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Background & AimsPeople who inject drugs (PWID) experience high incarceration rates which are associated with increased hepatitis C virus (HCV) transmission risk. We assess the importance of prison-based interventions for achieving HCV elimination among PWID in New South Wales (NSW), Australia.MethodsA model of incarceration and HCV transmission among PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from NSW, incorporating elevated HCV acquisition risk among recently released PWID. We projected the contribution of differences in transmission risk during/following incarceration to HCV transmission over 2020–2029. We estimated the past and potential future impact of prison-based opioid agonist therapy (OAT; ~33% coverage) and HCV treatment (1500 treatments in 2019 with 32.9%–83.3% among PWID) on HCV transmission. We estimated the time until HCV incidence reduces by 80% (WHO elimination target) compared to 2016 levels with or without prison-based interventions.ResultsOver 2020–2029, incarceration will contribute 23.0% (17.9–30.5) of new HCV infections. If prison-based interventions had not been implemented since 2010, HCV incidence in 2020 would have been 29.7% (95% credibility interval: 22.4–36.1) higher. If current prison and community HCV treatment rates continue, there is an 98.8% probability that elimination targets will be achieved by 2030, with this decreasing to 10.1% without current prison-based interventions.ConclusionsExisting prison-based interventions in NSW are critical components of strategies to reduce HCV incidence among PWID. Prison-based interventions are likely to be pivotal for achieving HCV elimination targets among PWID by 2030.

AIMS To estimate incidence and predictors of opioid agonist therapy (OAT) discontinuation in a national cohort of people who inject drugs (PWID). DESIGN AND SETTING Annually repeated cross-sectional serosurveillance among PWID attending ~50 needle-syringe programmes across Australia. PARTICIPANTS Between 1995 and 2018, 2651 PWID who reported current OAT and had subsequent survey participation completed 6739 surveys. Respondents were followed over 11 984 person-years of observation (PYO). Respondents were predominantly male (60%), and the median age was 34 years. Heroin was the most commonly reported drug last injected (46%), and methadone was the most commonly prescribed OAT (77%). MEASUREMENTS The primary outcome was discontinuation of OAT (methadone, buprenorphine or buprenorphine-naloxone). Among respondents who reported current OAT, those who did not report current OAT in all subsequent records were defined as discontinued, and those with current OAT at all subsequent records were defined as retained. Predictors of discontinuation included self-reported demographic (sex, location, Indigenous status) and drug use characteristics (drug last injected, frequency of injection). FINDINGS Just fewer than one-third of respondents (29%) reported an OAT discontinuation event. The crude discontinuation rate was 6.3 [95% confidence intervals (CI) = 5.9-6.8] per 100 PYO. Discontinuation was significantly higher among respondents who reported last injecting pharmaceutical opioids [adjusted hazard ratio (aHR) = 1.75, 95% CI = 1.41-2.17, P

Since the turn of the twentieth-century, the presumed invisibility of craft that defines dramatic theatre erases our capacity to usefully theorize the repeated use of a popular script in performance. This chapter suggests that the unrealistic expectation placed on dramatic theatre to represent events, thoughts, and feelings as if they were happening for the first time ignores the latent celebrity power of the oft-repeated play. This chapter argues that a Shakespeare play is a vibrant, archontic object. Scripted performance is not a single event, but an entelechial process of materialization that continues to grow and evolve as its own affective archive. The celebrity text, as latent with potentiality as the performing body, not only accrues value as it is repeated, but is agential in transmitting that value to the artists who engage with it. As a transmedial archontic object, the Shakespeare play as performance is caught in a process of transmission between the constrictive materialities of page and stage. Acknowledging the archontic nature of the celebrity play recognizes how its capacity to exist as its own archive affords it an affective, iterative power that navigates the production, marketing, and consumption of classical theatre without ever losing shape as “the play.”

The introduction acquaints readers with the concept of Shakespeare as a variable object and explains its value to Shakespeare studies. It proposes that through the lens of OOO, Shakespeare is perceived as an object that contains all vast meanings ascribed to it through performance and appropriation, recentering Shakespeare as the object at the heart of the appropriative act. Attending to rhizome theory and Desmet’s work on tiny ontologies, the introduction argues that appropriation can never be “unfaithful” to Shakespeare because Shakespeare has infinite capacity to absorb its various shapes, each actualized by the political ecologies in which human users situate him.

Background Monitoring the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is an essential component of the response to World Health Organisation's (WHO) hepatitis elimination goals. This study aimed to estimate the Consensus hepatitis C CoC among PWID using data collected in Australia prior to and after the introduction of unrestricted direct-acting antiviral (DAA) therapy in March 2016. Methods The Australian Needle Syringe Program Survey is a cross-sectional bio-behavioural surveillance system that recruits >2000 PWID annually. Using data from 2015 and 2019, HCV antibody and ribonucleic acid (RNA) test results from dried blood spots were combined with self-reported data on HCV diagnostic testing and treatment to project HCV Consensus CoC indicators at a population-level among Australian PWID. Results Among an estimated 75,000 people who inject drugs on a regular basis in Australia, the number with active HCV infection declined from 32,619 (44%) in October 2015 to 12,679 (17%) in October 2019. The majority (78% in 2015 and 2019) of PWID reported HCV diagnosis, while the proportion of those diagnosed who were treated increased from 3% in 2015 to 47% in 2019. Among those treated, the proportion who were HCV RNA negative and assumed to have been successfully treated (cured), increased from 27% in 2015 to 88% in 2019. Conclusion This study demonstrates remarkable HCV CoC progress among PWID in Australia following availability of DAA therapy. There was a substantial increase in the proportion of HCV diagnosed PWID who initiated treatment and were cured, while the number of PWID with active HCV infection more than halved over a 3.5 year period. Estimates of the Consensus hepatitis C CoC among PWID is required to monitor progress toward WHO HCV elimination goals.

In the mid 1590s, Shakespeare began a trend when he appropriated Ovid’s tale of Pyramus and Thisbe in two different genres, the tragedy Romeo and Juliet and the comic performance by the rude mechanicals in A Midsummer Night’s Dream The latter was the more subversive act, transforming the source material into a satire on the amateurs’ unskillful remix of their text, by focusing on the asymmetry between the performers’ transformative ambition and their skills. This janus-faced use of Ovid marks a divergence of appropriative treatment that saw the tragic adaptations struggle to maintain popularity against the widespread enjoyment of Shakespeare’s “tragical mirth,” and implicates Shakespeare in debates about the place of fidelity in appropriation. Pyramus and Thisbe’s Ovidian devolution aligns Shakespeare’s appropriative work with current theories about rhizomatic adaptation, and recognizes the collaborative and transformative nature of remediation.

Introduction and Aims There is a current epidemic of pharmaceutical opioid (PO) misuse, particularly fentanyl and fentanyl analogues, globally. Fentanyl is a highly potent synthetic opioid with rapid onset and significantly higher risk of overdose compared with other opioids. Contexts and correlates of fentanyl use among people who inject drugs (PWID) in Australia are under-researched. Design and Methods The Australian Needle Syringe Program Survey is conducted annually. Consenting PWID complete a self-administered questionnaire and provide a capillary dried blood spot for human immunodeficiency virus and hepatitis C virus antibody testing. Bivariate and multivariate logistic regressions determined correlates of recent (last 6 months) fentanyl injection in 2014. Results Recent fentanyl injection was reported by 8% (n = 193) of the total sample. Among the 848 PWID who recently injected POs, 23% injected fentanyl. Compared with PO injectors who had not injected fentanyl, those who had injected fentanyl were significantly more likely to identify as Indigenous Australian [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.04, 2.51; P = 0.034], inject daily or more frequently (AOR 1.92; 95% CI 1.30, 2.83; P = 0.005), inject in public (AOR 1.43; 95% CI 1.01, 2.02; P = 0.042) and to have overdosed in the past year (AOR 2.16; 95% CI 1.48, 3.13; P < 0.001), but were significantly less likely to receptively share syringes (AOR 0.56; 95% CI 0.36, 0.87; P = 0.010). Discussion and Conclusions Fentanyl injectors in Australia are significantly more likely to identify as Indigenous, report frequent injection, inject in public and experience overdose. Increased access to harm reduction interventions, including naloxone distribution, wheel filters and supervised injection facilities, are likely to benefit this population.

Background Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. Methods The Australian Needle and Syringe Program Survey is conducted annually and was conducted at 46 sites across Australia in 2019. Participation involves completion of a self-administered questionnaire and a capillary dried blood spot for HIV and hepatitis C virus testing. In 2019, respondents who reported a minimum of one NFOOD in the previous 12 months (recent NFOOD) were asked to complete supplementary questions regarding their last NFOOD. Bivariate and multivariate logistic regression were used to determine factors independently associated with multiple recent NFOOD. Results A total of 222 respondents reported recent NFOOD. Respondents were predominantly male (59%), one third (39%) were aged less than 39 years and 73% reported last injecting heroin at their last NFOOD. One in two respondents (48%, n = 107) reported multiple opioid overdoses (median 3, interquartile range 2–5). The odds of reporting multiple NFOOD were higher among respondents who reported injecting in a public location at their last NFOOD (adjusted odds ratio [AOR] 2.10, 95% CI 1.14–3.90, p = 0.018) and benzodiazepine use in the 12 h prior to NFOOD (AOR 2.74, 95% CI 1.50–4.99, p = 0.001). Conclusions Multiple NFOOD was prevalent among PWID who utilised NSPs who reported recent NFOOD. Public injecting and benzodiazepine use were associated with increased risk of multiple NFOOD, and there is a need for interventions specifically targeting PWID who report these high risk injecting practices.

Rates of depression in older people with HIV range as high as 63%, compared to 15% in the general older adult U.S. population. We tested an adaptation of the RESPECT intervention for its feasibility in addressing depression among older adults with HIV (N = 25). RESPECT involves weekly phone calls made by care managers who engage and listen to the participants, and help to identify needed resources. Over the 6-month study period, depressive symptoms were significantly reduced. Qualitative analyses elucidated the participants’ complex behavioral health problems as well as the supportive nature of phone intervention. Implications for practice are explored.

Thomas Cartelli’s provocative and erudite new book is a wide-ranging study of the diverse media objects that exist as what he terms the Shakespearean aftermath. In addition to what we might more co...

Background While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. Methods Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex‐specific analyses. Results Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1–20.7) in females and 7.6/100 PYO (95% CI, 6.0–9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37–2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25–2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62–4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01–2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33–1.53]; P < .001). Conclusions Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

Due to the interactive affordances of twenty-first century technologies, the relationship between readers and texts is often repositioned as part of a communal experience of consumption and reproduction. Inclusive in this expanding culture are user-generated adaptations of Shakespeare, most saliently fanfic. The fanfic universe prolifically crosses genres, putting the Shakespearean urtext in conversation with any other object of cultural interest, and occasionally subjugates the Shakespearean text to the dominant popular icon of the moment. Fanfic manifests textual enjoyment as a creative act; the genre is both recreational and re-creational, resulting in new adaptive works that expand the dramas to include sequels, prequels, and off-stage explorations of character and plot. Because Shakespeare is experienced variously through printed text, television, film, theatrical, or digitized performance – all of which underline the instability of an authoritative Shakespeare text – Shakespeare studies is uniquely positioned to expand critical understanding of adaptation and appropriation vis-a-vis the fanfiction universe. Fanfic’s online modality, existing on websites that facilitate dialogic interaction between author and audience, offers scholars an ongoing chronicle of reception. Uniquely, online interactions allow Shakespeare cultural critics to analyze the ways user-generated fanfic positions Shakespeare’s work as open to transition, crafting adaptations that illustrate what Shakespeare means to everyday users.

Recently, critics have approached the cultural appropriation of “not-Shakespearean texts, arguing that the Jacobean revivals of the 1980s and 1990s “are as conservative as their Shakespearean counterparts” (Aebischer 282), due to their emphasis on historical continuity and coherence. However, the drama produced in the 1970s and 1980s asserted a new theatrical aesthetic that demands that the audience recognize its own complicity in perpetuating the myth of historical continuum through the stylistic assertion of disunity. Instead of employing a ‘usable history,’ the playwrights of this era created a ‘usable culture’ that used literature as historicity in order to highlight the inefficiency of both as a means of mediating the present. Barrie Keeffe's play, A Mad World My Masters, under the guise of Jacobean nostalgia, confronts the implications of the emergent Conservative cultural dictate that assumes governmental responsibility for defining and maintaining “the good standards and best things” (Thatcher) of postwar England—a missive that repeatedly conflated the form of outrage with the “good” art that should contain such protest. Keeffe challenges the audience's cultural expectations by putting the worst of Thatcher's “scroungers” onstage and demands that the audience recognized its complicity in the emergent fraudulent meritocracy that characterized political reform.

There is a current epidemic of pharmaceutical opioid (PO) misuse, particularly fentanyl and fentanyl analogues, globally. Fentanyl is a highly potent synthetic opioid with rapid onset and significantly higher risk of overdose compared with other opioids. Contexts and correlates of fentanyl use among people who inject drugs (PWID) in Australia are under-researched.The Australian Needle Syringe Program Survey is conducted annually. Consenting PWID complete a self-administered questionnaire and provide a capillary dried blood spot for human immunodeficiency virus and hepatitis C virus antibody testing. Bivariate and multivariate logistic regressions determined correlates of recent (last 6 months) fentanyl injection in 2014.Recent fentanyl injection was reported by 8% (n = 193) of the total sample. Among the 848 PWID who recently injected POs, 23% injected fentanyl. Compared with PO injectors who had not injected fentanyl, those who had injected fentanyl were significantly more likely to identify as Indigenous Australian [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.04, 2.51; P = 0.034], inject daily or more frequently (AOR 1.92; 95% CI 1.30, 2.83; P = 0.005), inject in public (AOR 1.43; 95% CI 1.01, 2.02; P = 0.042) and to have overdosed in the past year (AOR 2.16; 95% CI 1.48, 3.13; P0.001), but were significantly less likely to receptively share syringes (AOR 0.56; 95% CI 0.36, 0.87; P = 0.010).Fentanyl injectors in Australia are significantly more likely to identify as Indigenous, report frequent injection, inject in public and experience overdose. Increased access to harm reduction interventions, including naloxone distribution, wheel filters and supervised injection facilities, are likely to benefit this population.

This introductory chapter argues that in the twenty-first century, Shakespeare readers are increasingly replaced by Shakespeare users. The chapter imagines Shakespeare not as a man or a body of work but a network of collective innovation, and considers the ways in which materialist forces shape—and are shaped by—Shakespeare use. The emergence of digital culture as mass media has expanded the user’s ability to participate in the text, and this chapter considers how new opportunities for critical interrogation arise when Shakespeare is used in communities, online and otherwise, that catalyze a new economy of creative and critical appropriation. Fan agency, transmedia representation, and creative critical use point to a new intracultural identity for Shakespeare, encouraging critics and users to rethink Shakespeare’s presence in cultural and intellectual thought.

Purpose – The purpose of this paper is to examine the role of tiers of governance and discuss the findings from research into a crime policy's implementation focusing on resourcing, community engagement, accountability and leadership. The paper examines the shift from partnership delivery to the Big Society. Design/methodology/approach – 18 in-depth semi-structured interviews with partnership managers from a range of organisations combined with non-participant semi-structured of ten partnership meetings and documentary analysis were undertaken, in tandem with the policy networks framework. Findings – Despite the expectations placed on crime partnerships by New Labour, governance has continued to be driven by professionals and dominated by the large public sector organisations, rather than the community they serve or their service users, and with little involvement from the business sector in delivery. The focus upon voluntarism, enterprise and business in the Big Society vision will mean rapid adaptation in the sector if it is to fit the Big Society agenda successfully. Originality/value – The paper serves to set out the relationships between key actors in governance in this policy area and the relevance of this to the Big Society idea. Its findings and lessons can be used to compare the policy sector across countries and for practical use by policy makers.

Background Use of opioid analgesic medicines has doubled globally over the past decade, with a concomitant increase in prevalence of injection of pharmaceutical opioids (PO), including in Australia. This study investigates types of PO injected, methods used to prepare PO for injection and correlates of recent (last 6 months) PO injection among a large national sample of people who inject drugs (PWID). Methods The Australian NSP Survey (ANSPS), conducted annually at ∼50 NSP services across Australia, consists of a brief self-administered questionnaire and provision of a capillary dried blood spot for HIV and hepatitis C antibody testing. Data from 2014 were used to conduct univariable and multivariable logistic regression analysis to determine factors independently associated with recent injection of PO. Results Among 1488 ANSPS respondents who were identified as opioid injectors, 57% (n=848) reported injection of PO in the previous six months. The majority of PO injectors (85%) reported filtering PO prior to injection, although use of efficacious wheel filters was relatively rare (11%). Correlates of POs injection included daily injection (AOR=1.65, 95% CI 1.31–2.08), receptive sharing of syringes (AOR=2.00, 95% CI 1.43–2.78), receptive sharing of drug preparation equipment (AOR=1.55, 95% CI 1.19–2.01), drug overdose in the previous year (AOR=1.81, 95% CI 1.36–2.42) and residence in inner regional (AOR=3.27, 95% CI 2.21–5.23) or outer regional/remote (AOR=5.50, 95% CI 3.42–8.84) areas of Australia. Conclusion PO injection is geographically widespread among Australian PWID and takes place in the context of poly-drug use. People who inject POs are at high risk of overdose, injection related injury and disease and blood borne viral infections. Harm reduction services that target this group, including in non-urban areas, should deliver health education regarding PO-specific overdose risks, the requirement to adequately filter PO before injection and to ensure that both naloxone and specialist pill filters are readily accessible.

This paper describes how managers from disparate organizations collaborated to implement a crime programme through the mechanism of a multi-layered crime partnership. The case is analysed using three theoretical models: collaborative public management (CPM), new public management (NPM) and public administration (PA). A case study research strategy was adopted with eighteen managers from the partnership being interviewed and ten partnership meetings being observed, to enhance understanding of management practice under partnership. This paper provides evidence for CPM, a model of management suited to deliver on the shared outcomes required by government from the varied organizations involved in crime programmes.

Sexual behavior among older adults with HIV in Sub-Saharan Africa has been understudied despite the burgeoning of this population. We examined sexual behavior among older adults living with HIV in Uganda. Participants were eligible for the study if they were 50 years of age or older and living with HIV. Quantitative data were collected through face-to-face interviews, including demographic characteristics, health, sexual behavior and function, and mental health. Of respondents, 42 were men and 59 women. More than one-quarter of these HIV-positive older adults were sexually active. A greater proportion of older HIV-positive men reported being sexually active compared to women (54 vs. 15%). Among those who are sexually active, a majority never use condoms. Sixty-one percent of men regarded sex as at least somewhat important (42%), while few women shared this opinion (20%). Multivariate logistic regression analyses revealed that odds of sexual activity in the past year were significantly increased by the availability of a partner (married/cohabitating), better physical functioning, and male gender. As more adults live longer with HIV, it is critical to understand their sexual behavior and related psychosocial variables in order to improve prevention efforts.