The criminalization of behaviors such as the ingestion of certain mood-altering drugs creates ethical dilemmas for researchers studying those behaviors. The Syringe Access, Use, and Discard (SAUD) project is designed to uncover microcontextual factors that influence HIV and hepatitis risk behaviors of injection drug users. The article presents seven ethical dilemmas encountered using ethnographic methods: issues involving syringe replacement at injection locales, risks of participants' arrest, potential disruptions in participants' supply routes, risks of research staff arrest, threats to the protection of confidentiality, issues surrounding informed consent in working with addicts, and the confiscation of potentially incriminating information by police. The article concludes with a discussion of the limitations of traditional ethical frameworks, such as utilitarianism, for resolving these dilemmas and recommends instead improving public health professionals' capacity for practical reasoning (phronesis) through the greater use of case studies in public health curricula.
We assessed the efficacy of a Spanish-language HIV/AIDS and HIV testing video as a substitute for comparable orally-delivered information in healthcare and non-health care settings for Spanish-speakers regardless of health literacy level. In a non-inferiority clinical trial, Spanish-speaking Latinos from an emergency department, a clinic, and community-based organizations were randomly assigned to receive HIV/AIDS and HIV testing information orally or from a video. Comprehension of the information was measured using a questionnaire. Of the 150 participants, 39% met criteria for lower health literacy and 75% previously had been tested for HIV. Mean scores on the questionnaire for the video (20.4; 95% CI: 19.5∼21.3) and the orally-delivered information arms (20.6; 95% CI: 19.7∼21.5) were similar (Δ = -0.15; 95% CI: -1.4∼1.1). Mean scores among lower health literacy participants also were similar (18.3 (video) vs. 19.6 (in-person); p<0.30). This Spanish-language video is a viable substitute for orally-delivered HIV/AIDS and HIV testing information.
Experiences of perceived stigma and discrimination are associated with a range of negative health outcomes. Individuals with substance use disorders and co-occurring mental health problems experience significant public stigma and discrimination associated with multiple aspects of identity. Less is known as to how these experiences of stigma and discrimination are associated with mental health among women in substance abuse treatment. This study examined experiences of perceived stigma and discrimination as well as associations among these experiences and poor mental health among women in publicly funded substance abuse treatment services. Structured interview data from 240 women (59% racial/ethnic minority, M Ϯ SD age ϭ 33.42 Ϯ 9.16) include measures of devaluation stigma, perceived discrimination, and symptoms of psychological distress and posttraumatic stress disorder (PTSD) and open-ended questions exploring experiences of stigma and discrimination. Participants identified substance use as the most prevalent source of devaluation stigma and the most common reason for experiences of discrimination. Adjusting for covariates, discrimination was associated with higher severity of mental health symptoms (p Ͻ .001) and PTSD symptoms (p Ͻ .001). Devaluation stigma based on race, substance use, and mental illness were not associated with mental health indices. In addition, recent trauma experience partially mediated the relationships of perceived discrimination with mental health symptoms (p Ͻ .001) and PTSD symptoms (p Ͻ .001), after adjusting for covariates. These findings suggest importance of strategies to address experiences of discrimination to improve mental health of women in publicly funded substance abuse treatment.
Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006-2008 with street drug users in Rio de Janeiro (focus groups, N=24; a pile sort, N=108; open-ended interviews, N=34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention.
The criminalization of behaviors such as the ingestion of certain mood-altering drugs creates ethical dilemmas for researchers studying those behaviors. The Syringe Access, Use, and Discard (SAUD) project is designed to uncover microcontextual factors that influence HIV and hepatitis risk behaviors of injection drug users. The article presents seven ethical dilemmas encountered using ethnographic methods: issues involving syringe replacement at injection locales, risks of participants' arrest, potential disruptions in participants' supply routes, risks of research staff arrest, threats to the protection of confidentiality, issues surrounding informed consent in working with addicts, and the confiscation of potentially incriminating information by police. The article concludes with a discussion of the limitations of traditional ethical frameworks, such as utilitarianism, for resolving these dilemmas and recommends instead improving public health professionals' capacity for practical reasoning (phronesis) through the greater use of case studies in public health curricula.
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