Tesi: "Injecting drug use"

1

Xia, Yang. "Characterising patterns of injecting drug use". Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648787.

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2

Steensma, Colin. "Predictors of cessation of injection drug use in a cohort of young, street-based injecting drug users". Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=19415.

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Objectives: To identify the factors associated with cessation of injecting drug use in young street-based injecting drug users. Methods: Subjects were originally recruited from various street-based outreach programs and had to have reported injecting drugs within the prior 6 months at baseline or during follow-up, as well as having completed at least 2 follow-up questionnaires. Follow-up occurred from January 1995 to September 2000. Cessation of injecting drug use was defined as having reported no injection at 2 consecutive follow-up questionnaires, averaging at least one year in total. Incidence rates of cessation were calculated and stratified by duration of injection. Adjusted hazard ratios were calculated in order to identify independent predictors of cessation. Results: A total of 305 subjects met the inclusion criteria. Of those, 119 (39%) ceased injecting for approximately one year or more. The incidence of cessation was 32.6/100 person-years, but consistently declined as duration of time spent injecting increased. Independent predictors of IDU cessation were: having at least one parent born outside of Canada (HR=1.4; 95% Confidence Interval (CI): 1.1-1.7); injecting on a less than monthly or less than weekly basis on average within the last month (HR=6.6; 95% CI: 3.1-14.1 and HR=2.4; 95% CI: 1.1-5.5, respectively); injecting an average of two or fewer different types of drug within the last six months (HR=1.8; 95% CI: 0.9-3.5); and having been employed within the last six months (HR=1.7; 95% CI: 1.1-2.7). Independent predictors of not stopping injecting drugs were: homelessness within the last six months (HR=0.6; 95% CI: 0.4-1.0); and having attended a needle exchange program within the last six months (HR=0.5; 95% CI: 0.3-0.8). Conclusion: Cessation of injecting drug use among youth is considerably higher in the first years of injecting. Young IDUs with non-Canadian family backgrounds, as well as those who inject less frequently, inject fewer different types of drugs, and have a more stable lifestyle tend to be more likely to stop injecting drugs for a period of one year.

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Sheerin, Ian G., e n/a. "Consequences of drug use and benefits of methadone maintenance therapy for Maori and non-Maori injecting drug users". University of Otago. Christchurch School of Medicine & Health Sciences, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070502.142602.

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The consequences of drug use and benefits of methadone maintenance therapy (MMT) were investigated in a random sample of Maori and non- Maori injecting drug users in Christchurch, Aotearoa New Zealand. Eighty- five injecting drug users (IDUs) who had been on MMT for a mean time of 57 months were interviewed and followed up over an average 18 month period. Markov models were used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. The savings in life from reductions in drug overdoses were used as the main outcome measure in cost-effectiveness analysis. Cost-utility and cost-benefit analysis were also used to provide additional information on the costs and outcomes of treatment. Comparisons were made between: (a) MMT alone; (b) MMT provided with conventional combination therapy for hepatitis C virus (HCV); and (c) MMT provided with anti-viral therapy with pegylated interferon. The monetary costs of drug use and benefits of MMT were similar for Maori and non-Maori. However, Markov modelling indicated that MMT is associated with greater savings in life for Maori than for non-Maori. Further, Maori IDUs identified the main personal costs of drug use as being loss of their children and loss of marriage or partners. Large reductions in use of opioids and benzodiazipines were reported at interview, compared with before starting MMT. The participants also reported large reductions in crime and stabilisation of their lifestyles. Improvements in the general health of IDUs om MMT were reported. However, 89% were positive for HCV infection, which was identified as the major physical health problem affecting IDUs in New Zealand. Few IDUs had received anti-viral therapy for HCV infections, despite having stabilised on MMT. This study investigated the benefits of providing anti-viral therapy for HCV to all patients meeting treatment criteria. The cost-effectiveness of MMT alone was estimated at $25,397 per life year saved (LYS) for non- Maori men and $25,035 for non-Maori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing anti-viral therapy for HCV to all eligible patients were to save extra years of life, as well as to involve additional costs. The net effect was that anti-viral therapy could be provided, at a similar level of cost-effectiveness, to all patients who meet HCV treatment criteria. Cost-effectiveness could be improved if IDUs could be stabilised on MMT five years earlier at an average age of 26 instead of the current age of 31 years. The cost-effectiveness of treatment with pegylated interferon was similar to that for conventional combination therapy because there were incremental savings in life as well as increased treatment costs. Costs per LYS were estimated to be lower for Maori than for non-Maori, reflecting ethnic differences in mortality. Sensitivity analysis revealed that provision of MMT with anti-viral treatment remained cost-effective under varying assumptions of mortality, disease progression and compliance with treatment. the main problems that were not improved during MMT were continuing use of tobacco and cannabis, low participation in paid employment, only three participants had received specific treatment for their HCV infections. Cost-benefit analysis using a conservative approach showed a ratio of the benefits to the costs of MMT of 8:1. Benefits were demonstrated in terms of large reductions in crime. Benefit to cost ratios were similar for the different policy examined, as well as for both Maori and non-Maori IDUs.

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4

Green, Traci Craig. "My place, your place, or a safer place : the intention among Montreal injecting drug users to use supervised injecting facilities". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29426.

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Pilot studies of supervised injecting facilities (SIF) are under consideration in Canada, but it is elemental to first establish acceptability among the injecting drug use (IDU) population that are potential attendees. This study aimed to assess SIT acceptability and to determine factors associated with the willingness of public injectors to use SIF in a city considering their establishment. From April 2001--February 2002, qualitative, key informant interviews and survey data collection methods were employed. Questions were appended to a study monitoring HIV risk among Montreal IDU. Univariate and bivariate analyses preceded logistic regression. 11 key informants and 251 IDU participated in the study. Key informants generated specific SIT models subsequently presented to IDU. Overall, SIF acceptability was high. Two logistic regression models presented factors independently predictive of potential SIF use including drug use characteristics and SIF attributes. Initial community and user consultations are essential in assessing relevance and planning of SIF.

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Ahmed, S. M. Tanvir. "HIV Infection and Behavioural Risk Factors among Injecting Drug Users in Hai Phong, Vietnam". Thesis, Griffith University, 2015. http://hdl.handle.net/10072/366244.

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Injecting drug use worldwide accounts for a high proportion of new Human Immunodeficiency Virus (HIV) infection, driving the national epidemics in many countries where HIV prevalence among injecting drug users (IDUs) is prominent. HIV testing started in Vietnam in 1988 and the first HIV case was detected in 1990. The epidemic has now concentrated among young IDUs in northern Vietnam. Hai Phong is one of the provinces located in the north of Vietnam which has become a high HIV prevalence province affecting young IDUs. The present research estimates HIV infection rates among IDUs in Hai Phong. It examines behavioural risk factors associated with HIV infection, sharing and condom use as well as highlighting drug and sex related transmission risks. The research has several stages including secondary analysis of national level behavioural survey data (2011) and qualitative exploratory research (2012). Each phase of the research supplements the others, in order to attain the research objectives and to address behavioural issues associated with the current epidemic.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medicine
Griffith Health
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6

Bonar, Erin Elizabeth. "Using the Health Belief Model to Predict Injecting Drug Users' Use of Harm Reduction". Bowling Green State University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1282833406.

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7

Alexandrescu, Liviu Gabriel. "Legally high, officially lost: injecting NPS use and drug abjection in Post-Communist Romania". Thesis, Lancaster University, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.716377.

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Since the late 2000s the distribution of what seemed to be unregulated ‘recreational’ drugs by street and online retailers has prompted media hype and public anxiety in Europe and elsewhere. These ‘legal highs’ or ‘new psychoactive substances’ (NPS) were often associated with health risks and antisocial behaviour, and they eventually inspired policy debates along with new scheduling measures. This project explores NPS’ general reception in Romania and their more specific integration into injecting drug users' repertoires, a segment of the local drug market traditionally dominated by heroin. By drawing on mainstream media texts and field data collected around treatment facilities such as a methadone maintenance clinic, it focuses on the troubling moral identities of intravenous substance users and the disciplinary practices of the medico-legal apparatus meant to monitor them. In setting out a moral panic model re-imagined as bouts of collective disgust or social abjection, it seeks to connect lived experiences and moral understandings of emerging drugs with historical layers of prohibition discourses that stratify drug using bodies into abject identities. NPS are thus revealed to shape two types of moral panic as drug abjection in post-communist Romania. The first emerges from media discourse and concerns the clean or valuable youth of the nation, calling for the containment of the new drugs trade to assure the sanitisation and survival of the social body. The second surfaces among injecting drug users, with ‘legalists’ or NPS users being increasingly seen by both drug workers and opiate users as a source of disruption to the regulatory devices and collaborative goals of rehabilitation. This ultimately raises larger questions about the liberal governance of pleasure and consumption in Romania’s transition to market democracy. The fluidity o f ‘NPS’ as a medical and policy object thus seems to indicate the ontological spilling of the rational choice-making self out of the flows of capital, power and historical time

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8

Chakragiri, Arathi M. "Drug Use and Risk Behavior Patterns for HIV in Men Who Have Sex with Men". Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/iph_theses/32.

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Men who have sex with men (MSM) account for a majority of all men currently diagnosed with AIDS. MSM is also recognized as the largest risk category of all AIDS cases. Drug use has been shown to have a synergistic effect on the prevalence of HIV in the MSM population. The study aimed to examine the association between injection drug use, non-injection drug use, and non-drug use with sexual risk behaviors for HIV in men who have sex with men. Secondary, cross-sectional data procured from the National HIV Behavioral Surveillance System for the Atlanta Metropolitan Survey Area were used for the study. The study population was 960 participants. Using binary logistic regression analyses, the drug use categories were studied for unprotected intercourse, unprotected receptive anal intercourse and HIV status. Strong associations were seen independently for unprotected intercourse, unprotected receptive anal intercourse, and HIV status with injection and non injection drug use, but the association weakened for drug use categories when controlled for other independent factors. Taking into account current findings and findings from previous research, the importance of clinical significance over statistical significance was considered. Racial disparities were evident, in that, although the Black participants showed no increased odds for sexual risk factors or drug use, it had a higher odds for being HIV positive compared to Whites. Combining Viagra/Levitra with drugs was significantly associated with unprotected intercourse (AOR=1.9), and each individual drug showed a different degree of association with Viagra/Levitra. Further research is recommended to identify sub-populations at risk and appropriately allocate resources and channel programs and interventions.

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Kimber, Joanne Public Health &amp Community Medicine Faculty of Medicine UNSW. "Role of the Sydney Medically Supervised Injecting Centre in reducing injecting drug use-related harm: evaluating accessibility, utilisation, coverage and selected health impacts". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/23038.

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Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

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Wood, Richard Alan. "Issues of gender in injection drug use : examining contextual circumstances of women’s first injecting experience and factors associated with treatment engagement". Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23599.

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Women who inject drugs (IDU) are at elevated risk for drug-related harms. While there has been growing interest in first injecting experiences of IDU, less attention has been given to broader socio-cultural, structural and environmental risk conditions in which marginalized women live and injection risk practices and addiction treatment engagement occur. For this thesis, I sought to build on previous research by using gender-based analysis (GBA) to describe the risk environment of IDU women and examine gender differences in circumstances surrounding first injecting experiences and addiction treatment engagement among IDU in Vancouver. Between May 2005 and December 2007, cross-sectional data were drawn from a prospective cohort of 1,436 participants, including 496 women. GBA was used to identify gender differences in circumstances surrounding first injecting experiences and current addiction treatment enrolment. Risk environment, gendered violence and cultural safety conceptual lenses were used to inform the interpretation of findings. Regarding first injection experiences, associations were found between female gender and Aboriginal ancestry, receiving assisted injection, and intimate partner injection drug use as a reason for first injection, whereas syringe borrowing, injecting in public, first taught to inject by self, and curiosity as a reason for first injection were negatively associated with female gender. Current addiction treatment enrolment was reported by 597 (41.6%) participants – 220 women (89 Aboriginal) – and 377 men (69 Aboriginal). Among women age at first injection and having an intimate partner were associated with treatment enrolment, whereas Aboriginal ancestry, homelessness, and frequent heroin injection were negatively associated. Among men, age at first injection was associated, whereas Aboriginal ancestry, homelessness, frequent alcohol and frequent heroin were negatively associated. Methadone was the most common type of addiction treatment reported by both genders. Most common reasons for non-enrolment were ‘don’t feel a need to stop using drugs’ for women, and ‘don’t think treatment programs work for me’ for men. Findings suggest intimate partner power relations are significant factors in mediating women’s drug using risk practices as well as the perceived degree of safety in accessing health services. These findings contribute to existing literature and provide significant implications for practice, policy and future research.

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Hudson, Susan Lee National Centre in HIV Epidemiology &amp Clinical Research Faculty of Medicine UNSW. "Sex, drugs and 'ugly mugs': an ethnographic study of women who inject psychostimulants and engage in street-based sex work in Kings Cross, Sydney". Awarded by:University of New South Wales. National Centre in HIV Epidemiology & Clinical Research, 2009. http://handle.unsw.edu.au/1959.4/44834.

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Australian and international literature provides strong evidence that intravenous use of psychostimulants increases the harms experienced by users, including heightening the risk of blood-borne virus (BBV) infection. The few Australian studies that include women who inject psychostimulants identify street-based sex work as the main method of income generation and highlight the harms that result from combining these practices. However, there has been little exploration into the way these practices are shaped by the environments in which they occur or the ways in which women manage these harms. This thesis aims to provide an in-depth exploration of the daily lives of women who inject psychostimulants and engage in street-based sex work in Kings Cross, Sydney. Over 18 months between 2005 and 2007, the author conducted ethnographic fieldwork with women who injected psychostimulants and engaged in street-based sex work in Kings Cross, Sydney. Data sources included observations recorded as fieldnotes and transcripts of in-depth interviews with 12 women. Thematic analysis of the data was employed with particular attention to the women???s shared narratives. Key findings of the thesis were that 1) the Kings Cross environment plays a prominent role in shaping the lives of women, their psychostimulant injecting and street-based sex work practices; 2) psychostimulant injecting reinforces the opportunistic nature of street-based sex work as the primary method of income generating for women, restricting the development of occupational norms; 3) synergies exist between the drug and sex markets in Kings Cross, increasing the harms associated with both injecting and street-based sex work practices; 4) public health messages relating to sharing of injecting equipment and condom use fail to account for contextually driven decision-making and risk prioritising; 5) women develop lay epidemiological understandings as they attempt to reconcile the public health messages with the lived reality. The value of these findings is in the insights they provide into the everyday lives of these women in Kings Cross that have not been documented previously and their potential for informing ???bottom-up??? rather than ???top down??? approaches to future policy, practice and research.

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Ho, Hien Thi Public Health &amp Community Medicine Faculty of Medicine UNSW. "Culture, risk, and vulnerability to blood-borne viruses among ethnic Vietnamese injecting drug users". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/25501.

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There is increasing concern about hepatitis C virus (HCV) and potential HIV transmission among ethnic Vietnamese injecting drug users (IDUs) in Australia. To date ethnic and cultural differences in vulnerability to blood-borne viruses (BBV) have received little attention and few studies have attempted to explore the role of cultural beliefs and values in influencing injection risk behaviour. This study aimed to systematically explore the cultural beliefs and behavioural practices that appear to place ethnic Vietnamese IDUs at increased risk of BBV infection, identify barriers to this group accessing health and preventive programs, and document antibody HIV and HCV prevalence and associated risk behaviours. The first component of the research consisted of an ethnographic study designed to explore underlying explanatory models of health and illness employed by Vietnamese IDUs and identify cultural influences on risk behaviours and vulnerability to BBVs. These data were subsequently used to inform the development of the instrument used in the second component ??? a cross-sectional survey and collection of capillary blood samples designed to assess risk behaviours and antibody HIV and antibody HCV prevalence. Analysis of data from both components indicates that cultural beliefs and practices influence risk-taking and health-seeking behaviours and suggests pathways through which this influence occurs. Relevant cultural characteristics include those pertaining to spiritual and religious beliefs, the role of the family and traditional Vietnamese family values, cultural scripts of self-control and stoicism, the importance of ???face??? and non-confrontational relationships, trust and obligation, and a reluctance to discuss problems with outsiders. Vulnerability to BBVs is influenced by these cultural characteristics, together with Vietnamese IDUs??? perceptions of risk, knowledge about HIV and HCV, and situational and environmental factors. Main factors contributing to the under-utilisation of health services include the use of self-managed care practices, ambivalence surrounding Western medicine, long waiting times, concerns in relation to confidentiality, stigmatisation of drug use, and limited knowledge of BBVs. The data indicate a need for interventions based on understanding of culturally specific meanings and contexts of health, illness and risk in order to better meet the needs of this vulnerable group.

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Reyes-Ortiz, Victor Emanuel. "Social Network Correlates of HCV and HIV Transmission Risk Behaviors among Injecting Drug Users". Thesis, Walden University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3742821.

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Abstract (sommario):

Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. A total of 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants’ personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self-reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality.

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Svedberg-Lindqvist, Ann-Louise. "Preventiva samtal om risk för infektioner vid injektionsmissbruk–ökar utbildningsintervention personalens kunskap och motivation?" Thesis, Nordic School of Public Health NHV, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3575.

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Bakgrund: Personer som injicerar droger riskerar att drabbas av allvarliga infektioner. Tidigare studier har visat att personal som möter personer i risk inte har tillräckligt med kunskap för att erbjuda hälsofrämjande insatser. Syfte:Att kartlägga personalens kunskap om infektioner som kan drabba personer som injicerar droger,samt undersöka om utbildnings intervention ökar personalens kunskap och motivation till preventiva samtal. Metod:Totalt genomfördes fem utbildningar med 26 deltagare från psykiatri-, och infektionsavdelning, samt ungdomsmottagning. Studien genomfördes med enkät före och en månad efter utbildning. Enkäten innehöll kunskapsfrågor och frågor om erfarenhet av preventionssamtal med personer i risk. Resultat:Studien visade att personalen saknade tillräcklig kunskap om smitta vid injektion av droger och att personer i risk inte i tillräcklig omfattning erbjöds information och stöd. Innan utbildning skulle enbart 60 % av personalen samtala om smitta vid injektion av droger om de fick frågor av personer i risk. Hinder för samtal uppgavs vara brist på kunskap och osäkerhet på hur frågorna skulle tas emot vid samtal. Personalens upplevda och faktiska kunskap visade på en signifikant förbättring efter utbildningsinterventionen (p<0,001). Utbildningen upplevdes som relevant och 80 % av deltagarna önskade ytterligare utbildning i form av föreläsningar på arbetsplatsen och handledning av sakkunnig. Konklusion:För att kunna erbjuda personer som injicerar droger hälsofrämjande insatserkrävs att personal har tillgång till anpassad utbildningoch aktivt stödutifrån verksamhetensbehov
Background:People who inject drugs are at risk of contracting severe infections. Previous studies have shown that personnel meeting people at risk often lack sufficient knowledge to offer health promotion measures. Aims:This study aimed to investigate knowledge among personnel about infectious diseases contracted due to injecting drugs and determine whether educational intervention can increase knowledge and motivation for preventive communication. Methods:We administered a total of five courses to 26 healthcare workers employed in an infectious diseases department, psychiatric clinic, and youth counseling clinic. The study was conducted with questionnaires before and one month after completing the courses. The questionnaires included questions about disease facts, and workers’ experience regarding preventive conversations with people at risk. Results:The study revealed that respondent slacked sufficient knowledge about infections associated with injecting drugs, and that people at risk did not receive adequate information and support. Before education, only 60% of respondents would consider talking about infections contracted while injecting drugs if they got questions by persons at risk. Barriers to addressing such questions included lack of knowledge,and uncertainty about how the questions would be received. After the educational intervention, respondents perceived a significant improvement of knowledge (p<0,001). They perceived the coursesas relevant,and 80% of participants wanted more lectures and expert guidance in the workplace. Conclusion:Providing health promotion to persons who inject drugs requires appropriate educationfor personnel,as well as active support adapted to their needs.

ISBN 978-91-86739-82-9

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Goldstone, Irene, R. Albert, A. Churchill, A. Schilder, T. Perry, R. Markowski, R. S. Hogg e W. A. McLeod. ""HIV and injection drug use amongst First Nations in Vancouver"". School of Native Human Services, 2000. http://142.51.24.159/dspace/handle/10219/450.

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The purpose of this study was to examine First Nation's use of the hospital care from the point at which they were known to be HIV positive until death occurred. In British Columbia, First Nation's persons represent approximately 5% of the population. However, in 1997 First Nations made up 13.6% of new HIV diagnoses in BC. Because St. Paul's Hospital in Vancouver cares for the majority of persons with HIV/AIDS in BC, data were collected from a chart review of all HIV/AIDS related deaths occurring at St. Paul's and from the Drug Treatment Program of the British Columbia Centre for Excellence in HIV/AIDS.

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Callon, Cody Terry. "Evaluation of a drug user-led safer injecting education campaign". Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/37601.

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Background: Unsafe injection practices remain a significant source of morbidity and mortality among people who inject drugs (IDU), this thesis sought to: review the literature outlining the ways in which people inject unsafely, the health consequences associated with unsafe practices, the factors that influence injection practices, and the interventions that have been designed to address these problems; describe a drug user-led safer injecting education campaign; and finally, examine the facilitators’ and participants’ perceptions of a unique user-led intervention. Methods: Qualitative data was derived from semi-structured qualitative interviews conducted with eight members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops and 20 individuals who participated in these workshops. Interviews were transcribed verbatim and a thematic analysis was conducted. Results: A literature review identified numerous specific unsafe injection practices, which are associated with negative health outcomes, including HIV, hepatitis C, bacterial infections, and venous damage. Research demonstrates that various individual, physical, social, and structural factors influence injection practices, and has identified a number of interventions (e.g. syringe distribution, education) that reduce negative health consequences. Results indicate that IDU typically learn about injecting by watching or sharing experiences with other IDU and that significant gaps in knowledge regarding safer injecting practices persist. Accounts of IDU suggest that the unique process and structure of IS Team workshops enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants, most of whom expressed that they prefer user-led interventions to other approaches. Facilitators reported gaining knowledge, skills, and positive feelings about themselves from their involvement in the campaign, while many participants reported that they acquired new knowledge that would alter their future injecting practices. Discussion: The IS Team education campaign focuses on health issues relevant to IDU that are not being adequately addressed by existing public health programs. This study demonstrates the feasibility and benefits of involving IDU in educational initiatives targeting unsafe injecting. Increased involvement of IDU in interventions designed to address unsafe injecting is urgently required.

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Jeanty, Yves. "Correlates of Self-efficacy to Disclose Injection Drug Use to HIV Primary Care Providers Among a Sample of HIV Seropositive Injection Drug Users". Scholarly Repository, 2011. http://scholarlyrepository.miami.edu/oa_dissertations/628.

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This dissertation sought to identify correlates of perceived self-efficacy to disclose drug use to one’s HIV primary care provider (DISDR) among a sample of HIV-positive injection drug users (IDUs). Additionally the relationship between identified correlates and DISDR was evaluated to determine whether it persists longitudinally. Potential correlates consisted of individual characteristics (socio-demographic), health care service utilization, sex/drug use behaviors, and psychosocial characteristics. It was postulated that selected variables from these domains would be associated with DISDR. This study presents baseline and longitudinal data that suggest a positive association between self-efficacy to disclose injection drug use to one’s HIV primary care provider and the following variables: patient-provider relationship, attendance of a drug treatment program during the previous six months, “taking control of one’s healthcare,” and social support. However, current receipt of HIV medications and being recruited from the city of Miami were negatively associated with reporting a high DISDR. These findings will potentially inform interventions that can improve HIV treatment among drug users and inform policymakers and stakeholders regarding the importance of providing comprehensive HIV care in conjunction with substance abuse treatment options to achieve optimal health outcomes. A recommendation for further study is enclosed.

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18

Marshall, Brandon David Lewis. "The epidemiology of methamphetamine use among street youth and injection drug users". Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/30237.

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Background: Given the limited understanding of the epidemiology of methamphetamine (MA) use among street-involved youth and injection drug users (IDU), this thesis sought to: systematically characterise the evidence base demonstrating associations between MA use and adverse health outcomes among young people; examine the incidence and predictors of MA injection initiation among a cohort of IDU in Vancouver; describe the prevalence and correlates of MA use among sexual minority drug users; determine whether frequent MA injection predicts emergency department (ED) utilisation; and finally, explore the pathways through which MA use drives injection-related risk behaviour including syringe sharing. Methods: Street-involved youth and IDU participating in three open prospective cohort studies were asked to complete semi-annual interviewer-administered questionnaires, provide blood samples for HIV testing, and consent to hospital database linkages. A variety of longitudinal techniques were used to investigate the association between self-reported MA-related outcomes (e.g., initiation, frequent use) and individual, social, and structural determinants of interest. Results: A systematic review identified consistent associations between MA use and a number of health outcomes, including depression, suicidal ideation, and psychosis. Scientific evidence to suggest an association between MA use and a number of previously suggested harms (e.g., infectious disease transmission, dental problems) is equivocal. Some subpopulations, including sexual minority drug users, are more likely to use MA, which appears to exacerbate exposure to HIV-related risks and other vulnerabilities. Longitudinal analysis revealed that young people, non-injection stimulant users, homeless individuals, and those involved in the city’s open drug scene are most likely to initiate MA injection. The injection of MA, particularly frequently, was associated with a number of health and behavioural outcomes, including an increased hazard of ED utilisation and syringe sharing. Barriers to accessing harm reduction and HIV prevention services likely account for many of these relationships. Conclusions: Methamphetamine use is increasingly common among street youth and IDU in Vancouver. Its use and resultant harms appear to be driven by intersecting individual, social, and structural factors. Comprehensive interventions that are based upon sound scientific evidence and that address existing health and social inequities among marginalised populations are required.

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Milloy, Michael-John Sheridan. "Harm production : correctional environments, injection drug users and risk of infection with blood-borne pathogens". Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/3433.

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Background: Analyses of the individual-, social- and structural-level factors promoting the transmission of HIV and other blood-borne pathogens have consistently identified exposure to correctional environments, especially for individuals who use injection drugs (IDU), as a risk factor for infection. The objectives of this project were: to review the epidemiologic literature on incarceration and HIV infection among IDU, critically examining evidence presented supporting a causal linkage between imprisonment and infection; to investigate incarceration experiences in a cohort of active IDU; and to assess the possible effects of incarceration on the post-release risk environment of active IDU. Methods: Longitudinal datasets for quantitative analyses were derived from the Vancouver Injection Drug User Study (VIDUS) and the Scientific Evaluation of Supervised Injection (SEOSI), both prospective cohorts of IDU in Vancouver’s Downtown Eastside neighbourhood. In the first analysis, the prevalence and correlates of reporting incarceration in the the previous six months were identified in SEOSI using generalized estimating equations (GEE). In the second analysis, the possible effect of imprisonment on the prevalence of risk factors for HIV infection was estimated in VIDUS using linear growth curve analysis. Results: In the first analysis, 902 individuals interviewed at least once between 1 July 2004 and 30 June 2006 were included. Overall, 423 (46.9%) reported an incarceration event at some point during the study period. In a multivariate GEE model, recent incarceration was independently associated with a number of high-risk factors, including syringe sharing. In the second analysis, 1603 individuals were interviewed at least once between 1 May 1996 and 31 December 2005 and in cluded. Of these, 147 (9.2%) matched the study criteria and were included as cases; 742 (46.3%) were included as matched controls. In linear growth curve analyses adjusted for age, gender and ethnicity, syringe sharing was significantly more common in the incarcerated group (p = 0.03) after incarceration than in the control group. Conclusions: Our findings support the existence of a role for incarceration in continued viral transmission. In response, appropriate harm reduction measures should be expanded within correctional environments and social, political and legal reforms enacted to reduce the incidence of imprisonment for individuals who use illicit drugs.

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20

Brogly, Susan. "Towards more effective public health programming for injection drug users : development, evaluation and application of the injection drug user quality of life scale". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82835.

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Background. Little attention has been given to the assessment of quality of life (QOL) in injection drug users (IDUs). Some studies have suggested that existing measures are inadequate for use in IDUs.
Objectives. The objectives were: (1) to develop and evaluate a QOL measure for IDUs, the Injection Drug User Quality of Life Scale (IDUQOL), (2) to describe the QOL of cocaine and heroin IDUs and identify its constituents and correlates, and (3) to describe the relation between the QOL of cocaine and heroin IDUs and the use of public health programs.
Methods. The psychometric properties of the IDUQOL were assessed in 61 IDUs, 85% of whom were re-interviewed within 4-weeks. The Flanagan Quality of Life Scale was used to assess the criterion validity of the IDUQOL. The IDUQOL was subsequently applied in a study of 260 Montreal IDUs to identify their most important life areas. Associations between QOL and the use of public health programs and other correlates were assessed using multiple linear regression.
Results. The IDUQOL had good psychometric properties: the test-retest reliability was within accepted standards (intraclass correlation coefficient = 0.71) and the concurrent criterion validity between the IDUQOL and the Flanagan was moderate (Pearson coefficient = 0.57). In the study of 260 Montreal IDUs, housing was the most frequently selected life area of cocaine IDUs. Heroin IDUs most frequently selected money and feeling good about yourself. Both cocaine and heroin IDUs were generally dissatisfied with how these life areas fared. QOL was significantly better for HIV positive IDUs and IDUs who used meal programs, and was worse for IDUs who attended shelters and emergency departments. No strong relations were found with needle exchange program use, methadone or other drug treatment.
Conclusion. The IDUQOL appeared to be a conceptually clear and culturally relevant QOL instrument with good psychometric properties. Programs that address the life conditions of IDUs might be needed foremost to other initiatives. Understanding the constituents and correlates of the QOL of IDUs is important to the development of more effective programs to curb disease transmission, and improve the well-being of IDUs.

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21

Sanderson, Alicia. "Insite as Representation and Regulation: A Discursively-Informed Analysis of the Implementation and Implications of Canada's First Safe Injection Site". Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/20113.

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This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

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22

Simpson, Laura. "The Obstacles to Implementing Supervised Injection Services in Ottawa, Ontario". Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36953.

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The current opioid crisis has, among other things, resulted in soaring rates of fatal overdose across Canada, prompting officials to turn to harm reduction in hopes of combatting the epidemic. The Coroners Service of British Columbia issued a statement in March 2017 reporting an 80% increase in the number of deaths resulting from illicit drug use in 2016 from 2015 (Coroners Service of British Columbia, 2017). Despite the abundance of evidence demonstrating the effectiveness of supervised injection services (SIS) in Canada and worldwide, the implementation of this intervention has remained highly controversial, particularly in Ottawa. Guided by Michel Foucault’s theory of governmentality, this thesis explores the obstacles hindering the implementation of supervised injection services in Ottawa, Ontario. Through eight qualitative semi-structured interviews with front-line workers of harm reduction programs, this thesis identifies and explores several obstacles to the implementation of SIS, primarily bureaucratic obstacles stemming from the enactment of the Respect for Communities Act (2015).

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23

Chambers, Catharine Tamara. "Risk and resiliency factors associated with injection drug use among at-risk youth in Vancouver, British Columbia". Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/13140.

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Background: Street-involved youth are a vulnerable population with respect to injection drug use (IDU) initiation; however, despite being considered an “at-risk” population, many street-involved youth do not use drugs intravenously. The objective of this thesis was to explore risk and resiliency factors associated with IDU among at-risk youth in Metro Vancouver, British Columbia and to determine if these factors differ by gender. Methods: Data were obtained from the Vancouver-subset of the Enhanced Surveillance of Canadian Street Youth Survey (E-SYS), which collected data from January to November 2006. Logistic regression was performed overall and by gender to identify factors associated with IDU among street-involved youth aged 15 to 25. Results of the E-SYS study were used to inform 16 in-depth, semi-structured interviews with service providers who work with at-risk youth populations in Metro Vancouver. Domain analysis was performed to identify risk and resiliency factors. Results: Among the 195 E-SYS participants, 55 (28.2%) youth reported injecting drugs more than once in their lifetimes. Youth who use injection drugs are entrenched within the street culture and engage in high-risk sexual activities. Males who use injection drugs reported more intense street involvement, while females who use injection drugs reported engaging in sex for trade. Six themes emerged from the service provider interviews: (i) interpersonal relationships for example with family members or peer groups; (ii) social influences such as the normalization and social acceptability of IDU; (iii) structural influences such as the lack of safe, affordable housing; (iv) family history factors including violence, abuse, and neglect as well as parental drug use; (v) individual-level factors such as the development of tolerance to non-injection drugs; and (vi) gender differences related to the youths’ social influences and vulnerabilities on the street. Conclusions: Youth who use injection drugs are more involved with the street culture and engage in sexual behaviours that may increase the risk for HIV, hepatitis C and other sexually-transmitted infections. The results of this study will inform evidence-based, youth-driven intervention strategies in the community. These findings suggest that intervention strategies should focus on the social structural influences around IDU in conjunction with individual-level risk factors.

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24

Miller-Roenigk, Brittany D. "Predictors of Recidivism in Rural Incarcerated Women". University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504794695385065.

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25

Tavitian-Exley, Isabel. "The relevance of polydrug use in HIV risk and associated injecting and sexual risk behaviours among people who inject drugs". Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/55175.

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HIV transmission has effectively been reduced in many countries by focusing on high transmission foci with interventions tailored to key populations groups and high risk behaviours. However people who inject drugs (PWID) still accounted for significant proportions of new HIV and Hepatitis C infections in several regions in 2014 . Among PWID, as in other populations, risk behaviours are not distributed equally. Polydrug use (using multiple drugs) in particular has increasingly been cited as a source of harm and possibly greater HIV infection risk but remains under-researched. In this thesis, I assessed the epidemiological significance of polydrug use on HIV and HCV risk behaviours among PWID, using several methods, and data sources from different settings. Multiple methodological challenges were faced, related to inherent difficulties in studying PWID, including stigmatised behaviours, comparatively small sample sizes and the absence of sampling frame for PWID. I established that polydrug use was frequent among PWID, in contrast with the common assumption that PWID mainly inject heroin, and considerable proportions of injectors across locations had recently injected or used multiple drugs (chapter 2). I generated new evidence on the biological and behavioural risks associated with injecting certain drugs and drug combinations in three stages. First, in the meta-analysis, HIV incidence rates were consistently higher among PWID injecting cocaine, amphetamine (ATS) or combinations of heroin and stimulants, compared to those not injecting or not injecting the drug(s). Wide confidence intervals and inconsistent reference categories however, limited conclusions (chapter 3). Second, I identified differences in injecting risk and HIV status between ATS and opiate injectors (chapter 5), and greater injecting and sexual risk among polydrug- than single-drug injectors in Russia and Estonia (chapter 6). Finally, using a generic polydrug typology developed in latent variable modelling, I found significant differences in HIV-related injecting and sexual risk behaviours between polydrug classes (chapter 7). The results of this work fill important research gaps by establishing that polydrug use is frequent and associated with substantial heterogeneity in HIV risk among PWID. My thesis examines the implications of these findings and proposes a polydrug use typology to help tailor drug and HIV prevention and treatment interventions to high risk PWID sub-groups to prevent the spread of new HIV and HCV infections.

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26

Juergensen, Linda Tataryn. "Searching for a clean fit, a feminist analysis of the function and meaning of illicit injection drug use for women". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22753.pdf.

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27

Gallo, Maria L. "Nursing advocacy and the accuracy of intravenous to oral opioid conversion at discharge in the cancer patient". [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003235.

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28

Deshmukh, Shivprasad Shahajirao. "Investigation of injection moulding for novel drug delivery systems : an investigation into the use of injection moulding to produce pharmaceutical dosage forms and to understand the relationship between materials, processing conditions and performance, in particular drug release and stability". Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14302.

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The feasibility of the injection moulding (IM) was explored for the development of novel drug delivery systems. Controlled release formulations were developed using a substituted cellulose derivative, hydroxypropyl methyl cellulose acetate succinate (HPMCAS) and a graft co-polymer (Soluplus®). BCS class II drugs ibuprofen and the felodipine were selected based on their physicochemical properties. In the present work, a homogenous dispersion of drugs in the polymer matrices was achieved using Hot Melt Extrusion (HME) and extruded pellets obtained were used for the development of the injection moulded systems. Four systems were developed using the IM consisting of ibuprofen-HPMCAS, ibuprofen-Soluplus®, felodipine-PEO-HPMCAS and felodipine-Soluplus®. The ibuprofen acts as a good plasticiser compared to felodipine therefore, felodipine containing IM systems required a plasticiser (PEO) when processed with HPMCAS. The analysis of extruded pellets and injection moulded systems using modulated DSC (MDSC) and Raman spectroscopy confirmed the formation of an amorphous molecular dispersion (i.e solid solution) in the case of all four systems. The phase separation behaviour and the amorphous stability of the systems was studied at various stress conditions. This revealed the “surface crystallisation” behaviour of the ibuprofen-HPMCAS systems. Temperature-composition phase diagram constructed based on the melting point depression and the Flory-Huggins lattice solution theory provided the explanation for the phase separation and crystallisation behaviour of ibuprofen-HPMCAS systems. The advanced characterisation techniques like DMA, 2D XRD and 3D laser microscopy provided the detailed understanding of crystal habits, phase seperation and surface crystallisation. The significant effect of the stress conditions on the rate of shrinkage was observed where, higher shrinkage tendency of a HPMCAS IM system was observed compared to Soluplus® IM systems. The extruded pellets provided the faster drug release compared to the moulded tablets suggests the effect of particle size as well as the densification during IM on the dissolution rate of the dosage form. The nature of the polymer and processing history were the contributing factors for the dissolution of the dosage forms.

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29

Deshmukh, Shivprasad S. "Investigation of injection moulding for novel drug delivery systems. An investigation into the use of injection moulding to produce pharmaceutical dosage forms and to understand the relationship between materials, processing conditions and performance, in particular drug release and stability". Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14302.

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Abstract (sommario):

The feasibility of the injection moulding (IM) was explored for the development of novel drug delivery systems. Controlled release formulations were developed using a substituted cellulose derivative, hydroxypropyl methyl cellulose acetate succinate (HPMCAS) and a graft co-polymer (Soluplus®). BCS class II drugs ibuprofen and the felodipine were selected based on their physicochemical properties. In the present work, a homogenous dispersion of drugs in the polymer matrices was achieved using Hot Melt Extrusion (HME) and extruded pellets obtained were used for the development of the injection moulded systems. Four systems were developed using the IM consisting of ibuprofen-HPMCAS, ibuprofen-Soluplus®, felodipine-PEO-HPMCAS and felodipine-Soluplus®. The ibuprofen acts as a good plasticiser compared to felodipine therefore, felodipine containing IM systems required a plasticiser (PEO) when processed with HPMCAS. The analysis of extruded pellets and injection moulded systems using modulated DSC (MDSC) and Raman spectroscopy confirmed the formation of an amorphous molecular dispersion (i.e solid solution) in the case of all four systems. The phase separation behaviour and the amorphous stability of the systems was studied at various stress conditions. This revealed the “surface crystallisation” behaviour of the ibuprofen-HPMCAS systems. Temperature-composition phase diagram constructed based on the melting point depression and the Flory-Huggins lattice solution theory provided the explanation for the phase separation and crystallisation behaviour of ibuprofen-HPMCAS systems. The advanced characterisation techniques like DMA, 2D XRD and 3D laser microscopy provided the detailed understanding of crystal habits, phase seperation and surface crystallisation. The significant effect of the stress conditions on the rate of shrinkage was observed where, higher shrinkage tendency of a HPMCAS IM system was observed compared to Soluplus® IM systems. The extruded pellets provided the faster drug release compared to the moulded tablets suggests the effect of particle size as well as the densification during IM on the dissolution rate of the dosage form. The nature of the polymer and processing history were the contributing factors for the dissolution of the dosage forms.
The thesis is hardbound in two volumes. Volume II starts at Chapter 5, page 135.

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30

Shawa, Isaac Thom. "Protection from HCV infection : identification of mechanisms of resistance to HCV infection in exposed uninfected injection drug users". Thesis, University of Plymouth, 2017. http://hdl.handle.net/10026.1/10386.

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Hepatitis C virus (HCV) is a leading cause of chronic liver disease. In the developed world, injection drug use (IDU) through sharing of infected needles and other paraphernalia remains the principal risk factor for HCV transmission. Effective but expensive treatment is now possible but there remains a pressing need for a vaccine. A proportion of people who inject drugs (PWIDs) remain uninfected despite HCV exposure from a long history of sharing needles and other paraphernalia. These cases are termed exposed but uninfected (EU) and test negative for both HCV antibodies and RNA and exhibit a phenotype of resistance to HCV infection. Improved understanding of the mechanisms that confer resistance in the EUs has the potential to aid development of an effective vaccine and novel therapeutic strategies. This thesis reports on the findings from 3 different strategies to identify characteristics of HCV resistance. I used urinary metabolomics, serum lipidomics and the study of adaptive and innate immune responses. Each of these methods has demonstrated clear differences between EU cases and healthy controls and/or spontaneous resolvers of HCV infection. Urinary metabolomics suggest a potential role of the gut microbiome, the serum lipidomics showed marked differences in lipid profiles in EU cases pointing towards a perturbed lipid/virus interaction, and the immune studies confirmed previous work identifying low level T cell responses in many EU cases but has also identified a marked upregulation of interferon alpha production to low dose viral RNA in EU cases utilising ELISA assay. In conclusion, this thesis reports data that identifies a number of new findings that provide insight into mechanisms of resistance to HCV infection. My findings suggest that the complex interplay between the virus and lipids together with an upregulated innate immune response may together help determine the outcome following HCV exposure. In summary, studies performed in this thesis have demonstrated that there are different pathways that define the EU phenotype. Despite being a heterogenous subgroup of PWIDs, the EUs are clearly distinct from a healthy control population.

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Shane, Amanda. "Defining Intervention Location from Social Network Geographic Data of People who Inject Drugs In Winnipeg, Canada". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24394.

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Sharing and inappropriate discarding of syringes and drug use equipment can lead to transmission of bloodborne pathogens and decreased sense of community safety. To reduce these risks, interventions such as syringe drop boxes, are implemented. However, little consideration has been made of the social and spatial networks of the injection drug use (IDU) populations in the placement of these drop boxes. A sample of IDU was obtained through respondent driven sampling in Winnipeg, Canada in 2009. Characteristics of the sample and distribution of these characteristics through the social network were assessed. A spatial network was constructed which focused on the connections between IDU and specific geographic locations. Measures of centrality were calculated using Pajek and the geographic network was mapped using ArcGIS. Analysis of the social network revealed variation among network components in demographic and drug use characteristics. Spatial analysis revealed geographic clustering, quantified through network centrality measures. There was congruence between locations of high degree and current drop box placement in Winnipeg. This research illustrates the benefit of combining IDU social network and spatial data to inform evidence-based municipal policies and programs.

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32

Straube, Ragnar, e Abouaoun Denny. "Ett skademinimerande arbete : Sprututbytesprogrammet i Sverige". Thesis, Malmö universitet, Malmö högskola, Institutionen för socialt arbete (SA), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-43181.

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Earlier research shows that persons who inject drugs are in heightened need of healthcare and medical assistance. But research has also shown that it can be difficult for them to receive care and assistance due to their circumstances. Sweden has a long history of restrictive drug policy and practice. This has affected how care for drug users has been managed and formed. In recent years, due to a change in the Swedish legislation, it has become easier to establish needle exchange programs. As a result, there has been an increase in the number of needle exchange programs during the last five years. The aim of this study was to examine the harm reducing work that is done within the swedish needle exchange program. For this, the study primarily focused on how the staff perceived harm reduction work, its possibilities and difficulties. The data was collected through four semistructured interviews with staff at needle exchanges in Sweden. The participants were either nurses or counselors, working at either newer or more established needle exchanges. The data was coded into the following themes; Reduction of harm- and transmission of infectious diseases, The outlook on drug abuse and The importance of treatment and relations. The results show that harm reduction is perceived to be a pragmatic alternative to the traditional care of drug users by the staff. The participants do stress that needle exchange programs by themselves aren't enough to reduce the harms of addiction. The results also highlight the importance of the relational- and emotional work, which is a real factor for effective harm reduction work. By developing trust and relations, the target groups' needs are both easier expressed and met at needle exchanges.

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33

Wassberg, Bengt, e Johan Ramnebrink. "Sprutbyte – Not In My Back Yard : En diskursanalys om attityder kring införandet av Stockholms sprutbytesverksamhet". Thesis, Linnéuniversitetet, Institutionen för socialt arbete (SA), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-35338.

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About 35 years ago the WHO advocated that countries with injecting drug users should introduce the so-called needle exchange programs (NEP) to curb the spread of infection by blood-borne diseases. In Sweden the first NEP started 1985 in Lund, but the program was extremely controversial in a country with such a restrictive drug policy like Sweden. The study you are about to read shall process this controversy, when a NEP opened in Stockholm, by analyzing the articles published in the newspapers Dagens Nyheter and Svenska Dagbladet. By using discourse analysis as a processing tool we’ll try to see the difference between the two chosen newspapers. We will identify and analyze the different participant’s, such as doctors, politicians, user associations and media, arguments in the needle exchange issue. Our results show that the liberal DN articles were supportive of the NEP and that they considered it to be an infectious disease control issue. The liberal conservative newspaper SvD had a different view of the issue and considered NEP to be a question about drug policy. Even after the decision was made the city had problems to find suitable premises for the NEP to operate from.

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Aglipay, Mary M. O. "Positive and Negative Support Roles in the Social Networks of Vulnerable People". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24337.

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Abstract (sommario):

Introduction: Social networks have shown promise in curbing drug dependency and infectious diseases among marginalized populations. The purpose of this study is to elucidate how relationship strength in social networks is associated with risk behaviours for infectious diseases. Methods: Two reviews were conducted: 1) a systematic review exploring the association between risk behaviours and relationship strength 2) a review on the utilization of respondent driven sampling (RDS). We also analyzed network data to determine the association between recent injection drug use and recent crack use. Results: Our reviews revealed that few studies link relationship strength and risk behaviours; moreover, RDS is effective method of sampling from marginalized populations. Finally, our analysis demonstrated that close relationships are associated with drug use. Conclusion: “Close” relationships are important in arbitrating injection drug use and crack smoking. More research addressing the issues of using data from dynamic social processes and hard-to-reach populations is needed.

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Syvertsen, Jennifer L. "Love and Risk: Intimate Relationships among Female Sex Workers who Inject Drugs and their Non-Commercial Partners in Tijuana, Mexico". Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4235.

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This dissertation examines the influence of love and other emotions on sexual and drug-related HIV risk among female sex workers who inject drugs and their intimate, non-commercial partners in Tijuana, Mexico. My work on a public health study along the Mexico-U.S. border and independent ethnographic research in Tijuana suggests the importance of emotions in shaping sex workers' relationships and health risks. Love is a universal human emotional experience embodied within broader cultural, social, and economic contexts. A growing body of cross-cultural research suggests that modern relationships have transformed to emphasize love and emotional intimacy over moral or kinship obligations. Particularly in contexts of risk and uncertainty, intimate relationships provide emotional security. Drug-using couples may engage in unprotected sex or even needle sharing to convey notions of love and trust and help sustain emotional unity, but such acts also place partners at heightened risk for HIV. For female sex workers in Tijuana who endure poverty, marginality, and an increased risk of contracting HIV, establishing and maintaining emotional bonds with intimate partners may be of paramount importance. Yet little is known about how female sex workers' intimate male partners shape their HIV risk perceptions and practices. Moreover, male partners' perspectives are critically absent in HIV prevention strategies. This dissertation is nested within Proyecto Parejas, a study of the social context and epidemiology of HIV among sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. Through semi-structured and ethnographic interviews, photo elicitation interviews, and participant observation, I got to know seven of the couples in Tijuana who are enrolled in Parejas. I examine their relationships through the lens of critical phenomenology, which combines concern with experience, emotions, and subjectivity with political economy perspectives that argue sex work, drug use, and HIV/AIDS is not randomly distributed but historically and structurally produced. My work suggests that female sex workers and their intimate partners experience their relationships in gradations of love and emotional content. These relationships hold significant meaning in both partners' lives for emotional and material reasons, and shape each partner's HIV risk within and outside of the relationships. Couples choose not to use condoms with each other, often to define themselves as a couple. Sex outside of the relationship occurs for economic and culturally conditioned reasons, but does not necessarily diminish the meaning of the primary relationship. Motivations and ability to use condoms with clients and outside partners are context dependent and, in order to preserve trust and unity, sexual risks are typically not discussed. Partners share drugs and syringes with each other as a sign of care within a context of scarce material resources. Emotionally close couples tend to confine their sharing within the relationship, whereas less close couples also share with friends and family in more social forms of drug use. Given their vulnerability within a milieu of poverty, social marginalization, and discrimination, love alone cannot explain the HIV risk that female sex workers and their partners face. Nevertheless, emotions are significant factors in both risk taking and risk management. This study encourages researchers, practitioners, and policy makers to consider the affective dimensions of HIV risk within sex workers' intimate relationships as an integral part of a multi-level strategy to address each partner's health and wellbeing.

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Zhang, jishen. "Etude expérimentale de la réduction de trainée par injection de bulles dans une couche limite turbulente décollée redéveloppée". Thesis, Paris, ENSAM, 2019. http://www.theses.fr/2019ENAM0057.

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Abstract (sommario):

Cette étude s’inscrit dans le contexte de la réduction de la résistance visqueuse descarènes de navire par injection de bulles sous la coque. Nous avons réalisé des expériencesd’injection de bulles dans la zone de redéveloppement d’une couche limite turbulente décollée.Les expériences ont été menées dans le tunnel hydrodynamique de l’École Navale. Des bullesd’air ont été injectées en aval de la zone de recirculation d’un obstacle bidimensionnel carrémonté à la paroi supérieure du tunnel. Le champ de vitesse a été caractérisé par Particle ImageVelocimetrie (PIV) dans le plan vertical de l’amont de l’obstacle et jusque dans la zone deredéveloppement. L’écoulement diphasique à bulles a été étudié pour une position longitudinalesituée dans la zone de redéveloppement de la couche limite. Les caractéristiques de la phasegazeuse ont été obtenues par visualisations ombroscopiques. La réduction de frottement estobservé au maximum de 35% à 6 m/s. Physiquement la présence des bulles entraine unedécorrélation des fluctuations de vitesse longitudinales et normales dans la zone interne et desfluctuations du mouvement des bulles dans la direction normale à la paroi qui peuvent êtreassociées à la modification observée du frottement
The bubbly drag reduction in turbulent flow is of significant interest in the navalindustry, particularly to reduce the viscous resistance of ships hulls. This thesis is focused onexperimental observations of the recovery region of a separated turbulent boundary layer in bothsingle-phase and bubbly flows. The experiments were performed in the Cavitation WaterTunnel of the French Navy Academy Research Institute. Air bubbles of intermediate size (0.4-1.3mm) were injected in the recovery region downstream of the recirculating region of a 2Dsquare obstacle (of height h = 16 mm) mounted at the upper wall of the tunnel. The single-phaseflow velocity field was characterized in the vertical plane using Particle Image Velocimetry(PIV) technique in 11 stream-wise measuring stations from upstream of the obstacle down to therecovery region. The gas-phase velocity field in the vertical plane, the gas volume fractiondistribution and the bubble size were characterized by means of Shadowgraphy. A maximumlocal viscous drag reduction DR of 35% is achieved for 6 m/s. The bubbly drag reduction ispromoted by the increase of the velocity and enhanced by increasing the air injection rate. Wesuggest that bubbles can induce a decorrelation between the stream-wise and wall normalfluctuating velocity in the inner layer, but most of the bubbly drag reduction is attributed to thewall normal fluctuating motion of the bubbles

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Bailey, Kathleen Susanna. "Health Care Seeking Behavior and Provider Responses for HCV-Positive African Americans". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1670.

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Abstract (sommario):

Of the 3.5 million persons infected with chronic HCV in the United States, the African American population is the largest racial group with chronic HCV. Disparities in access to care and treatment involve a complex set of individual, interpersonal, socioeconomic, and environmental factors that influence the course of HCV infection in the African American population, resulting in poorer outcomes and survival. Drawing upon both the theory of reasoned action and the theory of planned behavior, this study was conducted to determine whether the seeking of health care by HCV-positive African Americans and the responses of health care providers to HCV-positive African Americans had improved since 2008 following the introduction of new treatment options, as compared to other HCV-positive racial/ethnic groups, using secondary data analyses with survey datasets from the National Health and Nutrition Examination Survey, 2005-2012. Using chi-square test of difference and logistic regression analyses, the study did not identify a statistically significant relationship between health care seeking behavior and responses from health care providers for HCV-positive African Americans before (2005-2008) and after (2009-2012) the introduction of new treatment options as compared to other HCV-positive racial/ethnic groups. Given the ongoing development of new and improved drugs to treat HCV infection, further research might focus on the HCV-infected population as a whole to ascertain whether differences exist as compared to earlier therapies before 2013. This study may drive social change within the health care community by raising awareness of the risks of HCV infection resulting in less provider bias and the introduction of resources into the African American and underserved communities that will improve outcomes and reduce barriers to care.

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38

Duchesne, Léa. "Prise en charge de l'hépatite C dans les pays à ressources limitées en santé : quels outils et quelles stratégies diagnostiques ? HCV Ag quantification as a one-step procedure in diagnosing chronic hepatitis C infection in Cameroon : the ANRS 12336 study Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in people who use injecting drugs in Senegal". Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS198.

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Abstract (sommario):

L’arrivée sur le marché en 2011 de nouveaux traitements de l’hépatite C – les antiviraux à action directe (AAD) – bien plus efficaces et mieux tolérés que leurs prédécesseurs ont rendu l’élimination de cette dernière envisageable. Le prix élevé des AAD ainsi que le faible taux de diagnostic de l’hépatite C dans le monde ont cependant limité le nombre de personnes ayant pu en bénéficier jusqu’à présent. Dans les pays à revenu faible et intermédiaire (PRFI) où vivent 72% des personnes atteintes d’hépatite C chronique dans le monde, seules 6% d’entre elles auraient été diagnostiquées. L’Organisation Mondiale de la Santé (OMS) a appelé à diagnostiquer 30% et 90% des cas d’hépatite C chronique dans le monde respectivement d’ici à 2020 et 2030. Les méthodes de référence pour le diagnostic de l’hépatite C sont la détection d’anticorps anti-VHC et la quantification de l’ARN du VHC. Ces méthodes sont onéreuses et requièrent un personnel hautement qualifié ainsi que de lourdes infrastructures. Étant donné que les PRFI disposent de ressources financières et matérielles restreintes, ces méthodes y sont peu disponibles. Atteindre les objectifs de l’OMS dans ces pays implique donc de simplifier, de décentraliser et de rendre abordable le diagnostic de l’hépatite C dans les PRFI. Cette thèse a eu pour objectif d’identifier des outils pouvant permettre de répondre à ces enjeux. Pour cela, trois axes d’étude ont été développés. Une première étude menée sur un grand nombre d’échantillons sanguins camerounais nous a permis de valider les performances diagnostiques de la quantification de l’antigène de capside du VHC (AgC), une technique de confirmation virémique alternative à la détection de l’ARN du VHC, avec une sensibilité de 95,7%, une spécificité de 99,7% et une aire sous la courbe de 0,99. À la suite de ce premier travail, plusieurs études évaluant les performances de divers outils diagnostiques autres que la quantification de l’AgC ont été publiées. À partir des données de ces dernières, nous avons mené deux études médico-économiques dans le but d’identifier parmi ces outils ceux qui offriraient le meilleur rapport coût-efficacité pour renforcer le diagnostic de l’hépatite C. Ces deux études portaient sur deux contextes différents : d’une part la population d’usagers de drogues injectables de Dakar au Sénégal et, d’autre part, les populations générales de trois pays d’Afrique sub-Saharienne. Dans les deux cas étudiés, combiner la détection des anticorps anti-VHC par un test portatif appelé « point-of-care » (POC) et la détection de l’ARN du VHC – grâce soit à un test POC, soit à un test de laboratoire effectué sur un échantillon de sang prélevé sur papier buvard (un type d’échantillons pouvant être transportés à température ambiante) ‒, était plus coût-efficace que les autres stratégies proposées. Notre critère d’efficacité ne permettant pas de se référer à un seuil de coût-efficacité de référence, il n’a cependant pas été possible de définir laquelle de ces deux stratégies il serait préférable de mettre en place dans chaque contexte. Par ailleurs, dans le cas de la population générale, nos estimations de budget pour atteindre les objectifs de l’OMS dans les trois pays étudiés indiquent qu’il est peu vraisemblable qu’ils soient atteints aux dates visées sans une baisse des prix des tests diagnostiques ou une augmentation des ressources financières disponibles. Bien que représentant un véritable progrès vers la décentralisation du diagnostic, les tests POC actuels comportent certaines limites techniques pouvant restreindre leur potentiel. Une revue de la littérature sur les innovations diagnostiques a montré qu’une grande variété de solutions techniques pouvant permettre de dépasser ces limites étaient en cours de développement, pour certaines à un stade avancé. Plusieurs barrières empêchent cependant leur diffusion commerciale
The advent in 2011 of new hepatitis C treatments, direct-acting antivirals (DAAs), much more effective and better tolerated than their predecessors, made the elimination of hepatitis C conceivable. However, the high cost of DAAs combined to the low diagnosis rate of hepatitis C worldwide have limited the number of people who have been able to benefit from it so far. In low- and middle-income countries (LMICs) where 72% of people with chronic hepatitis C live worldwide, only 6% of them have been diagnosed. The World Health Organization (WHO) has called for the diagnosis of 30% and 90% of chronic hepatitis C cases worldwide by 2020 and 2030, respectively. The reference methods for the diagnosis of hepatitis C are the detection of anti-HCV antibodies and the quantification of HCV RNA. These methods are expensive and require highly qualified personnel as well as heavy infrastructure. Given the limited financial and material resources of LMICs, these methods are not readily available in these countries. Thus, achieving the WHO objectives in these countries implies simplifying, decentralizing and making hepatitis C diagnosis in LMICs affordable. The aim of this thesis was to identify tools that could be used to address these issues. For this purpose, three areas of study have been developed. A first study, conducted on a large number of Cameroonian blood samples, enabled us to validate the diagnostic performance of the HCV core antigen quantification, an alternative viraemic confirmation technique to the detection of HCV RNA, with a sensitivity of 95.7%, a specificity of 99.7%, and an area below the curve of 0.99. Concurrently with this first work, studies assessing the performance of several other diagnostic tools were published. Based on their data, we conducted two health economic studies in order to identify which of these tools would be the most cost-effective for scaling-up the diagnosis of hepatitis C in two different contexts: the population of injecting drug users in Dakar, Senegal, and the general population in three sub-Saharan countries. In both cases, combining the detection of anti-HCV antibodies by a point-of-care (POC) test and the detection of HCV RNA, either by a POC test or by a laboratory test performed on dried blood spots (a type of sample that can be transported at room temperature), was more cost-effective than the other proposed strategies. However, given that the efficiency outcome we chose prevented us from using a reference cost-effectiveness threshold, we were not able to evaluate which of these two strategies was the most feasible. However, in the case of general population diagnosis, it appears that, given the budget required to achieve the WHO’s objectives with each of these strategies, it is unlikely that the latter can be achieved on the said dates without a decrease in the prices of diagnostic tests or an increase in the available financial resources. Although representing a real progress towards the decentralization of diagnosis, the current POC tests have some technical limitations that may limit their potential. A literature review on diagnostic innovations has shown that a wide variety of technical solutions that could overcome these limits are being developed, some at an advanced stage. However, there are several barriers to their commercial distribution. An exploratory work on the concept of frugal innovation and the implementation of health innovations in LMICs concluded that these barriers could probably be removed. Future studies to accurately identify the conditions required for successfully implement these innovations in LMICs are needed. This work shows that improving access to hepatitis C diagnostic tools is no longer a technical issue but an organizational, economic and political one

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39

Malins, Peta Husper. "An ethico-aesthetics of injecting drug use: body, space, memory, capital". 2009. http://repository.unimelb.edu.au/10187/4866.

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Harm minimisation approaches to illicit drug use have proven extremely successful in reducing drug-related harm and improving health outcomes for those using drugs, their families and the broader community. Despite these successes, however, many harm minimisation programmes face strong community opposition, and many others are limited in their effectiveness by their reluctance to acknowledge the complex ways in which drug using contexts, social relationships, desire, pleasure and aesthetics are involved in the production and reduction of drug-related harm.[NP] Deleuze and Guattari’s ethico-aesthetic philosophy offers a conceptual framework through which to begin to grapple with the sensory and affective elements of illicit drug use and their implications for an embodied ethics. Following an introduction to their key concepts, this thesis explores the implications of their ontology for understandings of injecting drug use across four inter-related dimensions: the drug using body; urban spaces of injecting; public overdose memorials; and drug referenced, ‘heroin chic’ advertising imagery. It argues that aesthetics and ethics are complexly intertwined, and that ethically positive responses to drug use require an active appreciation of the ways in which aesthetics affect bodies and their capacities to form relations with others

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40

Bishop, CA. "Exploration of patterns of drug use, methamphetamine dependence and associated harms, and barriers to treatment among people who inject drugs in north and south Tasmania". Thesis, 2017. https://eprints.utas.edu.au/23743/1/Bishop_whole_thesis.pdf.

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The current study examined patterns of drug use, associated harms, and access to drug treatment among individuals who inject drugs in northern and southern Tasmania. One hundred individuals in the south and 41 in the north were interviewed using the Illicit Drug Reporting System paradigm. Given recent community concern regarding methamphetamine, harms were examined as a function of likely dependence on methamphetamine by classifying respondents into groups based on Stimulant Severity of Dependence scores: no methamphetamine use; methamphetamine use, not likely dependent; and methamphetamine use, likely dependent. Differences were found in patterns of use and harms across the state, suggesting that generalisation of research conducted in the capital city is not appropriate. Even among a sample engaging in high levels of poly-drug use, certain harms were found to be associated specifically with methamphetamine use and dependence. Access to appropriate treatment for methamphetamine use was low among those displaying dependence, with the majority of the sample engaging only in treatment for opioid use disorders. Individuals often perceived that they did not need treatment, despite negative perceptions of methamphetamine use, and viewed treatment options as not efficacious. Lack of perceived need was also noted as a reason for not accessing metal health services despite self-perceived mental health problems. This suggests the importance of education and integrated service delivery to ensure that when clients present to mental health or alcohol and drug services both substance use and mental health needs are met, especially as co-morbid difficulties are common.

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41

Provazníková, Radka. "Odhad spotřeby injekčního materiálu klienty pražských kontaktních center a terénních programů". Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-346102.

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Background: Intravenous way of drug application is the most common between problem drug users at Prague. Due Mravčík et al. (2015), the estimate is, that there was a 15 700 intravenous drug users at Prague in 2014 (7 500 pervitin users, 2 500 heroin users and 5 700 buprenorphine users). And that they spend about 15,5 millions of syringes every year (Švůgerová, 2015). But the data in Annual report on drug situation 2014 says, there was only 2, 6 millions of syringes distributed (Mravčík et al., 2015). This means, that Prague intravenous drug users spend many more syringes, that are distributed by low-treshold services and pharmacies. That is a reason of charting of the behaviour of drug users in connection with application of addictive substance, especially how the consuption of injecting material is connected with single type of drug user. Aims: The main aim of the thesis is to find out the frequency of drug application in intravenous drug users and to estimate the total consumption of injecting materialial depended on single of users typology (used drugs, frequncy of contact with harm reduction services…) Research sample: The sample consists of 155 clients of harm reduction services at Prague (3 contact centers and 3 streetwork programs). All of the respondents stated the intravenous drug using in...

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42

"Female injecting drug users who are also sex workers: a bridge population for HIV transmission in China". Thesis, 2008. http://library.cuhk.edu.hk/record=b6074601.

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Conclusions. The "bridging effect" for HIV transmission is evident. Variables predicting condom use during commercial sex are multidimensional. Integrative programs are hence required. Methadone clinics may offer a platform for offering such services to IDU-FSWs. The performance of the TPB could be enhanced by addition of external variables; its applicability varies according to the wellbeing status of the IDU-FSWs. Future randomized control studies are warranted to design effective evidence-based programs targeting IDU-FSWs.
Introduction. Injecting drug users (IDUs) drive the HIV epidemic in China. Female injecting drug users who are sex workers (IDU-FSWs) is a strategic "bridge population" for HIV transmission from the IDU to non-IDU populations. Background characteristics, health behavioral theories (e.g. the Theory of Planned Behavior, TPB), drug dependence, economic pressure, psychological problems, social support and gender power are potential predictors of condom use during commercial sex among IDU-FSWs. Most of these associations have not been investigated in China or elsewhere, and the TPB has not been applied to HIV-vulnerable populations in China. A knowledge gap exists.
Objectives. This study validated two instruments measuring severity of drug dependence. The prevalence of inconsistent condom use among IDU-FSWs and its associations with the aforementioned variables were investigated. The hypotheses that different blocks of variables would have independent effects on condom use during commercial sex, and the effects of TPB-related variables on condom use would be moderated by some external variables (e.g. severity of drug dependence) were tested.
Results. The Opiate Addiction Severity Inventory-Revised (OASI-R) was fully validated in the Study I. Around 6.8% of IDU-FSWs were HIV positive and respectively 48% and 64% of them practiced needle sharing and unprotected commercial sex (last six months). After adjusting for significant background variables, the five TPB-related variables (AOR=0.43 to 1.92, p<0.001), severity of drug dependence (AOR=1.05, p<0.01), economic pressure (AOR=1.07, p<0.05) and all studied psychosocial variables (e.g. depression, social support and gender power; AOR=0.70 to 1.67, p<0.05) were significantly associated with condom use during commercial sex.
Subjects and methods. Two cross-sectional studies were conducted. In Study I, 178 non-institutionalized drug users were interviewed in Dazhou, Sichuan. In Study II, 281 non-institutionalized IDU-FSWs were interviewed in Dazhou, Sichuan and Hengyang, Hunan, using snowballing method and face-to-face interviews. Statistical methods such as hierarchical and interaction modeling, stratification analysis, ROC method were used in this study.
The final hierarchical model predicting condom use during commercial sex included variables coming from four blocks of independent variables, with ROC area = 94% and sensitivity/specificity = 0.84/0.91. A "Wellbeing Status Index" moderated the associations between some of the TPB-related variables and condom use during commercial sex.
Gu, Jing.
Adviser: Joseph T. F. Lau.
Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3462.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2008.
Includes bibliographical references (leaves 228-246).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.

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43

Sklenář, Ondřej. "Závislost na jehle u injekčních uživatelů drog v ČR". Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-332168.

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Univerzita Karlova v Praze 1. léka ská fakulta Studijní program: Specializace ve zdravotnictví Studijní obor: Adiktologie Bc. Ond ej Sklená Závislost na jehle u injek ních uživatel drog v R Needle Fixation among injecting drug users in Czech Republic Diplomová práce Vedoucí práce: PhDr. Josef Radimecký, Ph.D., MSc. Praha, 2014 Abstract of the thesis Background: The importance of injecting drug use and its frequency among Czech problem users of illegal drugs appears to be high. At the same time the risks associated with this method of application and the risk of transmission of infectious diseases and other health complications are described in numerous publications and it is a compelling reason why we should give more attention to the theme of needle fixation. Finally, complications during substitution therapy associated with the transition from injecting drugs to another method of substitution substances administration are also common. Author of the thesis therefore asked the question whether in relation to injecting drug use could play a role in creating a strong addiction and other facts besides therefore widely known arguments as the quickest and most effective method of administration of drugs to the human body thanks to the injection. The aim of this work is to get better understanding of "needle...

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44

Lefoka, Moganki Hendrick. "Exploring the experiences of women injecting nyaope residing in the City of Tshwane Municipality, Gauteng". Diss., 2019. http://hdl.handle.net/10500/27476.

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The purpose of the study was to explore the experiences of female nyaope injectors residing in City of Tshwane Municipality, Gauteng. The study was conducted at COSUP sites namely; Soshanguve, Pretoria CBD, Sunnyside, Mamelodi, Eersterust, and Attridgeville. The study focused on females who have a history of injecting nyaope, accessing substance use related services at a registered service provider within City of Tshwane Municipality, Gauteng. Research design of the study was exploratory, which is basically used to explore a new topic or learn more about phenomenon where little is known. The research approach was purely qualitative methodology. This permitted the researcher to deeply explore the lived experiences of female nyaope injectors residing in City of Tshwane Municipality, Gauteng. A qualitative in-depth interview method was used to collect data from 24 participants who took part in the study. Questions of the interview were semi-structured, in-depth one-on-one interviews and were used to explore the lived experiences of female nyaope injectors residing in City of Tshwane Municipality, Gauteng. The findings of the study revealed that females who are injecting nyaope, are at risk of contracting HIV and other blood-borne infections. The stigma that is perpetuated by families, intimate partners, communities, health care professionals, and police officers is creating a hostile environment for female nyaope injectors; which increases the risk of contracting HIV and other blood-borne infections. Harm reduction services have the potential to address the needs of female nyaope injectors if fully implemented. It can be concluded that there is a need for substance abuse service providers to implement comprehensive harm reduction services to curb HIV prevalence amongst female nyaope injectors.
Health Studies
M.A. (Social Behavioural Studies in HIV/AIDS)

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45

Mravčík, Viktor. "Prevence virové hepatitidy typu C u injekčních uživatelů drog - proléčenost virové hepatitidy typu C mezi injekčními uživateli drog, účinnost léčby a související faktory na straně systému péče". Doctoral thesis, 2013. http://www.nusl.cz/ntk/nusl-322582.

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Background: Injecting drug users (IDUs) represent considerable group of patients infected with hepatitis C virus (HCV). HCV treatment is an effective tool for reduction of HCV transmissions among IDUs. Nevertheless treatment rate among IDUs is rather insufficient. Treatment uptake, provision and adherence as well as its efficacy in IDUs are determined by number of specific factors. Aims: Mapping an extent of the provision of HCV treatment to IDUs in the Czech Republic, rules and practices for the admission of IDUs into HCV treatment and its provision, describing relevant factors related to drug use. Material and methods: From January to March 2011, a questionnaire survey among centres for treatment of viral hepatitis in the Czech Republic was conducted. 76 identified centres were addressed, of which 45 (59%) responded, and 40 (53%) filled in an online questionnaire. Results: Estimated number of centres treated HCV with combination of pegylated interferon α and ribavirin in the Czech Republic in 2010 was 61, 39 of them treated IDUs. Estimated 780 persons were treated, of whom 370 were (mostly ex-) IDUs. Reported treatment uptake in IDUs was 60% on average (range 0-90%). Treatment is completed by 80% of IDUs on average (0-100%) according to clinicians. Most clinicians reported no difference in the treatment...

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46

Caron, Jean-Bruno. "De l’influence du type de substance injectée sur le comportement du partage du matériel d’injection". Thèse, 2017. http://hdl.handle.net/1866/20558.

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47

Adamson, Andrea Kelly. "Injection drug use among youth: An exploration of key factors influencing safer and/or unsafe practices". 2013. http://hdl.handle.net/10222/36245.

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Background: Much of the research on injection drug use practices has focused on adult populations and relatively little is known about safer and/or unsafe injection practices among youth who use injection drugs (YWID). Unsafe practices may be risk factors for blood borne illnesses, abscesses or other infections, and overdose. Multiple factors may create barriers to the access of clean supplies and the ability to practice safer injection. It is important to understand how YWID engage in safer and/or unsafe injection practices so that use of safer practices may be supported. Purpose: The purpose of this study was to explore the understandings and practices of safer and/or unsafe injection drug use among YIWD, as well as key social factors influencing these understandings and practices. Methods: Ten semi-structured qualitative interviews were conducted with YWID aged 18 to 29 in Halifax, Nova Scotia. Voluntary informed consent was obtained prior to conducting the interviews. All interviews were audio-taped and transcribed, then analyzed using a modified approach to grounded theory for key themes and subthemes. Results: The experiences of the YWID can be categorized into two overarching themes. The first theme relates to the power of the drugs and the control (or, at times, lack of control) YWID have over safer practices. This theme explores how access to clean supplies and understandings of safer use can influence the control YWID have over safer practices. The second theme describes experiences YWID have with “getting clean,” or gaining power over drugs, including experiences with methadone maintenance treatment. Discussion: YWID can and do practice safer use, however multiple factors, such as the perception of cleanliness in injection practices and the availability of clean needles in the community, impact how YWID understand and practice safer injection drug use. Barriers that impede YWID’s ability to practice safer use need to be addressed.

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48

Miller, Caroline Lisa. "An interdisciplinary study of injection drug related harm among young people who use injection drugs in Vancouver, British Columbia". Thesis, 2006. http://hdl.handle.net/2429/18753.

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Research Problem: Young injection drug users (IDUs) may be at elevated risk for blood-borne infection, however there is a dearth of longitudinal data regarding factors that influence drug-related harms in this population. Methods: This study was an interdisciplinary exploration of drug-related harm among young (< or = 29 years) IDUs in Vancouver, B.C., undertaken through the VIDUS, a prospective cohort that began in 1996. Over 1500 participants have been enrolled and followed, among whom over 550 were aged < or = 29 years. Participants were eligible for an interview semiannually and have undergone serologic testing for HIV and HCV antibodies. In addition to the longitudinal survey data, 28 participants (aged < or = 29 years) consented to an in-depth interview. Results: Cumulative incidence rates for HIV and HCV among young participants were 11.1% and 52.1% respectively at 36 months after enrollment [sic] in the study. In total, 38% of the young IDUs initiated injection drug use in early adolescence (< or = 16 years) and those who did were more likely to be: HIV and HCV-seropositive, female, sex workers, binge drug users and incarcerated. Younger (< or = 29 years [N=582]) and older (> or = 30 years [N=1016]) IDUs were compared in multivariable analyses and younger age was associated with: female sex, homelessness, incarceration, sex work, borrowing syringes, > or = 1 daily injection of heroin, cocaine, and speedballs and being less likely to access drug treatment or MMT. In quantitative and qualitative analyses examining associations between younger age and frequent heroin injection, data revealed numerous sex and drug-related vulnerabilities among younger IDUs associated with heroin dependency, initiation and withdrawal. 22 young IDUs died during the study period for a crude mortality rate of 1,368 per 100,000 person-years. Young female IDUs were 54.1 times (95%CI; 29.6-90.8) and young male IDUs 12.9 times (95%CI; 5.5, 25.3) more likely to die compared to the Canadian non-IDU population of the same age. Findings: Younger IDUs demonstrated unique and elevated risk patterns as compared to older IDUs, including elevated use of injection heroin and lower uptake of available treatment. Young IDUs, particularly females, require targeted and ’youth-friendly’ interventions including the development of substitution therapies, drug treatment, injection initiation prevention and harm reduction education services.
Graduate and Postdoctoral Studies
Graduate

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49

Buxton, Meredith. "Blood borne infections and duration of injection drug use among young, newly initiated injection drug users". Thesis, 2013. https://doi.org/10.7916/D8MP59HV.

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The purpose of this research is to examine select baseline characteristics and drug use and sexual behaviors by duration of injection drug use among young, newly initiated injection drug users (IDUs) to better understand factors associated with risk of infection during the early stage of an injection drug users' career. This research was conducted using questionnaire data from the Collaborative Injection Drug Users Study II (CIDUS-II), a CDC-sponsored prospective study of young (18-29) and/or newly initiated IDUs (duration of injection < 6 years). The study was conducted at six sites in five United States' urban areas: Baltimore, Chicago, Los Angeles, New Orleans, and New York City (Harlem and the Lower East Side). Investigators conducted interviews to assess baseline characteristics and injection drug use and sexual risk factors and obtained serum for testing of bloodborne infections including Hepatitis C (HCV). Duration of injection was calculated from the age of first injection to age at the time of the interview and roughly divided into tertiles by duration while maintaining years as whole numbers: 0-1 year, 2-3 years, and 4-6 years. Among the 1836 participants included in the analysis, 34% (n = 619) had been injecting for 0-1 year, 38% (n = 697) for 2-3 years, and 28% (n = 520) for 4-6 years. Overall HCV prevalence was 34%. By duration of injection, HCV prevalence differed by site of recruitment. In Baltimore for blacks HCV prevalence increased from 33.3% among IDUs injecting <2 years to 79% among IDUs injecting 4-6 years. HCV prevalence in other cities (Chicago, Los Angeles, New Orleans and New York) showed less difference by duration. By racial and ethnic group, HCV prevalence was higher in blacks than non-blacks (=80% white) in all cities (OR = 1.43, 95% CI: 1.00 - 2.05) except Baltimore where prevalence was higher in whites (OR = 5.20, 95% CI: 2.94 - 9.18) than blacks (OR = 2.52, 95% CI: 1.38 - 3.07) as compared to whites in all other cities. The IDU groups of <2 years duration (n = 691) and 2-3 years duration (n = 697) had higher odds than the 4-6 year group (n = 520) of reporting injecting with others (Odds Ratio, OR = 1.52, and OR = 1.47, respectively) and injecting on average more now (OR = 1.44 and OR = 1.44, respectively). The associations remained after multivariate adjustment for demographic variables. In addition, the frequency of several other important risky injection practices were found to be higher among more newly initiated including indirect sharing (sharing of cookers, cotton and rinse water) and backloading, and certain preventive behaviors was found to be lower among this group as well, including use of new needles and NEPs. Duration of injection did not appear to be associated with sexual risk behaviors such as giving or receiving sex for money or drugs or frequency of condom use with sex partners. These data confirm high prevalence of HCV soon after initiation of injection, and increases in HCV prevalence by duration of injection that differed across U.S. cities and by racial/ethnic group. In addition, these data provide support to the ongoing discussions about increased risk among young, newly initiated injection drug users, with risky injection practices higher among more newly initiated IDUs. These findings help to improve our understanding about the periods of increased risk and provide important information about certain baseline characteristics and injection practices among young, newly initiated IDUs -- essential data to consider when developing risk reduction programs.

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Sinclair, Caitlin. "Barriers to accessing hepatitis C for individuals who have experience with injection drug use and are accessing methadone maintenance treatment". 2012. http://hdl.handle.net/10222/14589.

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Abstract (sommario):

Hepatitis C (HCV) is an infectious disease of the liver which affects more than 250,000 Canadians; the majority of those living with the disease have experience with injection drug use. Treatment for HCV involves a strict protocol, has only a 50% success rate and has harsh side effects. Interest in HCV treatment among people who use drugs is high, but actual uptake of treatment remains low. The objective of this research was to explore the barriers to accessing HCV treatment for individuals who were accessing methadone. A mixed methods approach was used; a cross sectional survey and an in-depth interview were administered to clients of a methadone maintenance program. The two sets of data identified three main barriers to HCV treatment; stigma, the toxicity of treatment, and day-to-day struggles. Future research should be conducted to further explore how stigma guides decisions around HCV treatment, particularly in a methadone treatment setting.

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