Integrating HIV and substance misuse services: a person-centred approach grounded in human rights.

Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.

Perfil eco-epidemiológico de los accidentes por ofidios en Monagas, Venezuela (2002-2006) / Eco-epidemiological profile of snakebite accidents in Monagas state, Venezuela (2002-2006)

El accidente causado por animales venenosos representa un problema global, especialmente en las áreas subtropicales y tropicales del mundo. En Venezuela, es endémico para varias regiones incluyendo la zona nororiental. Con el objetivo de ampliar y actualizar el perfil eco-epidemiológico del ofidismo en el estado Monagas, se evaluó su comportamiento, en cada municipio, durante 5 años de registro (2002 - 2006). Se contabilizaron 339 accidentes ofídicos (con promedio de 68 anuales). El incidente ocurrió con mayor frecuencia en agricultores, adultos jóvenes y de género masculino, durante sus labores en el campo y en el periodo diurno. La incidencia siguió un patrón estacional bimodal con predominio en épocas de alta y baja pluviosidad. Los envenenamientos botrópicos (28,6%) fueron más frecuentes que los crotálicos (14,5%), con proporción 2:1. El 87,9% recibió sueroterapia específica. La incidencia promedio anual en la entidad se ubicó en 11,30 casos por 100.000 habitantes, siendo Punceres (46,29), Acosta (20,91) y Bolívar (19,52) los municipios con mayor impacto. El estado Monagas presentó un mapa de endemicidad distribuido en municipios de (1) muy alta endemicidad, (2) alta endemicidad, (3) mediana endemicidad, (4) baja endemicidad y (5) muy baja endemicidad. Durante el período analizado no se registró muerte por esta causa en el estado. Los hallazgos sugieren la importancia del accidente por serpientes en Monagas, con especial importancia en la mitad norte de la entidad.

The accidents caused by venomous animals are a global problem, especially in subtropical and tropical regions of the world. In Venezuela, they are endemic in several regions including the northeast. In order to expand and update the ecoepidemiological profile of snake bites in Monagas state, their behavior was assessed in each municipality for 5 years (2002 -2006). There were 339 ophidian accidents (on average 68 per year). The bites occurred more frequently in young adult male farmers, while working in the field and during daytime. The incidence followed a bimodal seasonal pattern with predominance in high and low rainfall periods. Bothropic envenoming (28.6%) were the most frequent followed by Crotalic ones (14.5%), with a 2:1 ratio. 87.9% received specific serum therapy. The annual average incidence in the state was 11.30 cases per 100,000 inhabitants. Punceres (46.29), Acosta (20.91) and Bolivar (19.52) were the municipalities with the highest impact. Monagas state showed an endemicity map with municipalities having (1) very high endemicity, (2) high endemicity, (3) medium endemicity, (4) low endemicity and (5) very low endemicity. In the studied period there were no deaths from this cause in the state. The findings suggest the importance of snake accidents in Monagas, especially in the northern half of the state.

Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela

The first two cases of scorpion envenoming caused by Tityus neoespartanus (Buthidae) are described. The accidents took place within human environments (one inside a home and the other inside a school), in the village of La Sierra, Margarita Island, State of Nueva Esparta, northeastern Venezuela. Both cases were moderately severe and developed pancreatic involvement and electrocardiographic abnormalities. This report allows inclusion of Margarita Island among the endemic areas of scorpionism in Venezuela.

Descrevem se os dois primeiros casos de escorpionismo por Tityus neoespartanus (Scorpiones, Buthidae). Os acidentes ocorreram no ambiente antrópico (um no domicilio e outro na escola) na aldeia de La Sierra, Ilha de Margarita, Estado de Nueva Esparta, nordeste da Venezuela. Os dois acidentes, moderadamente graves, cursaram com acometimento pancreático e alterações eletrocardiografias. Este reporte permite incluir à Ilha de Margarita entre as áreas endêmicas de escorpionismo na Venezuela.

Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela.

The first two cases of scorpion envenoming caused by Tityus neoespartanus (Buthidae) are described. The accidents took place within human environments (one inside a home and the other inside a school), in the village of La Sierra, Margarita Island, State of Nueva Esparta, northeastern Venezuela. Both cases were moderately severe and developed pancreatic involvement and electrocardiographic abnormalities. This report allows inclusion of Margarita Island among the endemic areas of scorpionism in Venezuela.