Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study.

BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.

Impacts of Systems Thinking on Mission When Environmental Nonprofit Organizations Encounter the Complex Systems Problem of Homelessness.

The article examines how nonprofit organization staff navigate organizational mission as they encounter complex systems problems outside their area of expertise, focusing on environmental organizations encountering homelessness in river watersheds. Drawing on surveys from seventy-three individuals from forty-three organizations and interviews with seventeen nonprofit staff, I find that staff who demonstrate systems thinking are more likely to describe integrating complex systems problems into their mission and activities in meaningful ways. Not interacting with systems issues due to lack of skill is most often explained with language of mission adherence and avoiding mission drift.

An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments.

Individuals experiencing unsheltered homelessness face significant barriers to accessing water, sanitation, and hygiene services, but the risks associated with this lack of access and barriers to service provision have been largely understudied. We analyzed water samples upstream and downstream of three homeless encampments in the San Diego River watershed and interviewed service providers from public and nonprofit sectors to assess local perceptions about challenges and potential solutions for water and sanitation service provision in this context. Water upstream from encampments contained detectable levels of caffeine and sucralose. Escherichia coli concentrations downstream of the encampments were significantly greater than concentrations upstream, but there was no significant change in the concentrations of other pollutants, including caffeine and sucralose. The HF183 marker of Bacteroides was only detected in one sample upstream of an encampment and was not detected downstream. Overall, there was insufficient evidence to suggest that the encampments studied here were responsible for contributing pollution to the river. Nevertheless, the presence of caffeine, sucralose, and HF183 indicated that there are anthropogenic sources of contamination in the river during dry weather and potential risks associated with the use of this water by encampment residents. Interviews with service providers revealed perceptions that the provision of water and sanitation services for this population would be prohibitively expensive. Interviewees also reported perceptions that most riverbank residents avoided contact with service providers, which may present challenges for the provision of water and sanitation service unless trust is first built between service providers and residents of riverine encampments.

Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness.

Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.

A fast, reconfigurable flow switch for paper microfluidics based on selective wetting of folded paper actuator strips.

In paper microfluidics, the development of smart and versatile switches is critical for the regulation of fluid flow across multiple channels. Past approaches in creating switches are limited by long response times, large actuation fluid volumes, and use of external control circuitry. We seek to mitigate these difficulties through the development of a unique actuator device made entirely out of chromatography paper and incorporated with folds. Selective wetting of the fold with an actuation fluid, either at the crest or trough, serves to raise or lower the actuator's tip and thus engage or break the fluidic contact between channels. Here the actuator's response time is dramatically reduced (within two seconds from wetting) and a very small volume of actuation fluid is consumed (four microliters). Using this actuation principle, we implement six switch configurations which can be grouped as single-pole single-throw (normally OFF and normally ON) and single-pole double-throw (with single and double break). By employing six actuators in parallel, an autonomous colorimetric assay is built to detect the presence of three analytes - glucose, protein, and nitrite - in artificial saliva. Finally, this work brings the concept of origami to paper microfluidics where multiple-fold geometries can be exploited for programmable switching of fluidic connections.

Flexible and disposable paper- and plastic-based gel micropads for nematode handling, imaging, and chemical testing.

Today, the area of point-of-care diagnostics is synonymous with paper microfluidics where cheap, disposable, and on-the-spot detection toolkits are being developed for a variety of chemical tests. In this work, we present a novel application of microfluidic paper-based analytical devices (µPADs) to study the behavior of a small model nematode, Caenorhabditis elegans. We describe schemes of µPAD fabrication on paper and plastic substrates where membranes are created in agarose and Pluronic gel. Methods are demonstrated for loading, visualizing, and transferring single and multiple nematodes. Using an anthelmintic drug, levamisole, we show that chemical testing on C. elegans is easily performed because of the open device structure. A custom program is written to automatically recognize individual worms on the µPADs and extract locomotion parameters in real-time. The combination of µPADs and the nematode tracking program provides a relatively low-cost, simple-to-fabricate imaging and screening assay (compared to standard agarose plates or polymeric microfluidic devices) for non-microfluidic, nematode laboratories.

Staff perceptions of the benefits of religion in health and human services nonprofits: evidence from international development.

Some argue faith-based organizations (FBOs) provide desirable moral or spiritual components to health and human service provision, and that services are more effective due to staffs more supportive approach. However, the majority of research has been conducted in the United States, and has focused on the experiences of Christian FBOs. This article examines the benefits that FBO staff in Bosnia and Herzegovina, Lebanon, and Sri Lanka believe religious identity brings to the work of their organizations, based on interviews with more than 100 staff of Buddhist, Catholic, Druze, Orthodox Christian, Protestant Christian, Shiite Muslim, and Sunni Muslim FBOs, as well as secular NGOs. The interview data indicate that staff members from most of the religious traditions included in the study believe the faith orientation of their organization brings benefits to their service provision. However, these perceived benefits differ based on country context. Some of these benefits are similar to those often mentioned in the literature on FBOs in the United States; however, other benefits are quite different than those discussed in the US literature.