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Difficulty accessing crack pipes and crack pipe sharing among people who use drugs in Vancouver, Canada.

https://arctichealth.org/en/permalink/ahliterature128325
Source
Subst Abuse Treat Prev Policy. 2011;6:34
Publication Type
Article
Date
2011
Author
Lianping Ti
Jane Buxton
Evan Wood
Ruth Zhang
Julio Montaner
Thomas Kerr
Author Affiliation
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
Source
Subst Abuse Treat Prev Policy. 2011;6:34
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Crack Cocaine - adverse effects
Female
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
Risk factors
Risk-Taking
Street Drugs
Young Adult
Abstract
Crack pipe sharing can increase health risks among people who use drugs, yet the reasons for sharing these pipes have not been well described. Therefore, we sought to identify the prevalence and correlates of crack pipe sharing among a community-recruited sample of people who use illicit drugs in Vancouver, a setting where crack pipes are provided at low or no cost.
Data for this study were derived from two prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS). Multivariate logistic regression was used to identify factors independently associated with crack pipe sharing. Among 503 crack users, 238 (47.3%) participants reported having shared a crack pipe in the previous six months. Having acquired a mouthpiece in the last six months (adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.31 - 2.79) and difficulty finding new pipes (AOR = 2.19; 95%CI: 1.42 - 3.37) were positively associated with pipe sharing. Binge drug use (AOR = 1.39; 95%CI: 0.96 - 2.02) was marginally associated with sharing pipes.
There was a high prevalence of crack pipe sharing in a setting where crack pipes are distributed at low or no cost. Difficulty accessing crack pipes was independently and positively associated with this behavior. These findings suggest that additional efforts are needed to discourage crack pipe sharing as well as increase access to crack pipes.
Notes
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PubMed ID
22208877 View in PubMed
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Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature125660
Source
Drug Alcohol Rev. 2012 Nov;31(7):890-6
Publication Type
Article
Date
Nov-2012
Author
Lianping Ti
Jane Buxton
Evan Wood
Kate Shannon
Ruth Zhang
Julio Montaner
Thomas Kerr
Author Affiliation
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Source
Drug Alcohol Rev. 2012 Nov;31(7):890-6
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Cocaine-Related Disorders - epidemiology
Cohort Studies
Crack Cocaine - administration & dosage
Female
Follow-Up Studies
Harm Reduction
Hepatitis C - transmission
Humans
Male
Middle Aged
Multivariate Analysis
Prospective Studies
Risk-Taking
Abstract
Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada.
Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes.
Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%).
A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.
Notes
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PubMed ID
22462808 View in PubMed
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The impact of harm reduction on HIV and illicit drug use.

https://arctichealth.org/en/permalink/ahliterature104926
Source
Harm Reduct J. 2014;11:7
Publication Type
Article
Date
2014
Author
Lianping Ti
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
Source
Harm Reduct J. 2014;11:7
Date
2014
Language
English
Publication Type
Article
Keywords
British Columbia
HIV Infections - prevention & control
Harm Reduction
Humans
Street Drugs
Substance-Related Disorders - prevention & control
Abstract
There has been widespread support for harm reduction programs as an essential component for responding to the HIV and illicit drug use epidemics. However, despite the growing international acceptance of harm reduction, there continues to be strong opposition to this approach, with critics alleging that harm reduction programs enable drug use. Vancouver, Canada provides a compelling case study that demonstrates that many positive impacts of harm reduction can be attained while addiction treatment-related goals are simultaneously supported. While the evidence for harm reduction is clearly mounting, it is unfortunate that ideological and political barriers to implementing harm reduction programs in Canada remain. As evidenced by Vancouver and elsewhere, harm reduction programs do not exacerbate drug use and undermine treatment efforts and should thereby occupy a well-deserved space within the continuum of programs and services offered to people who inject drugs.
Notes
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PubMed ID
24559062 View in PubMed
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Police confrontations among street-involved youth in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature121717
Source
Int J Drug Policy. 2013 Jan;24(1):46-51
Publication Type
Article
Date
Jan-2013
Author
Lianping Ti
Evan Wood
Kate Shannon
Cindy Feng
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
Source
Int J Drug Policy. 2013 Jan;24(1):46-51
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior
Adult
British Columbia - epidemiology
Crime - psychology
Criminals - psychology
Female
Health Behavior
Homeless Persons - psychology
Homeless Youth - psychology
Humans
Law Enforcement
Life Style
Male
Multivariate Analysis
Odds Ratio
Police
Prospective Studies
Questionnaires
Risk factors
Sex Factors
Sex Workers - psychology
Street Drugs
Substance-Related Disorders - epidemiology - psychology
Time Factors
Violence - psychology
Young Adult
Abstract
Street-level policing has been recognized as a driver of health-related harms among people who inject drugs (IDU). However, the extent of interaction between police and street-involved youth has not been well characterized. We examined the incidence and risk factors for police confrontations among street-involved youth in a Canadian setting.
Using data derived from participants enrolled in the At-Risk Youth Study (ARYS) between 2005 and 2011, we assessed factors associated with being stopped, searched, or detained by police without arrest in the previous six months using generalized estimating equations (GEE) with logit link for binary outcomes.
Among 991 participants followed during the study period, 440 (44.4%) reported being stopped, searched, or detained by police for an incidence density of 49.20 (95% confidence interval [CI]: 36.42-65.01) per 100 person years. In multivariate GEE analyses, factors associated with police confrontations included: male gender (adjusted odds ratio [AOR]=1.35), homelessness (AOR=2.05), recent incarceration (AOR=1.78), daily cannabis use (AOR=1.31), daily heroin injecting (AOR=1.36), crack pipe/syringe sharing (AOR=1.61), injection drug use (AOR=1.37), public drug use (AOR=2.19), sex work involvement (AOR=1.67), and drug dealing (AOR=1.49) (all p
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PubMed ID
22883543 View in PubMed
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Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study.

https://arctichealth.org/en/permalink/ahliterature104985
Source
Sex Transm Infect. 2014 Aug;90(5):418-22
Publication Type
Article
Date
Aug-2014
Author
Lianping Ti
M-J Milloy
Kate Shannon
Annick Simo
Robert S Hogg
Sylvia Guillemi
Julio Montaner
Thomas Kerr
Evan Wood
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Source
Sex Transm Infect. 2014 Aug;90(5):418-22
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - therapeutic use
CD4 Lymphocyte Count
Canada - epidemiology
Cohort Studies
Disease Progression
Drug Users - statistics & numerical data
Female
HIV Seropositivity - drug therapy - mortality - physiopathology
HIV-1 - genetics - isolation & purification
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
RNA, Viral - isolation & purification
Risk factors
Sex Workers - statistics & numerical data
Social Class
Street Drugs
Substance Abuse, Intravenous - epidemiology
Treatment Outcome
Viral Load
Abstract
Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SW-DU).
Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression.
Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression.
Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.
PubMed ID
24523347 View in PubMed
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