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This paper describes a case study of an Outreach and Drop-in Centre (ODIC) established under the National Action Plan for Drug Demand Reduction, Ministry of Social Justice and Empowerment, Government of India. In the quantitative part, data were gathered from the ODIC office documents and analysed using MS Excel. Linear regression analysis demonstrated a relationship between the number of in-centre clients and the number of Community Outreach Programmes (COPs). Similarly, this study examined the relationship between the number of networks established and the number of participants in COPs. Hence, two regression lines were derived accordingly. In addition, qualitative data collected through key informant interviews corroborated the quantitative results. This case study highlights the importance of networks and COPs in increasing the reach of ODIC and ensuring the quality of services. Finally, in partnership with other government agencies, this ODIC sets a model for engaging marginalised adolescents in reducing substance abuse.

Introduction: Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths’ knowledge and efficacy to access and subsequently use drop-in center services. Methods: 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). Results: The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. Conclusions: The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths’ knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

Inddragelse af borgerne i udviklingen af vores velfæ rdsindsatser er i dag en central væ rdi og tilgang i den offentlige sektors styringsform. Fra et borgerperspektiv udfolder denne artikel inddragelse som fæ nomen i samskabelsesprocesser med udsatte borgere på det sociale område. Med dette perspektiv bidrager artiklen til den eksisterende litteratur med en nuanceret forståelse af borgerinddragelse ud fra et bottum-up-perspektiv. Ud fra en teoretisk inddragelsestypologi tages der empirisk afsæ t i tre cases på sociale væ resteder, der repræ senterer tre inddragelsesformer, hvor borgernes grad af involvering og roller varierer. Analysen identificerer inddragelse ud fra borgenes perspektiv som: Indflydelse, social deltagelse og praktisk inddragelse. Disse tre dimensioner beskriver og kendetegner brugernes oplevelser, samt hvad de får ud af at deltage. Analysen peger på, at det ikke er inddragelsesformen, der har størst betydning, men derimod brugernes udsatte position, som afgør, hvorvidt de oplever og væ gter at få indflydelse, udvikle sociale relationer eller udføre praktiske opgaver og udvikle praktiske kompetencer. Afslutningsvist diskuteres det, hvorledes en forståelse for borgernes udsathed og anvendelse af deres perspektiver i socialt arbejdes praksis fremadrettet kan bidrage til en differentieret form for inddragelse, der på sigt i højere grad kan inkludere udsatte borgere i udviklingen af sociale indsatser samt i samskabelses- og netvæ rkssamfundet.

Current research on sexual minority youth tends to be concentrated in the fields of public health, social work, and psychology with a focus on psycho-social health risks that often rely on sexuality as a fixed unit of analysis. A sociological understanding of the processes that drive an individual to identify as gay in the first place makes an important contribution to this existing body of literature, allowing an opportunity to understand not just how sexual minority youth are vulnerable, but why. Drawing on my ethnographic research with adolescent males who frequent a lesbian, gay, bisexual, and transgender youth drop-in center, I demonstrate how sexuality gets constructed through four processes: violating compulsory heterosexuality, seeking an explanation, exploring sexuality, and negotiating identity. I will show how individuals make meaning of their sexual selves within the context of a patriarchal, heteronormative structural system, where symbols of homophobia and masculinity inform their identity development, and how that reiterates heteronormative development. I conclude by drawing attention to how the shifting boundaries of queerness should inform efforts to improve conditions for sexual minority youth and inform future research.

Pre-exposure prophylaxis (PrEP) uptake remains woefully low among U.S. women at high risk for HIV acquisition. We evaluated a pilot intervention which involved Peers providing brief PrEP education and counseling at mobile syringe exchange sites and at sex worker and syringe exchange drop-in centers followed by navigation to PrEP care. Peers recruited English-proficient, self-identified women (i.e., cisgender and transgender women and persons with other transfeminine identities) over a 3-month period and delivered the intervention to 52 HIV-negative/status unknown participants. Thirty-eight participants (73.1%) reported PrEP interest, 27 (51.9%) accepted the offer of a PrEP appointment, 13 (25.0%) scheduled a PrEP appointment, 3 (5.8%) attended an initial PrEP appointment, and none were prescribed PrEP. We found a gap between PrEP interest and connecting women to PrEP care. Further study is needed to understand this gap, including exploring innovative approaches to delivering PrEP care to women at highest risk for HIV.

Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation. A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to have a validated rapid antibody assay for immunoglobulins M (IgM) and G (IgG) and to answer a questionnaire on medical health conditions, comorbidities, and previous COVID-19 symptoms. Information on their housing conditions since the COVID-19 crisis was also collected from the participants. From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. The overall seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3-7.0), ranging from 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P = 0.009). Around one third of the seropositive participants reported COVID-19 symptoms. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced a significantly increased risk of SARS-CoV-2 infection (|z| = 3.65 > 1.96). These findings highlight the need for regular screening among the homeless to prevent clustering in overcrowded or inadequate accommodations. It is also necessary to provide essential resources to keep homeless people healthy, the vast majority of whom have cumulative risk factors for SARS-CoV-2 infection.

Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. In 2023, an estimated 2.7 million cases of TB were undiagnosed or unreported. To address missing cases, the World Health Organization recommends systematic screening for TB. This is synonymous to active case finding (ACF) and involves provider-initiated screening and testing for TB. Despite the high incidence and prevalence of TB among people who use drugs (PWUD), there is a significant gap in data, on their perspectives, regarding the implementation of TB ACF services. This study aimed to explore facilitators and barriers to implementing peer-led TB ACF, as perceived by both, current and potential service users. We conducted in-depth interviews among purposively selected adult PWUD in Dar-es-Salaam region, Tanzania. Study participants included: (1) peer PWUD with prior history of illicit drug use and medication-assisted treatment (MAT) (n = 10), (2) current medication-assisted treatment service users receiving clinic-based daily methadone (n = 8), and (3) community PWUD not on MAT recruited from various community locations (n = 4). All peer PWUD were experienced in TB ACF. Thematic content analysis was utilized with the support of NVivo12. Our findings are presented into two categories: individual and structural, with three main themes pertaining to peer-led TB ACF: (1) facilitators (2) facilitators for targeted improvement and optimization and (3) barriers. A critical facilitator was the acceptability of peer PWUD in providing TB ACF services. Key facilitators for targeted improvement and optimization included the TB screening tool, mobile TB diagnostic services, integrated methadone/TB services, and monetary incentives to peer PWUD. Barriers included inadequate adherence to infection prevention and control (IPC) measures when providing TB ACF services resulting in a reluctance to wear face masks due to stigma, misconceptions that prior TB preventive therapy among peers negates their need for continued IPC adherence, high mobility of PWUD and the fear of withdrawal symptoms associated with the use of anti-TB medication. Due to this fear, many PWUD preferred not to take anti-TB, as they were concerned about the potential severity of withdrawal symptoms. Our findings highlight the crucial role of peer-led approaches in enhancing TB ACF among PWUD. Peer acceptance as service providers highlights the potential of community-driven interventions. Strengthening facilitators and addressing challenges is key to optimizing these services. Future research should explore the feasibility of providing peer-supported TB diagnosis and treatment services at friendly drop-in centers. 1. Strengthen mobile diagnostic services by increasing their frequency and coverage, enabling timely diagnosis and treatment. 2. Enhance the TB symptom screening tool by including a symptom-independent test, such as a chest X-ray, as the symptoms of illicit drug use can mask and mimic TB symptoms making diagnosis challenging. 3. Address stigma and misconceptions through peer-led education and awareness campaigns that utilize audio-visual materials tailored to PWUD. This will promote adherence to IPC measures and create a more supportive environment for TB ACF activities. 4. Use anti-TB with minimal interactions with opiates or shorter TB treatment regimens to prevent withdrawal symptoms and improve adherence.

Homeless youth have extremely high rates of suicidal ideation and attempts, but limited research has evaluated the efficacy of suicide prevention interventions. Suicidal homeless youth (N = 150) between the ages of 18 to 24 years were recruited from a local drop-in center. Of interest was (1) whether the proposed sample of eligible youth could be identified, (2) whether youth could be engaged and retained in the prevention intervention, and (3) whether the intervention was associated with reduced suicidal ideation, our primary outcome measure. In particular, youth were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) (N = 75) or TAU alone (N = 75). Findings showed that the proposed sample of eligible youth could be identified and engaged in the study, and all youth showed a significant decline in suicidal ideation over time, with a faster decline among youth assigned to CTSP. These findings suggest that (1) at-risk suicidal youth can be identified and engaged outside of hospital emergency rooms, such as in drop-in centers, and (2) intervention added to TAU can strengthen reductions in suicidal ideation. Ultimately, attention towards reducing suicide risk among these youth has the potential to reduce premature mortality, hospitalization and loss of human capital.

Long-acting injectable cabotegravir (CAB-LA) is in advanced stages of clinical trials. Under the standard protocol, CAB-LA is injected into the gluteal muscle by a healthcare provider every eight weeks. To explore transgender women’s barriers and facilitators to tailored delivery strategies—including self-injection and injection in “drop-in” centers—we completed in-depth interviews with N = 15 transgender women in New York City. Participants endorsed the alternative delivery methods and the corresponding features we proposed, and expressed likes and dislikes about each. These fell into the following categories: competence (e.g., the person delivering CAB-LA must have skills to do so), convenience (e.g., CAB-LA must be easy to obtain), and privacy or fear of judgement (e.g., participants did not want to feel judged for using CAB-LA by providers or other service consumers). Findings suggest the need to offer CAB-LA to transgender women through multiple delivery protocols.

In the United States, up to 70% of youth experiencing homelessness smoke cigarettes. Many are interested in quitting; however, little is known about psychosocial factors influencing smoking relapse in this population. This study, part of a larger project to develop an optimized smoking cessation intervention for youth experiencing homelessness, aimed to describe how psychosocial factors influence smoking relapse in this group. This study describes the smoking relapse experiences of 26 youth tobacco users, aged 14-24 years, who were recruited from a homeless drop-in center in Ohio. We conducted semi-structured interviews to understand how stress, opportunity, and coping contribute to smoking relapse. Five themes emerged from the data: (1) smoking as a lapse in emotional self-regulation in response to stress; (2) smoking as active emotional self-regulation in response to stress; (3) social opportunities facilitate smoking in the context of emotion-focused stress coping; (4) problem-focused stress coping; and (5) opportunity facilitates smoking relapse. Stress was a primary driver of smoking relapse among youth experiencing homelessness, yet social and environmental opportunities to smoke also precipitated relapse. Interventions to improve abstinence among this population should target foundational stressors, coping skills, social supports, and nicotine dependence.