Daily opioid and stimulant co-use and nonfatal overdoses in the context of social disadvantage: Findings on marginalized populations.

OBJECTIVE: Opioids and stimulants are increasingly implicated in overdose deaths, particularly among minoritized groups. We examined daily opioid and cocaine co-use, nonfatal overdoses, and naloxone carrying among minoritized people who inject drugs (PWID). METHODS: The study derived data from 499 PWID in Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Participants reported overdoses; sociodemographic characteristics; and use of nonmedical prescription opioids, heroin, cocaine, and naloxone. RESULTS: Among the participants, the mean age was 46, 34 % were female, 64 % self-identified as Black, and 53 % experienced recent homelessness. Black PWID, compared to White PWID, were as likely to use opioids and cocaine daily but were 61 % less likely to have naloxone. After controlling for sociodemographic characteristics, women (aOR:1.88, 95%CI: 1.14, 3.11), persons experiencing homelessness (aOR:3.07, 95%CI: 1.79, 5.24), and those who experienced a recent overdose (aOR:2.14, 95%CI: 1.29, 3.58) were significantly more likely to use opioids and any form of cocaine every day. In a subanalysis of only female PWID, females engaged in sex work (aOR:2.27, 95%CI: 1.02, 5.07) and females experiencing recent homelessness (aOR:5.82, 95%CI: 2.50, 13.52) were significantly more likely to use opioids and cocaine daily. Furthermore, females (aOR:1.69, 95%CI:1.03, 2.77), persons experiencing homelessness (aOR:1.94, 95%CI:1.16, 3.24), and those with higher educational attainment (aOR:2.06, 95%CI:1.09, 3.91) were more likely to often/always carry naloxone, while Black PWID were less likely to have naloxone (aOR:0.39, 95%CI:0.22, 0.69). CONCLUSIONS: These findings highlight the need for targeted naloxone distribution and other harm-reduction interventions among minoritized groups in urban areas.

Social geographies of African American men who have sex with men (MSM): a qualitative exploration of the social, spatial and temporal context of HIV risk in Baltimore, Maryland.

This qualitative study utilized a time-geography framework to explore the daily routines and daily paths of African American men who have sex with men (AA MSM) and how these shape HIV risk. Twenty AA MSM aged 18 years and older completed an in-depth interview. Findings revealed (1) paths and routines were differentiated by indicators of socio-economic status, namely employment and addiction, and (2) risk was situated within social and spatial processes that included dimensions of MSM disclosure and substance use. This study highlights the critical need for future research and interventions that incorporate the social and spatial dimensions of behavior to advance our ability to explain racial disparities in HIV and develop effective public health responses.

Social norms, social networks, and HIV risk behavior among injection drug users.

Social network structure and norms are linked to HIV risk behavior. However little is known about the gradient of norm of HIV risk that exists among social networks. We examined the association between injection risk network structure and HIV risk norms among 818 injection drug users (IDUs). IDUs were categorized into four distinct groups based on their risk behaviors with their drug networks: no network members with whom they shared cookers or needles, only cooker-sharing member, one needle-sharing member, and multiple needle-sharing members. The riskiest group, networks of multiple needle sharers, was more likely to endorse both risky needle-sharing and sex norms. Networks of only cooker sharers were less likely to endorse high-risk norms, as compared to the networks with no sharing. There were also differences based on gender. Future HIV prevention interventions for IDUs should target both injection and sex risk norms, particularly among IDUs in the multiple needle-sharing networks.

An examination of social network characteristics of men who have sex with men who use drugs.

OBJECTIVES: The purpose of this study was to compare the social network characteristics of men who have sex with men (MSM) to men who did not have sex with men (NMSM) in a sample of predominately African-American drug users. Specifically, we were interested in examining the differences in structure of the networks and drug and sexual risk partners within the network. METHODS: Data came from 481 male participants who reported having > or =1 sex partner in the past 90 days. MSM were defined as having sex with a male. Data on social network composition were collected using a Social Network Inventory. RESULTS: Of 481 men, 7% (n = 32) were categorised as MSM. Nearly two-thirds of MSM did not identify as gay. MSM were more likely to be HIV positive compared with NMSM. Social networks of MSM were younger and a greater proportion was HIV positive. After adjusting for HIV status, networks of MSM were less dense indicating fewer connections among network members. Among injection drug using men in the sample, MSM reported a greater number of needle sharing networks than NMSM. CONCLUSIONS: These findings underscore the importance of including social network factors in investigations of HIV risk among MSM. Further studies should focus on dynamics within a network and how they may operate to affect behaviour and health.

Multifocal small fiber sensory neuropathy.

PURPOSE: : To report four patients with unusual multifocal patterns of small fiber sensory neuropathy METHODS: : Four patients who developed multifocal sensory symptoms after infectious illnesses underwent neurologic examinations, nerve conduction studies, and serologic testing. All had one to three types of electrodiagnostic assessments of small nerve fibers by evaluation of thermal and vibratory thresholds. quantitative sudomotor axon reflex testing, or autonomic cardiovascular testing. RESULTS: Nerve conduction and serologic studies were normal. Quantitative sudomotor axon reflex testing, autonomic cardiovascular testing, or both revealed abnormalities of small fiber function in all patients, and thermal thresholds were abnormal in one. Three had progression and fluctuations of symptoms for months. CONCLUSIONS: : Small fiber sensory neuropathies occasionally occur in a multifocal rather than the typical distal distribution and may comprise part of the spectrum of postinfectious sensory neuropathies. Objective testing of small fiber function is useful in distinguishing small fiber sensory neuropathy from other causes of paresthesias in this setting.

The behavior of cancer affecting the subglottic space.

This retrospective study comprises 45 patients with subglottic carcinoma, arising either primarily or by spread from glottic carcinoma. The relevant literature is reviewed. Points of interest concerning the natural history of these carcinomata are: 1) The incidence of primary subglottic carcinoma was seven per cent of all laryngeal carcinomata and the incidence of subglottic spread of glottic carcinoma was 11.4 per cent. 2) At the time of presentation, vocal cord fixation was present in 40 per cent of the total group; 16 per cent of the true subglottic group had palpable nodes in the neck, and 5.5 per cent of the subglottic spread group. 3) Of the patients with true subglottic lesions, 44 per cent were women, 64 per cent presented with stridor and 32 per cent required emergency tracheostomy, 32 per cent developed distant metastases, half of these being in bone. 4) Only one of 45 patients developed mediastinal metastasis.