Evaluation of North Carolina Laws SB 20 and HB 850 and Development of Revised Drug Policy for UNC System Schools

Background: Drug overdoses have reached epidemic proportions, becoming the leading cause of unintentional injury deaths in the United States (U.S.), surpassing motor vehicle accidents in 2009 (Jones et al, 2013). To address this rising problem, North Carolina recently enacted Senate Bill 20 (SB 20), a Good Samaritan overdose prevention legislation that provides legal protection for those who call for medical help in the case of a drug overdose. This law also removes civil and criminal liability for prescriptions and use of naloxone, an opioid overdose reversal drug. Additionally, North Carolina's House Bill 850 (HB 850) was enacted to reduce the spread of blood-borne diseases by providing legal protection for those who declare a clean syringe to a law enforcement officer prior to being searched. The first aim of the Capstone project was to evaluate these policies to understand their impact in the populations they are intended to benefit. Through the second aim of the project, the Capstone team advocated for revision of the University of North Carolina's (UNC) system-wide drug policy to reflect the intent of the newly enacted laws. Methods: To evaluate the policies, we conducted 78 three to five minute interviews with those at risk of experiencing and/or witnessing unintentional overdose at five sites in North Carolina. We analyzed this data to assess individual knowledge of the new laws and how this knowledge may result in behavior change. To advocate for a revision of the UNC system drug policy, we conducted in-person interviews with stakeholders at UNC-Chapel Hill (UNC-CH) using semi-structured interview guides, and telephone interviews with administrative counterparts at other campuses, using a revised and shortened interview guide. Additionally, we conducted a web-based survey about campus drug policy and use to UNC-CH students. We then analyzed data from the interviews and surveys to inform a policy brief and executive summary, which were then disseminated to relevant system stakeholders. Results: Our evaluation findings revealed that a majority of participants were unaware of the components of the newly enacted laws. Additionally, mistrust of law enforcement played a large role in participant's intended behavior during an overdose or police search. These findings were summarized in a manuscript and submitted to the International Journal of Drug Policy. Three key ideas informed the revision of the UNC system-wide policy and the accompanying policy brief and executive summary: support received for the revised policy; information obtained on inadequacies in the current zero-tolerance policy; and methods suggested for implementation of the policy. Discussion: Evaluation results illustrate the need of expanded educational and advocacy campaigns to spread knowledge of SB 20 and HB 850. Additionally, the evaluation results indicate a sentiment that the laws' partial protections make them irrelevant to many individuals at risk of experiencing or witnessing an unintentional opioid overdose. Qualitative data from University stakeholders provided valuable insight into the current policy development and implementation process and informed recommendations for the UNC system Board of Governors. While most stakeholders felt Good Samaritan policies for alcohol could pave the way for these policies to include drugs, the inclusion of Good Samaritan drug policies will require additional efforts.Master of Public Healt

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex risk behaviors

Opt-Out HIV Testing of Inmates in North Carolina Prisons: Factors Associated with not Wanting a Test and not Knowing They Were Tested

Opt-out HIV testing is recommended for correctional settings but may occur without inmates’ knowledge or against their wishes. Through surveying inmates receiving opt-out testing in a large prison system, we estimated the proportion unaware of being tested or not wanting a test, and associations (prevalence ratios [PRs]) with inmate characteristics. Of 871 tested, 11.8% were unknowingly tested and 10.8% had unwanted tests. Not attending an educational HIV course (PR=2.34, 95% CI 1.47–3.74), lower HIV knowledge (PR=0.95, 95% CI 0.91–0.98), and thinking testing is not mandatory (PR=9.84, 95% CI 4.93–19.67) were associated with unawareness of testing. No prior incarcerations (PR=1.59, 95% CI 1.03–2.46) and not using crack/cocaine recently (PR=2.37, 95% CI 1.21–4.64) were associated with unwanted testing. Residence at specific facilities was associated with both outcomes. Increased assessment of inmate understanding and enhanced implementation are needed to ensure inmates receive full benefits of opt-out testing: being informed and tested according to their wishes

“You're in a World of Chaos”: Experiences Accessing HIV Care and Adhering to Medications After Incarceration

Most HIV-infected inmates leave prison with a suppressed viral load; many, however, become disconnected from care and non-adherent to medications during reentry to community life. In this secondary data analysis of focus groups (N = 6) and in-depth interviews (N = 9) with 46 formerly incarcerated HIV-infected people during reentry, we used an inductive analytic approach to explore the interplay between individual, interpersonal, community, and structural factors and HIV management. Participants described barriers and facilitators to care engagement and adherence at each of these 4 levels, as well as a milieu of HIV and incarceration-related stigma and discrimination. The constellation of barriers and facilitators created competing demands and a sense of chaos in participants’ lives, which led them to address reentry-related basic needs (e.g., housing, food) before health care needs. Interventions that simultaneously address multiple levels, including augmenting employment and housing opportunities, enhancing social support, and reducing stigma, are needed

出雲観光におけるストレス対策としてのヘルスツーリズムの可能性

出雲観光におけるストレス対策としてのヘルスツーリズムの可能性を検討した。ヘルスツーリズム商品化には、単に医療のみだけでなく、観光、経営の部分の比重も大きい。ツアーのメニューの内容次第では十分にヘルスツアーとして成立し、メンタルヘルス増進を打ち出すことなどにより、観光客の増加につながる可能性がある

HIV status disclosure during acute HIV infection in Malawi.

Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI.Clinical trial registration numberNCT01450189