Perceived benefits and negative consequences of alcohol consumption in cving with HIV: A qualitative study

BACKGROUND:

Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.

METHODS:

Four focus groups, with a total of 24 adult women (96 % African-American, 88 % HIV-positive), were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.

RESULTS:

Regarding reasons for drinking, women described themes that included biological (addiction, to manage pain), psychological (coping, to escape bad experiences, to feel in control), and social (peer pressure, family). Themes related to consequences from alcohol included biological (damage to body, poor adherence to medications), psychological (risky or regrettable behavior, memory loss), and social (jail, loss of respect, poor choices). When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.

CONCLUSION:

Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection.

Full article at:   http://goo.gl/vA9COI

By:  Cook RL1, Cook CL2, Karki M3, Weber KM4, Thoma KA5, Loy CM6, Goparaju L7, Rahim-Williams B8.

• 1Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. cookrl@ufl.edu.
• 2Department of Family, Community, and Health System Science, University of Florida College of Nursing, PO Box 100197, Gainesville, FL, 32610-0197, USA.
• 3Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA.
• 4Cook County Health and Hospital System and Hektoen Institute of Medicine, 2225 W Harrison St, Chicago, IL, 60612, USA.
• 5Clinical Research Specialist, UF CARES, University of Florida Center for HIV/AIDS, Research, Education & Service, 653-1 West 8th Street, LRC 3rd Floor L-13, Jacksonville, FL, 32209, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
• 7Women's Interagency HIV Study (WIHS), Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 130, Washington DC, 20007, USA.
• 8Department of Public Health, Bethune-Cookman University, College of Health Sciences, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, Florida, 32114, USA. 
• BMC Public Health. 2016 Mar 15;16(1):263. doi: 10.1186/s12889-016-2928-x.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Do Police Arrestees Substitute Legal Highs for Other Drugs?

Background

Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs.

Aims

To explore the extent to which police detainees substitute LH for illegal drugs

Method

A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., ‘no change’, ‘more’, ‘less’ or ‘stopped’). The detainees were placed into four groups: (i) no LH use; (ii) LH use and ‘no change’ in drug use; (iii) LH use and ‘more’ drug use; (iv) LH use and ‘less’ or ‘stopped’ drug use. Demographics and levels of drug use in the past month were compared between groups.

Results

Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used ‘less’ or ‘stopped’ cannabis use, and 3% had used SC and used ‘more’ cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used ‘more’ cannabis also used more methamphetamine and ecstasy.

Conclusion

Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 5% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations.

Purchase full article at:   http://goo.gl/XyTZkS

By:  Chris Wilkins, Karl Parker, Jitesh Prasad, Sonie Jawalkar

Corresponding author. SHORE & Whariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand, +64 9 366 6136. www.shore.ac.nz.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The King of Baltimore Bail Bonds

Via:  http://goo.gl/XtfRNs

Assessing Risk-Based Policies for Pretrial Release and Split Sentencing in Los Angeles County Jails

Court-mandated downsizing of the CA prison system has led to a redistribution of detainees from prisons to CA county jails, and subsequent jail overcrowding. 

Using data that is representative of the LA County jail system, we build a mathematical model that tracks the flow of individuals during arraignment, pretrial release or detention, case disposition, jail sentence, and possible recidivism during pretrial release, after a failure to appear in court, during non-felony probation and during felony supervision. 

We assess 64 joint pretrial release and split-sentencing (where low-level felon sentences are split between jail time and mandatory supervision) policies that are based on the type of charge (felony or non-felony) and the risk category as determined by the CA Static Risk Assessment tool, and compare their performance to that of the policy LA County used in early 2014, before split sentencing was in use. 

In our model, policies that offer split sentences to all low-level felons optimize the key tradeoff between public safety and jail congestion by, e.g., simultaneously reducing the rearrest rate by 7% and the mean jail population by 20% relative to the policy LA County used in 2014. 

The effectiveness of split sentencing is due to two facts: 

1. convicted felony offenders comprised ≈ 45% of LA County’s jail population in 2014, and 
2. compared to pretrial release, split sentencing exposes offenders to much less time under recidivism risk per saved jail day.

Below:  For each of the four options for split sentencing in the right column of Table 1, the optimal (i.e., optimizing over the remaining 16 options in Table 1) tradeoff curves of the annual rearrest rate vs. (a) the mean jail population and (b) mean jail overcrowding. The circle denotes the status quo policy for LA County in early 2014.

Full article at:   http://goo.gl/06yV9h

By:   

Mericcan Usta

Management Science & Engineering Department, Stanford University, Stanford, CA, United States of America

Lawrence M. Wein

Graduate School of Business, Stanford University, Stanford, CA, United States of America

  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The Impact of Medication-Focused Workshops in a Diabetes Educational Program in Jail: A Pilot Study

Background 

Correctional institutions have unique circumstances offering care and the opportunity to adopt healthy behaviours for populations suffering from chronic diseases such as diabetes. In view of their expertise on medication, pharmacists can contribute to multidisciplinary educational health programmes in prisons. 

Objective 

To assess the effectiveness of a pharmacist led diabetes medication-related workshops. Method Pharmacists led workshops about patients' empowerment in their treatment within the educational program. On a prospective observational study basis, the impact was assessed in terms of relevance, learning outcomes and achievement transfer using the Kirkpatrick training assessment method. Hb1Ac was measured as glycemic control outcome. 

Results 

Fifteen patients involved in the workshops showed a significant decrease in HbA1c compared to the control group (-1.18 ± 0.52 vs. +0.26 ± 0.28 %; p < 0.001).

Relevance:

All participants were satisfied and ready to join other sessions.

Learning Outcomes:

(LO) Postworkshop scores were significantly improved (LO1: 4.2 ± 0.9 vs. 2.2 ± 1.4; LO2: 4.5 ± 0.9 vs. 2.6 ± 1.3; p < 0.05). Decrease in HbA1c was correlated to increase in LO2's scores. (Y = 0.946 - 1.134X; R = -0.692; p < 0.05). Achievement transfer: Key points from all LOs were reported. In case studies, 70 % of participants adopted healthy strategies (LO3). Conclusion These results highlight the positive impact of the workshops and the additive value of pharmacists' involvement within the educational program in jail.

Purchase full article at:   http://goo.gl/LqoLtj

By:   Davoust S1, Ghaleb V2, Guillon S2, Amirat-Combralier V1, Bartoli C2, Hache G3.

• 1Penitentiary Center of Marseille, Pharmacy, 239 Chemin de Morgiou, Marseille, France.
• 2Penitentiary Center of Marseille, Medical Unit, 239 Chemin de Morgiou, Marseille, France.
• 3Penitentiary Center of Marseille, Pharmacy, 239 Chemin de Morgiou, Marseille, France. guillaume.hache@univ-amu.fr. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

An Exploratory Study of Mental Health & HIV Risk Behavior among Drug-Using Rural Women in Jail

Objective

Rural women, particularly those involved in the criminal justice system, are at risk for HIV due to the increasing prevalence of injection drug use, as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk behavior by three different mental health problems (depression, anxiety, and PTSD) among drug-using women in rural jails.

Methods

This study involved random selection, screening, and face-to-face interviews with 136 women from rural jails in one Appalachian state. Analyses focused on the relationship between mental health and HIV risk among this sample of drug-using women.

Findings

Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health was significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity.

Implications

Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Due to service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention.

Table 1

Sample profile of mental health, substance use, and HIV risk behavior (N=136)

Demographics	Mean or Percent
Age	31.3
White	98.5%
Years of Education	11.2
Married	39.7%
Employed in 6 mo. before Incarceration	29.4%
Days Incarcerated (current sentence)	76.5
Number of times incarcerated as an adult	6.3
Mental Health1
Anxiety	61.8%
Depression	77.2%
Post-Traumatic Stress	62.5%
Endorses symptoms for two mental health problems	23.5%
Endorses symptoms for all three mental health problems	47.1%
Substance use (average # days in past 6 months)
Oxycodone	78.8
Anti-anxiety medication	71.6
Buprenorphine	53.9
Marijuana	57.2
Lortab/Hydrocodone	43.6
Percocet	33.8
Methamphetamine	32.8
Alcohol	18.3
Methadone	16.2
Downers/sleeping pills	10.7
Used multiple drugs in past 6 mo.	80.9%
Mean # of days in past 6 mo. used multiple drugs	108.6
# of days in 6 mo. prior was high on drugs	135.3
HIV Risk Behavior
Ever injected a drug in lifetime	75.7%
Injected drug in past 6 months	62.5%
Shared needles in past year (n=59)	70.3%
Shared works in the past year (n=59)	96.6%
Average number of lifetime male sex partners	24.4 (range 2-250)
Average number of sex partner in past year	3.6 (range 0-100)
Ever traded sex for money/drugs/food	53 (39.0%)
Any past year exchange of sex for drugs or money	31 (22.8%)

1Note: Mental health issues based on meeting GAIN criteria.

Full article at:   http://goo.gl/2WMeEv

By:   Michele Staton-Tindall, Kathi LH Harp, Alexandra Minieri, Carrie Oser, J. Matthew Webster, Jennifer Havens, and Carl Leukefeld

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Tenants with Additional Needs: When Housing First Does Not Solve Homelessness

BACKGROUND:

At Home/Chez-Soi was a 24 month randomized controlled trial of Housing First (HF) conducted in five Canadian cities.

AIMS:

This article attempts to identify the characteristics of participants who experienced housing instability one year after entering HF.

METHODS:

Those defined as experiencing housing instability were housed <50% of the last 9 months of the first year, excluding time in institutions, unless they were housed 100% of the past 3 months.

RESULTS:

Only 13.5% of HF participants (n = 157/1162) met criteria for housing instability. Several variables were significant predictors of instability in between-group comparisons and multiple regression analyses: residence in Winnipeg, cumulative lifetime homelessness, percent of previous 3 months spent in jail, and community psychological integration; while residence in Moncton and a diagnosis of PTSD or panic disorder predicted stability. The predictive models were weak, identifying correctly only 3.8% of individuals that failed to achieve housing stability.

CONCLUSIONS:

It is not possible to predict confidently at baseline who will experience early housing instability in HF. There are certain individual characteristics that might be considered risk factors. Providing HF to all individuals who qualify for a HF program remains the most valid way to administer admission to housing.

Purchase full article at:  http://goo.gl/8Iirpn

By:  Volk JS1, Aubry T1, Goering P2, Adair CE3, Distasio J4, Jette J1, Nolin D5, Stergiopoulos V6, Streiner DL2,7, Tsemberis S8.

• 1 School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa , Ottawa , ON , Canada .
• 2 Department of Psychiatry , Centre for Addiction and Mental Health, University of Toronto , Toronto , ON , Canada .
• 3 Departments of Psychiatry and Community Health Sciences , University of Calgary , Calgary , Alberta , Canada .
• 4 Department of Geography & Institute of Urban Studies , University of Winnipeg , Winnipeg , Manitoba , Canada .
• 5 Centre de Recherche et de Développement, Université de Moncton, Moncton , New Brunswick , Canada .
• 6 Department of Psychiatry & Centre for Research on Inner City Health , St.-Michael's Hospital , Toronto , Ontario , Canada .
• 7 Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , ON , and.
• 8 Pathways to Housing Inc. , New York , NY , USA.

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

All-Cause, Drug-Related & HIV-Related Mortality Risk by Trajectories of Jail Incarceration & Homelessness among Adults in New York City

We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. 

Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period; all-cause and HIV-related SMRs in other patterns were not statistically significantly different. 

When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk.

Full article at: http://goo.gl/WyuLRa

By: Lim S, Harris TG, Nash D, Lennon MC, Thorpe LE.

  

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Methadone Continuation versus Forced Withdrawal on Incarceration in a Combined US Prison & Jail

Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable symptoms of withdrawal and renders prisoners susceptible to relapse and overdose on release. We aimed to study the effect of forced withdrawal from methadone upon incarceration on individuals' risk behaviours and engagement with post-release treatment programmes.

In this randomised, open-label trial, we randomly assigned (1:1) inmates of the Rhode Island Department of Corrections (RI, USA) who were enrolled in a methadone maintenance-treatment programme in the community at the time of arrest and wanted to remain on methadone treatment during incarceration and on release, to either continuation of their methadone treatment or to usual care--forced tapered withdrawal from methadone. Participants could be included in the study only if their incarceration would be more than 1 week but less than 6 months. We did the random assignments with a computer-generated random permutation, and urn randomisation procedures to stratify participants by sex and race. Participants in the continued-methadone group were maintained on their methadone dose at the time of their incarceration (with dose adjustments as clinically indicated). Patients in the forced-withdrawal group followed the institution's standard withdrawal protocol of receiving methadone for 1 week at the dose at the time of their incarceration, then a tapered withdrawal regimen (for those on a starting dose >100 mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3 mg per day to 0 mg; for those on a starting dose >100 mg, the dose was reduced by 3 mg per day to 0 mg). The main outcomes were engagement with a methadone maintenance-treatment clinic after release from incarceration and time to engagement with methadone maintenance treatment, by intention-to-treat and as-treated analyses, which we established in a follow-up interview with the participants at 1 month after their release from incarceration. Our study paid for 10 weeks of methadone treatment after release if participants needed financial help. This trial is registered with ClinicalTrials.gov, number NCT01874964.

Between June 14, 2011, and April 3, 2013, we randomly assigned 283 prisoners to our study, 142 to continued methadone treatment, and 141 to forced withdrawal from methadone. Of these, 60 were excluded because they did not fit the eligibility criteria, leaving 114 in the continued-methadone group and 109 in the forced-withdrawal group (usual care). Participants assigned to continued methadone were more than twice as likely than forced-withdrawal participants to return to a community methadone clinic within 1 month of release (106 [96%] of 110 in the continued-methadone group compared with 68 [78%] of 87 in the forced-withdrawal group; adjusted hazard ratio [HR] 2·04, 95% CI 1·48-2·80). We noted no differences in serious adverse events between groups. For the continued-methadone and forced-withdrawal groups, the number of deaths were one and zero, non-fatal overdoses were one and two, admissions to hospital were one and four; and emergency-room visits were 11 and 16, respectively.

Although our study had several limitations--eg, it only included participants incarcerated for fewer than 6 months, we showed that forced withdrawal from methadone on incarceration reduced the likelihood of prisoners re-engaging in methadone maintenance after their release. Continuation of methadone maintenance during incarceration could contribute to greater treatment engagement after release, which could in turn reduce the risk of death from overdose and risk behaviours.

Below: Probability of attending a methadone clinic in (A) the intention-totreat and (B) the as-treated populations. Data are for 1 month follow-up after particpants’ release from incarceration.

Full article at: http://goo.gl/74GZF3

By: Rich JD1, McKenzie M2, Larney S3, Wong JB4, Tran L5, Clarke J6, Noska A2, Reddy M2, Zaller N7.

• 1Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA. Electronic address: jrich@lifespan.org.
• 2Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.
• 3Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA; National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.
• 4Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
• 5The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.
• 6Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA; Memorial Hospital, Pawtucket, RI, USA.
• 7Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, AR, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.  

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Patterns of Homelessness and Implications for HIV Health After Release from Jail

This empirical study examines the association between substance abuse, mental illness, health behaviors and different patterns of homelessness among recently released, HIV-infected jail detainees. Using longitudinal data from a 10-site study, we examine correlates of homelessness, transitions to and from stable housing and the effect of housing on HIV treatment outcomes. Based on our analysis, we found evidence that the transitions from homelessness are closely associated with a reduction in the use of alcohol and illicit drugs, a decline in drug addiction severity, and an improvement in mental health. In addition, we found evidence that disparities in the housing status contributed substantially to the observed gap in the HIV treatment outcomes between homeless and non-homeless patients, including in achievement of virological suppression over time…

A sixth of all people living with HIV/AIDS (PLWHA) in the United States cycle through prison or jail annually, with nearly all doing so initially through a jail [14]. Therefore, reducing the vulnerability of the recently released HIV-infected jail detainees is a crucial component of coordinating post-release services and promoting optimal HIV treatment outcomes. Jail detainees, often released without a transitional plan, frequently face unstable housing circumstances, problems finding employment and loss of medical and social entitlements. Indeed, compared to their housed counterparts, homeless HIV-infected individuals who enter jail experience poor HIV treatment outcomes before incarceration [5]. The interdependence between incarceration and housing instability, drug and alcohol use, mental health and HIV poses many challenges for designing effective interventions that result in improved social and health outcomes [6].

Homelessness and incarceration are syndemic and mutually reinforcing of poor treatment outcomes. Depending on location, available estimates suggest that between 23 % and 68 % of homeless individuals have a history of incarceration [15, 16]. Similarly, among the criminal justice population, between 10 % and 50 % experienced homelessness at some point in the year prior to incarceration [17]...

Below: Behavioral model for vulnerable populations: adaptation for homeless outcomes (Color figure online)

Below: Patterns of housing from baseline to 6 months after release from jail (N = 867) (Color figure online)

Full article at: http://goo.gl/1CjR9c

By: Alexei Zelenev, Ruthanne Marcus, Artem Kopelev, Jacqueline Cruzado-Quinones, Anne Spaulding, Maureen Desabrais,Tom Lincoln, and Frederick L. Altice

Alexei Zelenev, Section of Infectious Diseases, AIDS Program, Department of Internal Medicine, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA;

Contributor Information.

Email: ude.elay@venelez.iexela

   

More at:  https://twitter.com/hiv_insight