PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives

To examine substance abuse treatment providers’ views on engaging clients in Pre-exposure Prophylaxis (PrEP) care and research trials. Thirty-six medical and counseling service providers in six New York City outpatient substance abuse treatment programs participated in semi-structured qualitative interviews. Thematic content analysis was conducted by three coders, independently. Providers’ perspectives toward PrEP were characterized by six salient themes: 1) Limited PrEP awareness. 2) Ambivalence about PrEP; 3) Perception of multiple challenges to delivery; 4) Uncertainty about clients’ ability to be adherent to medication; 5) Concerns about medication safety/side effects; and 6) Perception of multiple barriers to conducting clinical trials. Despite anticipated challenges, providers supported the introduction of PrEP in outpatient substance abuse treatment. Comprehensive training for providers is needed and should include PrEP eligibility criteria, strategies to support adherence and medication monitoring guidelines. Linkages between substance abuse treatment and primary care and/or enhancement of capacity within clinics to offer PrEP may help facilitate PrEP delivery. When conducting research in outpatient clinics, it is particularly important to protect client confidentiality

Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007–2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6–0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups

Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS

Objectives. We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS. Methods. We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents’ knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS. Results. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS. Conclusions. Personal resources and mental health factors are likely to influence the public’s ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40384/2/Des Jarlais_Stigmatization of Newly Emerging Infectious Diseases_2006.pd

Social Factors Associated with AIDS and SARS

We conducted a survey of 928 New York City area residents to assess knowledge and worry about AIDS and SARS. Specific sociodemographic groups of persons were more likely to be less informed and more worried about contracting the diseases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40253/2/Des Jarlais_Social Factors Associated with AIDS_2005.pd

Substance Use Disorders and HIV/AIDS Prevention and Treatment Intervention: Research and Practice Considerations

Faithful Falcons / Aida Barrera -- Fathers of the Valley–1800 / Dorothy McWhorter -- Hidalgo\u27s Two Musketeers-1905 / Shirley Ann Wallace -- Royal Salt Mine-1730 / Dorothy Burnett -- Citrus King Of Texas-1892 / Jackie Lee Carter -- Edinburg Gets County Seat-1908 / Vilma Gorena -- Legend Of Juan Grande-1820 / Frances Garza -- Valley Terminology-1802 / Joyce Jean Turner -- Martyr of Hidalgo-1854 / Sara S. Weaver -- El Mesquite-1528 / Mary K. Elliott -- First Commissioners\u27 Meeting-1852 / Morgan Groves -- Texas Mustang-1785 / Wanda Davis -- Oil In The Valley-1910 / Otto Woods -- Early Hidalgo Transportation / Dora Mae Kelley -- Better Roads Worst Need-1852 / Morgan Groves -- County Land Grants-1798 -- White Gold Of Bagdad-1840 / Margaret Looney -- A Trip To La Coma Ranch-1903 / Hidalgo Advance -- First Commissioner\u27s Meeting-1852 -- Edinburgh-Circa 1893 / W. H. Chatfield -- A. Y. Baker, Political Ruler-1920 / Allan Engleman -- Border Patrol-1924 -- Battle of Ojo De Agua [Ojo de Agua Raid]-1915 / Louis Consler -- Vegetable and Citrus-1902 / W. H. Friend -- County Agriculture Statistics-1890 / W. H. Chatfield.https://scholarworks.utrgv.edu/lrgv/1003/thumbnail.jp

Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco’s Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind