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Article: Sharing Research, Building Possibility: Reflecting on Research with Men Who Have Sex with Men in Kenya.

Syvertsen, Jennifer L

Human organization

2023 Volume 79, Issue 2, Page(s) 83–94

Abstract: Sharing our research with participants and communities is a standard and critically important ethical practice in anthropology, but do we use such opportunities to their full potential? In this article, I reflect on the possibilities generated by a ... ...

Abstract	Sharing our research with participants and communities is a standard and critically important ethical practice in anthropology, but do we use such opportunities to their full potential? In this article, I reflect on the possibilities generated by a community dissemination event to share my research with men who have sex with men and engage in sex work in Kisumu, Kenya. Drawing on Arjun Apaddurai's concept of an "ethics of possibility" that pushes beyond ordinary ethical practice, I reflect upon engagement with participants in the research process and advocate for greater emphasis on research dissemination events as a strategy to make research more meaningful to communities. Although my project was initially framed around HIV, what emerged were men's desire for spirituality, belonging, and new possibilities of inclusive citizenship that better attend to men's health and well-being. Research dissemination creates a critical space to generate ethnographic insight and guide theoretically rich applied health research.
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Journal Article
ISSN	0018-7259
ISSN	0018-7259
DOI	10.17730/1938-3525.79.2.83
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Article ; Online: Learning from women who trade sex in Kenya about the antiblackness of Global Health.

Simmons, Brianna / Syvertsen, Jennifer L

Social science & medicine (1982)

2022 Volume 313, Page(s) 115246

Abstract: Sex work and violence have become co-constituted, routinized, and even sanitized in Global Health journals dispassionately advocating for intervention. This paper situates ethnographically shared experiences of Kenyan sex working women within the global ... ...

Abstract	Sex work and violence have become co-constituted, routinized, and even sanitized in Global Health journals dispassionately advocating for intervention. This paper situates ethnographically shared experiences of Kenyan sex working women within the global condition of antiblackness. By grounding our conceptual analytic in Black Feminist scholarship, we illustrate how antiblackness subtends the conditions of possibility for women's entry into sex work, their subsequent experiences with interpersonal and institutional forms of predatory violence, and lack of recourse for their material needs and suffering. This analysis requires a meditation on the relationships between the types of violence conditioning Kenyan women's lives and the limitations of Global Health's conceptual logics and disciplinary practice. Our discussion reflects on the ways Global Health practice can neglect conceptual foundations in antiblackness, thus complicit in upholding violence against the very groups it purports to assist. In charging Global Health "as usual" as methodologically violent and sustaining global antiblackness, we call for disciplinary transformations beginning from a shared consciousness regarding the ways global antiblackness structures health inequities. Beyond critique, our meditation is an invitation for all committed to dignified Global Health to contribute creative, non-hierarchically collaborative work engaged with those in material, structural, and immaterial need.
MeSH term(s)	Female ; Humans ; Kenya ; Global Health ; Violence ; Aggression ; Feminism
Language	English
Publishing date	2022-07-31
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2022.115246
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Article ; Online: Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California.

Ozga, Jenny E / Syvertsen, Jennifer L / Pollini, Robin A

Journal of viral hepatitis

2022 Volume 29, Issue 7, Page(s) 518–528

Abstract: Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti-HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, ... ...

Abstract	Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti-HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, which has among the highest prevalence of injection drug use (IDU) in the United States. We surveyed 494 peer-recruited PWID (≥18 years of age) in 2016 about their experiences with HCV testing and treatment, and conducted HCV and HIV antibody testing for all participants. Bivariate analyses and multivariable logistic regressions were used to identify correlates of anti-HCV seropositivity. A majority (65%) tested positive for anti-HCV, with 32% of those being unaware of their HCV status. Anti-HCV seroprevalence was independently and positively associated with older age (AOR = 1.11 per year, 95% CI = 1.06, 1.17), years injecting (AOR = 1.08 per year, 95% CI = 1.03, 1.13), distributive syringe sharing (AOR = 2.76, 95% CI = 1.29, 5.94), having syringes confiscated by police (AOR = 2.65, 95% CI = 1.22, 5.74), ever trading sex (AOR = 3.51, 95% CI = 1.40, 8.81) and negatively associated with being Black/African American (non-Hispanic) (AOR = 0.06, 95% CI = 0.01, 0.47). Prior HCV testing was associated with older age, ever getting syringes from a syringe services program, and having interactions with police. For those aware of their anti-HCV seropositivity, only 11% had initiated treatment; reasons for not seeing a physician regarding diagnosis included not feeling sick (23%), currently using drugs/alcohol (19%) and not knowing where to go for HCV medical care (19%). Our findings highlight the importance of expanding community-based access to sterile syringes alongside HCV testing and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking testing and treatment.
MeSH term(s)	Drug Users ; HIV Infections/complications ; Health Services Accessibility ; Hepacivirus ; Hepatitis C/diagnosis ; Hepatitis C Antibodies ; Humans ; Prevalence ; Seroepidemiologic Studies ; Substance Abuse, Intravenous/complications ; Substance Abuse, Intravenous/epidemiology
Chemical Substances	Hepatitis C Antibodies
Language	English
Publishing date	2022-04-06
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1212497-7
ISSN	1365-2893 ; 1352-0504
ISSN (online)	1365-2893
ISSN	1352-0504
DOI	10.1111/jvh.13677
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Article ; Online: Syringe access and health harms: Characterizing "landscapes of antagonism" in California's Central Valley.

Syvertsen, Jennifer L / Pollini, Robin A

The International journal on drug policy

2019 Volume 75, Page(s) 102594

Abstract: Background: Sterile syringe access reduces injection-related health harms, yet access in the U.S. remains grossly inadequate. In California, syringe services programs (SSPs) are authorized mainly at the local level, and many communities remain ... ...

Abstract	Background: Sterile syringe access reduces injection-related health harms, yet access in the U.S. remains grossly inadequate. In California, syringe services programs (SSPs) are authorized mainly at the local level, and many communities remain underserved. State law also allows, but does not require, non-prescription syringe sales at pharmacies, but participation is low. We draw on the theoretical concept of "landscapes of antagonism" to examine how discordance between state and local decision-making contributes to uneven syringe access and health harms in California's Central Valley, where injection rates are high. Methods: Our study took place in Fresno and Kern counties. We draw on participant observation and qualitative interviews with individuals who inject drugs and key informants to examine issues around syringe access. Results: Overall, 8 key informants represented harm reduction, medical, and faith-based organizations. Among 46 people who inject drugs, mean age was 39 (range: 20-65), 37% were female, and 37% self-identified as Latino. About half of individuals at each site had ever successfully purchased from pharmacies, but limited locations and perceived judgement from pharmacy staff posed common barriers. There was no SSP in Kern County due to political opposition; Fresno's SSP has been run by volunteers for more than 20 years despite opposition, and recently gained authorization. Reflecting this disparity, all but two individuals in Fresno accessed syringes from the SSP, whereas only one person in Kern had ever been to an SSP. To fill gaps in access in both sites, individuals obtained syringes that were often already used from diabetics, friends, and people on the street, sharing and reusing syringes at dangerously high rates. Conclusion: Landscapes of antagonism create syringe access inequities that threaten to exacerbate disease transmission and other health harms. Our study raises questions about accountability for the health of people who use drugs and suggests a need for political action.
MeSH term(s)	Adult ; Aged ; California ; Commerce/statistics & numerical data ; Female ; Harm Reduction ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Needle-Exchange Programs/organization & administration ; Pharmaceutical Services/organization & administration ; Substance Abuse, Intravenous/complications ; Substance Abuse, Intravenous/epidemiology ; Syringes/supply & distribution ; Young Adult
Language	English
Publishing date	2019-11-24
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2019.10.018
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Article ; Online: Mobile phone and internet use among people who inject drugs: Implications for mobile health interventions.

Ozga, Jenny E / Paquette, Catherine / Syvertsen, Jennifer L / Pollini, Robin A

Substance abuse

2021 Volume 43, Issue 1, Page(s) 592–597

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Cell Phone ; Drug Users ; HIV Infections ; Humans ; Internet Use ; Substance Abuse, Intravenous/epidemiology ; Telemedicine
Language	English
Publishing date	2021-09-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1080/08897077.2021.1975871
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Article ; Online: A community-based study of abscess self-treatment and barriers to medical care among people who inject drugs in the United States.

Ozga, Jenny E / Syvertsen, Jennifer L / Zweifler, John A / Pollini, Robin A

Health & social care in the community

2021 Volume 30, Issue 5, Page(s) 1798–1808

Abstract: Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess ... ...

Abstract	Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess characteristics, treatment utilization, and barriers to medical treatment among N = 494 community-recruited PWID. We used descriptive statistics to determine the frequencies of self-treatment and medical treatment for their most recent past-3-month abscess as well as barriers to seeking medical treatment. We then used bivariate and multivariate logistic regression to identify factors associated with having an abscess in the past 3 months. Overall, 67% of participating PWID ever had an abscess and 23% had one in the past 3 months. Only 29% got medical treatment for their most recent abscess whereas 79% self-treated. Methods for self-treatment included pressing the pus out (81%), applying a hot compress (79%), and applying hydrogen peroxide (67%). Most (91%) self-treated abscesses healed without further intervention. Barriers to medical treatment included long wait times (56%), being afraid to go (49%), and not wanting to be identified as a PWID (46%). Factors associated independently with having an abscess in the past 3 months were injecting purposely into muscle tissue (adjusted odds ratio [AOR] = 2.64), having difficulty finding a vein (AOR = 2.08), and sharing injection preparation equipment (AOR = 1.74). Our findings emphasize the importance of expanding community-based access to SSTI education and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking resources.
MeSH term(s)	Abscess/drug therapy ; Abscess/epidemiology ; Drug Users ; HIV Infections ; Humans ; Self Care ; Soft Tissue Infections/drug therapy ; Soft Tissue Infections/epidemiology ; Substance Abuse, Intravenous/complications ; Substance Abuse, Intravenous/epidemiology ; Substance Abuse, Intravenous/therapy ; United States/epidemiology
Language	English
Publishing date	2021-09-01
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1155902-0
ISSN	1365-2524 ; 0966-0410
ISSN (online)	1365-2524
ISSN	0966-0410
DOI	10.1111/hsc.13559
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Article ; Online: Consider the Source: Associations between Syringe Sources and Risky Injection Behaviors in California's Central Valley.

Pollini, Robin A / Ozga, Jenny E / Blanchard, Dallas / Syvertsen, Jennifer L

Substance use & misuse

2021 Volume 56, Issue 13, Page(s) 2007–2016

Abstract: Background: Sterile syringe access is critical to prevent serious viral and bacterial infections among people who inject drugs (PWID) but many areas across the United States lack sufficient access. Although California law allows nonprescription pharmacy ...

Abstract	Background: Sterile syringe access is critical to prevent serious viral and bacterial infections among people who inject drugs (PWID) but many areas across the United States lack sufficient access. Although California law allows nonprescription pharmacy syringe sales and syringe services programs (SSPs), access gaps remain in the largely rural Central Valley. Objective: The purpose of this study was to examine syringe access and related injection behaviors among PWID in Fresno, California. Methods: We used respondent driven sampling to recruit 494 individuals for a survey about syringe access and injection behaviors between April and September 2016. Participants were ≥18 years old and injected at least twice in the past 30 days. Descriptive statistics examined syringe access and logistic regression determined if discrete syringe source categories were significantly associated with syringe sharing and/or reuse. Results: A majority (67%) obtained syringes from an authorized source; SSPs were most common (59%), while few reported pharmacy purchase (14%). Unauthorized sources were even more common (79%), primarily friends (64%) or someone on the street (37%). Compared to PWID who used only authorized sources, those using only unauthorized sources had a higher odds of syringe sharing (AOR = 3.40, 95% CI: 1.66, 6.95) and syringe reuse (AOR = 6.22; 95% CI: 2.24, 17.29), as did those who reported mixed sources (AOR = 3.78; 95% CI: 1.90, 7.54 and AOR = 4.64; 95% CI: 2.08, 10.35). Conclusions: Our findings demonstrate a need to expand syringe access in nonurban California to prevent the syringe sharing and reuse that contributes to serious viral and bacterial infections among PWID.
MeSH term(s)	Adolescent ; California/epidemiology ; HIV Infections ; Humans ; Needle Sharing ; Needle-Exchange Programs ; Risk-Taking ; Substance Abuse, Intravenous/epidemiology ; Syringes ; United States
Language	English
Publishing date	2021-08-11
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1310358-1
ISSN	1532-2491 ; 1082-6084
ISSN (online)	1532-2491
ISSN	1082-6084
DOI	10.1080/10826084.2021.1963987
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Article ; Online: Health, harm reduction, and social service providers' perspectives on the appropriateness and feasibility of peer distribution of HIV self-test kits among people who use drugs.

Bazzi, Angela R / Valasek, Chad J / Stamos-Buesig, Tara / Eger, William H / Harvey-Vera, Alicia / Vera, Carlos F / Syvertsen, Jennifer L / Storholm, Erik D / Bartholomew, Tyler S / Tookes, Hansel E / Strathdee, Steffanie A / Pines, Heather A

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 29

Abstract: Background: People who use drugs (PWUD) experience elevated HIV risk and numerous barriers to facility-based HIV testing. HIV self-testing (HIVST) could circumvent many of those barriers and is acceptable among PWUD, yet HIVST implementation for PWUD is ...

Abstract	Background: People who use drugs (PWUD) experience elevated HIV risk and numerous barriers to facility-based HIV testing. HIV self-testing (HIVST) could circumvent many of those barriers and is acceptable among PWUD, yet HIVST implementation for PWUD is limited. Service providers' perspectives on specific HIVST delivery strategies could help increase availability for PWUD. Methods: From April-November 2021, we interviewed 16 health, harm reduction, and social service providers working with PWUD in San Diego, CA. Interviews and rapid thematic analysis explored perspectives on HIVST's utility and appropriateness, as well as the feasibility of and anticipated challenges with specific HIVST delivery strategies, including peer or secondary distribution. Results: Participants viewed HIV as a significant threat to PWUD health and confirmed the presence of numerous barriers to local facility-based HIV testing. Participants viewed HIVST as a promising and potentially empowering solution. Based on community familiarity with secondary distribution of harm reduction supplies (i.e., naloxone) and information, participants viewed secondary distribution of HIVST kits as an appropriate and feasible strategy for increasing the reach of HIVST, but also described potential barriers (e.g., engaging socially disconnected individuals, ensuring linkages to services following HIVST) and provided suggestions for alternative HIVST kit delivery models (e.g., harm reduction vending machines). Conclusions: Service providers viewed secondary distribution of HIVST kits among PWUD as promising, appropriate, and feasible, yet specialized efforts may be needed to reach the most marginalized individuals and ensure consistent provision of educational information and referral supports that maximize the impact of this approach.
MeSH term(s)	Humans ; Harm Reduction ; Self-Testing ; Pharmaceutical Preparations ; Feasibility Studies ; HIV Infections/diagnosis ; HIV Infections/prevention & control
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2024-02-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-00950-x
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Article ; Online: Conceptualizing stigma in contexts of pregnancy and opioid misuse: A qualitative study with women and healthcare providers in Ohio.

Syvertsen, Jennifer L / Toneff, Hannah / Howard, Heather / Spadola, Christine / Madden, Danielle / Clapp, John

Drug and alcohol dependence

2021 Volume 222, Page(s) 108677

Abstract: Background: Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely ... ...

Abstract	Background: Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely unchallenged. Drawing on a multidimensional model of stigma, we examine how stigma manifested across women's pregnancy journeys to shape access and quality of care. Methods: We triangulate in-depth interviews with 28 women with histories of opioid misuse who were pregnant or recently gave birth and 18 healthcare providers in Ohio. Thematic analysis examined how stigma operates across contexts of care. Results: Providers represented physicians, nurses, social workers, counselors, and healthcare administrators. Among 28 women, average age was 30 (range: 22-41) and 79 % were White. Most women used prenatal medication-assisted treatment (MAT), including Suboxone (n = 19) or methadone (n = 8), and 15 were pregnant. Evidence of stigma emerged across healthcare contexts. Structural stigma encoded barriers to care in insurance practices and punitive drug treatment, while enacted stigma manifested as mistreatment and judgment from providers. Unpredictability of an infant diagnosis of neonatal abstinence syndrome (NAS), even when women were "doing everything right" by using MAT, perpetuated anticipated stigma from fear of loss of custody and internalized stigma among women who felt guilty about the diagnosis. Providers recognized the harmful effects of these stigmas and many actively addressed it. Conclusions: We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.
MeSH term(s)	Adult ; Buprenorphine/therapeutic use ; Female ; Health Personnel ; Humans ; Infant, Newborn ; Methadone/therapeutic use ; Neonatal Abstinence Syndrome ; Ohio ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Pregnancy ; Pregnancy Complications/drug therapy
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2021-03-18
Publishing country	Ireland
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2021.108677
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Article ; Online: Stigma at every turn: Health services experiences among people who inject drugs.

Paquette, Catherine E / Syvertsen, Jennifer L / Pollini, Robin A

The International journal on drug policy

2018 Volume 57, Page(s) 104–110

Abstract: Background: People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences ... ...

Abstract	Background: People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences health care access and utilization. Methods: We conducted 46 qualitative interviews with PWID in California's Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A "risk environment" framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data. Results: Participants repeatedly cited the impact of stigma on syringe access, particularly in the context of meso-level pharmacist interactions. They described being denied syringe purchase as stigmatizing and embarrassing, and these experiences discouraged them from attempting to purchase syringes under the new pharmacy access law. Participants described feeling similarly stigmatized in their meso-level interactions with first responders and hospital staff, and associated this stigmatization with delayed and substandard medical care for overdoses and injection-related infections. Drug treatment was another area where stigma operated against PWID's health interests; participants described macro-level public stigma towards methadone (e.g., equating methadone treatment with illicit drug use) as discouraging participation in this evidence-based treatment modality and justifying exclusion of methadone patients from recovery support services like sober living and Narcotics Anonymous. Conclusion: Stigma played an undeniably important role in PWID's experiences with health services access and utilization in the Central Valley. Our study illustrates the need to develop and test interventions that target drug use stigma at both structural and individual levels to minimize adverse effects on PWID health.
MeSH term(s)	Adult ; Aged ; Female ; Health Services Accessibility/legislation & jurisprudence ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Qualitative Research ; Social Stigma ; Substance Abuse, Intravenous/psychology ; Young Adult
Language	English
Publishing date	2018-04-30
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2018.04.004
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