Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic

Bowles, Jeanette M.; Kolla, Gillian; Smith, Laramie R.; Scheim, Ayden I.; Dodd, Zoë; Werb, Dan

doi:10.1016/j.dadr.2023.100167

Cited by 4 publications

(1 citation statement)

References 50 publications

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“…However, syndemics of mental health disorders, drug use, and STIs have become exacerbated due to a variety of challenges including lack of access to health care (Hong et al, 2023). This disconnection from healthcare services could have resulted in decreased education about HIV or other conditions aside from COVID-19, which could influence attitudes and perceptions, and amplify existing disparities, as seen in one case study from Canada (Bowles et al, 2023). Furthermore, the 2022 global mpox outbreak has resulted in significant stigma, particularly in gay, bisexual, and other men who have sex with men throughout the globe, indicating stigma is still a pervasive problem.…”

Section: Discussionmentioning

confidence: 99%

Associations between HIV-related knowledge and discriminatory attitudes in Lesotho, Malawi, Tanzania, Zambia, and Zimbabwe: Results from population-based HIV impact assessments.

Yonko,

Low,

Carpino

2024

Stigma and Health

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Stigma and discrimination toward people living with HIV are barriers to achieving the Joint United Nations Programme on HIV/AIDS 95-95-95 targets. Despite the high prevalence of negative attitudes toward people living with HIV in sub-Saharan Africa, factors associated with these attitudes are understudied. Using population-based HIV impact assessment (PHIA) data among adults aged 15-59 in Lesotho, Malawi, Tanzania, Zambia, and Zimbabwe, the relationship between HIV-related knowledge and discriminatory attitudes (DA) toward people living with HIV was assessed in a multivariable logistic regression model. Among 64,458 individuals, median age was 29 years (range 15-59), 51% were female, 63% rural, 65% self-reported HIVnegative, and 29% reported never testing for HIV. The study population was from Tanzania (44%), Zimbabwe (16%), Zambia (16%), Malawi (15%), and Lesotho (10%). Lesotho had the highest prevalence of insufficient HIV knowledge (70%), and Tanzania had the highest prevalence of DA (25%). Poor HIV prevention knowledge was significantly associated with having a DA, after adjustment for country, urbanicity, age, wealth quintile, education level household head HIV status, and self-reported HIV status (aOR: 2.65, 95% CI [2.47, 2.83]). Other variables that had a strong association with DA included a lack of formal education (aOR: 3.75, 95% CI [2.97, 4.74]), reporting of an "unknown" HIV status (aOR: 3.49, 95% CI [2.55, 4.78]), as well as being from Lesotho, Tanzania, Zambia, or Zimbabwe, from a rural area, aged 15-25 years, being HIV-negative, never testing for HIV, and lack of a head of household living with HIV ( p < .05). Inverse dose-response relationships were observed for education level and wealth quintile with DA (Table 2). Gender had no association with DA. Though this is not an intervention study, attention to factors associated with DA, especially modifiable factors such as HIV-related knowledge, can inform intervention development to globally reach the 95-95-95 targets. Clinical Impact StatementThis study adds to the literature by providing an update on the state of discriminatory attitudes in several HIV-impacted countries using nationally representative populations. Individuals with lower HIV prevention knowledge, aged 15-25 years, of rural residence, the lowest wealth quintile, without formal education or with only primary education, without an HIV-positive head of household, and people who reported their HIV status as "unknown" or never being tested had significantly higher odds of holding a discriminatory attitude than their comparison groups. These individuals could be prioritized for intervention development, and further investigation of country-level causes of negative attitudes towards people living with HIV could be a focus for future research.

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Section: Discussionmentioning

confidence: 99%

Associations between HIV-related knowledge and discriminatory attitudes in Lesotho, Malawi, Tanzania, Zambia, and Zimbabwe: Results from population-based HIV impact assessments.

Yonko,

Low,

Carpino

2024

Stigma and Health

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Bridging the Gap in Harm Reduction Using Mobile Overdose Response Services (MORS) in the Context of the COVID-19 Pandemic: A Qualitative Study

Seo,

Rioux,

Rider

et al. 2024

J Urban Health

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The COVID-19 pandemic introduced a myriad of challenges for accessing healthcare services, especially for people who use substances (PWUS). Numerous supervised consumption sites (SCS) across Canada faced shutdowns and reduced operating capacity in order to comply with public health measures, which has exacerbated the mortality rates associated with opioid toxicity. In an effort to reduce the harms associated with these dual public health crises, Mobile Overdose Response Services (MORS) were introduced to allow PWUS to consume substances under virtual supervision. Here, we examine the role of MORS in the context of the pandemic. A total of 59 semi-structured interviews were conducted with relevant interest groups, including PWUS, health care providers, harm reduction workers, and operational experts. Major themes and subthemes were identi ed using inductive thematic analysis informed by grounded theory. Overall, participants felt that the COVID-19 pandemic shifted the public focus away from harm reduction and neglected the needs of PWUS. MORS were regarded as a useful tool to mitigate the closure/reduced capacity of physical SCS, prevent the transmission of COVID-19, and help alleviate the prevailing sense of isolation during public health crises. MORS were seen as a useful and muchnecessary adjunct service to address the unmet needs of physical SCS during the pandemic and beyond.

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Media framing xylazine as a “zombie drug” is amplifying stigma onto people who use drugs

Bowles,

Copulsky,

Reed

2024

International Journal of Drug Policy

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Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic

Cited by 4 publications

References 50 publications

Associations between HIV-related knowledge and discriminatory attitudes in Lesotho, Malawi, Tanzania, Zambia, and Zimbabwe: Results from population-based HIV impact assessments.

Associations between HIV-related knowledge and discriminatory attitudes in Lesotho, Malawi, Tanzania, Zambia, and Zimbabwe: Results from population-based HIV impact assessments.

Bridging the Gap in Harm Reduction Using Mobile Overdose Response Services (MORS) in the Context of the COVID-19 Pandemic: A Qualitative Study

Media framing xylazine as a “zombie drug” is amplifying stigma onto people who use drugs

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