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Prevention, Care and Treatment of HIV, Substance Use and Addiction

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 29348

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Special Issue Editors

Dr. Sten H. Vermund

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Guest Editor

Yale School of Public Health, Yale University, New Haven, CT 06520, USA
Interests: infectious disease epidemiology; HIV prevention; social determinants of disease; global health

Dr. Jeffrey A. Wickersham

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Assistant Guest Editor

Yale School of Medicine, Section of Infectious Diseases, Yale University, New Haven, CT 06510, USA
Interests: HIV treatment and prevention; transgender health; sex work and HIV

Dr. Lauretta E. Grau

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Assistant Guest Editor

Yale School of Public Health, Yale University, New Haven, CT 06510, USA
Interests: HIV; injection-associated infectious diseases; opioid use; chronic pain; qualitative and mixed-methods research

Special Issue Information

Dear Colleagues,

A Special Issue on how issues of substance use and addiction relate to global HIV prevention, care, and treatment is being organized in the International Journal of Environmental Research and Public Health. For detailed information on the journal, I refer you to https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

With over 35 million deaths in persons with HIV disease in the past four decades, HIV/AIDS is a defining pandemic of our era. It has highlighted vulnerable populations by age, sexual preference, drug use patterns, and social and gender–power relations, among others. Health systems and policies that are more robust in reducing disease transmission and death can be contrasted with those that are marginal or otherwise limiting. In this Special Issue of IJERPH, the problem of HIV prevention and control is seen through the prism of persons who use and abuse drugs. We seek papers that articulate the drug use–HIV risk syndemic from all aspects of pandemic control. We welcome diverse perspectives from public health, primary, secondary, and tertiary health care with policy, research, community, and implementation science perspectives.

We are keen to hear from frontline voices in the two most afflicted continents, Africa and Asia, as well as from any nation with unique policy responses, whether promising or disappointing. The goal of the Special Issue is to provide insights into how the global scourge of injection and non-injection drug use is linked to HIV transmission and compromises HIV care and treatment.

This Special Issue is open to submissions on the subject area of HIV prevention, care, and/or treatment and substance use and/or addiction. The keywords listed below provide an outline of some of the possible areas of interest.

Dr. Sten H. Vermund
Dr. Jeffrey A. Wickersham
Dr. Lauretta E. Grau
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Dr. Sten H. Vermund
Dr. Jeffrey A. Wickersham
Dr. Lauretta E. Grau
Guest Editors

Manuscript Submission Information

Keywords

co-diagnosis and treatment of substance use disorders and HIV infection
prevention of HIV among persons who use drugs
Treatment challenges in the face of substance use co-morbidities
living with HIV/AIDS in the context of substance use
epidemiology of the HIV/drug use syndemic
multi-morbidity of HIV and substances, including illicit drugs, alcohol and tobacco
behavioral and structural interventions
risk within carceral settings and upon release
primary prevention of drug use
health care integration for HIV and substance use disorders
experience and perception (patients, families and practitioners)
emerging challenges as with prescription opioids in the United States or rising injection drug use in parts of Central Asia or sub-Saharan Africa

Published Papers (13 papers)

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Research

Jump to: Review

10 pages, 344 KiB

Open AccessArticle

Engagement in Chemsex among Men Who Have Sex with Men (MSM) in Malaysia: Prevalence and Associated Factors from an Online National Survey

by Francesca Maviglia, Jeffrey A. Wickersham, Iskandar Azwa, Nicholas Copenhaver, Olivia Kennedy, Monique Kern, Antoine Khati, Sin How Lim, Kamal Gautam and Roman Shrestha

Int. J. Environ. Res. Public Health 2023, 20(1), 294; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010294 - 24 Dec 2022

Cited by 8 | Viewed by 3279

Abstract

Background: Chemsex is the use of illicit drugs—particularly methamphetamine, gamma hydroxybutyrate (GHB), and gamma-butyrolactone (GBL)—to enhance sexual activity. Chemsex, which occurs primarily among communities of men who have sex with men (MSM), is associated with greater HIV risk behaviors, including multiple sex partners, group sex, condomless sex, and injection drug use. Despite evidence showing chemsex engagement among Malaysian MSM, there is a paucity of research on chemsex among MSM in Malaysia. Methods: This cross-sectional study was conducted through an online survey (August to September 2021) among 870 Malaysian MSM. Participants were recruited through targeted advertisements on social networks. We collected information regarding participants’ recent (<6 months) engagement in chemsex, demographic characteristics, psychosocial factors, pre-exposure prophylaxis (PrEP) knowledge and history, and recent sexual- and drug-related behavior. Multivariable logistic regression was used to identify factors associated with recent (<6 months) chemsex engagement. Results: Just under 1 in 10 (9.0%) of participants reported having engaged in chemsex in the previous six months. More than two-thirds of participants (69.1%) had not disclosed their sexual orientation to anyone in their family and 35.2% reported moderate to severe depressive symptoms. Multivariable analysis found that recent injection drug use (adjusted odds ratio: aOR = 6.61; 95% confidence interval: CI, 2.30–19.03), having shared pre-exposure prophylaxis (PrEP) with someone else (aOR = 5.60; 95% CI, 1.76–17.77), higher perceived HIV risk (aOR = 3.15; 95% CI, 1.25–7.93), knowing someone using PrEP (aOR = 2.93; 95% CI, 1.62–5.31), recent engagement in transactional sex (aOR = 2.38; 95% CI, 1.06–5.39), having a recent STI diagnosis (aOR = 2.36; 95% CI, 1.25–4.44), recent engagement in anal sex (aOR = 2.21; 95% CI, 1.07–4.57), and recent sexual intercourse with an HIV-positive partner (aOR = 2.09; 95% CI, 1.07–4.08) were associated with recent engagement in chemsex. Conclusions: Malaysian MSM who practice chemsex are vulnerable to several HIV risk factors, such as transactional sex, HIV-positive sexual partners, and injection drug use. There is an urgent need for programs that integrate drug, sexual health, and mental health services, with a focus on harm reduction (e.g., condoms, access to and utilization of HIV testing and PrEP services, drug knowledge, and safer drug use) tailored for MSM who practice chemsex. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

17 pages, 345 KiB

Open AccessArticle

The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research

by Julia Dickson-Gomez, Sarah Krechel, Dan Katende, Bryan Johnston, Wamala Twaibu, Laura Glasman, Moses Ogwal and Geofrey Musinguzi

Int. J. Environ. Res. Public Health 2022, 19(16), 10382; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191610382 - 20 Aug 2022

Cited by 1 | Viewed by 1436

Abstract

Background: Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). Methods: The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. Results: Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. Conclusions: DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

11 pages, 486 KiB

Open AccessArticle

Healthcare Providers’ Perceptions about the Role of Spiritual Care and Chaplaincy Services in Substance Use Outpatient Treatment

by Brian S. W. Earl, Anne Klee, Ellen L. Edens, James D. Cooke, Holly Heikkila and Lauretta E. Grau

Int. J. Environ. Res. Public Health 2022, 19(15), 9441; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159441 - 01 Aug 2022

Viewed by 1778

Abstract

Addressing patients’ religion and spirituality (R/S) needs has been associated with positive health outcomes. However, despite receiving extensive training in spiritual assessment and care, chaplaincy services are primarily confined to inpatient settings, with few studies occurring in outpatient settings. The study sought to understand mental health providers’ views about what shaped provider and patient motivation to engage in R/S discussions and seek referrals to chaplaincy services. We conducted five one-hour focus group sessions with a total of 38 staff members and thematically analyzed the resulting session and field notes. We identified four themes concerning provider knowledge and attitudes about R/S and chaplaincy services: Staff Information Needs, Staff Motivation to Discuss R/S and Refer, Patient Motivation to Use Chaplaincy Services, and Chaplain Accessibility. The study findings suggest that providers in outpatient substance use treatment clinics in the Veterans Health Administration are receptive to learning about R/S care and the possibility of expanding chaplaincy services. However, staff have misconceptions about the roles and responsibilities of chaplains. Attitudes about and experiences with R/S discussions varied. Trust and confidence in the benefits of chaplaincy services may be improved among both providers and patients by increasing chaplains’ accessibility and visibility within these outpatient settings. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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11 pages, 906 KiB

Open AccessArticle

Integrating Cognitive Dysfunction Accommodation Strategies into an HIV Prevention Session: A 2-Arm Pilot Feasibility Study

by Colleen Mistler and Michael Copenhaver

Int. J. Environ. Res. Public Health 2022, 19(15), 9430; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159430 - 01 Aug 2022

Cited by 1 | Viewed by 1310

Abstract

Cognitive dysfunction is prevalent among persons on medication for opioid use disorder (MOUD). This cognitive dysfunction has been shown to reduce HIV treatment engagement and medication adherence. We investigated the impact of integrating specific behavioral strategies into an HIV prevention session to accommodate cognitive dysfunction among people on MOUD. Patients on MOUD (n = 20) were randomized to one of two different HIV prevention conditions. The same HIV risk reduction content was presented to both conditions; however, the experimental condition had accommodation strategies integrated into the session. Participants completed a skills checklist at pre-, post-, and 2-week follow-up to examine the level of HIV risk reduction content learned and utilized over time. Participants in the experimental condition indicated high acceptability (95%) for the accommodation strategies. These participants also demonstrated greater improvement in the ability to properly clean a syringe, from pre- to post- (p < 0.02) and from pre- to follow-up (p < 0.02) when compared to participants in the standard condition. Results from this pilot study indicate that accommodation strategies improved participants’ ability to learn, retain, and utilize risk reduction skills over time. This foundation of research indicates a promising, innovative strategy to increase the ability for persons on MOUD to engage in HIV prevention behaviors. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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13 pages, 325 KiB

Open AccessArticle

Stress, Marginalization, and Disruption: A Qualitative Rapid Situational Assessment of Substance Users and HIV Risk in Lebanon

by Kaveh Khoshnood, Amy B. Smoyer, Francesca Maviglia, Janine Kara, Danielle Khouri, Fouad M. Fouad and Robert Heimer

Int. J. Environ. Res. Public Health 2022, 19(15), 9242; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159242 - 28 Jul 2022

Viewed by 1564

Abstract

Lebanon is a diverse and dynamic nation of six million people that has experienced considerable disruption for the last two decades. The Syrian Civil War, which began in 2011, resulted in the displacement of 1.1 million Syrians to Lebanon. Today, Lebanon is the country with the largest per capita number of refugees in the world. In addition, the country experienced a social, economic, and political crisis in 2019 that destabilized the entire society—circumstances that were further complicated by COVID-19 pandemic. With all of the competing calamities in Lebanon, there has been limited scientific investigation into substance use and the risk of HIV infection among the country’s population. To address this gap in knowledge, a qualitative rapid situational assessment (RSA) of substance use and risk of HIV infection in and around Beirut, the nation’s capital, was conducted. The goal of this analysis is to describe the demographics and drug use patterns of this population, explore their HIV knowledge and risks, and build knowledge about their perceptions of and access to substance use treatment and other social services. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

12 pages, 487 KiB

Open AccessArticle

Material Security Scale as a Measurement of Poverty among Key Populations At-Risk for HIV/AIDS in Malaysia: An Implication for People Who Use Drugs and Transgender People during the COVID-19 Pandemic

by Nur Afiqah Mohd Salleh, Ahsan Ahmad, Balasingam Vicknasingam, Adeeba Kamarulzaman and 'Abqariyah Yahya

Int. J. Environ. Res. Public Health 2022, 19(15), 8997; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19158997 - 24 Jul 2022

Viewed by 1605

Abstract

The HIV epidemic is fueled by poverty; yet, methods to measure poverty remain scarce among populations at risk for HIV infection and disease progression to AIDS in Malaysia. Between August and November 2020, using data from a cross-sectional study of people who use drugs, (PWUD), transgender people, sex workers and men who have sex with men, this study examined the reliability and validity of a material security scale as a measurement of poverty. Additionally, we assessed factors associated with material security scores. We performed confirmatory factor analysis (CFA) for 268 study participants included in the analysis. A revised nine-item three-factor structure of the material security scale demonstrated an excellent fit in CFA. The revised material security score displayed good reliability, with Cronbach’s alpha of 0.843, 0.826 and 0.818 for housing, economic resources and basic needs factors, respectively. In a subsequent analysis, PWUD and transgender people were less likely to present good material security scores during the pandemic, compared to their counterparts. The revised nine-item scale is a useful tool to assess poverty among key populations at-risk for HIV/AIDS with the potential to be extrapolated in similar income settings. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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15 pages, 356 KiB

Open AccessArticle

The Impact of Housing Insecurity on Access to Care and Services among People Who Use Drugs in Washington, DC

by Monica S. Ruiz, Allison Williams, Allison O’Rourke, Elizabeth MacIntosh, Shareese Moné and Cyndee Clay

Int. J. Environ. Res. Public Health 2022, 19(13), 7561; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19137561 - 21 Jun 2022

Cited by 2 | Viewed by 1915

Abstract

People who use drugs are highly marginalized communities and are disproportionately affected by environmental changes—e.g., neighborhood gentrification—that affect housing availability and stability, particularly in urban locations. These changes could negatively affect individuals’ access to and utilization of health care and social services, resulting in poorer health outcomes. This study examined the impact of gentrification and housing instability on drug users’ access to harm reduction and other health services. Data were collected from 139 clients of a large harm reduction organization. Results showed that 67% of the participants were either unstably housed or homeless, and about one-third of participants indicated that their current housing situations negatively affected their access to primary care (33.9%), behavioral health services (36.7%) and basic services (38.3%). While homeless individuals were still able to access services generally, a greater percentage—compared to those unstably or stably housed—reported difficulty accessing care. As these data were collected prior to the COVID pandemic, it is likely that many of our participants faced greater struggles with housing insecurity and health care access issues due to shutdowns and increased need for social isolation and quarantine. More work is needed to address housing instability and homelessness among already marginalized populations. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

15 pages, 1060 KiB

Open AccessArticle

Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study

by Anees Bahji, Yu Li, Rachel Vickers-Smith, Stephen Crystal, Robert D. Kerns, Kirsha S. Gordon, Alexandria Macmadu, Melissa Skanderson, Kaku So-Armah, Minhee L. Sung, Fiona Bhondoekhan, Brandon D. L. Marshall and E. Jennifer Edelman

Int. J. Environ. Res. Public Health 2022, 19(9), 5649; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095649 - 06 May 2022

Cited by 3 | Viewed by 2005

Abstract

Background: The association between cannabis use and HIV-1 RNA (viral load) among people with HIV (PWH) engaged in care is unclear. Methods: We used data collected from 2002 to 2018 on PWH receiving antiretroviral therapy (ART) enrolled in the Veterans Aging Cohort Study. Generalized estimating equations were used to estimate associations between self-reported past-year cannabis use and detectable viral load (≥500 copies/mL), with and without adjustment for demographics, other substance use, and adherence. Results: Among 2515 participants, 97% were male, 66% were Black, the mean age was 50 years, and 33% had detectable HIV viral load at the first study visit. In unadjusted analyses, PWH with any past-year cannabis use had 21% higher odds of a detectable viral load than those with no past-year use (OR = 1.21; 95% CI, 1.07–1.37). However, there was no significant association between cannabis use and viral load after adjustment. Conclusions: Among PWH engaged in care and receiving ART, cannabis use is associated with decreased adherence in unadjusted analyses but does not appear to directly impact viral control. Future studies are needed to understand other potential risks and benefits of cannabis use among PWH. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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14 pages, 502 KiB

Open AccessArticle

Role of the Intersections of Gender, Race and Sexual Orientation in the Association between Substance Use Behaviors and Sexually Transmitted Infections in a National Sample of Adults with Recent Criminal Legal Involvement

by Tyler D. Harvey, Ijeoma Opara and Emily A. Wang

Int. J. Environ. Res. Public Health 2022, 19(7), 4100; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074100 - 30 Mar 2022

Cited by 4 | Viewed by 1842

Abstract

Limited research has focused on how substance use and sexual risk behaviors differ among individuals impacted by the criminal legal system based on social identities. Using the National Survey on Drug Use and Health, we estimated relative risk for reporting a sexually transmitted infection (STI) among intersectional social groups with criminal legal involvement using a modified Poisson regression. We then utilized multivariate logistic regression and marginal effects to measure associations between substance use behaviors and STIs and to estimate whether these varied among the intersectional social groups with elevated STI rates. Three groups had elevated risk of reporting an STI compared to white, heterosexual men: white, heterosexual women (1.53, 95% CI: 1.05–2.20); Black, heterosexual women (2.03, 95% CI: 1.18–3.49); and white, gay or bisexual men (5.65, 95% CI: 2.61–12.20). Considering the intersections of gender, race, and sexual orientation, elevated risks for STIs among white and Black heterosexual women were mitigated after adjusting for substance use alongside other confounders. Only those who identified as white, gay or bisexual, and male had increased STI risk after controlling for substance use. Interventions targeting Black and white heterosexual women’s sexual health following incarceration should focus on substance use and interventions targeting white, gay or bisexual men should focus on healthy sexual behaviors, HIV/STI screening, and care continuum efforts. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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12 pages, 1017 KiB

Open AccessArticle

Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City

by Sam Wilson Beckham, Jennifer L. Glick, Kristin E. Schneider, Sean T. Allen, Lillian Shipp, Rebecca Hamilton White, Ju Nyeong Park and Susan G. Sherman

Int. J. Environ. Res. Public Health 2022, 19(7), 3783; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19073783 - 22 Mar 2022

Cited by 6 | Viewed by 2018

Abstract

We describe patterns of polysubstance use and associations with HIV risk-related behaviors among women engaged in street-based transactional sex, an understudied yet important population and area of research. This sample was restricted to cisgender women who reported drug use (n = 244) in the baseline of the longitudinal SAPPHIRE cohort study. Latent class analysis (LCA) was conducted using drug use measures (route of administration (injection/non-injection); type of drug (specific opioids, stimulants)) and selection based on fit statistics and qualitative interpretation of the classes. Polysubstance use was prevalent (89% ≥ 2), and 68% had injected drugs in the past 3 months. A three-class solution was selected: Class 1 (“heroin/cocaine use”, 48.4% of sample), Class 2 (“poly-opioid use”, 21.3%), and Class 3 (“poly-route, polysubstance use”, 30.3%). Class 3 was significantly younger, and Class 2 was disproportionately non-White. Women reported high levels of housing (63%) and food (55%) insecurity, condomless sex with clients (40%), and client-perpetrated violence (35%), with no significant differences by class. Obtaining syringes from syringe services programs differed significantly by class, despite injection behaviors in all classes. Tailored HIV and overdose prevention programming that considers drug use patterns would strengthen their impact. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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Review

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24 pages, 740 KiB

Open AccessReview

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

by Wendee M. Wechsberg, Isa van der Drift, Brittni N. Howard, Bronwyn Myers, Felicia A. Browne, Courtney Peasant Bonner, Tara Carney, Jacqueline Ndirangu and Yukiko Washio

Int. J. Environ. Res. Public Health 2022, 19(14), 8661; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148661 - 16 Jul 2022

Cited by 5 | Viewed by 2405

Abstract

Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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19 pages, 431 KiB

Open AccessReview

Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

by Samuel R. Friedman, Leslie D. Williams, Ashly E. Jordan, Suzan Walters, David C. Perlman, Pedro Mateu-Gelabert, Georgios K. Nikolopoulos, Maria R. Khan, Emmanuel Peprah and Jerel Ezell

Int. J. Environ. Res. Public Health 2022, 19(12), 7453; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19127453 - 17 Jun 2022

Cited by 5 | Viewed by 3132

Abstract

Structural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an “upstream” institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, “downstream” efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

27 pages, 702 KiB

Open AccessReview

HIV and Substance Use in Latin America: A Scoping Review

by Hanalise V. Huff, Paloma M. Carcamo, Monica M. Diaz, Jamie L. Conklin, Justina Salvatierra, Rocio Aponte and Patricia J. Garcia

Int. J. Environ. Res. Public Health 2022, 19(12), 7198; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19127198 - 12 Jun 2022

Cited by 4 | Viewed by 3610

Abstract

This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA. Full article

(This article belongs to the Special Issue Prevention, Care and Treatment of HIV, Substance Use and Addiction)

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