Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences.

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

The Prevalence of Methamphetamine Dependence among Iranian Women in Methadone Maintenance Therapy in Tehran, Iran.

Objective: To date, there has been no specific survey of the prevalence of methamphetamine (MA) dependence among Iranian women in methadone maintenance therapy (MMT). The current study aimed at addressing this critical gap in the literature. Method: This study was part of a larger cross-sectional survey, which was conducted in 36 MMT clinics in Tehran during 2015 and 2016. A researcher-designed questionnaire was devised to collect data on demographics and drug and treatment characteristics. Data were analyzed using SPSS Version 19. Results: Overall, 307 women were in the study sites. Of them, 275 were MA dependent (89.5%) while in MMT. The mean age of the participants, who were MA-dependent, was 38 years. Age of MA dependence was 30 years, and duration of MA dependence was 7years. However, only 24.3% of the participants were currently in MA treatment (i.e. Matrix Model). This was accompanied with high rates of psychiatric hospitalization (29.4%), anxiety (33.4%), and depression (50.9%) because of long years of untreated MA dependence. Conclusion: The study revealed a high prevalence of untreated MA dependence and its adverse health impacts among the participants. However, no considerable treatment for MA dependence had been received by the participants. Psychosocial treatments should address MA dependence in MMT in Iran.

Barriers to Hepatitis C Treatment among Women in Methadone Treatment: A Study from Iran, the Most Populous Persian Gulf Country.

BACKGROUND: Untreated Hepatitis C Virus (HCV) has been reported among many Iranian female methadone patients. However, few of them report receiving HCV treatment. The present study is the first research from western Asia that explored the barriers to receiving HCV treatment among a group of Iranian female HCV-infected methadone patients. METHODS: This qualitative study was conducted in four main methadone treatment clinics in Tehran, Iran, in November 2016. Overall, fifty-six untreated HCV-infected women and eight clinicians from HCV and methadone treatment services were interviewed. Women either had not received HCV treatment or received HCV treatment but left it. Data were analyzed using NVivo software. This was based on the grounded theory of Strauss and Corbin. FINDINGS: Barriers to receiving HCV treatment included factors related to individuals and factors related to the system. Individual factors included the perception that untreated HCV infection was not a serious health concern, family responsibilities, and self-perceived discrimination against HCV-infected women. System-related factors included the lack of referral from methadone treatment staff, and a long distance between HCV treatment centers and methadone treatment centers. Interviews with the health professionals also confirmed the women' self-reports. CONCLUSION: The results of this research confirm the necessity of providing HCV education and the delivery of comprehensive care for this group in methadone treatment clinics. Other services such as staff education and HCV treatment services at methadone treatment centers are suggested.

HIV Responses in Arab States on the Southern Persian Gulf Border: The First Review.

CONTEXT: There is no review of HIV responses in Arab states on the southern Persian Gulf border. This narrative review aimed to describe and synthesize HIV responses in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE). EVIDENCE ACQUISITION: A review of scientific databases and grey literature was conducted based on an international guide. Overall, 16 original studies and reports were found. RESULTS: The review indicates that HIV has been found present in each Arab state based on sporadic case finding. The prevalence of HIV is the result of heterosexual relationship and/or drug injection. Mandatory testing of the nationals and expatriate workers is the main route of HIV detection. In general, HIV knowledge and education are poor. Only Bahrain has some non-governmental organizations that provide HIV education. Lack of identifying key populations and high risk behaviors has been reported in all of the states. HIV responses are mainly for Arab and Arabic-speaking nationals. Effective strategic plans for HIV have not been developed in all of the states. The provision of antiretroviral therapy for the nationals is the main HIV response. Only Qatar has paid for the treatment of Qatari and non-Qatari HIV-infected patients. As a HIV response, drug treatment is based on short-term inpatient rehabilitation. Only Qatar has voluntary HIV counseling and testing. Lack of needle and syringe programs has been reported for people who inject drugs with HIV problem in all of the states. CONCLUSIONS: To conclude, HIV problem needs a comprehensive policy response in each state. Providing effective strategic plans for HIV and sero-surveillance data systems is required. Empowering human resources and infrastructural development are suggested.

Willingness to Receive Treatment for Hepatitis C among Injecting Drug Users on Methadone Program: Implications for Education and Treatment.

BACKGROUND: Hepatitis C virus (HCV) is common among people who inject drugs (PWID) on methadoneprogram in Iran (Persia). However, a few PWID on methadone program report willingness to receive HCVtreatment. This study aimed to assess the factors which were associated with willingness to receive HCVtreatment in a group of PWID on methadone program in Iran. METHODS: We surveyed 187 PWID at seven drops in centers in Tehran, Iran. Details of demographiccharacteristics, drug use, injection, HCV, and drug treatment history were collected using a 25-itemquestionnaire. Participants were serologically tested for the current status of HCV. FINDINGS: The study found that 28.3% of the participants were HCV seropositive. In total, 49.1% of theparticipants reported unwillingness to receive HCV treatment. Awareness of current HCV status [odds ratio(OR) = 3.43; 95% confidence interval (CI): 1.33-7.26; P < 0.050]; adequate knowledge of HCV treatmentcenters in the community (OR = 3.9; 95% CI: 1.24-5.38; P < 0.050); participation in an educational programon HCV (OR = 2.9; 95% CI: 2.33-8.56; P < 0.001) and recent participation in the meetings of self-helpgroups (OR = 4.6; 95% CI: 3.43-9.33; P < 0.001) were significantly associated with current willingness toreceive HCV treatment. CONCLUSION: The study results indicate that awareness of HCV status and the provision of adequate HCVeducation via different information centers can be associated with an increased willingness for HCVtreatment among PWID on methadone program. Conducting more research is suggested to assess theefficacy of educational programs and self-help groups in facilitating HCV treatment among PWID onmethadone program.

Persian At-Risk Women and Barriers to Receiving HIV Services in Drug Treatment: First Report From Iran.

BACKGROUND: As the most populated Persian Gulf country, in Iran, engagement with drug injection and unsafe sex are the main routes of HIV transmission among some drug-dependent women. OBJECTIVES: The current study explored the barriers that a group of drug-dependent women reported in accessing and adhering to HIV services in drug use treatment. PATIENTS AND METHODS: Qualitative interviews were conducted with 47 Persian women at five outpatient drug treatment centers between January and December 2011. Five focus group interviews were conducted with ten key informants (KI). The interviews made use of a semi-structured interview guide, which facilitated discussion regarding the barriers. The interview transcripts were analyzed thematically using Atlas-ti software. RESULTS: The interview accounts highlighted a number of barriers, including stigmatization, a considerable lack of knowledge about free HIV centers in the community, previous traumatic events, misconceptions about the quality of HIV services, and a poor supportive referral system among drug treatment and HIV centers. CONCLUSIONS: The findings highlight a need for removing stigma and providing high quality women-only HIV services. Increasing trust and knowledge of available HIV services are needed for this group of women. Increasing staff knowledge is a priority. An integrated supportive network among drug treatment and HIV centers is suggested in Iran.

HIV Programs in Iran (Persia), Iraq and Saudi Arabia: A Brief Review of Current Evidence in West and Southwest Asia.

BACKGROUND: In Western and Southwest Asia, literature is not documented on human immunodeficiency virus (HIV) programs in Iran, Iraq and Saudi Arabia. The present study is the first brief review that describes HIV programs in these three neighboring countries. METHODS: Data regarding the evidence of HIV programs were gathered through a systematic literature searching. English publications were retrieved through searching online scientific databases. Grey literature was also searched online. The review was based on the studies related to the last decade. FINDINGS: Systematic searching resulted in retrieving 21,948 studies but only 21 studies were relevant to the study aim. The review findings indicated that Iran has provided a nationwide sero-surveillance data system and has identified its key populations. Detecting HIV prevalence has been limited to case-finding in Iraq and Saudi Arabia. However, strategic plans for HIV have been provided in the three countries. HIV education, knowledge and support have been provided but still needs consideration in the three countries especially in Iraq. The low coverage of antiretroviral therapy (ART) has remained a critical gap in the provision of comprehensive HIV programs in these three countries. This issue has been followed by the lack of opiate substitution therapies for drug dependents and injecting drug users in Iraq and Saudi Arabia. Condom promotion and voluntary HIV counselling and testing have been provided for at-risk groups in the three countries but need more nationwide coverages. However, needle and syringe programs (NSPs) have been only provided in Iran. CONCLUSION: The review concluded that the provision of effective HIV programs should address training human resources and infrastructural development. This issue should be facilitated by international collaborations and governmental supports.

Patterns of brain activation during craving in heroin dependents successfully treated by methadone maintenance and abstinence-based treatments.

OBJECTIVE: Abstinence-based therapy (ABT) and methadone maintenance therapy (MMT) are common methods of treatment in heroin dependence as both suppress subjective feeling of drug craving. However, it is not clear whether the neural basis of craving suppression is similar in both types of treatments. In this study, we compared brain activation during pictorial presentation of heroin-related cues in ABT and MMT groups to understand the neural basis of drug craving in these groups. METHODS: Three groups of subjects (successful ABT and MMT clients and healthy control) underwent functional magnetic resonance imaging, while heroin-related cues and neutral cues were presented to them. In addition, subjective cue-elicited craving has been measured using drug drive questionnaire before and after imaging. RESULT: Self-report of craving was not different between ABT and MMT groups before and after scanning. Anterior cingulate cortex and inferior frontal gyrus showed higher activations in ABT than in healthy control. Inferior frontal gyrus and superior temporal gyrus showed higher activity in ABT than in MMT. Lingual gyrus and cerebellum showed higher activity in MMT than in healthy control. CONCLUSIONS: Heroin avoidance may be achieved by MMT or ABT; however, the neural mechanism underlying these therapeutic methods differs.