The relationship between violence and engagement in drug dealing and sex work among street-involved youth

OBJECTIVES:

Street-involved youth are highly vulnerable to violence. While involvement in income-generating activities within illicit drug scenes is recognized as shaping youths' vulnerability to violence, the relative contributions of different income-generating activities remain understudied. We sought to examine the independent effects of drug dealing and sex work on experiencing violence among street-involved youth.

METHODS:

Data were derived from a prospective cohort of street-involved youth aged 14-26 who used drugs in Vancouver, British Columbia, between September 2005 and May 2014. Multivariable generalized estimating equations were used to examine the impact of involvement in drug dealing and sex work on experiencing violence.

RESULTS:

Among 1,152 participants, including 364 (31.6%) women, 740 (64.2%) reported having experienced violence at some point during the study period. In multivariable analysis, involvement in drug dealing but not sex work remained independently associated with experiencing violence among females (adjusted odds ratio [AOR]: 1.43; 95% confidence interval [CI]: 1.08-1.90) and males (AOR: 1.50; 95% CI: 1.25-1.80), while involvement in sex work only was not associated with violence among females (AOR: 1.15; 95% CI: 0.76-1.74) or males (AOR: 1.42; 95% CI: 0.81-2.48).

CONCLUSION:

Findings indicate that involvement in drug dealing is a major factor associated with experiencing violence among our sample. In addition to conventional interventions, such as addiction treatment, novel approaches are needed to reduce the risk of violence for drug-using youth who are actively engaged in drug dealing. The potential for low-threshold employment and decriminalization of drug use to mitigate violence warrants further study.

Purchase full article at:   http://goo.gl/emWqd9

By: Hayashi K1, Daly-Grafstein B, Dong H, Wood E, Kerr T, DeBeck K.

• 1Department of Medicine, University of British Columbia; British Columbia Centre for Excellence in HIV/AIDS. khayashi@cfenet.ubc.ca.
• Can J Public Health. 2016 Jun 27;107(1):e88-93. doi: 10.17269/cjph.107.5219. 

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

And:        http://twitter.com/Prison_Health

Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada

Background

Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers’ experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC.

Methods

Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers’ Health Access). Multivariable logistic regression analyses, using generalized estimating equations (GEE), were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013).

Results

In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%). In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10–1.94), workplace- (AOR = 1.31, 95% CI 1.05–1.63), and community-level violence (AOR = 1.41, 95% CI 1.04–1.92), as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03–1.69), a mental illness diagnosis (AOR = 1.66, 95% CI 1.34–2.06), and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59–7.57) emerged as independent correlates of institutional barriers to health services.

Discussion

Despite Canada’s UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex workers’ health and human rights.

Below: Frequency of institutional-level barriers to health care among sex workers in Vancouver, Canada, 2010–2013

Full article at:   http://goo.gl/2p7VoO

By: 

M. Eugenia Socías, Paul Nguyen, Julio Montaner, Kate Shannon 
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada

M. Eugenia Socías, Julio Montaner, Kate Shannon 

Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada

Jean Shoveller 

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

Chili Bean

Sex Workers United Against Violence Society, Vancouver, BC, Canada

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

And: http://twitter.com/Prison Health

Prescription Opioid Injection among HIV-Positive People Who Inject Drugs in a Canadian Setting

Prescription opioids (POs) are commonly prescribed to patients living with HIV/AIDS, while the illicit use of POs remains a major public health concern throughout Canada and the United States. 

We sought to identify the prevalence and correlates of PO injection among HIV-positive people who inject drugs (PWID) in Vancouver, Canada, where HIV/AIDS treatment and care is offered at no cost. We examined data from 634 individuals from an ongoing prospective cohort of HIV-positive PWID. 

Between December 2005 and November 2013, the median prevalence of recent PO injection was 24.2% [interquartile range (IQR): 21.5-25.8 %]. 

In a multivariable generalized estimating equation model, 

• Caucasian ethnicity, 
• heroin injection, 
• and drug dealing were positively associated with PO injection, 

While older age and methadone maintenance treatment were negatively associated with PO injection (all p < 0.05). Engagement on antiretroviral therapy was inversely associated with PO injection in a bivariable analysis, but did not remain significant after adjusting for heroin injection. 

These findings describe a particularly vulnerable sub-group of PWID who may benefit from targeted efforts to both minimize drug-related risk behaviors and support HIV/AIDS treatment.

Purchase full article at:   http://goo.gl/k7Eozb

By:  Lake S^1,2, Kerr T^1,3, Buxton J², Guillemi S¹, Parashar S¹, Montaner J^1,3, Wood E^1,3, Milloy MJ^4,5.

¹British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

²School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada.

³Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

⁴British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

⁵Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

AIDS Behav. 2016 May 5. [Epub ahead of print] 

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

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

Vancouver’s First Supervised Injection Site - Video

Via:  https://goo.gl/dFNMVW

Injecting drugs in tight spaces: HIV, cocaine and collinearity in the Downtown Eastside, Vancouver, Canada

This commentary revisits the political turmoil and scientific controversy over epidemiological study findings linking high HIV seroincidence to syringe exchange attendance in Vancouver in the mid-1990s. The association was mobilized polemically by US politicians and hard-line drug warriors to attack needle exchange policies and funding. In turn, program restrictions limiting access to syringes at the Vancouver exchange may have interfaced with a complex conjunction of historical, geographic, political economic and cultural forces and physiological vulnerabilities to create an extraordinary HIV risk environment: 

1. ghettoization of services for indigent populations in a rapidly gentrifying, post-industrial city; 
2. rural-urban migration of vulnerable populations subject to historical colonization and current patterns of racism; and 
3. the flooding of North America with inexpensive powder cocaine and heroin, and the popularity of crack. 

In fact, we will never know with certainty the precise cause for the extreme seroincidence rates in Vancouver in the early to mid-1990s. 

The tendency for modern social epidemiology to decontextualize research subjects and assign excessive importance to discrete, "magic bullet" variables resulted in a counterproductive scientific and political debate in the late 1990s that has obfuscated potentially useful practical lessons for organizing the logistics of harm reduction services - especially syringe exchange - to better serve the needs of vulnerable populations and to mitigate the effects of political-economically imposed HIV risk environments. 

We would benefit from humbly acknowledging the limits of public health science and learn to recognize the unintended consequences of well-intentioned interventions rather than sweep embarrassing histories under the rug.

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

By:  Ciccarone D¹, Bourgois P².

¹Family and Community Medicine, UCSF 500 Parnassus Avenue, MU-3E, Box 0900, San Francisco, CA 94143-0900, United States. Electronic address: Daniel.Ciccarone@ucsf.edu.

²Psychiatry, Center for Social Medicine, UCLA, 760 Westwood Plaza, B7-435, Los Angeles, CA 90025, United States.

Int J Drug Policy. 2016 Mar 8. pii: S0955-3959(16)30060-3. doi: 10.1016/j.drugpo.2016.02.028.

  

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

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

No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada

BACKGROUND:

The evidence to date on whether HIV infection increases the risk of accidental drug overdose among people who inject drugs (PWID) is equivocal. Thus, we sought to estimate the effect of HIV infection on risk of non-fatal overdose among two parallel cohorts of HIV-positive and -negative PWID.

METHODS:

Data were collected from a prospective cohort of PWID in Vancouver, Canada between 2006 and 2013. During biannual follow-up assessments, non-fatal overdose within the previous 6months was assessed. Bivariable and multivariable generalized mixed-effects regression models were used to determine the unadjusted and adjusted associations between HIV status, plasma HIV-1 RNA viral load, and likelihood of non-fatal overdose.

RESULTS:

A total of 1760 eligible participants (67% male, median age=42, and 42% HIV-positive at baseline) were included. Among 15,070 unique observations, 649 (4.3%) included a report of a non-fatal overdose within the previous 6months (4.4% among seropositive and 4.3% among seronegative individuals). We did not observe a difference in the likelihood of overdose by HIV serostatus in crude (odds ratio [OR]: 1.05, p=0.853) analyses or analyses adjusted for known overdose risk factors (adjusted OR [AOR]: 1.19, p=0.474). In a secondary analysis, among HIV-positive PWID, we did not observe an association between having a detectable viral load and overdose (AOR: 1.03, p=0.862).

CONCLUSIONS:

Despite the evidence that HIV infection is a risk factor for fatal overdose, we found no evidence for a relationship between HIV disease and non-fatal overdose. However, overdose remains high among PWID, indicating the need for ongoing policy addressing this problem, and research into understanding modifiable risk factors that predict non-fatal overdose.

Purchase full article at:   http://goo.gl/P8cfBQ

By:  Escudero DJ1, Marshall BD1, Kerr T2, Hayashi K2, Feng C3, Guillemi SA3, Hogg RS3, Montaner J2, Wood E2, Milloy MJ4.

• 1Department of Epidemiology, Brown University School of Public Health, 2nd Floor, 121 S. Main St., Providence, RI 02906, United States.
• 2British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
• 4British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: uhri-mjsm@cfenet.ubc.ca. 
• Addict Behav. 2016 Apr 1;60:8-12. doi: 10.1016/j.addbeh.2016.03.029. 

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

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

Prevalence and Co-Occurrence of Heavy Drinking and Anxiety and Mood Disorders among Gay, Lesbian, Bisexual, and Heterosexual Canadians

OBJECTIVES:

To investigate the prevalence and co-occurrence of heavy drinking, anxiety, and mood disorders among Canadians who self-identified as gay, lesbian, bisexual, or heterosexual.

METHODS:

Pooled data from the 2007 to 2012 cycles of the Canadian Community Health Survey (n = 222 548) were used to fit logistic regression models controlling for sociodemographic characteristics.

RESULTS:

In adjusted logistic regression models, gay or lesbian respondents had greater odds than heterosexual respondents of reporting anxiety disorders, mood disorders, and anxiety-mood disorders. Bisexual respondents had greater odds of reporting anxiety disorders, mood disorders, anxiety-mood disorders, and heavy drinking. Gay or lesbian and bisexual respondents had greater odds than heterosexuals of reporting co-occurring anxiety or mood disorders and heavy drinking. The highest rates of disorders were observed among bisexual respondents, with nearly quadruple the rates of anxiety, mood, and combined anxiety and mood disorders relative to heterosexuals and approximately twice the rates of gay or lesbian respondents.

CONCLUSIONS:

Members of sexual minority groups in Canada, in particular those self-identifying as bisexual, experience disproportionate rates of anxiety and mood disorders, heavy drinking, and co-occurring disorders.

Purchase full article at:   http://goo.gl/1nHKaR

By:  Pakula B1, Shoveller J1, Ratner PA1, Carpiano R1.

• 1Basia Pakula is a PhD candidate with the School of Population and Public Health, University of British Columbia, Vancouver. Jean Shoveller is with the School of Population and Public Health, University of British Columbia and the Epidemiology/Population Health and Drug Treatment Program, BC Centre for Excellence in HIV/AIDS, Vancouver. Pamela A. Ratner is with the Faculty of Education and the Enrollment and Academic Facilities, University of British Columbia. Richard Carpiano is with the Department of Sociology, University of British Columbia. 
• Am J Public Health. 2016 Mar 17:e1-e7.

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

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

Eviction & Loss of Income Assistance among Street-Involved Youth in Canada

Loss of housing and income assistance among vulnerable youth has not been well described in the literature, yet it is a crucial issue for public health. 

This study examines the prevalence and correlates of loss of income assistance as well as eviction among street-involved youth. We collected data from a prospective cohort of street-involved youth aged 14-26. 

Among 770 participants, 64.3 per cent reported having housing and 77.1 per cent reported receiving income assistance at some point during the study period. Further, 28.6 and 20.0 per cent of youth reported having been evicted and losing income assistance, respectively. 

In multivariable generalized estimating equations analysis, heavy alcohol use, unprotected sex, being a victim of violence, and homelessness were all independently associated with eviction. 

Separately, homelessness, recent incarceration, and drug dealing were independently associated with loss of income assistance. 

Eviction and loss of income assistance are common experiences among street-involved youth with multiple vulnerabilities. Our findings highlight the importance of improving continued engagement with critical social services.

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

By:  Zivanovic R1,2, Omura J2, Wood E2,3, Nguyen P2, Kerr T2,3, DeBeck K2,4.

• 1University of British Columbia's (UBC) MD program, Vancouver, Canada.
• 2Urban Health Research Initiative, BC Centre of Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, Canada V6Z 1Y6.
• 3Department of Medicine, University of British Columbia, Vancouver, Canada V5Z 1M9.
• 4School of Public Policy, Simon Fraser University, Vancouver, Canada V6B 5K3.
• J Public Health Policy. 2016 Mar 10. doi: 10.1057/jphp.2016.12. 

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

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

Socioeconomic Marginalisation in the Structural Production of Vulnerability to Violence among People Who Use Illicit Drugs

OBJECTIVE:

Many people who use illicit drugs (PWUD) face challenges to their financial stability. Resulting activities that PWUD undertake to generate income may increase their vulnerability to violence. We therefore examined the relationship between income generation and exposure to violence across a wide range of income generating activities among HIV-positive and HIV-negative PWUD living in Vancouver, Canada.

METHODS:

Data were derived from cohorts of HIV-seropositive and HIV-seronegative PWUD (n=1876) between December 2005 and November 2012. We estimated the relationship between different types of income generation and suffering physical or sexual violence using bivariate and multivariate generalised estimating equations, as well as the characteristics of violent interactions.

RESULTS:

Exposure to violence was reported among 977 (52%) study participants over the study period. In multivariate models controlling for sociodemographic characteristics, mental health status, and drug use patterns, violence was independently and positively associated with participation in street-based income generation activities (ie, recycling, squeegeeing and panhandling), sex work, drug dealing, and theft and other acquisitive criminal activity. Engagement in regular, self-employment or temporary employment was not associated with being exposed to violence. Strangers were the most common perpetrators of violence (46.7%) and beatings the most common type of exposure (70.8%).

CONCLUSIONS:

These results suggest that economic activities expose individuals to contexts associated with social and structural vulnerability to violence. The creation of safe economic opportunities which can minimise vulnerability to violence among PWUD is therefore urgently required.

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

By:  Richardson LA1, Long C2, DeBeck K3, Nguyen P4, Milloy MJ5, Wood E5, Kerr TH5.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada.
• 2British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Public Policy, Simon Fraser University, Burnaby, British Columbia, Canada.
• 4British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
• 5British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Medicine (Division of AIDS), University of British Columbia, British Columbia, Canada. 
• J Epidemiol Community Health. 2015 Jul;69(7):686-92. doi: 10.1136/jech-2014-205079. Epub 2015 Feb 17.

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

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

Implementation Challenges & Opportunities for HIV Treatment as Prevention (TasP) among Young Men in Vancouver, Canada

Background

Despite evidence supporting the preventative potential of HIV Treatment as Prevention (TasP), scientific experts and community stakeholders have suggested that the success of TasP at the population level will require overcoming a set of complex and population-specific implementation challenges. For example, the factors that might influence decisions to initiate ‘early’ treatment have yet to be thoroughly understood; neither have questions about the factors that enhance or impede their ability to achieve long-term adherence to ARVs or the social norms regarding various treatment regimens been examined in detail. This knowledge gap may hamper opportunities to effectively develop public health practices that are informed by the various challenges and opportunities related to TasP implementation and scale up.

Methods

Drawing on 50 in-depth, individual interviews with young men ages 18–24 in Vancouver, Canada, this study examines young men’s perspectives regarding factors that might affect their engagement with TasP.

Results

While findings from the current study indicate young men generally have a high receptiveness to TasP, our findings also identify key social and structural forces that will warrant ongoing consideration for TasP implementation. For example, participants described how an enhanced awareness regarding treatment (including awareness of the universal availability of treatment in Vancouver) would be a necessary, but not sufficient, condition to decide to endorse TasP. Their decisions about engaging in HIV care in the context of TasP (e.g., HIV testing, treatment initiation, long-term adherence) also appear to be contingent on their ability to negotiate or ‘balance’ the risks and benefits to themselves and others. The findings also offer insight into the complex and sometimes controversial narratives that continue to emerge regarding risk compensation practices in the context of TasP.

Conclusion

Based on the results of this study, we identify several areas that hold promise for informing the effective scale up of TasP, including new information regarding implementation adaptation strategies.

[sample of interview responses]

But I don’t know if that [information about HIV treatment and prognoses] makes me any less concerned about certain aspects of the disease just because I also know that it’s [treatment] expensive, and that definitely plays into me, ‘cause I know that if I needed to afford expensive medication, I just couldn’t right now. (#018)

You’re still fucked [in the event of an HIV diagnosis]. I don’t even know if it’s covered by MSP [Medical Services Plan, the provincial health care plan in the province of British Columbia]. I highly doubt it. So if you’re on welfare and you have HIV, I think you’re pretty fucking screwed. And I would not want to have to figure it out, either. (#041)

The person may feel like, ‘Well, you’re only making me undergo treatment because you just wanna protect those around me and decrease their chance of contracting the infection, as opposed to treating me and being concerned about me.’ So I can see the person viewing the measure as ‘all but me.’ (#001)

Full article at:   http://goo.gl/xmw22R

By:  Rod Knight, Will Small, Kim Thomson, Mark Gilbert, and Jean Shoveller

Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada

British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada

Ontario HIV Treatment Network, Toronto, Canada

Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

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

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

Factors Associated with Productive Recruiting in a Respondent-Driven Sample of Men who Have Sex with Men in Vancouver, Canada

Respondent-driven sampling (RDS) has become a preferred sampling strategy for HIV research and surveillance in many global settings. Methodological investigation into the validity of RDS-generated samples has helped improve theoretical components of design. However, the operational challenges of implementing RDS remain underreported. 

We sought to identify factors independently associated with productive recruiting in an urban RDS-generated sample of gay, bisexual, and other men who have sex with men (MSM). Data were collected from the Momentum Health Study, a cohort of MSM recruited by RDS in Vancouver, Canada. Eligible men were given up to six RDS coupons to recruit their peers. 

The primary outcome was a count variable of each participant's number of eligible recruits. Multivariable Poisson regression identified independent predictors of productive recruitment. In total, 719 individuals comprised this analysis, of which 119 were seeds. The distribution of eligible recruits was right skewed, with 391 (54.4 %) having never recruited another participant and only eight participants (1.1 %) having recruited five. 

Significant, independent predictors of recruiting one additional participant included network size per ten unit increase (adjusted risk ratio [aRR] 1.03), being of Aboriginal race/ethnicity compared with White (aRR 1.51), being HIV-positive (aRR 1.31), being sexually active with only males (aRR 2.48), being single compared with common law/married (aRR 1.37), having recently read gay newspapers (aRR 1.58), having recently sought sex partners online (aRR 1.33) and being out to a male parent (aRR 1.30). 

This analysis demonstrates the importance of social network size in RDS adjustment, but also identifies other socio-demographic and behavioral variables that increased RDS coupon return, which may help researchers better operationalize the implementation of RDS.

Purchase full article at:  http://goo.gl/Ln9czR

By:  Forrest JI1, Lachowsky NJ2,3, Lal A3, Cui Z3, Sereda P3, Raymond HF4,5, Ogilvie G2, Roth EA6, Moore D2,3, Hogg RS3,7.

• 1Faculty of Medicine, University of British Columbia, Vancouver, Canada. jamie.forrest@alumni.ubc.ca.
• 2Faculty of Medicine, University of British Columbia, Vancouver, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
• 4San Francisco Department of Public Health, San Francisco, USA.
• 5University of California San Francisco, San Francisco, USA.
• 6Department of Anthropology, University of Victoria, Victoria, Canada.
• 7Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. 
• J Urban Health. 2016 Mar 9. 

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

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

Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load among HIV-Positive People Who Use Drugs

We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. 

We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. 

Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9 %) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless as well as not homeless post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. 

These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction.

Purchase full article at:   http://goo.gl/LWwZ9d

By:  Kennedy MC^1,2, Kerr T^1,3, McNeil R¹, Parashar S¹, Montaner J^1,3, Wood E^1,3, Milloy MJ^4,5.

¹British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

²School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada.

³Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.

⁴British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

⁵Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. uhri-mjsm@cfenet.ubc.ca.

AIDS Behav. 2016 Feb 23.

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

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