A Syndemic Approach to Understanding HIV/AIDS Among People Who Inject Drugs in the U.S.

Pouget, Enrique R.; Bennett, Alex S.

doi:10.1007/978-3-319-34004-3_8

Cited by 4 publications

(2 citation statements)

References 87 publications

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“…One useful way to think about correlated social determinants and HIV/STI-related outcomes is using the 'syndemics' framework [154]. Syndemics are defined as two or more diseases or other health conditions that act synergistically, often as a result of social inequality [155].…”

Section: (B) Analytical Challengesmentioning

confidence: 99%

Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA

Pouget

2017

Phil. Trans. R. Soc. B

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In Black population centres in the USA, adult sex ratios (ASRs) are strongly female-biased primarily due to high male incarceration and early mortality rates. I explore the system of social determinants that shape these ASRs, and describe their apparent consequences. Evidence suggests that female-biased ASRs play a role, along with racial residential segregation, to increase mixing between core and peripheral members of sexual networks, facilitating transmission of human immunodeficiency virus and other sexually transmitted infections. Unique historical factors underlie Black male incarceration and mortality rates in the USA, making comparisons with other groups or other countries challenging.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.

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Section: (B) Analytical Challengesmentioning

confidence: 99%

Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA

Pouget

2017

Phil. Trans. R. Soc. B

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“…Approximately 3.7 million people who inject drugs (PWID) in the United States (US) represent 1.46% of the US population [1], and PWID account for 7% of new HIV acquisitions annually [2]. The domestic HIV burden among PWID is driven by interconnected syndemic factors, including limited access to healthcare and medication for opioid use disorder (MOUD), poverty, polysubstance use, and unmet mental health needs [3,4]. The health impacts of these syndemic factors are further amplified by the criminalization of drug use [5,6] and stigma towards PWID within systems of care, which contribute to the disruption or discontinuation of healthcare services, including limited access to HIV-related medications and MOUD [5,7]; hindering treatment adherence and retention.…”

Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

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Background HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. Methods We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. Results Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. Conclusions Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. Trial registration ClincalTrials.gov, Registration Number: NCT04804072. Registered 18 February 2021.

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A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men

et al. 2020

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A Syndemic Approach to Understanding HIV/AIDS Among People Who Inject Drugs in the U.S.

Cited by 4 publications

References 87 publications

Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA

Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men

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