the PN was able to make personal contact compared with months when the PN was unavailable for substantial periods of time. Results A total of 9,511 individuals were screened, and 151 (1.6%) had a positive HIV test; 8 died and 2 were incarcerated. Of the remaining 141, 102 (72%) were LTC. The mean age was 49, 57% Male, 77% Black, 14% Hispanic, and 6% White. The reported HIV risk factors were 67% Heterosexual, 9% MSM, 6% IV drug use (IDU) and 18% Other. Of the patients with a positive HIV test, 60 (43%) were ND and 81 (57%) were PP. Only 52% ND patients were LTC, while 88% PP patients were LTC. Black and Hispanic patients tended to be PP (60% of both groups), while White patients tended to be ND (75% of white patients were ND). The risk factors for ND were 44% Heterosexual, 39% MSM, and 25% IDU. Average LTC while the PN was unavailable decreased from 78% to 56%. There were no demographic differences in the LTC group compared with the LTFU group. IDU had the highest rate of being LTFU at 37% followed by MSM and Heterosexual at approximately 23% each. The primary reason for LTFU was incorrect contact information in the medical record such as wrong address or phone number. PN would make 3 phone calls, send 2 letters and 1 outreach attempt. If all of those failed, the PN notified the state health department. Conclusion PN have a positive impact on LTC even in busy ED settings. Given limitations of staffing a busy ED 24/7, we need to develop strategies to link patients even if the PN is not present. To address this limitation, we plan on looking at the impact of involving medical residents to help with linkage to care after business hours. Disclosures S. Swaminathan, Gilead Sciences: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

The roles of gender affirmation and discrimination in the resilience of transgender individuals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Lelutiu-Weinberger ◽  
D English ◽  
P Sandanapitchai
Keyword(s):  
Substance Use ◽  
Psychological Distress ◽  
Suicidal Ideation ◽  
Hiv Testing ◽  
Latent Variables ◽  
Structural Equation ◽  
Equation Modeling ◽  
Lower Odds ◽  
Gender Affirmation ◽  
The Impact

Abstract Background Transgender individuals face severe stigma-driven health inequities structurally, institutionally and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression and/or role, may be considered a manifestation of resilience. Methods To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Results Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation (p &lt; .001) and psychological distress (p &lt; .001), and higher odds of substance use (p &lt; .001), and past-year healthcare use and HIV-testing (p &lt; .001). Discrimination was associated with higher odds of suicidal ideation (p &lt; .001), psychological distress (p &lt; .001), substance use (p &lt; .001), and past-year HIV-testing (p &lt; .001). Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation (p &lt; .01), with affirmation having a significant moderating protective effect against discrimination. Conclusions Gender affirmation is paramount in upholding transgender health, and these findings carry global significance, beyond the US. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

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