12. Specific population groups Flashcards

Question

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

Answer 1

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%

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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)

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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

Answer 13

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)

Answer 14

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

Answer 15

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

Answer 16

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”

Answer 17

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

Answer 18

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

Answer 19

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).

Answer 20

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

Answer 21

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.

Answer 22

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

Answer 23

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.

Answer 24

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.

Answer 25

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

Answer 26

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)

Answer 27

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%)

Answer 28

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

Answer 29

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

Answer 30

legislation to ban alcohol (among ATSI people) Exceptions e.g., mixed decent, “good hygiene” Alcohol used for payment and for trade

Answer 31

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

Answer 32

assimilation

Answer 33

reform prohibition laws, including rights to drink

Answer 34

a sign of equality & status

Answer 35

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

Answer 36

‘group-sharing’ Belonging Non-confronting culture

Answer 37

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

Answer 38

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

Answer 39

genetic predisposition to alcohol dependence | disease model

Answer 40

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

Answer 41

``` Availability Money Spare time Examples of others in immediate environment Permissive social ideology ```

Answer 42

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.

Answer 43

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.

Answer 44

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

Answer 45

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

Answer 46

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.

Answer 47

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.

Answer 48

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.

Answer 49

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.

Answer 50

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.

Answer 51

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.

Answer 52

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.

Answer 53

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

Answer 54

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

Answer 55

5. 6 % of men reported injecting drugs in the previous 6 months 3. 4 % reported methamphetamine injection and 0.4 % heroin

Answer 56

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.

Answer 57

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.

Answer 58

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

Answer 59

the prevalence of attempted suicide is 16% to 47%

Answer 60

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

Answer 61

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

Answer 62

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.

Answer 63

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).

Answer 64

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.

Answer 65

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

Answer 66

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

Answer 67

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