Human rights and HIV prevention, treatment, and care for people who inject drugs: key principles and research needs.
ABSTRACT Efforts to provide HIV prevention, treatment, and care to injecting drug users (IDU) are shaped by tensions between approaches that regard IDU as criminals and those regarding drug-dependent individuals as patients deserving treatment and human rights. Advocates for IDU health and human rights find common cause in urging greater attention to legal frameworks, the effects of police abuses, and the need for protections for particularly vulnerable populations including women and those in state custody. Arbitrary detention of drug users, and conditions of pretrial detention, offer examples of how HIV prevention and treatment are adversely impacted by human rights abuse. National commitments to universal access to prevention and treatment for injecting drug users, and the recognition that users of illicit substances do not forfeit their entitlement to health services or human dignity, offer a clear point of convergence for advocates for health and rights, and suggest directions for reform to increase availability of sterile injection equipment, opiate substitution treatment, and antiretroviral therapy. For IDU, protection of rights has particular urgency if universal access to HIV prevention and treatment is to become an achievable reality.
Article: Tobacco use in prisons.BMJ Clinical Research 08/2014; 349:g4946. DOI:10.1136/bmj.g4946 · 14.09 Impact Factor
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ABSTRACT: The Rapid Opioid Dependence Screen (RODS) is an 8-item measure of opioid dependence designed for quick, targeted screening in clinical and research settings. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, criteria, the RODS has an average administration of less than 2 minutes and can easily be administered as a stand-alone instrument or as part of a compre- hensive interview. This study reports on the initial validation of the RODS among a sample of 97 newly incarcerated, HIV-positive individuals. Using the Mini International Neuropsychiatric Inter- view as the primary measure of opioid dependence, the RODS showed good-to-strong sensitivity (.97), specificity (.76), positive predictive value (.69), and negative predictive value (.98), while con- cordance analysis revealed moderate diagnostic agreement (k 1⁄4 .67). Psychometric properties revealed strong internal consistency (a 1⁄4 .92) and inter-item correlations (.66 to .87).Journal of Correctional Health Care 01/2015; 21(1):12-26. DOI:10.1177/1078345814557513
Article: HIV, drugs and the legal environment[Show abstract] [Hide abstract]
ABSTRACT: A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs’ behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs’ risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.International Journal of Drug Policy 09/2014; 26. DOI:10.1016/j.drugpo.2014.09.001 · 2.40 Impact Factor