OBJECTIVES: This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. OBSERVATIONS: Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. CONCLUSION: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use. Language: en

/pdf/social-determinants-and-the-health-of-drug-users-316ke7hulq.pdf

Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.

▪ Abstract Social inequalities lie at the heart of risk of HIV infection among women in the United States. As of December, 1995, 71,818 US women had developed AIDS-defining diagnoses. These women have been disproportionately poor, African-American, and Latina. Their neighborhoods have been burdened by poverty, racism, crack cocaine, heroin, and violence. To explain which women are at risk and why, this article reviews the epidemiology of HIV and AIDS among women in light of four conceptual frameworks linking health and social justice: feminism, social production of disease/political economy of health, ecosocial, and human rights. The article applies these alternative theories to describe sociopolitical contexts for AIDS' emergence and spread in the United States, and reviews evidence linking inequalities of class, race/ethnicity, gender, and sexuality, as well as strategies of resistance to these inequalities, to the distribution of HIV among women.

Reframing Women's Risk: Social Inequalities and HIV Infection

Objectives. We report HIV seroprevalence and risk factors for urban indigent adults.Methods. A total of 2508 adults from shelters, meal programs, and low-cost hotels received interviews, blood tests, and tuberculosis screening.Results. Seroprevalence was 10.5% overall, 29.6% for men reporting sex with men (MSM), 7.7% for non-MSM injection drug users (IDUs), and 5.0% for residual non-MSM/non-IDUs. Risk factors were identified for MSM (sex trade among Whites, non-White race, recent receptive anal sex, syphilis), non-MSM IDUs (syphilis, lower education, prison, syringe sharing, transfusion), and residual subjects (≥ 5 recent sexual partners, female crack users who gave sex for drugs).Conclusions. HIV seroprevalence was 5 times greater for indigent adults than in San Francisco generally. Sexual behavior predicted HIV infection better than drug use, even among IDUs.

HIV Seroprevalence Among Homeless and Marginally Housed Adults in San Francisco

As mortality due to AIDS-related causes has decreased with the use of antiretroviral therapy, there has been a rise in deaths related to non–AIDS-defining illnesses. Given the exceedingly high prevalence of cigarette smoking among individuals living with HIV infection, tobacco has been implicated as a major contributor to this paradigm shift. Evidence suggests that smoking-related illnesses, such as cardiovascular disease, respiratory illnesses, and certain malignancies, contribute substantially to morbidity and mortality among HIV-infected persons. In this review, we summarize the adverse health consequences of smoking relevant to HIV-infected individuals and discuss smoking cessation in this unique population, including a discussion of barriers to quitting and a review of studies that have examined smoking cessation interventions.

/pdf/cigarette-smoking-in-the-hiv-infected-population-4wcnssxl5y.pdf

Cigarette Smoking in the HIV-Infected Population

HIV/AIDS: A Minority Health Issue

Socioeconomic Differences Among People with AIDS: Results from a Multistate Surveillance Project

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Socioeconomic Differences Among People with AIDS: Results from a Multistate Surveillance Project