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Objective/Approach The Black Health Equity Working Group's Applied Health Research Question aimed to compare cancer screening rates and surgical wait times between community health centre (CHC) clients based on race-related data and non-CHC clients. CHC client data was categorized by self-identified racial groups, with Black self-identification compared to non-Black racialized, White, and missing racial self-identification, and non-CHC clients. Health card numbers were encrypted to link individuals to the Primary Care Population dataset for breast, cervical, and colorectal cancer screening rates. Surgical wait time indicators, such as the number of patients undergoing surgery and average wait times for initial consultation and completed surgeries, were derived from the Wait Time Information System. Assessments were conducted semi-annually from fiscal year 2018 to 2021. Results Following the onset of COVID-19, CHC clients self-identifying as Black experienced the most significant decrease (6.8%) in colorectal screenings compared to other groups. Mammogram screenings remained consistently higher for CHC clients self-identifying as Black pre- and post-pandemic. Average cervical cancer screening rates were approximately 8% higher among CHC clients compared to non-CHC clients, irrespective of racial self-identification. However, due to small sample sizes and missing data among self-identified racial groups, trends in surgical wait times for both CHC and non-CHC clients were unstable. Conclusion/Implications Tailored interventions targeting Black CHC clients can enhance cancer screening rates, particularly colorectal screenings. The analysis of CHC data offers valuable insights into race-based disparities in health outcomes. Improved data completeness is essential for accurately assessing health outcome variations among different racial groups.

Abstract Background People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services representing potential opportunities (i.e., ‘touchpoints’) where COVID-19 testing could have been offered. Methods Between October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression identified factors associated with COVID-19 testing including potential touchpoints, comorbidities and COVID-19 related misinformation and disinformation. Results Of 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive (30.1%), 50.3% encountered at least one touchpoint where COVID-19 testing could have been offered within the prior six months. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego, recent incarceration, receiving substance use treatment, and experiencing ≥1 chronic health condition. Homelessness, having received ≥1 dose of COVID-19 vaccine, and having a HIV or HCV test since the COVID-19 epidemic began were also independently associated with having had a prior COVID-19 test. Conclusion We identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.

Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.

In this policy and practice brief, Mississippi State University Extension Services applies a coalition-driven approach to addressing the prevalence of obesity in communities in the Mississippi Delta through its High Obesity Program, funded by the Centers for Disease Control and Prevention (CDC). Focus groups were conducted with coali­tion members from six counties to evaluate efforts by this program. The evaluation team used content and thematic analysis to report on coalition activi­ties. Some the barriers coalition members identified were limited access to healthy foods and the need for more assistance from program staff. Action items were developed and implemented in re­sponse to focus group feedback. These items included enhanced communication tools and coalition trainings. This evaluation brief describes some of the common challenges in coalition build­ing and innovative ways to improve them. Our focus group findings are also valuable to public health scientists and practitioners working in rural communities.

BackgroundPeople who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services representing potential opportunities (i.e., 'touchpoints') where COVID-19 testing could have been offered.MethodsBetween October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression identified factors associated with COVID-19 testing including potential touchpoints, comorbidities and COVID-19 related misinformation and disinformation.ResultsOf 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive (30.1%), 50.3% encountered at least one touchpoint where COVID-19 testing could have been offered within the prior six months. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego, recent incarceration, receiving substance use treatment, and experiencing ≥1 chronic health condition. Homelessness, having received ≥1 dose of COVID-19 vaccine, and having a HIV or HCV test since the COVID-19 epidemic began were also independently associated with having had a prior COVID-19 test.ConclusionWe identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.

AimsGlobally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services.MethodsIn a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use.ResultsAmong 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks.ConclusionsDrawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.

Female sex work is often perceived as women being controlled by men. We used surveys and qualitative interviews with female sex workers and their intimate partners in two Northern Mexico cities to examine couples' own perceptions of their relationships and male partners' involvement in sex work. Among 214 couples, the median age was 34 and relationship duration was approximately 3 years. Only 10 women in the survey reported having a pimp, and the majority reported sole control over sex work decisions. Qualitative analyses revealed that while most men avoided direct involvement in sex work, they offered advice that was largely driven by concern for their partner's well-being. Our discussion of these results considers the broader socio-political context surrounding these relationships and how changing gender roles, economic insecurity and stigma shape couples' everyday social interactions. Assumptions that all sex workers' relationships are coercive and commercial marginalises these couples while leaving their health concerns unaddressed.

Due to heightened vulnerability to HIV from frequent engagement in sex work and overlapping drug-using and sexual networks, women who inject drugs should be a high priority population for pre-exposure prophylaxis (PrEP) and other biomedical HIV prevention tools. Kenya is one of the first African countries to approve oral PrEP for HIV prevention among "key populations," including people who inject drugs and sex workers. The objective of this study was to explore preferences and perceived challenges to PrEP adoption among women who inject drugs in Kisumu, Kenya. We conducted qualitative interviews with nine HIV-uninfected women who inject drugs to assess their perceptions of biomedical HIV interventions, including oral PrEP, microbicide gels, and intravaginal rings. Despite their high risk and multiple biomedical studies in the region, only two women had ever heard of any of these methods. All women were interested in trying at least one biomedical prevention method, primarily to protect themselves from partners who were believed to have multiple other sexual partners. Although women shared concerns about side effects and product efficacy, they did not perceive drug use as a significant deterrent to adopting or adhering to biomedical prevention methods. Beginning immediately and continuing throughout Kenya's planned PrEP rollout, efforts are urgently needed to include the perspectives of high risk women who use drugs in biomedical HIV prevention research and programing.

Sensationalistic media coverage has fueled stereotypes of the Mexican border city of Tijuana as a violent battleground of the global drug war. While the drug war shapes health and social harms in profoundly public ways, less visible are the experiences and practices of hope that forge communities of care and represent more private responses to this crisis. In this article, we draw on ethnographic fieldwork and photo elicitation with female sex workers who inject drugs and their intimate, non-commercial partners in Tijuana to examine the personal effects of the drug war. Drawing on a critical phenomenology framework, which links political economy with phenomenological concern for subjective experience, we explore the ways in which couples try to find hope amidst the horrors of the drug war. Critical visual scholarship may provide a powerful alternative to dominant media depictions of violence, and ultimately clarify why this drug war must end.

BackgroundSelf-reports are commonly used to assess prevalence and frequency of drug use, but it is unclear whether qualitative methods like semi-structured interviews are as useful at obtaining such information as quantitative surveys.ObjectivesThis study compared drug use occurrence and frequency using data collected from quantitative surveys and qualitative interviews. We also examined whether combining data from both sources could result in significant increases in percentages of current users and whether the concordance between the two sets of data was associated with the type of drug use, age, gender and socioeconomic status.MethodsSelf- reports of recent marijuana, heroin, crack, cocaine, crystal/methamphetamine, inhalant, and tranquilizer use were collected using both methods from a cohort of Mexican female sex workers and their non-commercial male partners (n = 82).ResultsParticipants were significantly less likely to report marijuana, cocaine and tranquilizer use and frequency of use during the qualitative interviews than during the quantitative surveys. Agreement on frequency of drug use was excellent for crystal/methamphetamine, heroin and inhalant use, and weak for cocaine, tranquilizers and marijuana use. Older participants exhibited significantly higher concordance than younger participants in reports of marijuana and methamphetamine use. Higher monthly income was significantly associated with higher concordance in crack use but lower concordance with marijuana use.ConclusionsAlthough use of such data can result in an underreporting of drug use, qualitative data can be quantified in certain circumstances to triangulate and confirm the results from quantitative analyses and provide a more comprehensive view of drug use.

The relationships between female sex workers and their non-commercial male partners are typically viewed as sites of HIV risk rather than meaningful unions. This ethnographic case study presents a nuanced portrayal of the relationship between Cindy and Beto, a female sex worker who injects drugs and her intimate, non-commercial partner who live in Tijuana, Mexico. Based on ethnographic research in Tijuana and our long term involvement in a public health study, we suggest that emotions play a central role in sex workers' relationships and contribute in complex ways to each partner's health. We conceptualize Cindy and Beto's relationship as a "dangerous safe haven" in which HIV risk behaviors such as unprotected sex and syringe sharing convey notions of love and trust and help sustain emotional unity amidst broader uncertainties, but nevertheless carry very real health risks. Further attention to how emotions shape vulnerable couples' health remains a task for anthropology.

ObjectivesWe examined correlates of love and trust among female sex workers and their noncommercial male partners along the Mexico-US border.MethodsFrom 2011 to 2012, 322 partners in Tijuana and Ciudad Juárez, Mexico, completed assessments of love and trust. Cross-sectional dyadic regression analyses identified associations of relationship characteristics and HIV risk behaviors with love and trust.ResultsWithin 161 couples, love and trust scores were moderately high (median 70/95 and 29/40 points, respectively) and correlated with relationship satisfaction. In regression analyses of HIV risk factors, men and women who used methamphetamine reported lower love scores, whereas women who used heroin reported slightly higher love. In an alternate model, men with concurrent sexual partners had lower love scores. For both partners, relationship conflict was associated with lower trust.ConclusionsLove and trust are associated with relationship quality, sexual risk, and drug use patterns that shape intimate partners' HIV risk. HIV interventions should consider the emotional quality of sex workers' intimate relationships.

Preventing human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs) requires an understanding of sexual relationship factors beyond the individual level. We estimated HIV/STI incidence and identified time-varying predictors of STI acquisition in a prospective cohort study of female sex workers and their intimate (noncommercial) male partners in northern Mexico. From 2010 to 2013, couples underwent behavioral and biological assessments biannually for 24 months. Among 413 initially HIV-uninfected participants, 8 seroconverted during follow-up. Incidence of HIV (1.12 cases/100 person-years (PY)), chlamydia (9.47 cases/100 PY), active syphilis (4.01 cases/100 PY), and gonorrhea (1.78 cases/100 PY) was higher among women than among men (HIV: P = 0.069; all STIs combined: P < 0.001). In multivariable conditional logistic regression with individual fixed effects and correlated error terms within couples, risk of STI acquisition was significantly higher among women who had recently used cocaine, crack, or methamphetamine (adjusted odds ratio (OR) = 2.13, 95% confidence interval (CI): 1.07, 4.28). STI risk was lower among women who reported physically assaulting their male partners (adjusted OR = 0.44, 95% CI: 0.22, 0.86) and among men whose female partners had regular sex-work clients (adjusted OR = 0.38, 95% CI: 0.14, 1.03). Improving vulnerable couples' sexual health will require addressing the contexts in which drug use, interpersonal conflict, and economic vulnerability converge.

Black and Latino gay, bisexual, and other men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections (STIs) than their White counterparts. Differences in sexual networks have been hypothesized to play an important role in the observed racial/ethnic disparities in risk. However, concerns about the acceptability and feasibility of conducting sociocentric sexual network studies have left a dearth of data on the structure of sexual networks of MSM. If certain network research procedures are unacceptable among target populations, biases may be introduced. We conducted qualitative interviews and brief surveys with 30 self-identified Black (n = 12), Hispanic/Latino, (n = 9) and White (n = 9) sexually active MSM in the Greater Boston area to assess the acceptability and feasibility of potential procedures for a sociocentric sexual network study. We found that referring recent sexual partners as part of a sociocentric network study was generally acceptable, but racial/ethnic differences emerged regarding specific preferences for how to recruit sexual partners. While the majority of Black participants (7/12) explained that they would not want their name disclosed to sexual partners approached for study participation, most Latino participants (7/9) preferred having the opportunity to inform referrals themselves about the study prior to researchers contacting them, and White participants (8/9) favored having researchers disclose their names when recruiting referrals, emphasizing the importance of transparency. In order to reduce differential rates of research participation, increase scientific validity, and reduce risks of social harm, researchers studying sexual networks among MSM should be aware of these potential differences, engage communities in study design, and provide participants with a variety of options for recruiting their sexual partners. [ABSTRACT FROM PUBLISHER]