Additional file 1: Table S1. Bivariate correlation matrix among all variables. Table S2. Estimate... more Additional file 1: Table S1. Bivariate correlation matrix among all variables. Table S2. Estimated drug treatment coverage rates. Table S3. Results from Full Multi-Domain Mixed-Effects Model by Domain.
Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for i... more Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001–2006) and investigates whether these trends are related to district racial/ ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. “Need ” was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999–2001), and the number of drug-related hos...
In the United States, people who inject drugs continue to be at greatly increased risk of HIV inf... more In the United States, people who inject drugs continue to be at greatly increased risk of HIV infection. To estimate the effectiveness of various prevention scenarios, we modeled HIV transmission in a dynamic network of drug users and people who did not use drugs that was based on the New York Metropolitan Statistical Area population. We compared the projected HIV incidence in 2020 and 2040 if current approaches continue to be used to the incidence if one or more of the following hypothetical interventions were applied: increased HIV testing, improved access to substance abuse treatment, increased use of needle and syringe programs, scaled-up treatment as prevention, and a “high impact” combination scenario, consisting of all of the strategies listed above. No strategy completely eliminated HIV transmission. The high-impact combination strategy produced the largest decrease in HIV incidence—a 62 percent reduction compared to the status quo. Our results suggest that increased resourc...
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and servic... more BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
This study examined overall and gender-specific associations between place-based characteristics ... more This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
JAIDS Journal of Acquired Immune Deficiency Syndromes
BACKGROUND To examine trends in state-level policy support for sexual minorities and HIV outcomes... more BACKGROUND To examine trends in state-level policy support for sexual minorities and HIV outcomes among MSM. METHODS This longitudinal analysis linked state-level policy support for sexual minorities (N=94 Metropolitan Statistical Areas [MSAs] in 38 states) to 7 years of data (2008-2014) from CDC on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (e.g., non-discrimination laws including sexual orientation as a protected class) from 1999-2014, deriving 3 latent groups: consistently low policy support; consistently high policy support; and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM; late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within three months of HIV diagnosis) per 10,000 MSM; AIDS diagnoses per 10,000 MSM with HIV; and AIDS-related mortality per 10,000 MSM with AIDS. RESULTS Compared to MSAs in states with low levels and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses (Risk Difference [RD]=-37.9, 95% Confidence Interval [CI]: -54.7, -21.0), late diagnoses (RD=-12.5, 95% CI: -20.4, -4.7), and AIDS-related mortality (RD=-33.7, 95% CI: -61.2, -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to policy climate. CONCLUSION State-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
Background Adequate access to effective treatment and medication assisted therapies for opioid de... more Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability...
ObjectivesEmerging literature shows that racialised police brutality, a form of structural racism... more ObjectivesEmerging literature shows that racialised police brutality, a form of structural racism, significantly affects health and well-being of racial/ethnic minorities in the USA. While public health research suggests that structural racism is a distal determinant of sexually transmitted infections (STIs) among Black people, no studies have empirically linked police violence to STIs. To address this gap, our study measures associations between police killings and rates of STIs among Black residents of US metropolitan statistical areas (MSAs).MethodsThis cross-sectional ecological analysis assessed associations between the number of Black people killed by police in 2015 and rates of primary and secondary syphilis, gonorrhoea and chlamydia per 100 000 Black residents of all ages in 2016 in 75 large MSAs. Multivariable models controlled for MSA-level demographic and socioeconomic characteristics, police expenditures, violent crime, arrest and incarceration rates, insurance rates and...
International Journal of Environmental Research and Public Health
Background: Hepatitis C virus (HCV) among young suburban people who inject drugs (PWID) is a grow... more Background: Hepatitis C virus (HCV) among young suburban people who inject drugs (PWID) is a growing epidemic in the United States, yet little is known about the factors contributing to increased exposure. The goal of this study was to explore and assess HCV knowledge and attitudes about treatment and identify risk behaviors among a cohort of young suburban PWID. Methods: We conducted interviews with New Jersey (NJ) service providers and staff from the state’s five syringe service programs to inform a semistructured survey addressing HCV knowledge, treatment, and risk factors among young suburban PWID. We then used this survey to conduct qualitative interviews with 14 young suburban PWID (median age 26 years) in NJ between April and May 2015. Data were analyzed using a modified grounded theory approach and coded to identify thematic relationships among respondents. Results: Most participants had substantial gaps in several aspects of HCV knowledge. These included: HCV transmission, ...
Additional file 1: Table S1. Bivariate correlation matrix among all variables. Table S2. Estimate... more Additional file 1: Table S1. Bivariate correlation matrix among all variables. Table S2. Estimated drug treatment coverage rates. Table S3. Results from Full Multi-Domain Mixed-Effects Model by Domain.
Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for i... more Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001–2006) and investigates whether these trends are related to district racial/ ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. “Need ” was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999–2001), and the number of drug-related hos...
In the United States, people who inject drugs continue to be at greatly increased risk of HIV inf... more In the United States, people who inject drugs continue to be at greatly increased risk of HIV infection. To estimate the effectiveness of various prevention scenarios, we modeled HIV transmission in a dynamic network of drug users and people who did not use drugs that was based on the New York Metropolitan Statistical Area population. We compared the projected HIV incidence in 2020 and 2040 if current approaches continue to be used to the incidence if one or more of the following hypothetical interventions were applied: increased HIV testing, improved access to substance abuse treatment, increased use of needle and syringe programs, scaled-up treatment as prevention, and a “high impact” combination scenario, consisting of all of the strategies listed above. No strategy completely eliminated HIV transmission. The high-impact combination strategy produced the largest decrease in HIV incidence—a 62 percent reduction compared to the status quo. Our results suggest that increased resourc...
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and servic... more BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
This study examined overall and gender-specific associations between place-based characteristics ... more This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
JAIDS Journal of Acquired Immune Deficiency Syndromes
BACKGROUND To examine trends in state-level policy support for sexual minorities and HIV outcomes... more BACKGROUND To examine trends in state-level policy support for sexual minorities and HIV outcomes among MSM. METHODS This longitudinal analysis linked state-level policy support for sexual minorities (N=94 Metropolitan Statistical Areas [MSAs] in 38 states) to 7 years of data (2008-2014) from CDC on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (e.g., non-discrimination laws including sexual orientation as a protected class) from 1999-2014, deriving 3 latent groups: consistently low policy support; consistently high policy support; and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM; late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within three months of HIV diagnosis) per 10,000 MSM; AIDS diagnoses per 10,000 MSM with HIV; and AIDS-related mortality per 10,000 MSM with AIDS. RESULTS Compared to MSAs in states with low levels and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses (Risk Difference [RD]=-37.9, 95% Confidence Interval [CI]: -54.7, -21.0), late diagnoses (RD=-12.5, 95% CI: -20.4, -4.7), and AIDS-related mortality (RD=-33.7, 95% CI: -61.2, -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to policy climate. CONCLUSION State-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
Background Adequate access to effective treatment and medication assisted therapies for opioid de... more Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability...
ObjectivesEmerging literature shows that racialised police brutality, a form of structural racism... more ObjectivesEmerging literature shows that racialised police brutality, a form of structural racism, significantly affects health and well-being of racial/ethnic minorities in the USA. While public health research suggests that structural racism is a distal determinant of sexually transmitted infections (STIs) among Black people, no studies have empirically linked police violence to STIs. To address this gap, our study measures associations between police killings and rates of STIs among Black residents of US metropolitan statistical areas (MSAs).MethodsThis cross-sectional ecological analysis assessed associations between the number of Black people killed by police in 2015 and rates of primary and secondary syphilis, gonorrhoea and chlamydia per 100 000 Black residents of all ages in 2016 in 75 large MSAs. Multivariable models controlled for MSA-level demographic and socioeconomic characteristics, police expenditures, violent crime, arrest and incarceration rates, insurance rates and...
International Journal of Environmental Research and Public Health
Background: Hepatitis C virus (HCV) among young suburban people who inject drugs (PWID) is a grow... more Background: Hepatitis C virus (HCV) among young suburban people who inject drugs (PWID) is a growing epidemic in the United States, yet little is known about the factors contributing to increased exposure. The goal of this study was to explore and assess HCV knowledge and attitudes about treatment and identify risk behaviors among a cohort of young suburban PWID. Methods: We conducted interviews with New Jersey (NJ) service providers and staff from the state’s five syringe service programs to inform a semistructured survey addressing HCV knowledge, treatment, and risk factors among young suburban PWID. We then used this survey to conduct qualitative interviews with 14 young suburban PWID (median age 26 years) in NJ between April and May 2015. Data were analyzed using a modified grounded theory approach and coded to identify thematic relationships among respondents. Results: Most participants had substantial gaps in several aspects of HCV knowledge. These included: HCV transmission, ...
Uploads
Papers by Barbara Tempalski