Providers' views concerning family planning service delivery to HIV-positive women in Mozambique

This study explores challenges and obstacles in providing effective family planning services to HIV-positive women as described by staff of maternal and child health (MCH) clinics. It draws upon data from a survey of service providers carried out from late 2008 to early 2009 in 52 MCH clinics in southern Mozambique, some with and some without HIV services. In all clinics, surveyed providers reported that practical, financial, and social barriers made it difficult for HIV-positive clients to follow protocols to prevent mother-to-child transmission of the virus. Likewise, staff were skeptical of their seropositive clients' ability to adhere to recommendations to cease childbearing and to use condoms consistently. Providers' recommendations to HIV-positive clients and their assessment of barriers to adherence did not depend on availability of HIV services. Although integration of HIV and reproductive health services is advancing in Mozambique, service providers do not feel that they can influence the behaviors of HIV-positive women effectively.     

Methamphetamine Use,Attitudes About Condoms,and Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men

This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM’s attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.     

Barriers to screening for intimate partner violence: a mixed-methods study of providers in family planning clinics

CONTEXT: Universal screening for intimate partner violence has been recommended for health care settings. However, provider adherence to this recommendation is low, and little research has explored perspectives on relevant policies and procedures among providers in family planning centers. METHODS: In 2009, a sample of 75 health care staff from a large, urban family planning organization that has a protocol for screening for partner violence participated in focus group discussions about their attitudes toward, perceptions of barriers to and preparedness for such screening; 64 of them also completed a brief survey. Multiple analysis of variance was used to assess differences between licensed practitioners (advanced practice clinicians and social workers) and unlicensed health care assistants; findings were analyzed for congruence with and divergence from the focus group data. RESULTS: Barriers included lack of time, training and referral resources, but were reported less by licensed than by unlicensed providers. Overall, participants rated screening as helpful to clients, but licensed providers had more positive attitudes toward and felt more prepared for it than unlicensed ones. In the focus groups, some providers expressed frustration with clients’ responses to referrals, concern about taking too much time away from other health care matters and opinions that it was more appropriate for licensed professionals than for unlicensed practitioners to conduct screening. Both licensed and unlicensed staff wanted more training on responding to disclosures of violence. CONCLUSIONS: Family planning providers who are working under an institutional protocol continue to perceive barriers to screening and may benefit from ongoing professional development.     

抗病毒治疗对美沙酮门诊HIV感染者吸毒和高危性行为影响的定性研究

目的 了解美沙酮门诊HIV感染者参加抗病毒治疗(ART)后高危行为是否变化,探索变化及发生高危行为的原因.方法 对云南省美沙酮门诊参加ART的34名HIV感染者进行调查,包括一般情况,HIV感染情况,美沙酮维持治疗(MMT)情况,接受ART情况,ART前后性伴数量、性行为频率、安全套使用、毒品使用、针具共用情况.结果 受访者平均年龄38.5岁,男性居多(70.6％),均表示参加ART后不安全性行为和共用针具等行为未增加,主要原因是获得HIV相关知识培训、免费安全套、清洁针具并受到MMT影响,存在偷吸(12/34)和不坚持使用安全套(3/19)等高危行为,同时出现ART药物与美沙酮相互作用导致偷吸、对ART的态度乐观导致不安全性行为等新挑战.结论 参加ART未引起MMT门诊HIV感染者高危行为增加,但高危行为仍然存在,应重视ART高期望引起的新挑战.     

Preventing AIDS and other STDs through condom promotion: a patient education intervention.

We report on two studies that assessed the impact of a soap-opera style videotape on inner-city STD (sexually transmitted disease) patients' knowledge about and attitudes toward condom use, and willingness to redeem coupons for free condoms. Subjects in the first study who viewed the videotape (and participated in a brief oral recall session) had higher knowledge scores and more accepting attitudes than subjects who did not (knowledge test means of 11.1 versus 7.9, attitude index means of 13.0 versus 11.3). The intervention was most effective among those who were relatively poorly educated and, to a lesser extent, among those who reported less frequent use of condoms and fewer sex partners. In the second study, intervention group subjects were more likely than control group subjects to redeem coupons. Both groups exhibited a high level of interest in the free condoms. We argue that education and accessibility to free condoms can increase condom use and that health care providers have a vital role in promoting this form of STD prevention.     

Perceptions of condom use among African American men who have sex with men

The objectives of this study were to describe what African American men perceive as the risks of different sexual acts when not using condoms, the social and situational barriers to using condoms, the attitudes towards condom use of other men they know, and the strategies needed to promote condom use. In semi‐structured interviews, participants were asked questions regarding their perceptions of the risks of HIV infection from various sexual activities, barriers to condom use, condom attitudes of people in their social and sexual networks, and strategies necessary to promote condom use. Analyses indicated that African American men who sex with men (MSM) most often mentioned sex without a condom as risky sexual behaviour, specifically anal sex. The most frequently perceived barrier to safer sex practice was ‘sex on the spur of the moment’. Respondents also perceived several salient attitudes towards condom use held by the African American MSM they knew. In particular, respondents were divided in their perception of social support for condom use among their friends and acquaintances. Also, they perceived that men in their social and sexual networks held less favourable attitudes towards condom use in committed relationships. Findings are discussed in relation to various interpersonal (e.g., relationship issues) and contextual (e.g., social support and social networks) factors that may influence HIV sexual risk behaviours among African American MSM.     

Cups for COVID: rapid implementation of a harm reduction initiative to support populations experiencing homelessness during the COVID-19 pandemic

SettingAs of June 10, 2020, 37 people experiencing homelessness or unstable housing in Calgary, Alberta, had developed lab-confirmed COVID-19. Spread occurred despite standard outbreak controls at affected shelter and supportive housing sites. Among these 37 cases, drink sharing was frequently identified as a modifiable mode of possible transmission. We collaborated with emergency shelters, a supportive housing site, and street and encampment outreach groups, using mixed service delivery by health staff, non-profits, and peers with lived experience with homelessness.InterventionTo empower individuals to decrease COVID-19 transmission using a harm reduction approach, we provided disposable paper cups to service providers for distribution to clients. Service providers tracked the number of cups distributed. To assess effectiveness, we interviewed staff and peers who distributed the cups.OutcomesCup distribution was highest among populations with higher rates of alcohol use, and the intervention was well received by people who drink alcohol regularly, providing unique opportunities to promote COVID-19 awareness and safer drinking practices. Providers to these populations reported enthusiastic client engagement and repeat requests for cups for safer drinking. Intervention usefulness was limited in contexts with low alcohol consumption and in the absence of paired COVID-19 education. Provider reports suggest appropriate disposal of these cups after use.ImplicationsDisposable cups are a novel, rapidly implementable, low-cost harm reduction tool to empower people experiencing homelessness to reduce the risk of COVID-19 transmission due to drink sharing, ideally as part of a larger harm reduction and community education strategy.     

The Chinese government's response to drug use and HIV/AIDS: A review of policies and programs

Illicit drug use has become popular in China. Acknowledging the challenge of illicit drug use, China has adopted several new policies on the management of illicit drug use in recent years. This study reviews the current policies on drug use and assesses the harm reduction interventions among drug users in China. The review documents that the new policies on drug use provide a variety of choices of detoxification treatment for drug users. The methadone maintenance treatment and needle exchange programs have been adopted as harm reduction models in China. Most of the reviewed harm reduction programs have been successfully implemented and yielded positive effects in reducing drug related risk behaviors among drug users. Although there remain barriers to the effective implementation of policies on drug use and harm reduction programs, Chinese government has shown their commitment to support the expansion of harm reduction interventions for drug users throughout the country.     

Emergency contraception: knowledge and attitudes of health care providers in a health maintenance organization.

One hundred sixty-four health care providers in a health maintenance organization were surveyed in 1996 regarding their knowledge of, attitudes toward, and perception of barriers regarding emergency contraceptive pills (ECPs), as well as their ECP prescribing practices. Providers reported primarily positive attitudes regarding ECPs. Only 42% reported having ever prescribed ECPs; those who had prescribed had more positive attitudes about ECPs. Knowledge of ECP provision was incomplete, with 40% believing treatment had to be initiated in 48 hours or less. Barriers identified by providers included lack of a dedicated product, lack of awareness of ECPs among providers, and liability issues.     

Withdrawal from methadone maintenance treatment: prognosis and participant perspectives

OBJECTIVE: To determine the proportion of clients engaged in methadone maintenance treatment who have favourable prognosis for withdrawal, and to examine client perceptions and expectations of withdrawal. METHODS: A broad cross-section of 856 methadone clients was sampled across Melbourne, Sydney and Brisbane. Self-complete surveys were developed for the clients, their clinic staff or pharmacists, and methadone prescribers. The client survey examined aspects of the clients' perspectives of withdrawal, and the surveys for the service providers collected information about each client's current treatment episode. Informed consent was provided by clients to obtain information from their clinic staff member or pharmacist, and their methadone prescriber. RESULTS: Most clients (70%) were at least very interested in methadone withdrawal. Clients were also more optimistic about their own post-withdrawal outcomes (in terms of opioid use) than both their clinic staff and prescribing doctors. Clinical criteria indicated that 31% of clients had a reasonable prognosis for withdrawal. However, when considering all factors, 17% had good withdrawal prognosis, were interested in methadone withdrawal, and believed it was very likely they would remain opioid-free for three months post-withdrawal. CONCLUSIONS: Despite the likely continued increase in client numbers in substitution maintenance treatment, the majority of methadone clients have a poor prognosis for withdrawal and should not be encouraged to cease treatment. IMPLICATIONS: Clients who do not meet key clinical criteria are likely to have poor clinical outcomes regardless of how withdrawal is attempted.     

Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents.

In August 1988, 1,773 Massachusetts 16-19-year-olds were surveyed by telephone using anonymous random digit dialing; response rate 82 percent. Logistic regression tested whether alcohol and drug use, perceived susceptibility to human immunodeficiency virus (HIV), severity of HIV if infected, effectiveness of condoms in preventing infection, barriers to condom use, and behavioral cues such as exposure to media or personal communication about acquired immunodeficiency syndrome (AIDS) were independently related to condom use. Among sexually active respondents, (61 percent of those interviewed) 31 percent reported always using condoms. Respondents who believed condoms are effective in preventing HIV transmission and worried they can get AIDS were 3.1 and 1.8 times, respectively, more likely to use condoms all the time. Respondents who carried condoms and who had discussed AIDS with a physician were 2.7 and 1.7 times, respectively, more likely to use them. Those who believed condoms do not reduce sexual pleasure and would not be embarrassed if asked to use them were 3.1 and 2.4 times, respectively, more likely to use condoms. Teens who averaged five or more drinks daily or used marijuana in the previous month were 2.8 and 1.9 times, respectively, less likely to use condoms. Among respondents who drink and use drugs, 16 percent used condoms less often after drinking and 25 percent after drug use. Those counseling adolescents about HIV should assess and discuss beliefs outlined in the Health Belief Model, as well as their alcohol and drug use.     

A cross-sectional study of public attitudes towards safer drug use practices in British Columbia,Canada

Background

Harm reduction programs are often vulnerable to political and vocal opposition despite documented evidence of their effectiveness and economic benefit. It is not well understood if opponents to harm reduction represent the general public’s attitudes.

Objective

To understand the attitudes of the people of British Columbia (BC) towards various harm reduction strategies and services, and factors associated with support for harm reduction.

Methods

A random-digit dialing telephone survey assessing attitudes towards various harm reduction strategies was administered to British Columbians in August 2011 (n?=?2000). We compared the level of support for general harm reduction by sex, age, education level, and area of residence (Health Authority region) (χ²). Multivariate logistic regression was used to assess odds of support for harm reduction.

Results

Overall support for general harm reduction among participants was 76%; needle distribution 72%; needle distribution in one’s local community 65%; and safer inhalation equipment distribution 52%. In the multivariate analysis, those with significantly lower odds of supporting harm reduction were male, older, had equal or less than high school education or completed a certificate/diploma program, and resided in the Fraser Health Authority region. The Health Authority region with a municipality that has introduced a bylaw prohibiting the implementation of harm reduction services was found to have 69% support for harm reduction. Another Health Authority region with a municipality that closed a long-standing needle distribution site was found to have over 78% support.

Conclusion

In contrast to some local policies, our results show the British Columbians surveyed in our study support harm reduction. It is unclear whether policy makers are swayed by a vocal minority or block harm reduction activities for other reasons. Tailoring messages towards segments of the public less likely to support harm reduction, as well civic policy-makers and the media, may help to reduce stigma and gain support for harm reduction services designed to protect and improve the health of the individual and the public.

     

Specialized Family Planning Clinics in the United States: Why Women Choose Them and Their Role in Meeting Women's Health Care Needs

BackgroundPublicly funded family planning clinics provide contraceptive care to millions of poor and low-income women every year. To inform the design of services that will best meet the contraceptive and reproductive health needs of women, we conducted a targeted survey of family planning clinic clients, asking women about services received in the past year and about their reasons for visiting a specialized family planning clinic.MethodsWe surveyed 2,094 women receiving services from 22 family planning clinics in 13 states; all sites included in the survey were clinics that specialize in contraceptive and reproductive health services and were located in communities with comprehensive primary care providers.ResultsSix in 10 (59%) respondents had made a health care visit to another provider in the past year, but chose the family planning clinic for contraceptive care. Four in 10 (41%) respondents relied on the family planning clinic as their only recent source for health care. The four most common reasons for choosing a specialized family planning clinic, reported by at least 80% of respondents, were respectful staff, confidential care, free or low-cost services, and staff who are knowledgeable about women's health.ConclusionsSpecialized family planning clinics play an important role as part of the health care safety net in the United States. Collaborations between such clinics and comprehensive primary care providers, such as federally qualified health centers, may be one model for ensuring women on-going access to the full range of care they need.     

Men's reproductive health services in family planning settings: a pilot study.

A 1984 pilot survey of administrators of 35 agencies offering family planning services revealed that all offered counseling/educational services for males, and 89 per cent offered medical/supply services for males. Nevertheless, total utilization of these services is low. Major barriers related to the provision of services to male clients are resource limitations, inadequate training, and negative or ambivalent staff attitudes; these factors may contribute to the discrepancy between service offering and utilization.     

Capacity of AIDS service organisations in Connecticut to respond to intimate partner violence

Although intimate partner violence (IPV) is prevalent among women living with HIV and negatively impacts their health, few studies have examined the ability of AIDS service organisations (ASOs) to address IPV. This study used a qualitative approach to identify facilitators of and barriers to addressing IPV in female clients of ASOs in the United States. In‐depth interviews were conducted between March and August 2011 with 20 ASO staff members and 19 female clients who reported a current or past history of IPV. Interviews were audio recorded, transcribed and analysed using the constant comparative method. These data identify barriers to addressing IPV at the organisation, provider and client levels, and include suggestions from both clients and providers about improving access to care. Client and provider suggestions differed in some areas. While providers emphasised structural changes such as increased training on IPV provided by their organisation, clients highlighted the importance of trusting personal relationships with staff to increase client disclosure of IPV experiences. Given the differing opinions of clients and staff, ASOs should consider involving women with histories of IPV in the process of programme and policy development. ASOs have the unique opportunity to provide comprehensive and holistic care by addressing IPV. The extent to which ASOs are able to recognise and address IPV and strategies for increasing this ability warrant greater attention from funders, ASO administrators and researchers.     

Agency approaches to common quality problems in home care: a scenario study

In a study of best practices in home care quality assurance (QA), a sample of 128 respondents from exemplary home care agencies were presented with 7 brief scenarios depicting common problems in home care quality. Agency respondents were asked to describe their likelihood of identifying the problem in each scenario, how they would identify the problem, and how they would correct it. We found that agencies expressed considerable confidence they would identify the problems, but were unlikely to view their QA efforts as contributing to detecting the problems. Identification was more often perceived to come from ordinary care, with considerable burden placed on paraprofessional staff or clients to bring the problem to the attention of the agency. Medically-oriented agencies were significantly more likely than socially-oriented to rely on formal QA to identify deteriorating patient conditions and depression. Across all agencies, a relationship existed between the type of problem in the scenario and the most frequent responses about detection and correction nodes. Once the problem was identified, agencies presented an appropriate and fairly wide range of corrective strategies. The implications for making QA more organically related to clinical care are discussed.     

Perspectives from the Veterans Health Administration about opportunities and barriers in telemedicine

We used qualitative interviews to examine the perceptions of direct providers of telemedicine services, primary care providers (PCPs) and hospital administrators about opportunities and barriers to the implementation of telemedicine services in a network of Veterans Health Administration hospitals. A total of 37 interviews were conducted (response rate of 28%) with 17 direct telemedicine providers, nine PCPs and 11 administrators. The overall inter-coder reliability across all themes was high (Scott's pi = 0.94). Direct telemedicine providers generally agreed that telemedicine improved rapport with patients, and respondents in all three groups generally agreed that telemedicine improves access, productivity, and the quality and coordination of care. Respondents mentioned several benefits to home telemedicine, including the ability to better manage chronic diseases, provide frequent clinician contact, facilitate quick responses to patient needs and provide care in patient's homes. Most respondents anticipated future growth in telemedicine services. Barriers to telemedicine implementation included technical challenges, the need for more education and training for patients and staff, preferences for in-person care, the need for programme improvement and the need for additional staff time to provide telemedicine services.     

Health risks and opportunities for harm reduction among injection-drug-using clients of Saskatoon's needle exchange program

Information about injection drug users' lifestyles is necessary to develop effective harm reduction strategies. One way to gather this information is through needle exchange programs. In 1998, a convenience sample of 100 clients of Saskatoon's needle exchange service was interviewed about their injection and sexual practices. Ritalin and morphine were the most commonly injected drugs. Over half the participants (53%) reported having shared needles, usually with friends, relatives, and partners. Slightly more (62%) had shared injection equipment. Most participants had multiple sexual partners, especially the women, half of whom were sex trade workers. Condom use was higher with casual partners than with regular partners. While awareness about HIV transmission was high, most participants considered their risk of infection to be below average. These findings are discussed in light of the insights they provide regarding both health risks and opportunities for harm reduction in the study population.