Suchergebnisse

BACKGROUND: With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C) is the world's first trial of HCV treatment-as-prevention in prison. Drawing on interviews with HCV expert stakeholders, this paper explores the factors respondents identified as crucial to the success of future scale-up. Accounting for such perspectives matters because of the influence expert discourse has in shaping implementation. METHODS: Semi-structured interviews were conducted with nineteen HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded using qualitative data management software (NVivo 11). Analysis proceeded via a hybrid deductive and inductive approach. RESULTS: Notwithstanding concerns regarding the lack of primary prevention in Australian prisons, stakeholders reported broad levels of support for the intervention and for the future scale-up of HCV treatment. A number of considerations, both external and internal to the prison system, were identified as key. The principal external factor was an enabling political-cum-policy environment; internal factors included: obtaining support from prisons' executive and custodial staff; promoting health within a security-first institutional culture; allocating time for treatment within prisoners' tightly regulated schedules; ensuring institutional stability during treatment given the routine movement of prisoners between prisons; prioritizing the availability of retreatment given the paucity of primary prevention; and securing sufficient clinical space for treatment. CONCLUSION: The challenges to implementation are considerable, ranging from macrolevel concerns to in-prison ...

In Western countries, people who inject drugs experience a disproportionate burden of hepatitis C as a result of effective transmission of the virus via the sharing of used injection equipment. With a hepatitis C prevalence of 60% and higher in many areas, previous and current prevention efforts focusing on the availability of sterile injecting equipment along with education, have had only limited effect on incidence rate. Little attention has been paid to the broader social and political positions that drug use and people who use drugs hold in these societies. Insights from social research provide opportunities to broaden the possibilities for prevention efforts. We will review the social inclusion literature to provide some examples of how hepatitis C prevention may be approached in innovative ways.

Background: Little is known about the factors that influence injecting drug users' (IDUs) choice of outlet, and in particular why some IDUs might prefer to use pharmacies. Greater understanding of the influences on this choice will contribute to more sophisticated policy and programme responses for blood-borne virus prevention and for health and wellbeing programmes for people who inject drugs. Method: In-depth interviews were conducted with 15 IDUs about their experiences of accessing injecting equipment from pharmacies that participated in the government-sponsored pharmacy needle and syringe scheme. Results: A range of factors influenced participants' decisions about equipment access. The advantages of the pharmacy scheme access included convenience, relative anonymity, increased positive feelings of self-worth when accessing equipment from pharmacies where they had a good relationship with staff, less police surveillance and access to a greater range of equipment than available in publicly funded Needle and Syringe Programmes. The disadvantages of pharmacy access included the cost of equipment and complications related to methadone dosing and equipment access. Conclusion: Pharmacy access to injecting equipment is highly valued by IDUs. The results of this study direct attention to several elements of programme and policy in the area that would increase access to equipment from pharmacies relating to cost, need for exchange, police surveillance practices, out-of-hours access and anonymity.

Unlike health policy in the United Kingdom, Australian health policy does not provide a strong endorsement for the involvement of service users in the design, delivery and evaluation of drug treatment services. There has been no research into service-users` views on the contentious issue of methadone takeaway doses. This study explores the value of takeaway doses from service-users` perspectives and highlights the contributions that service-user involvement can make to further drug treatment planning, delivery and evaluation. Twenty-five methadone clients were interviewed about the value of methadone takeaway doses. Benefits cited by participants included convenience, less travel and lower costs, protection of confidentiality and less restriction on employment as well as less tangible issues related to feelings of `normality` and flexibility in daily life patterns. Feeling trusted as a methadone client was also an important result of accessing takeaway doses. The inclusion of service-user perspectives is important for ensuring that services are not wrongly targeted and that evaluations of those services do not underestimate or misrepresent their value to clients. This is particularly important in policy around illicit drug use where public and political opinion is often a key driver in decision making.

A commentary on the implications for research and service delivery of the Australian federal government apporach to drug policy

Discourse on sex work is replete with narratives of risk and danger, predominantly focused on violence and disease. However, the risks instigated by police, maintained by the criminal justice system and sanctioned by the state—criminal laws, licensing laws and targeted policing—receive far less attention. This paper responds to this gap in three ways. First, we examine how stigma manifests in sex workers' experiences of Australian policing, which act to disincentivise sex workers from accessing criminal legal mechanisms. Second, we illustrate how sex workers are denied victim status as they are seen by law as 'irresponsible citizens' and blamed for their experiences of crime. Third, we argue that these factors create conditions in which sex workers must constantly assess risks to access safety and legal redress while structural sex work stigma persists unabated. We conclude that 'whore stigma' is entrenched in the criminal legal system and requires a systematic response that necessitates but goes beyond the decriminalisation of sex work.

AbstractThe COVID‐19 pandemic triggered widespread socioeconomic hardship, disproportionately impacting disadvantaged populations. People who use illicit drugs are more likely to experience unemployment, homelessness, criminal justice involvement and poorer health outcomes than the general community, yet little is known about the socioeconomic impacts of the pandemic on their lives. To address this gap in the literature, we conducted in‐depth interviews with 76 participants from two cohort studies of people who use illicit drugs (people who inject drugs and/or use methamphetamine) in Victoria, Australia. Findings support claims that pandemic‐related Social Security supplementary payments and initiatives to reduce homelessness, although not systemically transforming people's lives, produced temporary relief from chronic socioeconomic hardship. Results also indicate how temporary interruptions to drug supply chains inflated illicit drug prices and produced adverse consequences such as financial and emotional stress, which was exacerbated by drug withdrawal symptoms for many participants. Furthermore, increased community demand for emergency food and housing support during the pandemic appeared to reduce participants' access to these services. Our findings about the unintended consequences of pandemic responses on the socioeconomic lives of a group of people who use illicit drugs provide insights into and opportunities for policy reform to redress their entrenched disadvantage.

The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.

The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow‐up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.

The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of greater than 40%, representing an estimated 5.6 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including; poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components; service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.