Structural competency in the post-prison period for people who inject drugs: A qualitative case study

Treloar, Carla; Schroeder, Sophia; Lafferty, Lise; Marshall, Alison D.; Drysdale, Kerryn; Higgs, Peter; Baldry, Eileen; Stoové, Mark; Dietze, Paul

doi:10.1016/j.drugpo.2021.103261

Cited by 19 publications

(14 citation statements)

References 43 publications

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“…Nevertheless, subgroups of people with recent history of incarceration may have poorer treatment uptake, such as people serving sentences that are shorter than the duration of treatment. Housing, mental health, social support, and economic hardship have been identified as structural factors which impact health service access upon release from prison [ 34 ] and likely influence HCV treatment initiation. Despite access to HCV care in Australian prisons, criminalisation and imprisonment is damaging to health and wellbeing.…”

Section: Discussionmentioning

confidence: 99%

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Conway

Valerio

Alavi

et al. 2022

Viruses

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This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.

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Section: Discussionmentioning

confidence: 99%

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Conway

Valerio

Alavi

et al. 2022

Viruses

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“…As stated above, poor treatment due to substance use or sex work can be highly stigmatizing and alienate WWUD-SS from future resource engagement. Our findings speak to a need for increased structural and cultural competence related to substance use and sex work engagement on the part of providers to establish trusted and high-quality sources of care for WWUD-SS [ 55 , 58 , 59 ].…”

Section: Discussionmentioning

confidence: 94%

“…Often, these experiences precluded them from readily seeking out resources in the future despite the expressed need. Shame, self-blame, and general unworthiness of help that participants described are informed by WWUD-SS’ collective experiences of social and structural inattention or incompetence (e.g., sub-optimal health care, police inattention to their victimization), shaping their expectations about the treatment they will receive from others outside of the community [ 21 , 55 ]. Broad negative social attitudes about substance abuse, sex work, and experiencing poverty namely that these are personal choices (or consequences of personal choices) requiring personal responsibility for “fixing” problems further reinforce the perception that support is wholly unavailable [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland

et al. 2022

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Background Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience. Methods WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about recent difficult experiences with a focus on how they did or did not use social support or formal resources (e.g., clinic, crisis hotline) in response. Results Participants were a median age of 37 years, 50% identified as Black, and 50% reported currently injecting drugs. Participants described reluctance to ask for support and often felt resigned to address problems alone. Participants also distinguished between transactional relationships (help is contingent upon receiving something in return) versus genuine (non-transactional or altruistic) support, including the role of family members who do and do not use drugs. Resource utilization was rare, and “self-medication” through substance use was common absent other perceived options for help. Conclusions External resilience appears limited among WWUD-SS and shaped by the social and economic contexts of a street-involved life. WWUD-SS’ ability to exercise external resilience may be undercut by experiencing structural vulnerabilities and competition for material resources that create transactional relationships and diminish the perceived value of social support. Internalized stigma, reflecting the larger society’s stigmatized views of drug use, sex work, and poverty, left WWUD-SS eschewing help from outside sources. Focus on internal resilience alone offers an incomplete picture of the construct in drug-using populations. Improving connections to community resources may be a targeted way to strengthen external resilience, as are policies addressing structural vulnerabilities for marginalized communities.

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“…Structurally competent healthcare (Metzl & Hansen, 2014) seeks to produce workers and systems who recognise the effects of structural disadvantages on health and develop responses that prevent further harms. It is especially relevant in addressing the challenges to health equity that arise from systemic discrimination for people who use drugs (McNeil, Kerr, Pauly, Wood, & Small, 2016; Treloar et al, 2021), as well as inequities arising due to gender (Mackenzie, Gannon, Stanley, Cosgrove, & Feder, 2019; Preis, Garry, Herrera, Garretto, & Lobel, 2020).…”

Section: Discussionmentioning

confidence: 99%

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

Clifford

Gordon

Magee

et al. 2022

Preprint

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Background Australia has a high prevalence of regular use of methamphetamine (MA). While half of people who use MA regularly are women, they make up only one third of people seeking treatment for MA use disorder (MaUD). There is a lack of qualitative research into the facilitators and barriers to treatment for women who use MA regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use MA, to inform person-centred changes in practice and policy that break down barriers to treatment. Methods We conducted semi-structured interviews with 11 women who frequently use MA (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their MA use and health service needs and preferences. Thematic analysis was completed using Nvivo software. Results Three themes were developed from participants' responses around experiences of regular MA use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. Clear service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. Conclusion Gender-inclusive health care services for people who use MA should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other MA.

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Structural competency in the post-prison period for people who inject drugs: A qualitative case study

Cited by 19 publications

References 43 publications

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

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