Search

The article presents the discussion on group of public health researchers and practitioners. Topics include aware of the devastating impact the drug toxicity crisis has had across North America and the challenges faced by health care providers; and drug toxicity crisis is impacting the spectrum of PWUD across demographics and socioeconomic status.

Community-based models of cannabis cultivation, distribution, and consumption—such as cannabis clubs—have been documented across Europe, North America, South America, and New Zealand since the 1990s. For the most part, these models have a history of operating outside existing legislation and regulations. Jurisdictions that have legalized cannabis have approached community-based models in opposite ways (eliminate vs. regulate). Canada legalizing cannabis has resulted in more stringent enforcement and concerted efforts to close these models despite documented health and social benefits. This paper presents a case study of the Victoria Cannabis Buyers Club (VCBC) and its consumption space—The Box. We conducted a survey of VCBC members to explore four domains: demographics, cannabis consumption, access to and use of The Box, and the impact of its temporary closure due to COVID-19. From the survey data (n = 104), descriptive statistics were generated and three conceptual avenues were identified. The majority of respondents were 40 years old and older and identified as White (European descent) cisgendered men and women. The majority reported an income of $40,000 or less and a housing status that prevented them from smoking. Close to 75% of our sample consumed cannabis multidaily for therapeutic purposes primarily, but also for a mix of recreation, social, spiritual, and traditional healing purposes. Smoking was the preferred mode of consumption. Respondents accessed The Box daily or weekly. Reasons and benefits for using The Box fell into three categories: public health, harm reduction, and wellness perspectives. Conceptually, we found that The Box acted as a therapeutic space and offered a much-needed consumption space for smokers. We also identified a need to unpack the concept of safety. Overall, the survey reinforces the need for an equity-informed approach to community-based models and cannabis consumption spaces in Canada. [ABSTRACT FROM AUTHOR]

Objectives: Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. Methods: The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes. Results: We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally. Conclusion: Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl. [ABSTRACT FROM AUTHOR]

Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical. [ABSTRACT FROM AUTHOR]

The experiences of nurses who blew the whistle during the COVID‐19 pandemic have exposed gaps and revealed an urgent need to revisit our understanding of whistleblowing. Aim: The aim was to develop a better understanding of whistleblowing during a pandemic by using the experiences and lessons learned of Quebec nurses who blew the whistle during the first wave of COVID‐19 as a case study. More specifically, to explore why and how nurses blew the whistle, what types of wrongdoing triggered their decision to do so and how context shaped the whistleblowing process as well as its consequences (including perceived consequences). Design: The study followed a single‐case study design with three embedded units of analysis. Methods: We used content analysis to analyse 83 news stories and 597 forms posted on a whistleblowing online platform. We also conducted 15 semi‐structured interviews with nurses and analysed this data using a thematic analysis approach. Finally, we triangulated the findings. Results: We identified five themes across the case study. (1) During the first wave of COVID‐19, Quebec nurses experienced a shifting sense of loyalty and relationship to workplace culture. (2) They witnessed exceedingly high numbers of intersecting wrongdoings amplified by mismanagement and long‐standing issues. (3) They reported a lack of trust and transparency; thus, a need for external whistleblowing. (4) They used whistleblowing to reclaim their rights (notably, the right to speak) and build collective solidarity. (5) Finally, they saw whistleblowing as an act of moral courage in the face of a system in crisis. Together, these themes elucidate why and how nurse whistleblowing is different in pandemic times. Conclusion: Our findings offer a more nuanced understanding of nurse whistleblowing and address important gaps in knowledge. They also highlight the need to rethink external whistleblowing, develop whistleblowing tools and advocate for whistleblowing protection. Impact In many ways, the COVID‐19 pandemic has challenged our foundational understanding of whistleblowing and, as a result, it has limited the usefulness of existing literature on the topic for reasons that will be brought to light in this paper. We believe that studying the uniqueness of whistleblowing during a pandemic can address this gap by describing why and how health care workers blow the whistle during a pandemic and situating this experience within a broader social, political, organizational context. [ABSTRACT FROM AUTHOR]

Background: The area of substance use is notable for its early uptake of incentives and wealth of research on the topic. This is particularly true for prize-based contingency management (PB-CM), a particular type of incentive that uses a fishbowl prize-draw design. Given that PB-CM interventions are gaining momentum to address the dual public health crises of opiate and stimulant use in North America and beyond, it is imperative that we better understand and critically analyze their implications. Purpose: The purpose of this scoping review paper is to identify the characteristics of PB-CM interventions for people who use substances and explore ethical implications documented in the literature as well as emerging ethical implications that merit further consideration. Methods: The PRISMA-ScR checklist was used in conjunction with Arksey and O'Malley's methodological framework to guide this scoping review. We completed a two-pronged analysis of 52 research articles retrieved through a comprehensive search across three key scholarly databases. After extracting descriptive data from each article, we used 9 key domains to identify characteristics of the interventions followed by an analysis of ethical implications. Results: We analyzed the characteristics of PB-CM interventions which were predominantly quantitative studies aimed at studying the efficacy of PB-CM interventions. All of the interventions used a prize-draw format with a classic magnitude of 50%. Most of the interventions combined both negative and positive direction to reward processes, behaviors, and/or outcomes. One ethical implication was identified in the literature: the risk of gambling relapse. We also found three emerging ethical implications by further analyzing participant characteristics, intervention designs, and potential impact on the patient–provider relationship. These implications include the potential deceptive nature of PB-CM, the emphasis placed on the individual behaviors to the detriment of social and structural determinants of health, and failures to address vulnerability and power dynamics. Conclusions: This scoping review offers important insights into the ethics on PB-CM and its implications for research ethics, clinical ethics, and public health ethics. Additionally, it raises important questions that can inform future research and dialogues to further tease out the ethical issues associated with PB-CM. [ABSTRACT FROM AUTHOR]

The authors comment on research by Molldrem and Smith on molecular HIV surveillance and the implications of phylogenetic analysis and cluster detection. It cites imperfections of the science of molecular surveillance due to concerns raise about discrimination, health disparities and criminalization. The authors also explore the issues of ethics, data justice and oppression to examine the global COVID-19 pandemic.

Background: Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. Yet, despite showing some level of efficacy (albeit only short-term) and being praised by researchers as beneficial and cost-saving, it continues to be underutilized by health care and service providers. Why that is remains unclear. Methods: Recognizing a gap, we conducted a targeted analysis of a larger set of qualitative interviews conducted on the experience of health care and service providers with incentives (including prize-based CM) (n = 25). Results: Four themes were identified during the analysis: 1) The specificities of prize-based CM, 2) The role of providers in administering prize-based CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM. Overall, our findings are consistent with existing literature and suggest that providers are wary of using prize-based CM because they tend to value effort over success, support over reward, honesty over deceit, and certainty over probability and variability. Conclusion: Our analysis offers additional insights into the experiences of providers who use prize-based CM and possibly some indications as to why they may not wish to work with this type of incentive. The question raised here is not whether there is enough evidence on the effectiveness of prize-based CM, but rather if this type of incentive is appropriate and ethical when caring for people who use substances. [ABSTRACT FROM AUTHOR]

Background: In October 2018, Canada became the second country in the world to legalize cannabis. However, at this stage in the implementation process, it can be challenging to get a sense of the outcomes of this policy shift – hence why we turned to media. Purpose/objectives: We present the results of a qualitative content analysis conducted on the media coverage between October 2018 and April 2019. Methods: We used Google News and ProQuest database to complete our search. We included online media articles published between October 2018 and April 2019 in English. This left us with 81 eligible articles. These articles were analyzed by blending deductive and inductive approaches. Results: The articles were grouped into 5 categories: 1) housing, 2) access, 3) workplace, 4) driving, and 5) public consumption. Each category was then analyzed to identify emerging themes across news stories. Overall, we found that non-governmental actors such as landlords and employers were given a great deal of flexibility to introduce overly broad and restrictive regulations that disproportionately impact various communities. We also found that emphasis was placed on banning cannabis in various spheres of life as opposed to adapting to the new reality that cannabis is now legal. Conclusion: Real-time observations are critically needed to better understand the impact of policy implementation across the three levels of government: federal, provincial and territorial, and municipal. Our findings suggest that media coverage analysis can help us understand and track issues as they arise. [ABSTRACT FROM AUTHOR]

The concept of whistleblowing, which began to emerge in the 1970s, has gained significant traction over time and across disciplines, including law, management, public administration, sociology, psychology, and health sciences. Interestingly, nurses and nursing students account for the majority of the participants in studies pertaining to whistleblowing. Nursing research conducted in the past two decades provide a good foundation on which to build a better understanding of the context in which whistleblowing takes place, the process of whistleblowing itself, and the repercussions experienced by whistleblowers, but major conceptual gaps remain. In fact, limited attention has been given to the conceptual underpinnings and the use of the concept of whistleblowing in nursing. The goal of the present conceptual analysis was to start addressing this gap and raise some critical questions about the future application of this concept in nursing, including potential opportunities and limitations. Our analysis allowed us to identify a number of antecedents, attributes, and consequences of whistleblowing in nursing. It also revealed three areas needing more attention: the concept itself, organizational culture, and research into the complexities of whistleblowing. [ABSTRACT FROM AUTHOR]

Side effects are central to the experience of living longer with HIV but rarely have they been studied alone. Unlike other aspects of that experience, like quality of life, treatment adherence, chronicity, episodic disability, aging, health, and viral load suppression, side effects have not benefited from the same level of empirical and theoretical engagement from qualitative researchers. In this paper, we draw on syndemics theory and 50 qualitative interviews to better understand the experience of HIV treatment side effects. Two main categories were identified in the data: side effects as a product and side effects as a risk factor. The first category suggests that side effects are not just the product of taking antiretroviral drugs. They are also the product of particular conditions and tend to cluster with other health problems. The second category puts forward the idea that side effects can act as a syndemic risk factor by exposing PLWH to a greater risk of developing health problems and creating conditions in which psychosocial issues are more likely to emerge. The paper concludes by calling for more research on the complex nature of side effects and for the development of comprehensive approaches for the assessment and management of side effects. [ABSTRACT FROM AUTHOR]

Background: Emphasis on HIV testing as a gateway to prevention, treatment and care has grown tremendously over the past decade. In turn, this emphasis on testing has created a demand for new policies, programs, and technologies that can potentially increase access to and uptake of HIV testing. HIV self-testing (HST) technologies have gained important momentum following the approval of the over-the-counter self-tests in the United States, the UK, and France. While the renewed interest in HST has given rise to a number of high quality reviews of empirical studies conducted on this topic, we have yet to find an article that captures the extent of the debate on HST. Mapping the debate: A critical review of the literature on HST was conducted and organized into three categories based on the focus of the article: 1) Empirical research, 2) Arguments, and 3) Context. We focused exclusively on the second category which included ethical analyses, policy analyses, editorials, opinion pieces, commentaries, letters to the editor and so forth. 10 lines of argument on HST were identified in the literature: 1) Individual - Public Health, 2) Strengths - Limits, 3) Benefits - Harms, 4) Screening - Testing, 5) Target - Market, 6) Health Care - Industry, 7) Regulation - Restriction, 8) Resource-Rich Settings - Resource-Limited Settings, 9) Ethical - Unethical, and 10) Exceptionalism - Normalization. Each line of argument is presented and discussed in the paper. Conclusion: We conclude by providing examples of critical questions that should be raised in order to take the debate to another level and generate new ways of thinking about HST. [ABSTRACT FROM AUTHOR]

Based on our respective research programs (psychiatry, forensic psychiatry, public health, HIV/AIDS, harm reduction) this article aims to use purposely non-conventional means to present the substantial contribution of poststructuralist perspectives to knowledge development in nursing science in general and in our current research in particular. More specifically, we call on the work of Michel Foucault and Deleuze & Guattari to politicize nursing science using examples from our empirical research programs with marginal and often highly marginalized populations. We discuss the concepts of power, discourse, and resistance to illustrate the essential contribution of poststructuralism to marginal, even "nomadic", nursing research. [ABSTRACT FROM AUTHOR]

Over the last decade, the concept of the 'complex patient' has not only been more widely used in multidisciplinary healthcare teams and across various healthcare disciplines, but it has also become more vacuous in meaning. The uptake of the concept of the 'complex patient' spans across disciplines, such as medicine, nursing, and social work, with no consistent definition. We review the chronological evolution of this concept and its surrogate terms, namely 'comorbidity,' 'multimorbidity,' 'polypathology,' 'dual diagnosis,' and 'multiple chronic conditions.' Drawing on key principles of concept clarification, we highlight disciplinary usage in the literature published between 2005 and 2015 in health sciences, attending to overlaps and revealing nuances of the complex patient concept. Finally, we discuss the implications of this concept for practice, research, and theory. [ABSTRACT FROM AUTHOR]

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of 'assemblage'. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs. [ABSTRACT FROM AUTHOR]

Objective: we present the findings of a grounded theory study designed to gain a critical understanding of the experience of side effects of treatment for HIV. Method: this study was undertaken in Canada’s capital region with 50 participants through a questionnaire. Data analysis began with the initial line-by-line coding of key interviews. After it were categorized. Results: three main categories emerged from the data: the side effects, the experience, and the connections. Conclusion: the first category suggests that we need to change how we think about side effects in order to take into account the context in which they are experienced as well as the types and nature of side effects. The second category puts forward the idea that the experience of side effects is composed of three interrelated processes: becoming with, living with, and dealing with. Finally, the third category points to new connections that are formed with people, things and systems in the presence of side effects. [ABSTRACT FROM AUTHOR]

Nurse practitioners (NPs), as advanced practice nurses, have evolved over the years to become recognized as an important and growing trend in Canada and worldwide. In spite of sound evidence as to the effectiveness of NPs in primary care and other care settings, role implementation and integration continue to pose significant challenges. This article utilizes postcolonial theory, as articulated by Homi Bhabha, to examine and challenge traditional ideologies and structures that have shaped the development, implementation and integration of the NP role to this day. Specifically, we utilize Bhabha's concepts of third space, hybridity, identity and agency in order to further conceptualize the nurse practitioner role, to examine how the role challenges some of the inherent assumptions within the healthcare system and to explore how development of each to these concepts may prove useful in integration of nurse practitioners within the healthcare system. Our analysis casts light on the importance of a broader, power structure analysis and illustrates how colonial assumptions operating within our current healthcare system entrench, expand and re‐invent, as well as mask the structures and practices that serve to impede nurse practitioner full integration and contributions. Suggestions are made for future analysis and research. [ABSTRACT FROM AUTHOR]

HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure ‘community viral load’. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of ‘community’ through the re-configuration of space, the problematization of viral concentrations in specific micro-locales, and the government (in the Foucauldian sense) of specific bodies which are seen as ‘risky’, dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition – forming the ‘conditions of possibility’ – for the recent shift to high impact prevention tactics that are being scaled up across North America. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Facial lipoatrophy has been described as the most distressing and stigmatizing expression of the lipodystrophy syndrome, a syndrome that is caused by antiretroviral combination therapy. In recent years, reconstructive treatments (such as poly-l-lactic acid and polyalkylimide) have been increasingly considered for this condition. These treatments allow for facial contours and facial fullness to be restored while being minimally invasive. Objective: The main objective of this qualitative research was to explore and describe the experience of people who suffer from facial lipoatrophy, specifically in regard to reconstructive treatments. Method: A qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. The data was collected using semi-structured interviews and was then analyzed following the principles of thematic analysis. Participants: Over a period of three months, 11 men and 1 woman enrolled in the study which was conducted in Montreal (Quebec), Canada. Findings: Overall, participants explained that facial lipoatrophy had forced them into a situation of intense vulnerability by making them recognizable as persons living with HIV/AIDS and discreditable in the eyes of others. In this sense, they were willing to go to great lengths to restore their facial features and regain a sense of normalcy. Findings revealed that people who suffer from facial lipoatrophy engage in a process of reconstruction to reduce the visibility and disruptiveness of their condition but face many uncertainties along the way. Conclusions: While the findings of this research corroborated what has been previously stated by other researchers about the impact of reconstructive treatments, they also shed light on the consequences of not making these treatments accessible as well as the undocumented realities of those who cannot afford the recommended course of dermal fillers. [Copyright &y& Elsevier]

Fear appeals are once again popular in public health campaigns aimed at preventing unhealthy behaviors and dangerous life practices such as smoking, unsafe sexual practices, drug use, alcohol abuse, impaired driving, etc. Every year in the province of Quebec (Canada), a new prevention campaign for sexually transmitted infections is launched by the SLITSS (Service de lutte contre les infections transmissibles sexuellement et par le sang). In 2006-2007, the SLITSS created a fear-based campaign entitled 'Condoms: They aren't a luxury' for the prevention of sexually transmitted infections in young adults. The purpose of this paper is to share the results of a discursive analysis of the documents retrieved from this campaign, which was developed using commercial advertising and marketing strategies. Using situational analysis and the mapping process proposed by Clarke (2005), we critically examine the use of fear appeal in the campaign. Drawing on Michel Foucault's concepts of governmentality and bio-power, we assert that fear should be understood as a bio-political technology deployed to manage/govern young adults' sexual practices. In doing so, we critique the use of fear as a strategy to create a state of permanent (in)security and challenge the adoption of commercial advertising and marketing strategies to develop public health campaigns. [ABSTRACT FROM AUTHOR]

The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created. [ABSTRACT FROM AUTHOR]

• Public experiences of surveillance and control are recreated in SROs. • The liminality of SROs between public and private space structure experiences of privacy and safety. • Using drug alone can be both a way to claim privacy and a survival strategy within the context of SRO housing. • Interventions accounting for broader contextual factors that render using alone as instrumental to survival are needed to reduce vulnerability to overdose and other harms. Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms. [ABSTRACT FROM AUTHOR]

Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma—the pre-HAART era of the HIV/AIDS epidemic—characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men. [ABSTRACT FROM AUTHOR]

Background: Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. Yet, despite showing some level of efficacy (albeit only short-term) and being praised by researchers as beneficial and cost-saving, it continues to be underutilized by health care and service providers. Why that is remains unclear.Methods: Recognizing a gap, we conducted a targeted analysis of a larger set of qualitative interviews conducted on the experience of health care and service providers with incentives (including prize-based CM) (n = 25).Results: Four themes were identified during the analysis: 1) The specificities of prize-based CM, 2) The role of providers in administering prize-based CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM. Overall, our findings are consistent with existing literature and suggest that providers are wary of using prize-based CM because they tend to value effort over success, support over reward, honesty over deceit, and certainty over probability and variability.Conclusion: Our analysis offers additional insights into the experiences of providers who use prize-based CM and possibly some indications as to why they may not wish to work with this type of incentive. The question raised here is not whether there is enough evidence on the effectiveness of prize-based CM, but rather if this type of incentive is appropriate and ethical when caring for people who use substances. [ABSTRACT FROM AUTHOR]

Objectives: In May 2018, St. Paul's Hospital (SPH) in Vancouver (Canada) opened an outdoor peer-led overdose prevention site (OPS) operated in partnership with Vancouver Coastal Health and RainCity Housing. At the end of 2020, the partnered OPS moved to a new location, which created a gap in service for SPH inpatients and outpatients. To address this gap, which was magnified by the COVID-19 pandemic, SPH opened a nurse-led OPS in February 2021. This paper describes the steps leading to the implementation of the nurse-led OPS, its impact, and lessons learned. Methods: Four steps paved the way for the opening of the OPS: (1) identifying the problem, (2) seeking ethics guidance, (3) adapting policies and practices, and (4) supporting and training staff. Results: The OPS is open between 10:00 and 20:00 and staffed by two nurses per shift. It is accessible to all patients including inpatients, patients in the Emergency Department, and patients attending outpatient services. Between February 1, 2021 and October 23, 2021, the OPS recorded 1612 visits for the purpose of injection, for an average weekly visit number of 42. A total of 46 overdoses were recorded in that 9-month period. Thirty-seven (80%) required administration of naloxone and 12 (26%) required a code blue response. Conclusions: Due to the unique nature of our OPS, we learned many important lessons in the process leading to the opening of the site and the months that followed. We conclude the paper with lessons learned grouped into six main categories, namely engagement, communication, access, staff education and support, data collection, and safety. [ABSTRACT FROM AUTHOR]

Objectives: In May 2018, St. Paul's Hospital (SPH) in Vancouver (Canada) opened an outdoor peer-led overdose prevention site (OPS) operated in partnership with Vancouver Coastal Health and RainCity Housing. At the end of 2020, the partnered OPS moved to a new location, which created a gap in service for SPH inpatients and outpatients. To address this gap, which was magnified by the COVID-19 pandemic, SPH opened a nurse-led OPS in February 2021. This paper describes the steps leading to the implementation of the nurse-led OPS, its impact, and lessons learned. Methods: Four steps paved the way for the opening of the OPS: (1) identifying the problem, (2) seeking ethics guidance, (3) adapting policies and practices, and (4) supporting and training staff. Results: The OPS is open between 10:00 and 20:00 and staffed by two nurses per shift. It is accessible to all patients including inpatients, patients in the Emergency Department, and patients attending outpatient services. Between February 1, 2021 and October 23, 2021, the OPS recorded 1612 visits for the purpose of injection, for an average weekly visit number of 42. A total of 46 overdoses were recorded in that 9-month period. Thirty-seven (80%) required administration of naloxone and 12 (26%) required a code blue response. Conclusions: Due to the unique nature of our OPS, we learned many important lessons in the process leading to the opening of the site and the months that followed. We conclude the paper with lessons learned grouped into six main categories, namely engagement, communication, access, staff education and support, data collection, and safety. [ABSTRACT FROM AUTHOR]

Since the start of the COVID-19 pandemic, a steady stream of propositions from tech giants and start-ups alike has furnished us with the idea that GPS- or Bluetooth-enabled contact tracing apps are a vital part of the pandemic response. This commentary considers these apps as 'corporate contact tracing', emphasizing the private-sector role that such developments imply. We first discuss corporate contact tracing's potential to de-center the power of public health authorities. Then, using the frames of surveillance capitalism and disaster capitalism, we suggest how corporate contact tracing might feed the rise of corporate power in the public sphere. We question its capacity to address structural inequalities and to foster a social justice vision of public health. And, we wonder whether corporate contact tracing might intensify the effects of discriminatory design and algorithmic oppression. We conclude by calling for a discussion of this technology beyond questions of privacy and efficacy. [ABSTRACT FROM AUTHOR]

The article focuses on the moral and ethical aspects of telecare and telemedicine and on the article "Telecare, Surveillance and the Welfare State" by Tom Sorell and Heather Draper. In the article the authors offer their opinions on several points which are raised in Sorell and Draper's article and on the moral and ethical issues that are raised with the use of technologies which are used in telemedicine to remotely monitor patients.

The article discusses a study related to need of assisted injection for ensuring equitable access to supervised injection sites based on health care needs of people. Topics discussed include the injection not permitted in Canada and even prohibit someone from getting assistance at a supervised injection site, prohibition due to reasons such as no clear professional guidance for nurses and no legal protection, and increased risk of syringe-sharing from help.

Public health experts in the US and Canada are increasingly mobilizing molecular-based surveillance techniques in seeking to identify and control HIV. Both countries are also leading in the world to criminalize HIV exposure, transmission and non-disclosure, as well as having pervasive ongoing criminalization regimes toward drug use, sex work and migration. Molecular surveillance aims to rapidly identify 'risk network' clusters of people normally out of reach to public health (e.g. drug taking sexual networks of gay men, rural people living in poverty), in the near real-time, where transmissions are taking place, and to then intervene with enhanced public health approaches. This commentary critically interrogates the seemingly benign new technology that is being presented by leading public health authorities evacuated of social and political context. We outline a series of concerns facing people living with HIV related to molecular surveillance as it intersects with consent and criminalization. [ABSTRACT FROM AUTHOR]

Background: The intersection of dual public health emergencies—the COVID-19 pandemic and the drug toxicity crisis—has led to an urgent need for acute care based harm reduction for unregulated opioid use. Emergency Departments (EDs) as Complex Adaptive Systems (CASs) with multiple, interdependent, and interacting elements are suited to deliver such interventions. This paper examines how the ED is organized to provide harm reduction and identifies facilitators and barriers to implementation in light of interactions between system elements. Methods: Using a case study design, we conducted interviews with Emergency Physicians (n = 5), Emergency Nurses (n = 10), and clinical leaders (n = 5). Nine organizational policy documents were also collected. Interview data were analysed using a Reflexive Thematic Analysis approach. Policy documents were analysed using a predetermined coding structure pertaining to staffing roles and responsibilities and the interrelationships therein for the delivery of opioid-specific harm reduction in the ED. The theory of CAS informed data analysis. Results: An array of system agents, including substance use specialist providers and non-specialist providers, interacted in ways that enable the provision of harm reduction interventions in the ED, including opioid agonist treatment, supervised consumption, and withdrawal management. However, limited access to specialist providers, when coupled with specialist control, non-specialist reliance, and concerns related to safety, created tensions in the system that hinder harm reduction provision with resulting implications for the delivery of care. Conclusions: To advance harm reduction implementation, there is a need for substance use specialist services that are congruent with the 24 h a day service delivery model of the ED, and for organizational policies that are attentive to discourses of specialized practice, hierarchical relations of power, and the dynamic regulatory landscape. Implementation efforts that take into consideration these perspectives have the potential to reduce harms experienced by people who use unregulated opioids, not only through overdose prevention and improving access to safer opioid alternatives, but also through supporting people to complete their unique care journeys. [ABSTRACT FROM AUTHOR]

The article discusses digital medicine panopticon's impact on issues of autonomy and trust in marginalized communities in the article by Klugman et al. in 2018. Topics covered include questions on the neutrality of digital technologies, and concerns on smart pharmaceuticals' surveillance of patients with the human immunodeficiency virus (HIV) or psychiatric disabilities. Also noted are the technologies' potential in eroding the duty to care and in integrating within larger governance systems.

The article comments on the article "EBM: Evidence to Practice and Practice to Evidence," by C. A. Isaac and A. Franceschi. According to the authors, while the article promotes the need for connections between different forms of knowledge, its shows a lack of understanding about epistemology. The authors question how Isaac and Franceschi came to formulate their claim about the need for more connections between perspectives and why they ignored the underlying meaning behind the term connections.

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex. [ABSTRACT FROM AUTHOR]

Background: Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI's) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. Methods: Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. Results: We interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. Conclusion: Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI's prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services. [ABSTRACT FROM AUTHOR]

The article presents a commentary in response to the article "Our Life Depends on This Drug: Competence, Inequity, and Voluntary Consent in Clinical Trials on Supervised Injectable Opioid Assisted Treatment" (siOAT). Topics discussed include concern about the ethics of conducting further trials on the efficacy of siOAT, the need for siOAT as a health care intervention in the context of the North American wide opioid overdose epidemic and a different research direction for siOAT.

An editorial is presented in which the authors discuss their concerns with what they identify as punitive enforcement of public health measures such as contact tracing and stay-at-home orders in some jurisdictions that emerged during the COVID-19 pandemic that may be an affront to human rights protections and standards that resemble the response of criminal law to HIV. The authors discuss how such practices negatively impact Black and Indigenous people and the concept of carceral public health.

Persistent Human Immunodeficiency Virus (HIV) prevalence rates remain a challenge, particularly because health care providers (HCP) are not fully prepared to engage in HIV care. This hesitancy to engage creates access to care barriers for people living with HIV (PLWH). We conducted a systematic review to identify educational interventions focused on developing HIV competencies in higher education across health science disciplines. We searched databases for primary studies focused on interventions. Using PRISMA guidelines, we identified 20 articles from 19 distinct studies. While there was an overwhelming body of literature that assessed knowledge, skills, and attitudes in health sciences students on HIV and AIDS, the low number of intervention studies was notable. With the exception of two studies, PLWH were not included in the interventions. This finding stands in sharp contrast to the well-established Greater Involvement of People Living with HIV and/or AIDS (GIPA) and Meaningful Engagement of People Living with HIV and/or AIDS (MEPA) principles. The primary means of the educational intervention was focused on delivering lectures to address HIV and AIDS knowledge for HCP. There was a significant lack of focus on historical, cultural, policy and legal contexts of HIV and AIDS care; theoretical justifications for the interventions were absent. No study focused on the impact of an intervention on the care provided to PLWH by HCP after graduation. There is an urgent need to develop long-term sustainable and scalable interventions that address the consistently identified lack of knowledge and skills, and stigmatizing attitudes of HCP and students. [ABSTRACT FROM AUTHOR]

Objectives: To explore the similarities and differences of organization-based and informal spotting (remote supervision of substance use) from the perspectives of spotters and spottees across Canada.Methods: Spotters and spottees who spot informally and for organizations were recruited across Ontario and Nova Scotia. We interviewed 20 informal and 10 organization-based participants by phone using semi-structured interviews between 08/2020 and 11/2020. Participants were asked about each methods benefits and limitations. Interviews were audio-recorded, transcribed, and analyzed thematically.Results: Benefits of informal spotting included its ability to strengthen social connections and foster autonomy in overdose response planning. The lack of support for informal spotters created stress and burnout. Organization-based spotters enjoyed the spotting training and support provided. However, regulations surrounding having to call ambulance in overdose events deterred many people from wanting to work for or call these services.Conclusions: Both organization-based and informal spotting have a role in mitigating harms associated with the overdose crisis. Moving forward, further research is needed on how to optimize these services for all people who use drugs in varying jurisdictions internationally. [ABSTRACT FROM AUTHOR]

In this paper the development of a self-management program to optimize long-term adherence to antiretroviral therapy for people living with HIV/AIDS is presented. The program is based on intervention mapping: that is, a framework that facilitates the use of theory and empirical evidence in intervention development. In the preparatory phase we conducted a needs-assessment. The results of this phase were then used in the operational phase in which the program was elaborated as follow: in Step 1 we established program objectives; in Step 2 we translated theoretical methods into practical strategies; and in Step 3 we integrated the strategies into a self-management program which were designed to help individuals mobilize their skills to cope with their antiretroviral therapies (ART). These particular abilities are: ability to integrate ART in daily routine, to cope with side effects, to handle situations in which ART is difficult to take, to interact with health professionals and to maintain relationships with social contacts. To address individuals' resources and skills in conjunction with the experience of taking the medication, we developed two different modalities to deliver the intervention: direct support and virtual support. Direct support consists of four 45-minute individualized, face-to-face sessions with a health professional. The Web application involved at least four interactive sessions with a computer. This application was developed with the intention to support individuals in managing their therapy, in a punctual, real-time mode. Treatment adherence behavior is an indicator or gauge that can reveal problems in being able to manage the therapy. [ABSTRACT FROM AUTHOR]

Background: People who use drugs (PWUD), and especially those who inject drugs, are at increased risk of acquiring bloodborne infections (e.g., HIV and HCV), experiencing drug-related harms (e.g., abscesses and overdose), and being hospitalized and requiring inpatient parenteral antibiotic therapy delivered through a peripherally inserted central catheter (PICC). The use of PICC lines with PWUD is understood to be a source of tension in hospital settings but has not been well researched. Drawing on theoretical and analytic insights from "new materialism," we consider the assemblage of sociomaterial elements that inform the use of PICCs.Methods: This paper draws on n = 50 interviews conducted across two related qualitative research projects within a program of research about the impact of substance use on hospital admissions from the perspective of healthcare providers (HCPs) and people living with HIV/HCV who use drugs. This paper focuses on data about PICC lines collected in both studies.Results: The decision to provide, maintain, or remove a PICC is based on a complex assemblage of factors (e.g., infections, bodies, drugs, memories, relations, spaces, temporalities, and contingencies) beyond whether parenteral intravenous antibiotic therapy is clinically indicated. HCPs expressed concerns about the risk posed by past, current, and future drug use, and contact with non-clinical spaces (e.g., patient's homes and the surrounding community), with some opting for second-line treatments and removing PICCs. The majority of PWUD described being subjected to threats of discharge and increased monitoring despite being too ill to use their PICC lines during past hospital admissions. A subset of PWUD reported using their PICC lines to inject drugs as a harm reduction strategy, and a subset of HCPs reported providing harm reduction-centred care.Conclusion: Our analysis has implications for theorizing the role of PICC lines in the care of PWUD and identifies practical guidance for engaging them in productive and non-judgemental discussions about the risks of injecting into a PICC line, how to do it safely, and about medically supported alternatives. [ABSTRACT FROM AUTHOR]