“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

Abstract BackgroundWomen’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opioid intervention court program.MethodsThe authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court,a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. ResultsPrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged: HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.

Download Full-text

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

10.21203/rs.3.rs-44053/v1 ◽

2020 ◽

Author(s):

Sarahmona Przybyla ◽

Catherine Cerulli ◽

Jacob Bleasdale ◽

Kennethea A. Wilson ◽

Melissa Hordes ◽

...

Keyword(s):

Criminal Justice ◽

Hiv Prevention ◽

Hiv Risk ◽

Risk Perceptions ◽

Hiv Transmission ◽

Opioid Use Disorder ◽

High Risk Population ◽

Research Approach ◽

Opioid Use ◽

Exposure Prophylaxis

Abstract Background: Women’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opiate intervention court program.Methods: The authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court, a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. Results: PrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged regarding HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions: Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.

Download Full-text

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-020-00331-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Sarahmona M. Przybyla ◽

Catherine Cerulli ◽

Jacob Bleasdale ◽

Kennethea Wilson ◽

Melissa Hordes ◽

...

Keyword(s):

Criminal Justice ◽

Hiv Prevention ◽

Hiv Risk ◽

Risk Perceptions ◽

Hiv Transmission ◽

Opioid Use Disorder ◽

High Risk Population ◽

Research Approach ◽

Opioid Use ◽

Exposure Prophylaxis

Abstract Background Women’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opioid intervention court program. Methods The authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court, a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. Results PrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged: HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.

Download Full-text

Psychological Sense of Community and the Use of Condoms and PrEP Among a Sample of Aging Black MSM

Innovation in Aging ◽

10.1093/geroni/igaa057.3007 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 824-824

Author(s):

Andre Brown ◽

Mark Brennan-Ing ◽

Steven Meanley ◽

Sabina Haberlen ◽

Deanna Ware ◽

...

Keyword(s):

Hiv Prevention ◽

Condom Use ◽

Risk Reduction ◽

Hiv Risk ◽

Sense Of Community ◽

Hiv Transmission ◽

Future Research ◽

Psychological Sense Of Community ◽

Hiv Risk Reduction ◽

Psychological Sense

Abstract Psychological sense of community (PSOC) in Black men who have sex with men (BMSM) may facilitate condom and pre-exposure prophylaxis (PrEP) use to prevent HIV transmission. Understanding BMSM’s PSOC contribution to HIV risk reduction may inform HIV prevention efforts for this population, that is disproportionately affected by HIV. Adjusted for sociodemographic characteristics and HIV status, we conducted logistic regressions to test the association between PSOC and condom use among aging BMSM (n=176). Multivariate analyses exhibited no association between PSOC and condom use (AOR= 0.994, 95% CI= 0.942, 1.049). HIV+ participants had higher condom use odds compared to HIV- participants (AOR= 4.031, 95% CI= 1.723, 9.426). A sub-analysis of HIV- participants (n=61), showed no associated between PSOC and PrEP use (AOR= 1.002, 95% CI= 0.904, 1.112). These results have implications for secondary HIV prevention and future research on alternative aspects of social support that may increase BMSM’s HIV risk reduction behaviors.

Download Full-text

Medicaid Expansion Increased Medications For Opioid Use Disorder Among Adults Referred By Criminal Justice Agencies

Health Affairs ◽

10.1377/hlthaff.2020.01251 ◽

2021 ◽

Vol 40 (4) ◽

pp. 562-570

Author(s):

Utsha G. Khatri ◽

Benjamin A. Howell ◽

Tyler N. A. Winkelman

Keyword(s):

Criminal Justice ◽

Opioid Use Disorder ◽

Medicaid Expansion ◽

Opioid Use

Download Full-text

Strategies for Primary and Secondary Prevention of HIV Transmission

Handbook of AIDS Psychiatry ◽

10.1093/oso/9780195372571.003.0009 ◽

2010 ◽

Author(s):

Mary Ann Cohen ◽

Harold W. Goforth

Keyword(s):

Primary Prevention ◽

Hiv Prevention ◽

Secondary Prevention ◽

Risk Reduction ◽

Hiv Risk ◽

Hiv Transmission ◽

Sexual Practices ◽

Prevention Strategies ◽

Primary And Secondary Prevention ◽

Hiv Risk Reduction

Since HIV disease was first recognized three decades ago, numerous efforts have been made to prevent its continued transmission. The Centers for Disease Control and Prevention (CDC) estimates that more than 56,000 Americans become infected each year—one person every 9 1/2 minutes—and that more than one million people in this country are now living with HIV (CDC, 2008, 2009;Hall et al., 2008). The CDC estimates that roughly 1 in 5 people infected with HIV in the United States is unaware of his or her infection and may be unknowingly transmitting the virus to others (CDC, 2008). Over the past 15 years, many behavioral HIV risk reduction interventions have been developed, with prevention efforts targeting mostly HIV-negative individuals and focusing almost exclusively on HIV testing and counseling. More recently, comprehensive HIV prevention has involved both primary and secondary prevention activities to decrease the number of new HIV infections and associated complications, respectively (Marks et al., 2006; O’Leary and Wolitski, 2009). Psychiatric factors both complicate and perpetuate the HIV pandemic as a result of unsafe sexual practices and substance use disorders. In this chapter, we describe some of the psychiatric and psychodynamic factors that lead to HIV transmission and present novel strategies to assist clinicians and health-care policymakers in prevention efforts. Primary prevention is defined as any activity that reduces the burden of morbidity or mortality from disease; it is to be distinguished from secondary prevention, in which activities are designed to prevent the complications of already existing disease. In the case of HIV, primary prevention efforts focus on strategies designed to prevent the transmission of HIV—keeping seronegative people seronegative. In the HIV pandemic, however, many prevention strategies share characteristics of both primary and secondary efforts, so the distinction is somewhat artificial. Multiple prevention strategies have been devised, and these center around HIV counseling, substance abuse programs, and HIV prevention and intervention programs for children. Counseling healthy pregnant women, uninfected children, adolescents, adults, and older persons about HIV risk reduction and providing information about sexual health are important components to primary prevention strategies, but few physicians and other clinicians actually do this unless it is a part of a program specifically designed to prevent HIV transmission.

Download Full-text

1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1136 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S458-S458

Author(s):

Jason Zucker ◽

Deborah Theodore ◽

Caroline Carnevale ◽

Elijah LaSota ◽

Paul Richards ◽

...

Keyword(s):

Hiv Prevention ◽

Sexual Health ◽

Hiv Risk ◽

Perceived Risk ◽

Medical Center ◽

Academic Medical Center ◽

Health Clinic ◽

Receptive Anal Intercourse ◽

Online Questionnaire ◽

Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described. Methods We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH). Results Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP. Conclusion Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care. Disclosures All authors: No reported disclosures.

Download Full-text

What do patients consulting in a free STI center know about HIV transmission and prevention?

European Journal of Public Health ◽

10.1093/eurpub/ckz186.613 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C Duteil ◽

E de La Rochebrochard ◽

P Piron ◽

C Segouin ◽

P Troude

Keyword(s):

Hiv Prevention ◽

Screening Test ◽

Hiv Transmission ◽

Needle Exchange ◽

Treatment As Prevention ◽

False Beliefs ◽

Hiv Knowledge ◽

Unprotected Sexual Intercourse ◽

Prevention Messages ◽

Exposure Prophylaxis

Abstract Background Despite therapeutic progress, HIV remains a public health issue with about 6400 new HIV contaminations each year in France. HIV prevention relies on health education, early screening, treatment as prevention, post and pre-exposure prophylaxis. Patients’ visits to free sexually transmitted infections (STIs) screening centers (CeGIDD) are opportunities to spread prevention messages. This study aimed to assess level of HIV knowledge in a Parisian CeGIDD to improve prevention messages. Methods The study included patients older than 18 who came for STIs testing between August 2017 and August 2018 and who understand written French language. Data were collected by a self-administered electronic questionnaire filled in before medical consultation. It included sociodemographic data and knowledge regarding HIV transmission and prevention. Results The study included 2002 patients. The median age was 27 years and 66% were men. More than 96% of patients know that HIV transmission is possible through unprotected sexual intercourse and through needle exchange. However, some misconceptions persist: 20% of patients believe that HIV transmission is possible from using public toilets and 22% by mosquito bite. Prevention measures perceived as “absolutely or rather efficient” by patients were: using condom (97%), requesting a screening test from his partners (91%), getting screening tests regularly (90%), choosing his partners correctly (62%), having sex with few different partners (50%). Half of patients heard of post-exposure prophylaxis (51%). Conclusions Main modes of HIV transmission are well known (unprotected intercourse and needle exchange). However, false beliefs regarding prevention may lead to risk behavior (doing screening test regularly doesn’t protect against HIV) and need to be explored. Moreover, assessment of variation in level of HIV knowledge according to patient’s profile may help to target prevention message according to specific populations. Key messages Main modes of HIV transmission are well known. False beliefs regarding modes of prevention need to be explored to target HIV prevention messages.

Download Full-text

Opioids and the Criminal Justice System: New Challenges Posed by the Modern Opioid Epidemic

Annual Review of Criminology ◽

10.1146/annurev-criminol-061020-125715 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Jonathan P. Caulkins ◽

Anne Gould ◽

Bryce Pardo ◽

Peter Reuter ◽

Bradley D. Stein

Keyword(s):

Criminal Justice ◽

Criminal Justice System ◽

Justice System ◽

Crime Control ◽

Medical Condition ◽

Opioid Use Disorder ◽

Annual Review ◽

Publication Date ◽

Opioid Use ◽

New Challenges

The traditional US heroin market has transformed into a broader illegal opioid market, dominated first by prescription opioids (PO) and now also by fentanyl and other synthetic opioids (FOSO). Understanding of opioid-use disorder (OUD) has also transformed from being seen as a driver of crime to a medical condition whose sufferers deserve treatment. This creates new challenges and opportunities for the criminal justice system (CJS). Addressing inmates’ OUD is a core responsibility, including preventing overdose after release. Treatment can be supported by diversion programs (e.g., drug courts, among others) and by providing medication-assisted treatment in prison, not only as a crime-control strategy but also because of ethical and legal responsibilities to provide appropriate healthcare. The CJS also has opportunities to alter supply that were not relevant in the past, including deterring pill-mill doctors and disrupting web sites used to distribute FOSO. Expected final online publication date for the Annual Review of Criminology, Volume 4 is January 13, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Download Full-text