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Community Perceptions of Comprehensive Harm Reduction Programs and Stigma Towards People Who Inject Drugs in Rural Virginia

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Abstract

The spread of infectious diseases, including Human Immunodeficiency virus and Hepatitis C virus, is a major risk of injection drug use. The Center for Disease Control’s 2015 ranking of counties vulnerable to rapid dissemination of HIV/HCV infection among people who inject drugs (PWID) places Dickenson County, Virginia at 29th in the nation and 2nd in Virginia. Comprehensive Harm Reduction is an evidence-based intervention shown to reduce the negative impacts of drug use including the spread of infectious diseases, overdose and death among people who are unable or not ready to stop using drugs. The aim of this study was to assess community perceptions of comprehensive harm reduction programs and stigma towards PWID in a rural community. Data were collected through the use of an anonymous survey and interviews with community stakeholders. Surveys were distributed online through email and social media, as well as in person. Participants were included based on their zip code as an indicator of residence in Dickenson County. Statistical analysis of survey results was conducted using Sigma Plot. The survey was completed by 153 participants. The perception of PWID in rural Virginia is strikingly negative. Participants consider injection drug use a major problem in their community but have little to no knowledge of harm reduction programs and display high levels of stigma towards PWID. Additionally, higher levels of stigma towards PWID was associated with lower support for CHR programs. The results of this study show a definite and perceived need for harm reduction programs in rural Virginia. Challenges to implementing harm reduction programs include low levels of knowledge and high levels of stigma.

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References

  1. Abdul-Quader, A. S., Feelemyer, J., Modi, S., et al. (2013). Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: A systematic review. AIDS and Behavior,17(9), 2878–2892. https://doi.org/10.1007/s10461-013-0593-y.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hagan, H., Pouget, E. R., & Des Jarlais, D. C. (2011). A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. Journal of Infectious Diseases,204(1), 74–83. https://doi.org/10.1093/infdis/jir196.

    Article  PubMed  Google Scholar 

  3. Lankenau, S. E., Kecojevic, A., & Silva, K. (2015). Associations between prescription opioid injection and Hepatitis C virus among young injection drug users. Drugs (Abingdon England),22(1), 35–42. https://doi.org/10.3109/09687637.2014.970515.

    Article  Google Scholar 

  4. Davis, S. M., Kristjansson, A. L., Davidov, D., Zullig, K., Baus, A., & Fisher, M. (2019). Barriers to using new needles encountered by rural Appalachian people who inject drugs: Implications for needle exchange. Harm Reduction Journal.. https://doi.org/10.1186/s12954-019-0295-5.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Page, K., Morris, M. D., Hahn, J. A., Maher, L., & Prins, M. (2013). Injection drug use and hepatitis C virus infection in young adult injectors: Using evidence to inform comprehensive prevention. Clinical Infectious Diseases,57(Suppl 2), S32–S38. https://doi.org/10.1093/cid/cit300.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zibbell, J. E., Iqbal, K., Patel, R. C., et al. (2015). Increases in hepatitis C virus infection related to injection drug use among persons aged ≤ 30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. MMWR. Morbidity and Mortality Weekly Report,64(17), 453–458.

    PubMed  PubMed Central  Google Scholar 

  7. Suryaprasad, A. G., White, J. Z., Xu, F., et al. (2014). Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clinical Infectious Diseases,59(10), 1411–1419. https://doi.org/10.1093/cid/ciu643.

    Article  CAS  PubMed  Google Scholar 

  8. Young, A. M., & Havens, J. R. (2012). Transition from first illicit drug use to first injection drug use among rural Appalachian drug users: A cross-sectional comparison and retrospective survival analysis. Addiction (Abingdon England),107(3), 587–596. https://doi.org/10.1111/j.1360-0443.2011.03635.x.

    Article  Google Scholar 

  9. Schranz, A. J., Barrett, J., Hurt, C. B., Malvestutto, C., & Miller, W. C. (2018). Challenges facing a rural opioid epidemic: Treatment and prevention of HIV and hepatitis C. Current HIV/AIDS Reports,15(3), 245–254. https://doi.org/10.1007/s11904-018-0393-0.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ramachandran, S., Thai, H., Forbi, J. C., et al. (2018). A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015. EBioMedicine,37, 374–381. https://doi.org/10.1016/j.ebiom.2018.10.007.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Conrad, C., Bradley, M. H., Broz, D., et al. (2015). Community outbreak of HIV infection linked to injection drug use of OXYMORPHONE–Indiana, 2015. MMWR. Morbidity and Mortality Weekly Report,64, 443. https://doi.org/10.7448/ias.18.5.20488.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fraser, H., Zibbell, J., Hoerger, T., et al. (2018). Scaling-up HCV prevention and treatment interventions in rural United States-model projections for tackling an increasing epidemic. Addiction (Abingdon England),113(1), 173–182. https://doi.org/10.1111/add.13948.

    Article  Google Scholar 

  13. Van Handel, M. M., Rose, C. E., Hallisey, E. J., et al. (2016). County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. Journal of Acquired Immune Deficiency Syndromes 1999,73(3), 323–331. https://doi.org/10.1097/qai.0000000000001098.

    Article  PubMed  PubMed Central  Google Scholar 

  14. US Census Bureau. US Census Bureau QuickFacts: Dickenson County, Virginia. https://www.census.gov/quickfacts/fact/table/dickensoncountyvirginia/PST045218.

  15. Appalachian Regional Commission. Subregions in appalachia. https://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=31.

  16. Virginia Department of Health. Office of the Chief Medical Examiner’s Annual Report, 2014. http://www.vdh.virginia.gov/content/uploads/sites/18/2016/04/Annual-Report-2014-FINAL.pdf.

  17. Virginia Department of Health. (2016). Virginia Hepatitis C Epidemiologic Report 2016. http://www.vdh.virginia.gov/content/uploads/sites/10/2016/06/Virginia-Hepatitis-C-Epidemiologic-Profile-2016.pdf.

  18. Knick, T., Sherbuk, J. E., & Dillingham, R. (2019). Knowledge of hepatitis C risk factors is lower in high incidence regions. Journal of Community Health,44(1), 12–15. https://doi.org/10.1007/s10900-018-0545-6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Virginia Department of Health. Comprehensive harm reduction. http://www.vdh.virginia.gov/disease-prevention/chr/.

  20. Davis, S. M., Daily, S., Kristjansson, A. L., et al. (2017). Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: A systematic review with meta-analysis. Harm Reduction Journal,14(1), 25–25. https://doi.org/10.1186/s12954-017-0156-z.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Platt, L., Minozzi, S., Reed, J., et al. (2017). Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database of Systematic Reviews,9(9), 1–10. https://doi.org/10.1002/14651858.cd012021.pub2.

    Article  Google Scholar 

  22. Hagan, H., McGough, J. P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E. R. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment,19(3), 247–252. https://doi.org/10.1016/S0740-5472(00)00104-5.

    Article  CAS  PubMed  Google Scholar 

  23. Davis, S. M., Davidov, D., Kristjansson, A. L., Zullig, K., Baus, A., & Fisher, M. (2018). Qualitative case study of needle exchange programs in the Central Appalachian region of the United States. PLoS ONE,13(10), e0205466–e0205466. https://doi.org/10.1371/journal.pone.0205466.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Allen, S. T., Grieb, S. M., O’Rourke, A., et al. (2019). Understanding the public health consequences of suspending a rural syringe services program: A qualitative study of the experiences of people who inject drugs. Harm Reduction Journal,16(1), 33–33. https://doi.org/10.1186/s12954-019-0305-7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Des Jarlais, D. C. (2017). Harm reduction in the USA: The research perspective and an archive to David Purchase. Harm Reduction Journal,14(1), 51–51. https://doi.org/10.1186/s12954-017-0178-6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moody, L., Satterwhite, E., & Bickel, W. K. (2017). Substance use in rural central appalachia: Current status and treatment considerations. Journal of Rural Mental Health,41(2), 123–135. https://doi.org/10.1037/rmh0000064.

    Article  PubMed  Google Scholar 

  27. Wright, K. (2005). Researching internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer Mediated Communication. https://doi.org/10.1111/j.1083-6101.2005.tb00259.x.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Dickenson County Behavioral Health Services, Dickenson County Community Partners for Prevention Coalition, Haysi Partners, Virginia Department of Health, Selena Culbertson, Jason Dotson, Matt Owens, Daniel Hunsucker, Dr. Eleanor Cantrell, and Dr. Rebecca Dillingham.

Funding

This work was supported by the Healthy Appalachia Institute at the University of Virginia’s College at Wise.

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Authors and Affiliations

  1. University of Virginia’s College at Wise, 1 College Ave, Wise, VA, 24293, USA

    Logan S. Baker, Walter Smith & Margaret M. Tomann

  2. University of Pikeville, Pikeville, KY, 41501, USA

    Tauna Gulley

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  1. Logan S. Baker
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Correspondence to Logan S. Baker.

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Baker, L.S., Smith, W., Gulley, T. et al. Community Perceptions of Comprehensive Harm Reduction Programs and Stigma Towards People Who Inject Drugs in Rural Virginia. J Community Health 45, 239–244 (2020). https://doi.org/10.1007/s10900-019-00732-8

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