Homelessness and Incarceration Associated With Relapse into Stimulant and Opioid Use among Youth Who Are Street-Involved in Vancouver, Canada

Introduction and Aims: While much research has sought to identify the factors associated with initiation and cessation of various forms of drug use among vulnerable youth, little is known about relapse into drug use in this population. We sought to characterize relapse into stimulant and opioid use among street-involved youth in Vancouver, Canada. Design and Methods: Data were collected between 2005 and 2017 from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth who use illicit drugs in Vancouver. Multivariable extended Cox regression was utilized to identify factors associated with relapse into harder drug use among youth who had previously ceased using stimulants and/or opioids for six months or longer. Results: Among 246 participants who reported a period of cessation lasting six months or longer, 165 (67.1%) relapsed at some point during study follow-up. Youth who were recently incarcerated (adjusted hazard ratio [AHR]: 1.47), homeless (AHR: 1.40), or had a history of daily stimulant use (AHR: 1.64) were significantly more likely to report relapse, while youth of who identified as white (AHR: 0.78) were significantly less likely to report relapse (all p <0.05). Discussion: Relapse into harder drug use was common among youth in our setting, and incarceration, homelessness, and daily stimulant use (pre-cessation) were found to be positively associated with relapse among street-involved youth. Conclusions: Findings suggest that increased access to youth housing supports and alternatives to the criminalization of drug use may help to reduce the rates of relapse into harder drugs in this population

Dominican Republic (2006): HIV/AIDS RISK BEHAVIOR TRaC STUDY AMONG PEOPLE LIVING IN BATEYES. First Round.

The objective of this study was to generate concrete evidence for making decisions regarding the design of a Behavior Change Project for HIV/AIDS Prevention targeting adult residents of the bateyes. This study design seeks to answer questions regarding the segmentation and monitoring of the target population, which would be handled as follows: 1. Segmentation. Between males and females aged 20 to 49 living in the bateyes, What opportunity, motivation and ability factors of an individual and what characteristics of the population in general are correlated with the use of condoms in the last sexual act with a regular and/or casual partner? What is the profile of the group, which behaves in the desired manner (i.e. which uses a condom with all their partners)? 2. Monitoring. What are the behavior trends, indicators of the logical framework, and the opportunity, ability and motivation factors, which are correlated with key behaviors

The social psychology of the free speech and hate speech debate

Freedom of speech has long been considered an essential value in democracies. However, its boundaries concerning hate speech continue to be contested across many social and political spheres, including governments, social media, and university campuses. Despite the potential of examining the social psychological dynamics of this debate for advancing theory on meaning-making, polarization, emotions, and social status, empirical research in this area is scarce. This dissertation aims to address this gap by examining first-hand perspectives and media frames on the free speech and hate speech debate using digital, archival, and interview data from an online forum and four university campuses. The first empirical chapter focuses on the moral discourse of individuals within an online free speech community. I analyze 418 discussion posts on the r/FreeSpeech subreddit using a digital ethnographic approach and find that most users understand free speech in an absolutist sense but differ in their justifications for why hate speech should be allowed. The study highlights the variation in free speech discourse within online spaces. The second empirical chapter explores campus culture and students’ meaning-making processes toward speech on campus at four large public universities in the U.S. and Canada. The chapter, which draws on data from 150 student newspaper articles and 55 semi-structured interviews with students, finds the culture on each of the four campuses to be polarized around free speech issues. However, interview participants express complex and sometimes conflicting meaning-making processes, particularly around the concept of “harm,” theories about speech and how it spreads, and the roles and responsibilities of universities in society. Overall, these findings challenge the assumption that the campus free speech debate is neatly divided along ideological or moral lines. The third empirical chapter investigates how social status shapes university students’ experiences of campus speech. I draw on the same interview data and find that lower-status students express a high degree of fear and anxiety about expressing themselves openly on a range of politicized topics, including free speech itself. This self-censorship negatively impacts lower-status students’ educational experiences, sense of belonging, and professional aspirations.Arts, Faculty ofSociology, Department ofGraduat

Replication data for: Dominican Republic (2008): HIV/AIDS RISK BEHAVIOR TRaC STUDY AMONG PEOPLE LIVING IN BATEYES IN DOMINICAN REPUBLIC. SECOND ROUND. 2008.

The first round of the TRaC survey with men and women living in bateyes in the Dominican Republic was conducted in 2006 and served as a base line for the HIV/AIDS Prevention Project. This survey has the following objectives: (1) to monitor behavioral trends and other key determinants of Opportunity, Ability and Motivation (OAM) among people living in bateyes in the Dominican Republic since 2006, (2) to identify the factors characterizing people having more than two sexual partners, and (3) to evaluate the PSI program's impact on behavior and determinants of OAM.The purpose of the program is to iincrease healthy behaviors among people living in bateyes through education and a social marketing (SM) strategy of wide coverage for increased access to and availability of male condoms.The sampling was drawn by using a multi-stage cluster design for selecting participants in the studies. A total of 1500 informants were chosen in 2006 and a total of 1487 in 2008. The survey included questions related to demographic characteristics, sexual behavior, condom use, OAM determinants and exposure to PSI interventions

Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study

Background: The distribution of take-home naloxone (THN) kits has been an important strategy in reducing overdose fatalities among people who use drugs. However, little is known about the use of THN among youth who are street-involved. The present study explores knowledge and possession of THN among street-involved youth in a Canadian setting. Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth age 14–28 at enrollment in Vancouver, Canada. Participants completed a standardized questionnaire, which included items related to knowledge and possession of THN, sociodemographic characteristics, and substance use-related factors. Multivariable logistic regression models were used to identify factors independently associated with knowledge and possession of THN. Results: Between December 2014 and November 2016, 177 youth were interviewed, including 68 females (38.4%). While 126 (71.2%) participants reported knowledge of THN, only 40 (22.6%) possessed a THN kit. Caucasian/white ethnicity was found to be positively associated with both knowledge and possession of THN (both p < 0.05). Public injection drug use in the last 6 months was found to be positively associated with knowledge of THN, while daily heroin use and daily methamphetamine use were associated with possession of THN (all p < 0.05). Male gender was negatively associated with possession of THN (p < 0.05). Conclusions: These findings highlight important gaps between knowledge and possession of THN among youth and the need to increase participation in THN programs among specific populations including non-white and male youth. Further research is needed to gain a better understanding of the barriers that may prevent certain youth from acquiring THN kits.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult

Transgender female sex workers’ HIV knowledge, experienced stigma, and condom use in the Dominican Republic

<div><p>Introduction</p><p>Not only do transgender female sex workers have some of the highest rates of sexually transmitted infections (STI), human immunodeficiency virus (HIV), and experienced stigma, they also have higher likelihood of early sexual debut and some of the lowest levels of educational attainment compared to other stigmatized populations. Some of the most common interventions designed to reduce transmission of HIV and STIs seek to educate high-risk groups on sexual health and encourage condom use across all partner types; however, reaching stigmatized populations, particularly those in resource-limited settings, is particularly challenging. Considering the importance of condom use in stopping the spread of HIV, the aim of this study was two-fold; first to characterize this hard-to-reach population of transgender female sex workers in the Dominican Republic, and second, to assess associations between their HIV knowledge, experienced stigma, and condom use across three partner types.</p><p>Methods</p><p>We analyzed self-reported data from the Questionnaire for Transgender Sex Workers (N = 78). Respondents were interviewed at their workplaces. Univariate and bivariate analyses were employed. Fisher Chi-square tests assessed differences in HIV knowledge and experienced stigma by condom use across partner types.</p><p>Results</p><p>HIV knowledge was alarmingly low, condom use varied across partner type, and the respondents in our sample had high levels of experienced stigma. Average age of first sexual experience was 13.12 years with a youngest age reported of 7. Dominican Republic statutory rape laws indicate 18 years is the age of consent; thus, many of these transgender women’s first sexual encounters would be considered forcible (rape) and constitute a prosecutable crime. On average, respondents reported 8.45 sexual partners in the prior month, with a maximum of 49 partners. Approximately two thirds of respondents used a condom the last time they had sex with a regular partner. This was considerably lower than condom use reported with coercive partners (92.96%) and clients (91.78%). Bivariate analyses revealed two trends: experienced stigma was associated with lower rates of condom use, and lower HIV knowledge was associated with lower rates of condom use. The former provides additional evidence that experienced stigma may become internalized, affecting individual-level behaviors—lowering self-confidence and resilience—making it more difficult to negotiate condom use due to lack of self-efficacy and desire to show trust in one’s partner. The latter supports public health research that suggests gaps in HIV knowledge persist and are pronounced in highly stigmatized populations.</p><p>Discussion</p><p>The vulnerabilities experienced by transgender persons, particularly in environments that vehemently adhere to conservative ideologies related to sex and gender, are significant and harm this population. These vulnerabilities could potentially be addressed through critically examining of impact of policies that indirectly promote or allow victimization of transgender citizens and subsequently diminish the effectiveness of public health and educational interventions. By taking action through the revocation of such laws, the Dominican Republic has the opportunity to improve overall population health, to protect some of its most stigmatized citizens, and to become the flag bearer of enhanced human rights in the Caribbean and Latin America.</p></div

Bivariate association between condom use during last sexual encounter across three partner types.

<p>Bivariate association between condom use during last sexual encounter across three partner types.</p

Univariate statistics of transgender female sex worker respondents.

<p>Univariate statistics of transgender female sex worker respondents.</p