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While COVID-19 has become a global pandemic that has spread to all regions of the globe, local historic, health, and socio-environmental factors shape the epidemiological contours, response, and social challenges present within each affected nation. Thus, while countries like China, Italy, Iran, Brazil, and the United States have all been hard hit by the pandemic, there are critical differences across these nations in a number of variables (e.g. demographic features, health histories, healthcare systems, infection case rates, case fatality rates, national responses). In other words, within the global pandemic there are multiple importantly distinct national epidemics. Overcoming the grave threats to public health presented by COVID-19 requires both international cooperation and country-specific efforts that reflect local histories, needs, and resources. Already concerns are being expressed among health officials about how COVID-19 might be devastating in Africa. Currently, South Africa has the highest number of diagnosed COVID-19 cases on the continent and has been identified as being at high risk in the pandemic. This paper examines the public health response to the COVID-19 threat, how the prior and ongoing HIV and TB epidemics shape the COVID-19 epidemic and influence the response, and the potential ramifications of the response. [ABSTRACT FROM AUTHOR]

As originally conceived, syndemics refers to complex epidemics involving two types of adverse interaction – the clustering and interactions of two or more diseases or health conditions (the biological–biological interface) and social environmental factors (the biological–social interface). The theory has been widely applied in the fields of medicine, public health and anthropology, but how the concept is conceptualised and investigated in new syndemics literature remains unclear. This paper offers a scoping review of recent syndemics literature aiming to address the question: Where have scholars taken the syndemics concept? Five bibliographic databases were searched for titles containing 'syndemic[s]' revealing 334 records. A total of 143 journal articles, 23 book chapters, 21 commentaries, 2 books and 5 dissertations were assessed. Citations were classified into five categories: syndemics (n = 22), potential syndemics (n = 34), socially determined heightened burden of disease (n = 29), harmful disease cluster (n = 32) and additive adverse conditions (n = 71). The limited number of citations meeting the definition of a syndemic arrangement highlights the challenges related to describing and empirically supporting the biological–biological and biological–social relationships. Nevertheless, there is value in retaining the original, holistic, biosocial meaning of syndemics to identify and detail the casual pathways and mechanisms of interactions. [ABSTRACT FROM AUTHOR]

Women are at special risk for HIV/AIDS infection and disease progression due to an inter-related set of biopolitical factors. Biological factors that contribute to women's special vulnerability include hormonal, developmental, and immunological characteristics. Social and political factors such as poverty, gendered power relationships, and violence interact with biological factors to create an HIV risk profile among women. The approach of this paper is to review literatures that describe components of women's risks for HIV in order to create an integrated model of vulnerability. We present a syndemic model that calls attention to the importance of understanding the pathways of adverse interaction among interacting diseases and the social and political environments of sufferers. This paper synthesises known risk factors and analyses them through the lens of syndemics theory in order to demonstrate the biopolitical vulnerability of women to HIV. Applying a syndemic approach offers important implications for prevention and treatment of HIV among women. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper builds on prior discussion of the concept of syndemics in the social science and public health literatures to further define and extend the utility of this construct in analyzing the relationships among substance abuse, violence and HIV/AIDS. The term syndemic refers to a set of closely entwined and mutual enhancing health problems that "working together" in a context of noxious social and physical conditions can significantly affect the overall disease burden and health status of a population. The paper focuses on the emergence of what is termed the SAVA (substance abuse, violence, AIDS) syndemic among several populations that are at high risk because they are subject to social discrimination, stigmatization, and subordination, namely abused children and battered women, men who have sex with men, illicit drug users, and commercial sex workers. [ABSTRACT FROM AUTHOR]

Most research on the benefits of syringe exchange programs (SEPs) has focused on assessing program effectiveness and identifying risk profiles of SEP customers. To our knowledge, no empirical studies have considered the psychosocial characteristics of IDUs who do and do not use SEPs. To determine whether IDUs who do and do not use SEPs differ along demographic, psychosocial, and HIV risk characteristics and behaviors, we analyzed data from a three-city (Chicago, IL; Hartford, CT; Oakland, CA) observational study of how HIV prevention messages and supplies diffuse from SEPs. The study sample consisted of 350 participants with no reported history of HIV, hepatitis B or C virus infection. Self-efficacy was the only psychosocial factor to differentiate SEP customers from all non-customers groups; injecting others and pre-injection cleaning of the injection site differentiated some non-customers from customers. Implications for future interventions are discussed. [ABSTRACT FROM AUTHOR]

As part of a larger syringe access and HIV risk study, a subsample of 23 current injection drug users completed daily diaries, highlighting activities related to syringe acquisition, use, and discard. Diaries have been previously utilized in a variety of psychological, public health, and nutrition studies to assess risk as well as correlated behaviors. We piloted the diary methodology in three northeastern U.S. cities (Hartford and New Haven, CT, and Springfield, MA) to learn about correlates of HIV risk. We discovered that the method provided advantages over several other qualitative and ethnographic methods. Results indicate that daily diaries elucidated (1) patterns of injection drug use, (2) sporadic and high-risk events, (3) HIV and hepatitis risk related to the syringe life cycle, and (4) emotional correlates of drug use. Furthermore, we witnessed an unexpected intervention effect that the diary may have in the lives of drug users. [ABSTRACT FROM AUTHOR]

Aims Injection drug use is a major risk factor for HIV and hepatitis infections. Whereas programs to prevent new infections have focused on HIV, they have generally neglected hepatitis B and C. This study was designed to examine the interrelationships among HIV and hepatitis knowledge, risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs). Design Surveys of injection drug users (IDUs) collected data on sociodemographics, medical history, drug use and injection practices, and HIV- and hepatitis-related knowledge. Setting Inner-city US neighborhoods in Chicago, 1L, Hartford, CT and Oakland, CA. Participants The study population was a convenience sample of 493 IDUs recruited using street outreach and snowball sampling strategies. Measurements HIV and hepatitis knowledge, injection-related risks for virus transmission, associations between the two, and with SEP use. Findings HIV knowledge was significantly higher than hepatitis knowledge among SEP customers and non-customers alike. Elevated hepatitis knowledge was associated with a history of substance abuse treatment, hepatitis infection, hepatitis B vaccination and injection practices that reduced contact with contaminated blood or water but not with SEP use. SEP customers were consistently less likely to engage in risk behaviors, with the notable exception of safely staunching blood postinjection. Conclusion Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages—as evidenced by lowered risk behaviors among their customers—they must do more to prevent hepatitis transmissions. [ABSTRACT FROM AUTHOR]

To test the efficacy of culturally targeted acquired immunodeficiency syndrome (AIDS) prevention programs on ethnic minority street drug users, 669 African-American and Puerto Rican drug users were assigned to receive either the National Institute on Drug Abuse (NIDA) standard intervention or a culturally competent enhanced intervention in a quasi-experimental study. The standard intervention was a two-session educational program, while both the African-American and Puerto Rican enhanced interventions provided additional AIDS information in a culturally appropriate fashion. Although human immunodeficiency virus (HIV) risk behaviors, as measured by Bell's risk indices, decreased, there were no meaningful significant differences between interventions. However, participants who went into drug treatment programs showed greater reduction in HIV risk behavior. Cultural interventions may provide better outcome if they concentrate on getting participants into drug treatment. [ABSTRACT FROM AUTHOR]

Violence is a regular and consequential event in the lives of street drug users, commonly beginning at an early age and continuing throughout their drug careers. Growing evidence indicates that involvement in violence, of various kinds, including as victim, perpetrator, and witness, is a factor in the initiation and continuation of drug use, as well as in AIDS risk behaviours associated with illicit drug consumption. As a result, improving our understanding of the role that violence plays in drug use is critical to drug research, prevention and treatment initiatives, and the development of effective public health efforts designed to reduce the spread of HIV/AIDS and other drug-related diseases. Paying closer attention to violence in qualitative research, however, raises a number of methodological and other problems for drug researchers. This paper, based on an ongoing ethno-epidemiological study of the relationship of violence to drug use and AIDS risk among not-in-treatment Puerto Rican street drug users in Hartford, Connecticut, examines ethical, methodological, human resource, and related issues encountered in studying the intersection of these intimately linked epidemics. Specifically, the paper examines the challenges presented to ethnographic researchers by the everyday violence in the lives of study participants. In other words, this paper is concerned with the study of violence among at-risk drug users and the ways in which a focus on violence challenges our personal, intellectual, emotional, and ethical capacities to undertake this research. [ABSTRACT FROM AUTHOR]

Abstract: Syringe exchange programs (SEPs) can reduce HIV risk among injecting drug users (IDUs) but their use may depend heavily on contextual factors such as local syringe policies. The frequency and predictors of transitioning over time to and from direct, indirect, and non-use of SEPs are unknown. We sought, over one year, to: (1) quantify and characterize transition probabilities of SEP attendance typologies; (2) identify factors associated with (a) change in typology, and (b) becoming and maintaining Direct SEP use; and (3) quantify and characterize transition probabilities of SEP attendance before and after changes in policy designed to increase access. Using data collected from 583 IDUs participating in a three-city cohort study of SEPs, we conducted a latent transition analysis and multinomial regressions. Three typologies were detected: Direct SEP users, Indirect SEP users and Isolated IDUs. Transitions to Direct SEP use were most prevalent. Factors associated with becoming or maintaining Direct SEP use were female sex, Latino ethnicity, fewer injections per syringe, homelessness, recruitment city, injecting speedballs (cocaine and heroin), and police contact involving drug paraphernalia possession. Similar factors influenced transitions in the syringe policy change analysis. Policy change cities experienced an increase in Indirect SEP users (43–51%) with little increased direct use (29–31%). We found that, over time, IDUs tended to become Direct SEP users. Policies improving syringe availability influenced SEP use by increasing secondary syringe exchange. Interactions with police around drug paraphernalia may encourage SEP use for some IDUs and may provide opportunities for other health interventions. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare demographic, HIV risk behaviors, and health status characteristics of injection drug users (IDUs) who have injected “crack” cocaine with IDUs who have not. Methods: Nine hundred and eighty-nine IDUs were recruited in New Haven, CT, Hartford, CT and Springfield, MA from January 2000 to May 2002. Participants were administered a modified version of the National Institute on Drug Abuse Risk Behavior Assessment Questionnaire. Results: Nine percent (n =89) of participants reported “ever” injecting crack cocaine and 4.2% (n =42) reported injecting crack in the past 30 days. Lifetime and current crack injectors did not differ significantly on any demographic characteristics. Lifetime and current crack injectors did not differ on gender, age or marital status from IDUs who have never injected crack. Significant differences were found on race, education, employment and residence, with crack injectors more likely to be white, employed, better educated and living in New Haven than IDUs who have never injected crack. After adjusting for current (past 30 day) speedball and powder cocaine injection, crack injectors reported higher rates of risky drug use behaviors and female crack injectors reported higher rates of risky sexual behaviors. Crack injectors reported higher rates of abscesses, mental illness and Hepatitis C infection, but not Hepatitis B or HIV infection. Conclusions: The emergence of crack cocaine injection requires urgent attention, as this new drug use behavior is associated with elevated rates of high risk behaviors. [Copyright &y& Elsevier]