Marziali Megan E, Kooij Katherine W, Martins Silvia S, Philbin Morgan M, Montaner Julio S G, Hogg Robert S
Mailman School of Public Health, Columbia University, New York, NY, USA.
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Can J Public Health. 2025 Mar 31. doi: 10.17269/s41997-025-01026-4.
The overdose and drug toxicity crisis continues to devastate communities across Canada. British Columbia has an overdose mortality rate nearly double the Canadian national average, emphasizing a dire need for proactive public health approaches. Within the general population, men experience higher overdose mortality rates in comparison to women; however, among people with HIV, the disparity is inverted such that women with HIV experience higher overdose mortality rates than men with HIV. Less is known concerning the epidemiology of nonfatal overdoses among people with HIV, and understanding gender disparities in nonfatal overdoses would allow public health practitioners and policymakers to focus evidence-informed interventions and clinical guidelines for people most in need. In this commentary, we propose that systemic and structural barriers function to hinder access to crucial services for women with HIV, thus placing them at a disproportionately high risk for nonfatal overdose. We argue that additional research is needed to understand how to completely address these barriers in order to create programmatic changes. Fatal overdoses are a failure of the healthcare system; intervening after the occurrence of a nonfatal overdose is crucial in order to prevent a subsequent fatal overdose.
药物过量和药物毒性危机继续肆虐加拿大各地的社区。不列颠哥伦比亚省的药物过量死亡率几乎是加拿大全国平均水平的两倍，这凸显了积极采取公共卫生措施的迫切需求。在普通人群中，男性的药物过量死亡率高于女性；然而，在艾滋病毒感染者中，这种差异却相反，即感染艾滋病毒的女性药物过量死亡率高于感染艾滋病毒的男性。关于艾滋病毒感染者中非致命药物过量的流行病学情况，人们了解得较少，而了解非致命药物过量中的性别差异将使公共卫生从业者和政策制定者能够针对最需要帮助的人群，集中开展基于证据的干预措施和临床指南。在本评论中，我们提出，系统性和结构性障碍阻碍了感染艾滋病毒的女性获得关键服务，从而使她们面临非致命药物过量的风险过高。我们认为，需要进行更多研究，以了解如何彻底消除这些障碍，从而实现方案变革。致命药物过量是医疗系统的失职；在非致命药物过量发生后进行干预对于预防随后的致命药物过量至关重要。
