17 results on '"Ondocsin, Jeff"'
Search Results
2. Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco.
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Holm, Nicole, Ondocsin, Jeff, Schlosser, Allison, Fessel, Jason, Cowan, Amanda, Mars, Sarah, and Ciccarone, Daniel
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Fentanyl ,Humans ,San Francisco ,Male ,Female ,Adult ,Smoking ,Drug Overdose ,Middle Aged ,Substance Abuse ,Intravenous ,Methamphetamine - Abstract
BACKGROUND: Illicitly manufactured fentanyls and stimulants are implicated in the escalating US mortality from drug overdose. San Francisco, California (SF) has seen declining fentanyl injection while smoking has increased. Beliefs and behaviors surrounding this development are not well understood. METHODS: The study used rapid ethnography to explore fentanyl and methamphetamine use in SF. The team conducted semi-structured interviews (n = 34) with participants recruited from syringe service programs. Video-recorded smoking sequences (n = 12), photography and daily field notes supplemented interview data. RESULTS: Difficulty injecting and fear of overdose motivated transitions from injecting to smoking. Fentanyl was extremely cheap-$10/gram-with variability in quality. Foil was the most commonly used smoking material but glass bubbles, bongs and dabbing devices were also popular. No reliable visible methods for determining fentanyl quality existed, however, participants could gauge potency upon inhalation, and developed techniques to regulate dosage. Several participants reported at least hourly use, some reporting one or more grams of daily fentanyl consumption. Smoking was also very social, with people sharing equipment, drugs and information. Participants raised concerns about hygiene and overdose risk to others arising from shared equipment. Reportedly potent fentanyl residue accumulated on smoking materials and was commonly shared/traded/stolen or consumed accidentally with diverse preferences for its use. CONCLUSION: Our data highlight fentanyl residue as a new overdose risk with potential mismatch between the potency of the residual drug and the recipients tolerance. Further, large doses of fentanyl are being consumed (estimated at approximately 50 mg of pure fentanyl/day). Smoking fentanyl has potential health benefits over injecting and may be protective against overdose, but substantial uncertainty exists. However, SF overdose mortality hit a record high in 2023. Recommendations to reduce fentanyl smoking overdose risks through pacing, greater awareness of dosages consumed and checking tolerance of residue recipients are potentially viable interventions deserving further exploration.
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- 2024
3. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives
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Moran, Lissa, Ondocsin, Jeff, Outram, Simon, Ciccarone, Daniel, Werb, Daniel, Holm, Nicole, and Arnold, Emily A
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Health Services and Systems ,Health Sciences ,Clinical Research ,Social Determinants of Health ,Opioid Misuse and Addiction ,Behavioral and Social Science ,Drug Abuse (NIDA only) ,Opioids ,Substance Misuse ,Prevention ,Physical Injury - Accidents and Adverse Effects ,8.1 Organisation and delivery of services ,Prevention of disease and conditions ,and promotion of well-being ,Health and social care services research ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Mental health ,Generic health relevance ,Good Health and Well Being ,Humans ,Harm Reduction ,Female ,Qualitative Research ,Male ,Opiate Overdose ,Adult ,San Francisco ,Drug Users ,Opioid-Related Disorders ,Drug Overdose ,Drug checking ,Harm reduction ,Opioid ,Fentanyl ,Substance use ,Overdose ,Qualitative ,North america ,Public Health and Health Services ,Substance Abuse ,Health services and systems ,Public health - Abstract
BackgroundMortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.MethodsWe conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: "clients" (individuals who use drugs and receive harm reduction services) and "providers" (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.ResultsWe found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.ConclusionThis study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.
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- 2024
4. The motives and methods of methamphetamine and 'heroin' co-use in West Virginia.
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Ondocsin, Jeff, Holm, Nicole, Mars, Sarah G, and Ciccarone, Daniel
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Humans ,Heroin Dependence ,Methamphetamine ,Heroin ,Fentanyl ,Self Medication ,Health Knowledge ,Attitudes ,Practice ,Motivation ,Adult ,West Virginia ,Female ,Male ,Interviews as Topic ,Pleasure ,Social Interaction ,Ethnography ,Injection ,Opioid ,Polysubstance use ,Substance-related disorders ,Analgesics ,Opioid ,Opiate Overdose ,Drug Overdose ,Drug Abuse (NIDA only) ,Substance Misuse ,Generic health relevance ,Public Health and Health Services ,Substance Abuse - Abstract
BackgroundOpioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years.MethodsThis study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews.ResultsWe found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: 'intrinsic use', encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; 'opioid assisting use' in which methamphetamine helped people manage their existing heroin/fentanyl use; and 'reluctant or indifferent use' for social participation, reflecting methamphetamine's low cost and easy availability.ConclusionsMethamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. 'Reluctant' uptake attests to methamphetamine's social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.
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- 2023
5. ‘The High Five Club’: Social Relations and Perspectives on HIV-Related Stigma During an HIV Outbreak in West Virginia
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Mars, Sarah G, Koester, Kimberly A, Ondocsin, Jeff, Mars, Valerie, Mars, Gerald, and Ciccarone, Daniel
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Social Work ,Human Society ,Opioids ,Drug Abuse (NIDA only) ,HIV/AIDS ,Prevention ,Brain Disorders ,Opioid Misuse and Addiction ,Social Determinants of Health ,Infectious Diseases ,Behavioral and Social Science ,Clinical Research ,Substance Misuse ,Sexually Transmitted Infections ,Infection ,Good Health and Well Being ,Humans ,Substance Abuse ,Intravenous ,West Virginia ,HIV Infections ,Social Stigma ,Disease Outbreaks ,Injecting drug use ,HIV ,Stigma ,Cultural Theory ,Psychiatry - Abstract
In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior ('grid') or degree of group allegiance/individual autonomy ('group'). Accordingly, we would expect that perceptions about HIV, including stigma, correspond with individuals' grid/group attributes. To explore this, we conducted qualitative interviews with people who inject drugs (PWID) recruited from a WV syringe service program. This paper focuses on our unexpected findings on stigma during a coinciding HIV outbreak. PWID living homeless identified as belonging to a 'street family'. Its members were mutually distrustful and constrained by poverty and drug dependence but despite their conflicts, reported openness between each other about HIV + status. Interviewees living with HIV perceived little enacted stigma from peers since the local outbreak. Contrasting stigmatizing attitudes were attributed to the town's mainstream society. The 'High Five' (Hi-V) Club, expressing defiance towards stigmatizing behavior outside the street family, epitomized the tensions between a desire for solidary and mutual support and a fatalistic tendency towards division and distrust. Fatalism may hinder cooperation, solidarity and HIV prevention but may explain perceived reductions in stigma.
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- 2023
6. Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs.
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Ondocsin, Jeff, Ciccarone, Daniel, Moran, Lissa, Outram, Simon, Werb, Dan, Thomas, Laura, and Arnold, Emily A
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Humans ,Substance-Related Disorders ,Harm Reduction ,Public Health ,Drug Users ,Pandemics ,Drug Overdose ,COVID-19 ,North America ,community-based ,drug checking ,fentanyl ,harm reduction ,substance use ,Health Services ,Drug Abuse (NIDA only) ,Substance Misuse ,Behavioral and Social Science ,Clinical Research ,Health and social care services research ,8.1 Organisation and delivery of services ,Good Health and Well Being ,Toxicology - Abstract
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.
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- 2023
7. Correction to: Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency
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Ondocsin, Jeff, Mars, Sarah G, Howe, Mary, and Ciccarone, Daniel
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Health Services and Systems ,Public Health ,Health Sciences ,Public Health and Health Services ,Substance Abuse ,Health services and systems ,Public health - Abstract
After publication of the original article [1], the authors identified an error in Acknowledgements section. The below disclosures is missing. "Dr. Ciccarone has received compensation in the past 36 months for: being on the Scientific Advisory Board for Celero Systems; providing expert testimony for Motley Rice LLP; being a one-time consultant for Arbor Pharmaceuticals; all outside the submitted work". The original article has been corrected.
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- 2021
8. The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States
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Mars, Sarah, Ondocsin, Jeff, Holm, Nicole, and Ciccarone, Daniel
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- 2024
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9. Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency
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Ondocsin, Jeff, Mars, Sarah G, Howe, Mary, and Ciccarone, Daniel
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Health Services and Systems ,Health Sciences ,Health Services ,Clinical Research ,Behavioral and Social Science ,Substance Misuse ,Prevention ,Drug Abuse (NIDA only) ,Generic health relevance ,Good Health and Well Being ,Analgesics ,Opioid ,Drug Overdose ,Empathy ,Harm Reduction ,Hostility ,Humans ,Naloxone ,Opiate Overdose ,Opioid-Related Disorders ,West Virginia ,Injection drug use ,Overdose ,Opioids ,Harm reduction ,Compassion ,Risk environment ,Public Health and Health Services ,Substance Abuse ,Health services and systems ,Public health - Abstract
BackgroundWest Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state's drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston's needle and syringe program was forced to close. This paper considers the risk environment in which the state's drug-related loss of life, and those attempting to prevent it, exist.MethodsThis rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out.ResultsPWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH.ConclusionsHostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.
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- 2020
10. Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco
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Ciccarone, Daniel, primary, Holm, Nicole, additional, Ondocsin, Jeff, additional, Schlosser, Allison, additional, Fessel, Jason, additional, Cowan, Amanda, additional, and Mars, Sarah G., additional
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- 2024
- Full Text
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11. Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency
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Mars, Sarah G, Ondocsin, Jeff, and Ciccarone, Daniel
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Drug Abuse (NIDA only) ,Substance Misuse ,Good Health and Well Being ,Drug Monitoring ,Drug Overdose ,Female ,Harm Reduction ,Heroin ,Heroin Dependence ,Humans ,Male ,Narcotics ,Substance Abuse ,Intravenous ,Taste ,United States ,Overdose ,Fentanyl ,Test shot ,Tester shot ,injection ,insufflation ,Inhalation ,Harm reduction ,Injection ,Insufflation ,Public Health and Health Services ,Substance Abuse - Abstract
BACKGROUND:Internationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin injectors are making to protect themselves from these risks. METHODS:Between 2015 and 2016, a team of ethnographers collected data through semi-structured interviews and observation captured in field notes and video recording of heroin preparation/consumption. Ninety-one current heroin injectors were interviewed (Baltimore, n = 22; Chicago, n = 24; Massachusetts and New Hampshire, n = 36; San Francisco, n = 9). Experience injecting heroin ranged from
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- 2018
12. Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD
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Mars, Sarah G, Ondocsin, Jeff, and Ciccarone, Daniel
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Drug Abuse (NIDA only) ,Substance Misuse ,Good Health and Well Being ,Adult ,Analgesics ,Opioid ,Baltimore ,Benzodiazepines ,Drug Contamination ,Drug Overdose ,Female ,Fentanyl ,Heroin ,Heroin Dependence ,Humans ,Interviews as Topic ,Lactose ,Male ,Middle Aged ,Quinine ,heroin ,injection drug use ,overdose ,"Scramble" ,United States ,“Scramble” ,Public Health and Health Services ,Psychology ,Substance Abuse - Abstract
Since 2001, heroin-related overdose deaths in the United States have risen six-fold, a rise unaccounted for by the expanding user population. Has heroin become a more dangerous drug? Reports of fentanyl and its analogs, often concealed in or sold as heroin, have also increased sharply. This article investigates heroin injectors' perceptions and experiences of changes in the heroin supply in the East Coast city of Baltimore, Maryland, currently facing an epidemic in heroin- and fentanyl-related overdose deaths. Unusually, Baltimore's heroin market is divided between two types: "Raw," believed to be Colombian in origin and relatively pure, and the more adulterated "Scramble" (raw heroin traditionally blended with quinine and lactose). Users reported that Scramble heroin, while gaining market share, has become a highly unstable product, varying dramatically in appearance, intensity of onset, duration of action, and effect. Some considered that Scramble was no longer "heroin," but was heavily adulterated or even replaced, mentioning fentanyl, benzodiazepines, and crushed opioid pills as additives. There was intense awareness of overdose as a present danger in users' lives, which they linked to the recent adulteration of the heroin supply. Responses to this perceived adulteration varied, including information gathering, attraction, avoidance, taking precautions, and acceptance.
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- 2018
13. Heroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’
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Ciccarone, Daniel, Ondocsin, Jeff, and Mars, Sarah G
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Substance Misuse ,Drug Abuse (NIDA only) ,Good Health and Well Being ,Adult ,Drug Contamination ,Drug Overdose ,Drug Users ,Female ,Fentanyl ,Harm Reduction ,Heroin ,Heroin Dependence ,Humans ,Interviews as Topic ,Male ,Massachusetts ,Middle Aged ,New Hampshire ,Opioid-Related Disorders ,Substance Abuse Detection ,Uncertainty ,United States ,Young Adult ,Opioids ,Overdose ,Mortality ,Qualitative research ,Medical and Health Sciences ,Studies in Human Society ,Psychology and Cognitive Sciences ,Substance Abuse - Abstract
BackgroundThe US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use.MethodsA team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.Results(1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports.ConclusionMassachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations.
- Published
- 2017
14. Pandemic expertise: qualitative findings on the experiences of living with HIV during the COVID-19 pandemic.
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Mars, Sarah G., Spinelli, Matthew A., Ondocsin, Jeff, Koester, Kim A., Rodriguez, Edda Santiago, Jain, Jennifer, Arreguin, Mireya, Johnson, Mallory O., and Gandhi, Monica
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COVID-19 ,SUBSTANCE abuse ,RESEARCH methodology ,MENTAL health ,INTERVIEWING ,HOUSING stability ,PATIENTS' attitudes ,QUALITATIVE research ,SELF-efficacy ,SOCIOECONOMIC factors ,RESEARCH funding ,HEALTH behavior ,THEMATIC analysis ,PSYCHOLOGICAL adaptation ,JUDGMENT sampling ,COVID-19 pandemic ,PSYCHOLOGY of HIV-positive persons ,PSYCHOLOGICAL resilience - Abstract
This qualitative study explored the experiences of people living with HIV (PLWH) in the San Francisco Bay Area, United States, during the COVID-19 pandemic and subsequent public health restrictions at a safety net HIV clinic. Patients (N = 30) were recruited for Spanish/English language semi-structured interviews (n = 30), translated when necessary, and analyzed thematically. The recurring theme of "pandemic expertise" emerged from the data: skills and attitudes developed through living with HIV helped PLWH cope with the COVID-19 pandemic, including effective strategies for dealing with anxiety and depression; appreciation for life; and practical experience of changing behavior to protect their health. A subset did not consider living with HIV helped them adapt to the COVID-19 pandemic, with some describing their lives as chaotic due to housing issues and/or ongoing substance use. Overall, interviewees reported finding trustworthy health information that helped them follow COVID-19 prevention strategies. Although living with HIV is associated with a higher prevalence of mental health concerns, substance use, and stigma, these challenges can also contribute to increased self-efficacy, adaptation, and resilience. Addressing structural issues such as housing appears to be key to responding to both pandemics. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
15. ‘The High Five Club’: Social Relations and Perspectives on HIV-Related Stigma During an HIV Outbreak in West Virginia
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Mars, Sarah G., primary, Koester, Kimberly A., additional, Ondocsin, Jeff, additional, Mars, Valerie, additional, Mars, Gerald, additional, and Ciccarone, Daniel, additional
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- 2022
- Full Text
- View/download PDF
16. Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD
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Mars, Sarah G., primary, Ondocsin, Jeff, additional, and Ciccarone, Daniel, additional
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- 2017
- Full Text
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17. Heroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’
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Ciccarone, Daniel, primary, Ondocsin, Jeff, additional, and Mars, Sarah G., additional
- Published
- 2017
- Full Text
- View/download PDF
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