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Understanding the Intersection of Behavioral Risk and Social Determinants of Health and the Impact on an Outbreak of Human Immunodeficiency Virus Among Persons Who Inject Drugs in Philadelphia
- Source :
- The Journal of Infectious Diseases. 222:S250-S258
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- Background In 2018, Philadelphia identified an outbreak of new human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID). Although conventional HIV surveillance systems capture individual-level behavioral risk, they are not able to capture the social and environmental factors contributing to rapid transmission. Methods HIV surveillance data were used to assess demographic, clinical, and behavioral factors for PWID with HIV diagnosed during 2017 and 2018. Social factors such as homelessness, disruption of encampments, and trends in sexual behaviors, drug use and syringe availability among PWID were captured through National HIV Behavioral Surveillance, routine hepatitis and sexually transmitted infection surveillance, and shelter and homeless outreach data. Results In 2018, there were 71 new infections among PWID, an increase of 115% since 2016. During this time, opioid overdose deaths peaked at 59 deaths per 100 000 persons, 85% of which involved the use of fentanyl. While overall reported homelessness increased, rates of those living unsheltered rose by 13%. The Philadelphia Department of Public Health identified increased injection frequency, encampment closures, and lack of syringe access as promoters of continued HIV transmission. Conclusion The use of conventional surveillance methods only is inadequate for determining HIV risk during outbreaks. Incorporation of individual and aggregate level data on social and environmental determinants is necessary to develop effective outbreak response interventions.
- Subjects :
- Adult
Male
0301 basic medicine
medicine.medical_specialty
Adolescent
Social Determinants of Health
Psychological intervention
Surveillance Methods
HIV Infections
Death Certificates
Disease Outbreaks
Cohort Studies
Drug Users
Young Adult
03 medical and health sciences
Risk-Taking
0302 clinical medicine
Risk Factors
Environmental health
Humans
Immunology and Allergy
Medicine
030212 general & internal medicine
Social determinants of health
Substance Abuse, Intravenous
Syringe
Philadelphia
business.industry
Transmission (medicine)
Public health
Outbreak
Opioid overdose
Middle Aged
medicine.disease
030112 virology
Infectious Diseases
Socioeconomic Factors
Epidemiological Monitoring
Ill-Housed Persons
Female
Drug Overdose
business
Subjects
Details
- ISSN :
- 15376613 and 00221899
- Volume :
- 222
- Database :
- OpenAIRE
- Journal :
- The Journal of Infectious Diseases
- Accession number :
- edsair.doi.dedup.....5615944dd16c4e2d625617b230e814ee