Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening.

Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed

Screening for Intimate Partner Violence

Intimate partner violence (IPV) is a serious concern for women that is associated with significant adverse health effects. Routine screening for IPV is recommended, but there are many barriers to screening that have been identified by providers, including discomfort, lack of training, and not knowing how to respond to a positive screen. This article reviews IPV screening and appropriate techniques for responding to a positive screen. IPV screening best practices include using a systematic protocol, developing a screening script, using a validated screening tool, and considerations for privacy and mandatory reporting. Responding to a positive screen should include acknowledging the experience, asking if the woman desires help, offering support and referrals, encouraging safety planning, and completing additional assessments to determine level of danger and to identify any comorbidities. Using these techniques along with therapeutic communication may increase IPV identification and create an environment in which women feel empowered to get help

Structural violence: A concept analysis to inform nursing science and practice.

This analysis is meant to elucidate the concept of structural violence and its implications for nursing science and practice. The concept of structural violence, also known as indirect violence, was first identified in the literature by peace researcher Johan Galtung. According to Galtung, structural violence broadly represents harm done to persons and groups through inequitable social, political, or economic structures. Such inequitable structures, such as systemic discrimination based on race, ethnicity, religion, gender, sexual orientation, etc. create conditions within society that directly disadvantage and oppress members of certain groups. This oppression can inflict profound physical, psychological, and socioeconomic harm on individuals, leading to disparate health outcomes. Using techniques for developing conceptual meaning as outlined in Chinn and Kramer (2018), our analysis seeks to specify meanings and applications of structural violence for application to nursing. This analysis draws on literature from clinical, historical, and other social sciences. Databases including CINAHL, PubMed, JSTOR, and PsychInfo were explored for references to structural violence. Structural violence is readily identified in specific contexts where individuals or groups are disadvantaged by socially constructed systems, such as those of race, gender, and economic privilege. Structural violence can result in health disparities and the development of conditions that predispose individuals to health risks. Nurses must be familiar with the concept to address these issues with patients