The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study.

Street-involved youth who use drugs (YWUD) face an elevated risk of HIV acquisition and represent a key population for HIV prevention initiatives, including pre-exposure prophylaxis (PrEP). However, little is known regarding the acceptability and feasibility of PrEP uptake and adherence among this multiply-marginalized population. Semi-structured qualitative interviews were conducted with 24 street-involved YWUD (ages 17-24) to examine their perspectives toward PrEP; youth were recruited through a longitudinal prospective cohort study in Vancouver, Canada. Youth reported high levels of ambivalence toward PrEP despite engagement in HIV-related risk behaviors. This ambivalence was driven by misperceptions regarding HIV transmission, including stigmatizing associations between HIV transmission and personal hygiene. Such misperceptions led participants to enact strategies that were ineffective in preventing HIV transmission. Participants contested their inclusion as a "key population" for PrEP, which limited their enthusiasm for PrEP uptake and adherence. Participants also highlighted that wider social-structural inequities (e.g., housing vulnerability, poverty) that produced HIV-related risks were likely to undermine sustained PrEP use. Findings demonstrate the need for tailored implementation strategies to increase PrEP acceptability, including targeted education and anti-stigma interventions to increase awareness about HIV transmission. Interventions should also target structural inequities in order to fully address HIV risk and PrEP ambivalence.

Food insufficiency is associated with depression among street-involved youth in a Canadian setting.

OBJECTIVE: Food insufficiency, defined by the experience of hunger, is known to be prevalent and a source of health-related harm among-street involved youth, but little is known about its relationship with depression in this population. Therefore, we sought to assess the association between food insufficiency and symptoms of depression among a cohort of street-involved youth. DESIGN: Multivariable logistic regression was used to assess the relationship between food insufficiency, defined as being hungry but not having enough money to buy food, and depression as measured by the Center for Epidemiological Studies Depression (CES-D) scale. SETTING: Data from April 2006 to November 2013 were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada. SUBJECTS: There were 1066 street-involved youth enrolled in the study, including 340 (31·9 %) females. RESULTS: Of 1066 youth enrolled in the study, 724 (67·9 %) reported some food insufficiency and 565 (53·0 %) met criteria for depression. Compared with youth who did not report food insufficiency, those who reported often experiencing food insufficiency had a higher likelihood of reporting depression (adjusted OR=2·52; 95 % CI 1·74, 3·67), as did those who reported sometimes experiencing food insufficiency (adjusted OR=1·99; 95 % CI 1·47, 2·70). CONCLUSIONS: Food insufficiency was prevalent and associated in a dose-dependent trend with symptoms of depression among street-involved youth in our setting. Findings highlight the need to address the nutritional and mental health needs of youth and identify pathways by which food insufficiency may contribute to depression among vulnerable populations.

PTSD and opioid use: implications for intervention and policy.

BACKGROUND: North America remains in the midst of an escalating opioid overdose epidemic, largely driven by the influx of synthetic opioids such a fentanyl and related analogues. High rates of mental illness among substance-using populations have been well documented; in particular, opioid-using individuals suffer from high rates of PTSD. Despite the devastating disease burden of both PTSD and OUD, especially within the context of the current opioid overdose epidemic, treatment options and outcomes remain suboptimal. MAIN BODY: Comorbid PTSD-OUD is often complex and inextricably intertwined, thereby impeding effective diagnosis, assessment and early intervention. Best outcomes occur when treatment addresses both comorbidities simultaneously, known as parallel or integrative approaches. Despite these findings, affected individuals often do not receive adequate or equitable access to healthcare. The WHO recommends that public spending for both mental and physical aspects of healthcare be equitable to the burden of disease. Despite these recommendations mental healthcare services remain chronically underfunded in Canada. The Mental Health Parity Act is a call for the Canadian government to implement equitable public spending on all aspects of healthcare. Furthermore, prohibitory legislative practices serve to marginalize substance-using populations thereby increasing the likelihood of exposure to traumatic violence and other associated harms. CONCLUSION: Efforts are now needed to address regulatory drug-use frameworks and public healthcare policies that perpetuate these inequalities. Alternative regulatory frameworks for drugs and mental health parity should be implemented and evaluated in an effort to reduce violence, trauma and ultimately opioid-related overdose deaths.