Edward Suarez

People who inject drugs (PWID) living with HIV are less likely to receive care at early disease stages and have low rates of viral suppression. This study examined the feasibility and acceptability of rapid antiretroviral therapy (ART) initiation among PWID with HIV at a syringe services program (SSP) and assessed retention in care after transition to a traditional HIV clinic. A mixed-methods single-arm pilot study was conducted at an SSP in Miami, Florida. Participants with HIV viral load >200 copies/mL were immediately connected with an HIV care provider and received HIV care and peer navigation at the SSP for 6 months, then were transitioned to a traditional HIV clinic. Demographic data were abstracted from the SSP's administrative records. Laboratory assessments and qualitative interviews were conducted at 1, 3, 6, 9, and 12 months. Sixty-nine percent, 70%, and 69% of participants were virally suppressed (<200 copies/mL) at 1, 3, and 6 months, respectively. Following transition to a traditional HIV clinic, viral suppression remained high at 74% and 79% at 9 and 12 months, respectively. Themes were identified on: 1) barriers to care in traditional HIV clinics, 2) the SSP as a 'safe haven', 3) benefits of the rapid ART initiation program, 4) acceptability of telehealth, and 5) persistent barriers to engaging in HIV care. Rapid ART initiation for PWID at an SSP was acceptable and feasible and showed preliminary effectiveness in achieving HIV viral suppression and sustaining it after transition to a traditional HIV clinic.

Peripregnant women who use drugs and are involved in the criminal legal system (CLS) face elevated risks of human immunodeficiency virus (HIV) acquisition due to overlapping vulnerabilities, including sexual violence, structural instability, and limited access to preventive healthcare. The unique needs of this population are routinely overlooked in both clinical practice and research. This qualitative study explores peripregnant women's perspectives on HIV risk, attitudes toward pre-exposure prophylaxis (PrEP), and opportunities for PrEP programming in jail settings and during pregnancy.
We conducted semi-structured qualitative interviews with 27 women in Miami-Dade County who met the following criteria: (1) peripregnancy experience, (2) history of drug use and CLS involvement, and (3) HIV-negative status. Participants were recruited through community-based outreach. Data collection was grounded in trauma-informed methods and community partnership. Data were transcribed and examined through a reflexive thematic analysis, employing a general inductive methodology. Coding was performed through an iterative process by an interdisciplinary team with diverse backgrounds.
There are five major themes: (1) perceptions of HIV risk and risk reduction strategies; (2) knowledge and attitudes toward PrEP; (3) preferences for PrEP delivery modalities; (4) PrEP programming in jail; and (5) perspectives on PrEP use during pregnancy. Women generally viewed PrEP positively, especially long-acting formulations like injectables and implantable devices (in development). However, they also expressed concerns about adherence, stigma, drug interactions, and fetal safety. Jail was identified as a key site for intervention, though participants emphasized the need for confidentiality and robust education.
Findings underscore the urgency of designing patient-informed, context-responsive PrEP interventions that center the lived realities of CLS-involved peripregnant women who use drugs. Prioritizing long-acting PrEP options and integrating services into jail and community-based settings rooted in trauma-informed care and privacy protections can enhance uptake. These strategies are essential to reducing HIV incidence and advancing the goals of the Ending the HIV Epidemic (EHE) initiative.

Alcohol use disorder (AUD) is highly prevalent among people experiencing homelessness with an estimated 29 %–63 % impacted by this disease. As the effects of alcohol further perpetuate cycles of homelessness, treatment of AUD among this population is an important area of research. Although treatment facilities and outpatient services exist, many unhoused individuals underutilize or lack engagement with these programs. To date, only a few studies have explored the lived experiences of individuals navigating pathways toward treatment for AUD from the streets. Therefore, a patient-centered understanding through the lens of individuals with lived experiences may help those embedded within addiction treatment networks better engage and care for people experiencing homelessness. This study consisted of in-depth semi-structured interviews with people experiencing homelessness being treated at a residential treatment facility for AUD (N = 19). Thematic analysis was used to understand their perspectives regarding the intricacies of navigating into a residential treatment facility for AUD from the streets. Interview transcripts were analyzed using Nvivo software, and an open codebook which guided the analysis. Frequently described barriers to AUD treatment initiation, navigation, and maintenance were compiled into themes such as, “alcohol as a method of escapism”, “burden of navigation lies on the participant”, and “gaps in knowledge and function of community resources.” Facilitators to AUD treatment included, “need for housing,” “linkage by good samaritans,” “internal faith,” and “being a role model and productive citizen.” Attitudes that influenced engagement within the treatment network included “self-efficacy,” “recognition of AUD risks,” and “medical mistrust.” This study unveiled perceived internal and external structural barriers and facilitators that guide AUD treatment initiation, navigation, and maintenance from the streets. More so, it generated common attitudes that facilitate various levels of engagement within the AUD treatment network among people experiencing homelessness. Through the generosity of participants in sharing their stories, this study can aid in informing the development and implementation of effective treatment models focused on guiding people experiencing homelessness toward treatment and recovery. •Underscore the lived experience of AUD and what navigation looks life from the perspective of unhoused individuals•This research underscores the complex and uncoordinated landscape of initiating and navigating alcohol treatment•Participants identified numerous barriers to treatment access, including gaps in knowledge of available community resources

Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP. Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy. Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]). Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care. KEY MESSAGES The Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program setting Using telehealth was associated with increased three-month buprenorphine retention Baseline stimulant use was negatively associated with three-month buprenorphine retention

We examined the unique and joint effects of ethnicity, gender, and age on cardiovascular and catecholamine responses to the anger recall interview, and beta(2)-adrenergic receptor density and function on peripheral blood mononuclear cells. Participants were 179 nonsmoking, normotensive men and women aged 18-49 years. All subjects showed similar blood pressure increases during the anger recall interview. Black men, however, showed the smallest increases in heart rate in conjunction with an attenuated peripheral vasodilatation. Black women and Whites showed similar increases in heart rate and peripheral vasodilatation. Increasing age was associated with greater norepinephrine increases to anger recall in Black males. Black men also exhibited higher epinephrine levels throughout the protocol, higher dissociation constant to (125)I-pindolol, and age-dependent increases in beta(2)-receptor density. Relative to Whites and Black females, arousal of negative affect in Black males led to a pattern of sympathetic nervous system activity that may help explain the higher prevalence of hypertension in this population.

Joint effects of the Type A behavior pattern and aerobic fitness were examined with regard to heart rate (HR) and blood pressure (BP) changes elicited by laboratory challenges. Sixty-one college students were classified as Type A or B using the Structured Interview (SI), and as physically fit or sedentary using selfreports of activity level and estimated VO 2 max values obtained on a step test. Subjects were challenged with the SI, presentation of a snake, mental arithmetic, a cold pressor task, and two competitive card games. Significant A-B differences were found only on the SI and the card games. During the SI: (a) As displayed significantly greater BP increases than Bs; (b) sedentary subjects showed greater BP increases than fit subjects; and (c) sedentary As revealed greater BP increases than either fit As, fit Bs, or sedentary Bs. In contrast, during the competitive games, physically fit As showed reliably greater BP increases than either sedentary As, sedentary Bs, or fit Bs. Since the physically fit subjects were almost exclusively varsity athletes and the sedentary subjects were college students who reported following a sedentary lifestyle, the differences between sedentary and fit groups may have been due to differences in aerobic fitness or to the improved ability of competitive athletes or those engaged in fitness training to match arousal level to task requirements.