Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data.

Injection drug use has long been a topic of investigation, whether through a health or criminal justice lens. Whilst these bodies of literature offer important perspectives, missing from the extant literature is evidence, particularly involving women who use drugs, and more specifically evidence about the health beliefs of these women. To address this knowledge gap, we undertook an ethnographic study of homeless women in downtown Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In this paper, we report on these ethnographic data to show the context and nature of the subjective lives of women who use injection drugs and their beliefs and perspectives on health. We use these data to make recommendations for nursing and healthcare practice moving forward.

The Process of Injection Drug Use Among Homeless Women in Ottawa, Canada: A Qualitative Study.

BACKGROUND: The literature on women who use injection drugs (WUIDs) is antiquated and diluted by data from men. Due to the higher rates of morbidity and mortality among WUID, we undertook a qualitative study to better understand their drug use practices. METHODS: We adopted a Deleuze-Guattarian lens and engaged in semi-structured interviews with 35 women in Ottawa, Canada. Data from 31 of these women were analyzed using applied thematic analysis. RESULTS: We divided these themes into (a) how WUID obtain resources to acquire drug,and (b) the steps involved in preparing, using, and discarding drugs. From our Deleuzo-Guattarian perspective, these findings highlighted that participants stratified their worlds according to rules of cleanliness to create hierarchies of appropriateness and acceptability. CONCLUSIONS: These findings, overall, highlight the importance of understanding the constructed world of WUIDs, particularly regarding the ways in which nurses interact with these women to provide care.

The Experience of Violence Against Women Who Use Injection Drugs: An Exploratory Qualitative Study.

BACKGROUND: While literature exists about persons who use injection drugs, few studies explore the experience of women who use these substances. Furthermore, even less research specifically focuses on the lives and experiences of homeless women who use injection drugs. What literature does exist, moreover, is often dated and primarily addresses concerns about infectious disease transmission among these women; and some highlight that these women have lives fraught with violence. PURPOSE: To update this knowledge and better understand the lives of women who use injection drugs in the Canadian context. METHODS: We undertook an exploratory qualitative study and we engaged in semi-structured interviews with 31 homeless women who use injection drugs in downtown Ottawa, Canada. We analyzed the data using the principles of applied thematic analysis. RESULTS: Our data identified that violence pervaded the lives of our participants and that these experiences of violence could be categorized into three main areas: early and lifelong experiences of violence; violence with authority figures (e.g., police, healthcare); and societal violence toward women who use injection drugs. CONCLUSIONS: We take these findings to mean that, violence toward women is rampant in Canada (not just internationally) and that healthcare workers play a role in propagating and addressing this violence.

Consideration of sexually transmitted infections in the differential diagnosis: Case studies.

BACKGROUND AND PURPOSE: The rates of many sexually transmitted infections (STIs) have increased in recent years. Many health care professionals miss these potential diagnoses in clinical practice. METHODS: Two case studies are presented, one an adult female with dysuria; the other an adult male with a rash. Appropriate differential diagnoses and relevant history, examination, and investigation details are discussed. CONCLUSIONS: Not all dysuria signifies a urinary tract infection. Although most rashes are not syphilis or HIV, it is important to rule out these etiologies for rashes in adults without a previous history of similar dermatologic conditions. IMPLICATIONS FOR PRACTICE: Due to increased rates of many STI and HIV, it is important for nurse practitioners who work in primary care to consider these infections in patients who present with dysuria and rashes. Similarly, nurse practitioners who work in STI clinic settings should consider non-STI diagnoses in their work. In both cases, a perspective that includes both STI and non-STI etiologies is essential.

Clinical ethics issues in HIV care in Canada: an institutional ethnographic study.

BACKGROUND: This is a study involving three HIV clinics in the Canadian provinces of Newfoundland and Labrador, and Manitoba. We sought to identify ethical issues involving health care providers and clinic clients in these settings, and to gain an understanding of how different ethical issues are managed by these groups. METHODS: We used an institutional ethnographic method to investigate ethical issues in HIV clinics. Our researcher conducted in-depth semi-structured interviews, compiled participant observation notes, and studied health records in order to document ethical issues in the clinics, and to understand how health care providers and clinic clients manage and resolve these issues. RESULTS: We found that health care providers and clinic clients have developed work processes for managing ethical issues of various types: conflicts between client-autonomy and public health priorities ("treatment as prevention"), difficulties associated with the criminalization of nondisclosure of HIV positive status, challenges with non-adherence to HIV treatment, the protection of confidentiality, barriers to treatment access, and negative social determinants of health and well-being. CONCLUSIONS: Some ethical issues resulted from structural disadvantages experienced by clinic clients. The most striking findings in our study were the negative social determinants of health and well-being experienced by some clinic clients - such as experiences of violence and trauma, poverty, racism, colonization, homelessness, and other factors affecting well-being such as problematic substance use. These negative determinants were at the root of other ethical issues, and are themselves of ethical concern.

The ethical case for providing cost-free access to lifesaving HIV medications in Canada: Implications of a qualitative study.

Antiretroviral therapy for HIV can be expensive if paid for out of pocket. In Canada, there are a variety of federal, provincial, and private prescription drug plans that lower the cost of these lifesaving medications for people living with HIV, and in some cases, these plans result in cost-free access. However, many people living with HIV must contend with high deductibles for their antiretroviral therapies, and many experience difficulty managing the administrative requirements of their drug plans. This article comments on some of the results of a qualitative study into ethical issues in HIV care. Access to antiretrovirals was a theme that emerged in this study. We argue on ethical grounds that provincial drug plans should guarantee cost-free access to antiretroviral therapies for people living with HIV with minimal administrative requirements.

Overviewing a Nurse-Led, Community-Based HIV PEP Program: Applying the Extant Literature in Frontline Practice.

This clinical concept paper overviews a program to facilitate access to postexposure prophylaxis (PEP) for gay, bisexual, and other men who have sex with men. The project, which was a collaborative initiative involving the local School of Nursing, public health unit, AIDS service organization, hospital-based HIV clinic, and an outpatient pharmacy, was implemented to circumvent common barriers to care identified in the literature. In this project, persons who present to one of the two participating clinics after having come, or likely having come, into contact with HIV within the previous 72 hr, are offered rapid HIV testing, also known as point-of-care (POC) testing, to rule out existing HIV infection, and provided with a follow-up appointment booked at the HIV clinic. Clients are also offered comprehensive STI testing, and HIV prevention counseling. The implementation of this collaborative community-based access-to-PEP project demonstrates the application of research to a real-world health care setting, and it is hoped that others will adapt this model to their local setting, enabling ease of access to PEP for members of groups that are disproportionately affected by HIV.

HIV status and sexual behaviour among gay men in Ottawa: considerations for public health.

OBJECTIVES: HIV prevention efforts, particularly among men who have sex with men (MSM), have not achieved maximum effectiveness. A survey of MSM in Ottawa, Canada was completed to ascertain whether there were differences in how the perceived HIV status of participants and their partners influenced sexual practices. METHODS: Self-directed surveys were administered to a convenience sample of 721 MSM in Ottawa, Canada from November 2011 through May 2012. Data collection occurred at 14 sites. The survey identified whether participants identified as HIV positive, negative or unsure of their HIV status. RESULTS: The findings indicated variation between HIV-negative MSM and those who are unsure of their HIV status. Men who were unsure of their HIV status were less likely to report that they asked sexual partners or have had their partners ask about HIV status. CONCLUSIONS: The results of this study indicate that some MSM may base decisions about HIV prevention on discussion about HIV status with their partners, rather than condom use. These practices may increase, rather than decrease, HIV transmission. Survey findings and extant literature demonstrate a need to inform MSM about the limitations of serosorting as a prevention strategy, and to provide facilitated access to sexually transmitted infection testing and treatment to further reduce onward HIV transmission.