MAPPING HIV PREVENTION IN POLAND: CONTESTED CITIZENSHIP AND THE STRUGGLES FOR HEALTH AFTER SOCIALISM

This ethnographic dissertation research project examines HIV prevention programs in Warsaw, Poland to explore the concurrent processes of democratization and privatization as Poland begins European Union accession. As inherently political public health interventions, HIV prevention programs provoke discussions of risk and responsibility, and visions of the moral social order. Therefore, they can be used to understand the ways in which politically and socially marginalized populations invoke claims to citizenship status through attention to health issues. From an epidemiological perspective, HIV/AIDS arrived in Poland relatively late (1985) and never reached the anticipated epidemic levels. In the 1980s, drawing attention to the potential threat of AIDS served as a forum through which the perceived failures of the socialist government could be publicly addressed. In the 1990s calls for improved access to AIDS information suggested that to be democratic meant to have open and easy access to scientific information, and debate surrounding the establishment of AIDS care facilities suggested that to be European was to be tolerant. However, issues of information and tolerance were problematic in reference to homosexuality. Prior to the advent of AIDS in Poland, socialist gender and sexual ideologies converged with Catholic notions of proper morality to marginalize and pathologize homosexuality. Nascent gay organizations saw the potential of HIV prevention as a way to justify the value of such organizations for the greater good of society. The possibility of controlling and participating in the task of HIV prevention presented an alternative to statesponsored surveillance under the guise of HIV prevention and encouraged public dialogue about the issues gays face in their daily lives. Whereas the national HIV prevention agenda focuses on risks as equally distributed across Polish society, a central component of the HIV prevention programs within Polish gay rights and drug abuse prevention organizations is harm reduction. As practiced by Polish gay organizations, a harm reduction philosophy draws attention to heterogeneity within gays and challenges the construction of them as a coherent risk group. These programs deemphasize sexuality in favor of a wider constellation of factors that contribute to finding oneself in situations that can lead to risky behavior

HIV prevention, precarity, and fragmented landscapes of service provision in Ukraine

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Opioid use and HIV treatment services experiences among male criminal justice‑involved persons in South Africa : a qualitative study

AVAILABILITY OF DATA AND MATERIALS : The datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request. The qualitative datasets are not publicly available in order to protect the participants’ privacy and confidentiality, particularly given the small sample size and the study’s geographic specificity. Study participants with stigmatized traits disclosed rich, detailed, and sensitive information that may unintentionally reveal their identities.BACKGROUND : Opioid use disorder (OUD) is overrepresented among people with criminal justice involvement; HIV is a common comorbidity in this population. This study aimed to examine how formerly incarcerated men living with HIV and OUD in South Africa experienced HIV and OUD services in correctional facilities and the community. METHODS : Three focus group discussions were conducted with 16 formerly incarcerated men living with HIV and OUD in Gauteng, South Africa. Discussions explored available healthcare services in correctional facilities and the community and procedural and practice differences in health care between the two types of settings. Data were analyzed thematically, using a comparative lens to explore the relationships between themes. RESULTS : Participants described an absence of medical services for OUD in correctional facilities and the harms caused by opioid withdrawal without medical support during incarceration. They reported that there were limited OUD services in the community and that what was available was not connected with public HIV clinics. Participants perceived correctional and community HIV care systems as readily accessible but suggested that a formal system did not exist to ensure care continuity post-release. CONCLUSIONS : OUD was perceived to be medically unaddressed in correctional facilities and marginally attended to in the community. In contrast, HIV treatment was widely available within the two settings. The current model of OUD care in South Africa leaves many of the needs of re-entrants unmet. Integrating harm reduction into all primary care medical services may address some of these needs. Successful HIV care models provide examples of approaches that can be applied to developing and expanding OUD services in South Africa.The US National Institutes of Health Fogarty International Center.http://www.harmreductionjournal.com/am2024Family MedicineSDG-03:Good heatlh and well-bein

Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents

<p>Abstract</p> <p>Background</p> <p>Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents.</p> <p>Methods</p> <p>Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior.</p> <p>Results</p> <p>Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations.</p> <p>Conclusions</p> <p>Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.</p

Pharmacist-initiated adherence promotion activities for persons living with HIV in ambulatory care settings: Instrument development and initial psychometric testing

OBJECTIVES: Consistent adherence to antiretroviral therapy (ART) remains a challenge for half the people living with HIV (PLWH) in the U.S. Pharmacists have the expertise in pharmacology and pharmacotherapeutics to manage ART and optimize PLWH outcomes. We developed and validated the psychometric properties of a scale to measure the breadth and depth of adherence promotion activities provided by pharmacists to PLWH in ambulatory care settings. METHODS: An initial 37-item instrument was developed from 31 pharmacists\u27 interviews and a comprehensive literature review. Psychometric properties were assessed from responses to questionnaires of 10 content experts and 184 ambulatory pharmacists in 37 States. Psychometric tests included: content validity index (CVI); Exploratory Factor Analysis (EFA); and internal reliability using Cronbach\u27s alpha (α). RESULTS: 26 items were eliminated in the item reduction stage. The final 11-item adherence promotion activities scale (APAS) was a single factor with high loadings (0.51-0.85), good internal consistency (α ≤ 0.93) and an explained variance of 60%. For known-groups validity, HIV-certified pharmacists had comparatively higher and statistically significant APAS score compared to non-certified pharmacists (4.00, p \u3c .001). CONCLUSIONS: Preliminary psychometric testing-factor analysis, and high internal consistency-depict that APAS can be useful in scientific research and pharmacy practice to assess the nature and range of pharmacists\u27 above-and-beyond prescription services in real-world ambulatory settings. Further validation work is needed to establish conclusive reliability and validity of the newly developed scale

HIV Testing as a Standard of Care for Men Who Have Sex With Men

In 2006, the Centers for Disease Control and Prevention (CDC) revised its HIV testing recommendations in health care settings. Current guidelines recommend that all patients aged 13 to 64 years be screened for HIV as part of routine medical care. Additionally, the CDC recommends that persons at high risk for HIV infection should be screened for HIV at least annually. Primary care providers in clinical settings are seen as important providers of HIV prevention services and will be critical to expand HIV testing rates, particularly among populations such as men who have sex with men (MSM). This article reports on results from a multifaceted study that combined qualitative and quantitative methods and targeted both MSM and primary care providers. Through a quantitative survey with 709 MSM in Wisconsin, we explored the relationship between having a primary care provider, risk behavior, and HIV testing patterns. In the qualitative portion of the study, we conducted structured interviews with 7 clinic medical directors to explore the acceptability and feasibility of increased HIV testing in clinical setting strategy among primary care providers. Consistent with previous research, the results of this study indicate that primary care providers can play a significant role in encouraging and facilitating annual routine testing as a standard of care for high-risk MSM. This article offers policy and practice recommendations based on these findings