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PYB159 - No.2 > 12. Specific population groups > Flashcards

12. Specific population groups Flashcards

1
Q

Globally, how many people inject drugs (WHO)?

A

16 million

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2
Q

how many people in the world who inject drugs are living with HIV?

A

3 million

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3
Q

Where did the Illicit Drug Reporting system originate?

A

National Drug and Alcohol Research Centre

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4
Q

What is the role of the Illicit Drug Reporting system in Australia?

A

It is Australia’s central monitoring and early warning system which identifies key and emerging trends among injecting drug users

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5
Q

What does the National Drug and Alcohol Reporting System comprise of?

A
  • nearly 1,000 interviews with injecting drug users across Australia
  • interviews with key experts who work in the drug and alcohol sector.
  • incorporates analysis of other national data related to illicit drug use in Australia.
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6
Q

What are the key findings of the IDRS 2016?

A

Australia’s injecting drug users are getting older

Average age of first injection was age 20

Poly drug use was high - varied markedly across states.

Nearly two thirds of Australia’s injecting drug users inject some form of methamphetamine (lowered frequently)

Morphine was the most commonly used prescription opioid; the majority of that obtained illicitly. Recent oxycodone was high

Methamphetamine and cannabis (daily) were the most commonly used drugs alongside heroin.

80% unemployed

Half of all survey participants are receiving opioid substitution treatment

56% reported high, or very high psychological distress compared (v 10%)

85 per cent had visited their GP in the past year (8x)

Nearly one in five have overdosed in the past year

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7
Q

What are the social factors that predict risky injecting practices?

A 
depression
suicide attempts
non-consensual sex
unstable housing
low education
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8
Q

What is injecting drug use strongly associated with?

A 
other highly marginalised characteristics such as:
Imprisonment
blood borne virus infections
homelessness and 
mental illness.
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9
Q

What are the harms of injecting drug use?

A 
Blood borne virus
Overdose
Physical health (including vein care etc)
Mental health
Psychosocial (relationships, law etc)
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10
Q

What is the percentage of infections caused by injecting drug use in australia, UK and US?

A

Australia: 90%
UK: >90%
USA: 54%

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11
Q

What is the prevalence of hep C infection among people who inject drugs?

A

it is estimated to be at 10 million people

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12
Q

What did the NSP National Data Survey report 2008-2013 find regarding the Prevalence of HIV, HCV and injecting and sexual behaviour among ASP attendees?

A

HCV antibody prevalence declined significantly over the period, from 62% - 53% (2012), evident for men (63% - 52%) and women (61% - 54%).

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13
Q

Who did the NSP National Data Survey report 2008-2013 find had the highest prevalence of HCV antibody in?

A

35 years and over and

those who first initiated injecting drugs more than ten years

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14
Q

When does the prevalence of HCV generally increase with?

A

longer duration of injecting drug use for both males and females
60% NSP; 2% general population
Females tested positive more frequently than males, particularly among those injecting < 3 years (48% and 23%, respectively).

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15
Q

Who is the prevalence of hep b higher for?

A

long-term injecting drug users
<0.5% of injecting drug users with an injecting history <5 years
14% of users with a history of 10+ years

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16
Q

What is the national prevalence of HIV?

A

National prevalence < 5%

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17
Q

how many new infections of HIV were there in 2012?

A

1253 new infections in 2012 (10% rise)

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18
Q

How many Australians are diagnosed with HIV?

A

28,600 - 34,300 with many people living with HIV unaware of the status

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19
Q

globally, how many IDVUs have HIV?

A

3 million

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20
Q

what does IDVU stand for?

A

intravenous drug users

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21
Q

what percentage of HIV diagnoses occured among men who have sex with men?

A

67%

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22
Q

what percentage of HIVs were attributed to heterosexual contact?

A

25%

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23
Q

what percentage of HIVs were caused by injecting drug use?

A

2%

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24
Q

what percentage of HIV were caused by undetermined means?

A

6%

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25
Q

What is the HIV antibody prevalence according to the Australian NSP National Data Survey Report 2008-2013?

A

Remained low at 1.5% or less nationally and at 3% or less in all state and territories.
Among men, HIV prevalence declined from 2.1% - 1.2%
Among women HIV prevalence increased from 0.4% - 1.3%

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26
Q

What are the interventions for IVDU?

A 
Psychoeducation
Access to NSP
Brief interventions
Replacement programs
Regular testing – prevention and early treatment
General health / well being
Peer interventions
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27
Q

What is involved in the intervention of psychoeducation in IVDU?

A 
education about:
Risk taking (injecting, sex, intoxication)
Safer injecting
Vein care
Overdose
Community safety/disposal
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28
Q

what did Westermeyer & Boedicker (2000) study?

A

“Course, severity and treatment of substance abuse among women verus men”…

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29
Q

what was involved in Westmeyer & Boedicker’s (2000) study?

A

Retrospective data analysis: 642 patients (43% women) from university medical program a&d programs (USA)
Data: demographics, family history, patterns of use++, periods of abstinence, current diagnosis
Comparisons were made between women and men

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30
Q

What were the results in Westmeyer & Boedicker’s (2000) study that women were…?

A

Women were…

More likely to be “homemakers” (unemployed)
More likely to have a substance-abusing spouse (if married)
Less likely to have legal problems associated with substance misuse
Less likely to report lifetime use of inhalants or hallucinogens
Less likely to be cannabis-dependent
More likely to have used substances for fewer years (shorter time period)

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31
Q

What were the results in Westmeyer & Boedicker’s (2000) study that women reported…?

A

Fewer admissions for treatment
Fewer treatment days (when admitted)
Lower overall treatment costs Implications regarding a “male-orientated” treatment system

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32
Q

Consistent with previous research, what did Westmeyer & Boedicker (2000) suggest women have?

A

A more rapid course (time frame) for developing substance problems
More commonly have a substance-abusing partner
Reduced treatment options/patterns

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33
Q

What are the biological differences for women?

A

Intoxication occurs with less alcohol intake
Metabolise alcohol differently
Develop cirrhosis of the liver more rapidly

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34
Q

What are the social differences for women?

A

Increased stigma associated with use/misuse
More often caring for children
Cultural differences regarding status in society

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35
Q

what are the patterns of use for women?

A

Develop problematic use more quickly
More use of prescription medications
More “private” use/misuse

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36
Q

What is there limited research on regarding women?

A

Lack of research regarding women
Conclusions drawn with men may not adequately generalise to women
Impacts prevention and treatment developments

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37
Q

stigma and substance-using in women

A

More stigma (Swift & Copeland, 1998; Simpson & McNulty, 2008)
Highest among pregnant women
Increased blame for difficulties (Banwell & Bammer, 2006)
Reluctant to seek treatment
Fear negative attitudes of health professionals (e.g., child safety)
Stereotypes and cultural aspects (Hahm et al., 2014)

38
Q

What are treatment barriers for women?

A

Lack of awareness of range of treatment options
Stigma
Childcare
Perceived economic and time costs of residential treatment, including costs to family disruption
Lack of support
Concerns about type of treatment, especially confrontational approaches
Having to talk in groups with men present
Fear of children being removed from their care
Male-orientated treatment may not address issues of particular importance to women
Women who are survivors of abuse or in an abusive relationship with a male may feel unsafe in the company of men during treatment
Woman may experience sexual harassment in mixed-gender settings
Women may feel in the minority and less able to speak freely about their issues

39
Q

What are the differences in men with regards to A&D?

A

Slower decline in smoking rates
Men: higher levels of risky and hazardous drinking
Similarities in levels of illicit drug use
Similarities in IVDU
Differences in frequencies and access
Less services and increased stigma

40
Q

What is CALD?

A

people are generally defined as those people born overseas, in countries other than those classified by the Australian Bureau of Statistics (ABS) as “main English speaking countries”

41
Q

What is the prevalence of alcohol use in CALD populations?

A

May have higher rates of AOD or be at higher risk

Migrants moving from a culture of no alcohol use to a culture of high alcohol use

Cultural specific substances brought to Australian context

Stressors: PTSD/Trauma, family stressors, unemployment, language barriers and a lack of understanding of available services

42
Q

what are the best practice approaches to addressing the needs of CALD communities?

A

Using trained interpreters

Displaying signage and images that reflect culturally diverse clients

Resources and service information in major community languages or in formats which are easier for CALD clients to understand

Providing care that is trauma-informed and client centred - making efforts to understand each client’s cultural background, family, migration and settlement experiences

Providing education and resources at CALD festivals/events
Addressing social determinants such as a lack of connectedness to their community and strained family relationships

Providing a culturally sensitive service which is familiar with the different needs, norms and experiences of different CALD groups

Ensuring appropriate training for frontline staff; diverse workforce

43
Q

What are some A&D problems in Aboriginal and torres strait islander people?

A

Experience significantly more ill health than other Australians.

Socioeconomic disadvantage experienced places them at greater risk of exposure and vulnerability to health risk factors such as smoking and alcohol misuse.

Suffer a disproportionate amount of harms from alcohol, tobacco and other drug use. Drug-related problems play a major role in disparities in health and life expectancy between Indigenous and non-Indigenous Australians (MCDS 2011).

44
Q

What is the gap in life expectancy between indigenous and non indigenous Australians?

A

Gap in life expectancy is now about 10 to 12 years earlier than non-Indigenous Australians

45
Q

why is there a gap in life expectancy between non indigenous and indigenous australians with respect to medical factors?

A

Due to chronic diseases such as diabetes, lung, heart and kidney disease and indigenous australians tend to contract these at an earlier age than other australians
Higher rates of illness and hospitalisation; earlier death
Much of this chronic illness, and the associated complications, can be prevented.

46
Q

what life factors contribute to the gap in life expectancy between non indigenous and indigenous australians?

A

Lifestyle factors such as smoking, lack of exercise, and obesity.

47
Q

What is the closing the gap program?

A

This program is the latest of the half hour documentary style programs in the Strong series. It emphasises the need for a comprehensive approach to the prevention, treatment and management of chronic disease. It also looks at Indigenous concepts of health and explores how these might shape more effective intervention programs. The program emphasises that the gap in life expectancy cannot be closed unless chronic disease issues are addressed in an approach that values autonomy, cultural identity, and community responsibility.

48
Q

What does the closing the gap program show that are making a difference?

A

The Family Wellbeing Program at Yarrabah in Queensland is a successful community program that aims to build and strengthen the social and emotional wellbeing of individuals, their families and communities. It emphasises the fact that emotional and social wellbeing is significantly implicated with physical health.

  • The Healthy Lifestyle Awareness Outreach Program, run by the Dharah Gibinj Aboriginal Medical Service in Casino NSW, has been specifically designed to address some of the lifestyle factors such as poor nutrition and lack of physical exercise that contribute to the development of chronic illness.
  • The Improved Primary Health Care Initiative at Mossman Gorge Aboriginal Community in Queensland is a team approach which aims to improve people’s understanding of the impact of diabetes on their health and encourages them to participate in the self management of their chronic condition.
49
Q

What are the risk factors that are more frequently experience that increase the risk of poor outcomes over every aspect of life?

A 
a changing population structure 
cultural change
family dysfunction/breakdown
removal of children from their families
poverty
lack of educational opportunities &amp; unemployment
alcohol and other drug misuse
social injustice and racism
50
Q

What is the issue of smoking among indigenous australians?

A

more likely to die of smoking-related illnesses, such as diseases of the respiratory system and cancers, than other Australians (AIHW 2008).

2.5 times more likely to smoke daily than non-Indigenous people

Daily smoking rate declined from 35% in 2010 to 32% in 2013 (not statistically significant)

51
Q

What is the issue of alcohol among indigenous australians?

A

more likely to abstain from drinking alcohol than non-Indigenous Australians (28% compared with 22% respectively).

Among those who did drink, a higher proportion of Indigenous Australians drank at risky levels

There were fewer Indigenous Australians drinking alcohol at levels that put them at risk of harm from a single drinking occasion at least once a month in 2013 (from 45% to 38%)

52
Q

What is the issue of illicit drugs among indigenous australians?

A

Other than ecstasy and cocaine, Indigenous Australians use illicit drugs at a higher rate than the general population.

53
Q

What is the historical perspective of A&D prevalence on aboriginals?

A

Acknowledge history in Aboriginal substance use-
Dispossession and human-rights violations

Increased susceptibility to substance use

Helped form & maintain drug problems

Evidence of controlled alcohol use prior to colonisation - Lack of awareness increased vulnerability

Some believe alcohol was used as a method of control Indigenous people encouraged to be like ‘white’ people – including binging/drinking

54
Q

what occurred in 1837 with regards to aboriginals and A&D?

A

legislation to ban alcohol (among ATSI people)

Exceptions e.g., mixed decent, “good hygiene”

Alcohol used for payment and for trade

55
Q

What is the effect of the 1837 legislation to ban alcohol among ATSI people?

A

May have shape drinking patterns

  • I.e., to avoid incarceration people would drink quickly
  • Illegal to drink in hotels –> drink in public places
  • Resulted in increased public drunkenness & arrests

Perpetuated stereotype & restricted access to treatment

56
Q

what was the period in 1960s - 1970s?

A

assimilation

57
Q

What occurred in 1957 and 1975 with regards to indigenous australians and A&D?

A

reform prohibition laws, including rights to drink

58
Q

What is drinking seen as by Indigenous community?

A

a sign of equality & status

59
Q

What is the anthropological perspective of AOD among indigenous people?

A

Culturally determined responses to change in history
Peer influence is particularly important
‘Hunter-gatherer’ explanation

60
Q

What are the peer influences that are particularly important according to the Anthropological perspective on AOD in indigenous people?

A

‘group-sharing’
Belonging
Non-confronting culture

61
Q

What is the hunter-gather explanation?

A

Food shortage means food gathered rarely & shared among the community
Extends to alcohol use
Bought when money available & consumed quickly
Shared amongst community

62
Q

what is the physiological disease perspective of indigenous AOD use?

A

Racial interpretation
Most treatment programs for ATSI have goal of abstinence
Disease model popular within ATSI community

63
Q

What is the racial interpretation in the physiological disease perspective if indigenous AOD use?

A

genetic predisposition to alcohol dependence

disease model

64
Q

What is the psycho-social perspective of indigenous AOD use?

A

Learned behaviours reinforce drinking, and social norms and cultural practices undermine resistance.

65
Q

what are the 5 elements of outbreak of susbtance misuse among indigenous australians according to Pearson (2002) in the psychosocial perspective?

A 
Availability
Money
Spare time
Examples of others in immediate environment
Permissive social ideology
66
Q

What are the interventions / policy in the National Drug Strategy (2004-2009) regarding indigenous australians?

A
  1. Enhanced capacity of individuals, families and communities to address current and future issues in the use of alcohol, tobacco and other drugs, and promote their own health and wellbeing.
  2. Whole-of-government effort in collaboration with non-government organisations to implement, evaluate and improve comprehensive approaches to reduce drug-related harm.
  3. Substantially improved access to the appropriate range of health and wellbeing services that play a role in addressing alcohol, tobacco and other drugs issues.
  4. A range of holistic approaches from prevention through to treatment and continuing care that is locally available and accessible.
  5. Workforce initiatives to enhance capacity of community-controlled and mainstream organisations to provide quality services.
  6. Increased ownership and sustainable partnerships of research, monitoring, evaluation and dissemination of information.
67
Q

What is an example of 1. Enhanced capacity of individuals, families and communities to address current and future issues in the use of alcohol, tobacco and other drugs, and promote their own health and wellbeing. in the NDA?

A

E.g., Community leaders and Elders taking responsibility and a leading role, in partnership with government, in design and delivery of alcohol, tobacco and other drug programs.

68
Q

What is an example of 2. Whole-of-government effort in collaboration with non-government organisations to implement, evaluate and improve comprehensive approaches to reduce drug-related harm. in the NDA?

A

E.g., Achieving better coordination among the three tiers of government and each local community in

69
Q

What is an example of 3. Substantially improved access to the appropriate range of health and wellbeing services that play a role in addressing alcohol, tobacco and other drugs issues.
in the NDA?

A

E.g., Providing and improving access for Aboriginal and Torres Strait Islander peoples to police diversion, pre-sentencing programs and legal aid.

70
Q

What is an example of 4. A range of holistic approaches from prevention through to treatment and continuing care that is locally available and accessible. in the NDA?

A

E.g., Medical services becoming more inclusive with consideration of holistic service provision and not denying people services due to their use of alcohol, tobacco and other drugs.

71
Q

What is an example of 5. Workforce initiatives to enhance capacity of community-controlled and mainstream organisations to provide quality services. in the NDA?

A

E.g., Employing Torres Strait and Northern Peninsula area people within health and related organisations to reflect their representation in the local population and special health requirements.

72
Q

What is an example of 6. Increased ownership and sustainable partnerships of research, monitoring, evaluation and dissemination of information in the NDA?

A

E.g., Increasing the availability of information about what does and does not work in relation to approaches to address the impact of the use of alcohol, tobacco and other drugs, and psychoactive substances on Torres Strait Islander peoples.

73
Q

What are best practice approaches to addressing the needs of Aboriginal and Torres Strait Islander people?

A

Culturally responsive and appropriate mainstream programs
Aboriginal and Torres Strait Islander community-controlled services leading the planning, implementation and delivery of programs
Services delivered by specialist Aboriginal and Torres Strait Islander drug and alcohol services with an understanding of their physical, spiritual, cultural, emotional and social needs
Screening and brief intervention in primary care, Aboriginal Medical Services and other relevant health services
Services delivered in urban, regional and remote locations and in settings such as prisons, hospitals and mental health facilities
Involvement of families and communities where appropriate
Addressing the social determinants of alcohol, tobacco and other drugs use, including homelessness, education, unemployment, grief/loss/trauma and violence
Interagency collaboration and data sharing.

74
Q

What are treatment issues to consider for Indigenous AOD users?

A

Few Aboriginal people choose to access treatment programs for the general population
Limited access to culturally sensitive treatment is a major theme in the research
The most successful strategies are often those designed & run by the community
Need for more rigorous evaluation of what works.

75
Q

What are the issues of people in contract with the criminal justice system?

A

High underlying rates of AOD use
50% of all prison entrants reported using cannabis prior to entering prison; 37% reported using methamphetamines.
Between 50-90% of people who inject drugs have spent time in prison and 34% continue to inject while incarcerated.
For those injecting drugs in prison, 90% report sharing needles/injecting equipment.
Blood borne virus rates among the prison population, who report injecting drug use in 2010 were for hepatitis C (51%); hepatitis B (1%); HIV (<1%).
80% of prison discharges reported that they smoked tobacco.

76
Q

what are Best practice approaches to addressing the needs of people in contact with the criminal justice system:?

A

Implement smoke-free policies in correctional facilities.
Access to education, health promotion, treatment and support services while in prison and during their transition back into the community
Provision of a range of treatments, including detoxification and withdrawal management, pharmacotherapy, drug free units or therapeutic communities
Testing, education and treatment for blood borne viruses
Restorative justice conferencing
Strengthen harm reduction efforts in prison settings, eg opioid substitution therapy; support inmates to adopt safe behaviours; assist inmates connect with health and social services post-release
Aftercare and support post release
Drug detection units and searching of offenders, staff, visitors, vehicles.

77
Q

What are some harm reduction recommendations?

A

Provide equal quality A&D Tx to that available to general population
Provide education re: substances
Introduce methadone treatment, NSPs
Use alternative sentencing/diversionary programs
Provide prison staff with better training
Provide voluntary testing of Hep B & C

78
Q

What is the AOD prevalence for the LGBTI community?

A

Australian and international research has found that rates of AOD use by LGBT people is two to four times higher than AOD rates by heterosexual people (Fergusson et al 2005, QAHC 2010).

Some studies have shown comparable rates or use, however increased poly-drug use and higher use of amphetamines, cannabis, amyl, and other “party” drugs

79
Q

What did Lea Et al (2013) discover with IVDU gay/bisexual men in Sydney?

A
  1. 6 % of men reported injecting drugs in the previous 6 months
  2. 4 % reported methamphetamine injection and 0.4 % heroin
80
Q

What did Lea Et al (2013) discover with IVDU gay/bisexual men in Sydney specifically with regards to men who injected?

A

less likely to be employed full-time
more likely to be HCV+, HIV+
more likely to have used party drugs for sex, and
have engaged in esoteric sexual practices.

81
Q

What are the mental health issues for the LGB community?

A

41% of LGB people had a mental disorder in the previous 12 months (20% of heterosexual people) (National Survey of Mental Health and Wellbeing: Summary of Results 2007).

This is higher than for any age group, any income level, any area of residence, any education level, and any employment status.

82
Q

what are the suicide rates for LGB people?

A

LGB people attempt suicide at rates between 3.5 – 14 x those of their heterosexual peers.

83
Q

what are the suicide rates among transgender people?

A

the prevalence of attempted suicide is 16% to 47%

84
Q

What is the connection of mental health issues in the LGBT community with AOD?

A

Minority Stress - (coming out leading to increased prjudicial treatment, stigma LGBT identity)
Homophobia (internalised and externalised)
Using to cope with negative feelings
Peer modelling of AOD - Use is commonly linked to social and/or sexual contexts—other places to socialise are limited
Many LGBTI people avoid mainstream services due to concerns about discrimination

85
Q

What is the relationship between substance use and sexual risk taking - implications for HIV transmission?

A

Prevalence of HIV among gay men
AOD used by gay men to fulfil specific functions
AOD use can facilitate sexual encounters and unsafe sex via a variety of mechanisms (state dependent learning, tension reduction, sensation seeking, expectancies, etc)
AOD use can facilitate HIV transmission

86
Q

What are the perceptions of AID use between LGBTI and heterosecual community?

A

Over half of the sample (59.5%) believed there were no differences in AOD use between the LGBT and heterosexual community.

Significant differences were found for gender with 50% of gender diverse and 46% of males correctly perceiving that there was more AOD use in the LGBT community compared to 24% of females.

71.1% of females perceive levels of use to be the same in the LGBT and general community.

87
Q

What percentage of young people were reported to having had experienced a form of homophobia?

A

96.9%

88
Q

What is the relationship between homophobia and AOD use?

A

Although the impact of homophobia varies individual to individual, in this study almost 60% of young people associated their AOD use with coping with homophobia.

Young people who associated AOD use with homophobia were significantly more likely to smoke tobacco, consume alcohol (and at hazardous levels), and use illicit substances (in particular cannabis and stimulants).

89
Q

what are best practice approaches for LGBTI community and AOD?

A

these are not well defined, however literature suggests the following to be effective:
• Involve GLBTI community/ local GLBTI-friendly health clinics in health education and prevention programs
• Review how consumer data can be collected by providers to collect baseline data on health needs and services usage by GLBTI consumers
• Address homophobia and bullying in school education as well as provide comprehensive education around sexuality
• Workforce development and training in appropriate supports for GLBTI people
• Provide support groups specifically for GLBTI people
• Provide relevant educational materials at GLBTI social events
• Build capacity within GLBTI communities.

90
Q

What are some interventions for LGBTI people and AOD issues?

A

The importance of creating opportunities for supporting disclosure & improving inclusive practises.
Decrease the ‘invisibility’ of LGBT clients accessing health services & provide a space that is safe & responsive.
Tailored to specific needs and issues

91
Q

What are some harm reduction strategies for LGBTI communities and AOD issues?

A

Improve social issues: stigma/discrimination
Provide safe places for LGBT—apart from contexts for AOD use
Promote appropriate and accessible Tx options for mental health and A&D issues
Continue community based health promotion campaigns

92
Q

how does one explore young people’s feelings about their sexuality and gender identity?

A

asking about “coming out,”
gender transition,
societal oppression & homophobia,
loss of family or significant other support,
isolation and connection to the LGBT community.

PYB159 - No.2 (5 decks)

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