Jacques Normand

Culturally competent healthcare systems: A systematic review☆

Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the clients language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.

The effectiveness of early childhood development programs: A systematic review

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

Providing affordable family housing and reducing residential segregation by income

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

Under the Influence? Drugs and the American Work Force

Drug use in the workplace, its effect on performance and safety, and the role of workplace drug testing has received much attention in the popular press. But what do we actually know about this troubling issue? With an extensive and readable overview of the literature, the committee presents what we do know by examining the major issues: * The extent and severity of drug use on and off the job. * The strengths and weaknesses of methods for detecting drug use through standard drug tests. * The effect of drug use on behavior, including the results of both laboratory and field studies that have examined work-related behavior and worker productivity. * The effectiveness of interventions to deal with drug use, such as employee assistance programs, health promotion programs, and treatment programs for substance abuse. This volume will be of practical interest to human resource and employee assistance program managers, policymakers, and investigators.

The Unrealized Potential of Addiction Science in Curbing the HIV Epidemic

The stubbornly high incidence of new HIV infections belies the overwhelming evidence showing that sustained highly active antiretroviral therapy (HAART) has the power to dramatically reduce the spread of HIV infection and forever change the face of this devastating epidemic. One of the main contributors to this public health paradox is the ongoing HIV epidemic among substance users who contribute significantly to HIV infection rates through injection drug use and high-risk sexual behaviours. Current evidence clearly shows that, in order to fill this gap, we need to integrate substance abuse treatment with HIV treatment programmes and provide substance abusers with universal access to HIV treatment through a focussed effort to seek, test, treat, and retain hard-to-reach high risk individuals. These aims will require structural changes in the health care system to overcome many of the obstacles that have inhibited the merging of substance abuse treatment with HIV programmes for far too long.

Introduction: new dynamics of HIV risk among drug-using men who have sex with men.

On March 1–2, 2004, the National Institute on Drug Abuse (NIDA) sponsored a workshop on “New Dynamics of HIV Risk Among Drug-Using Men Who Have Sex With Men.” The workshop convened NIDA-funded researchers and experts from the Centers for Disease Control and Prevention to review scientific findings on the epidemiology and prevention of HIV/AIDS and other health and medical consequences of drug abuse among men who have sex with men (MSM). It had been 10 years or more since NIDA last hosted such a meeting, and it quickly became apparent that although much had changed, much had remained the same. The past decade of research has advanced our understanding of the behavioral, social, and environmental factors that influence HIV risk behaviors in this population and has informed the development of effective outreach and HIV prevention interventions for drug-using MSM. However, the steady progress made since the epidemic began in reducing risks and sustaining behavioral change among drug-using MSM appears to have slowed. Today, there are concerns that a resurgence of HIV/AIDS may be imminent, fueled in part by increasing indicators of high-risk behavior in this population. The CDC reported in 2003, for example, that after declining every year from 1990 to 2000, the rate of primary and secondary syphilis in the United States increased by 9.1% in 2001, and in 2002, by 12.4% over the increase seen in 2001. Most of this increase is among MSM. For example, from 1998 to 2000, MSM in Chicago accounted for just 15% of syphilis morbidity, but since 2001, MSM have represented nearly 60% of syphilis cases in the city. Moreover, a high rate of HIV co-infection has been reported among MSM involved in recent syphilis outbreaks, raising additional concerns about the magnitude and scope of new HIV infections. Whether the increases in syphilis cases are specific to drug-using MSM is to be determined. Drug use can interfere with the ability and desire to practice safer sex. Methamphetamine use, in particular, is considered highly prevalent among MSM and a cause of sexual risk taking within the gay male community. Over the 2-day workshop, participants discussed their research and findings and the implications for public health interventions to prevent and treat HIV/AIDS among drug-using MSM. Considerable time was devoted to what is known today about the risk behaviors of drug-using MSM, and how emerging patterns of drug

Addressing the Need for Treatment Paradigms for Drug-Abusing Patients with Multiple Morbidities

Persons who use and abuse drugs are at risk for multiple morbidities that involve addiction, bloodborne infectious diseases, and sexually transmitted diseases, in addition to psychiatric illness and social instability. Infectious diseases acquired as a result of drug use can diffuse into non-drug using populations through other high-risk behaviors. Drug users also have substantial comorbidities from noncommunicable diseases and complications that can affect virtually every organ system in the body. Diagnosis of comorbidities and complications associated with drug abuse usually occurs late in the disease course, particularly for persons who are disenfranchised and have limited or no access to medical care. Medical management of these comorbid conditions constitutes a significant challenge. Directly observed therapy (DOT) can be useful but needs to conform to the needs of the targeted treatment population for full efficacy. DOT may have its greatest impact with drug users destabilized by cocaine or methamphetamine use but has yet to be fully investigated in this patient population.

Understanding the dynamics of sexual transmission of HIV among drug-using populations: an integration of biological, behavioral, and environmental perspectives.

In October 2002, the Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA) of the National Institute on Drug Abuse (NIDA) sponsored a science meeting, HIV Acquisition and Transmission Among Drug-Using Populations: Future Research Strategies. The meeting, chaired by Dr. David Vlahov, Director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, convened experts in HIV/AIDS and drug abuse research to examine the dynamics of HIV disease transmission among drug users and other at-risk populations, and to explore why new infections continue apace despite our best efforts at HIV prevention and control. This special issue of the Journal of Urban Health represents one step in the process of addressing new and emerging research gaps and unanswered questions that challenge our best efforts to prevent the continuing spread of HIV/AIDS. The particular focus of the issue is on identifying and understanding some of the dynamic factors involved in the sexual transmission of HIV among drug-using populations. It is hoped that, as we are challenged by yet another decade of HIV/AIDS, we will develop novel, more effective behavioral and biomedical strategies to reduce and prevent—and possibly even to eliminate—this disease. Since HIV/AIDS was first identified in the early 1980s, knowledge and understanding about the disease have grown exponentially. Today, we know more than we ever imagined possible about the natural history, epidemiology, virology, etiology, pathogenesis, prevention, and treatment of HIV/AIDS. Yet despite these gains, dynamic changes in the epidemic continue as new infections spread among drug users and their sexual partners both in the United States and around the world. In the United States today, the estimated annual rate of 40,000 new HIV infections continues, as it did throughout the 1990s. This persistent rate of new infections reminds us that, while we have made advances in the science of HIV prevention, there is much that we have yet to do to make HIV prevention efforts better, more far-reaching, and sustainable. The HIV/AIDS surveillance data from the US Centers for Disease Control and Prevention 1 reveal that, since the 1980s, there have been notable shifts in the demo

Prevention and treatment of HIV/AIDS among drug-using populations: a global perspective.

As the HIV/AIDS epidemic nears its fourth decade, there are signs that explosive spread of the virus may be subsiding, only to be replaced by outbreaks of HIV among vulnerable populations and in diverse locations that have, until now, been largely free of the disease. Yet today, just as in the earliest years, we have understood that containing the spread of HIV requires an ongoing commitment by scientists, clinicians, public health officials, and affected communities to HIV prevention and treatment among drug users. To this end, the National Institute on Drug Abuse (NIDA) and the International AIDS Society (IAS) convened a consultation meeting in January 2010 with leading national and international experts in the fields of HIV and substance abuse to renew our collective focus on the role of drug abuse in fuelling HIV transmission. Meeting participants reviewed the most current scientific evidence on HIV and substance abuse and worked to incorporate that evidence into new clinical recommendations for the prevention and treatment of HIV/AIDS among drug users. When the evidence was viewed as incomplete, new priorities were identified for future behavioral, clinical, and biomedical research.

Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP), July 2009: introduction.

In 2003, the National Institute on Drug Abuse (NIDA) of the National Institutes of Health invited collaborative research proposals on the sexual transmission of HIV and other infectious diseases among drug-using and non-drug-using populations. The outcome of this effort was the cooperative agreement program called the “Sexual Acquisition and Transmission of HIV Cooperative Agreement Program” or SATHCAP. SATHCAP was designed for multidisciplinary epidemiologic research on the behavioral, biological, and environmental processes involved in the sexual transmission of HIV and other sexually transmitted infections/diseases (STD) among drug users and to non-drug-using populations.