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The high and persistent unemployment rates of people with intellectual disabilities (PwID) reveal the wide gap that still remains to be bridged. Entrepreneurship combinedly with a high enterprising tendency could improve PwID's life satisfaction.

A mixed-method approach was used, based on questionnaires and structured face-to-face interviews on 37 PwID who had recently become entrepreneurs. Data were firstly quantitatively analyzed using partial least squares-structural equation modelling (PLS-SEM), and qualitative data were used to enable robust findings.

The entrepreneurial tendency of PwID who had recently become entrepreneurs was found to be a positive to their life quality (LQ), job satisfaction and life satisfaction.

This study revealed that entrepreneurship among PwID who had high enterprising tendency enhances their LQ, job satisfaction and life satisfaction. However, further research could evaluate whether becoming an entrepreneur is in itself enough to change PwID's life to better, such that a comparison could be done between PwID who become entrepreneurs and PwID who have a salaried job.

New aspects in the design of public social policies to improve PwID's life satisfaction are suggested. These include the facilitation of both entrepreneurship and enterprising tendency for PwID to enhance their life satisfaction.

There are very few occasions in which PwID set up businesses. This is one of the first studies to analyze the benefit of entrepreneurship and enterprising tendency on the LQ, the satisfaction at work and the life satisfaction of PwID.

This research aims to present the results of a study that operationalizes the construct of perceived work identity deprivation (PWID) and examines its validity.

The authors adopted a mixed method design in this study where a Likert-type scale to measure PWID was developed based on the interviews of 40 workers and the questionnaires of 625 participants successively. Later, the generalizability of the scale was tested through quantitative data from 412 workers. Finally, validity analysis was conducted based on 380 usable questionnaires. Data were analyzed using IBM SPSS 24 and Mplus 7.0.

The findings of the study indicate that the reliability measures, exploratory factor analyses, confirmatory factor analysis and subsequent convergent and discriminant validity tests support the PWID scale. The nomological validity of PWID is also presented, which demonstrates its predictive validity.

Despite highlighting the importance of work identity, prior research lacked to provide empirical foundations to understand this perception. This study fills this gap in the literature by providing a measure of PWID, distinguishing it from similar constructs and establishing convergent, discriminant and nomological validity. Moreover, by extending the range of theoretical and measurable deprivation of work identity, the authors hope to allow research to take into account a more complete picture of it. PWID scale can be used to develop more relevant suppression plans.

The COVID-19 outbreak has profoundly plagued the world, and current health efforts are focused on providing prevention and ensuring access to intensive services for people with the most severe symptomatology. Many reports have already described substantial psychological distress in the general population. Nevertheless, disasters tend to affect vulnerable subjects disproportionately, and individuals with intellectual disabilities/autism spectrum disorder with high and very high support needs (PwID/ASD-HSN) seem to be counted among the hardest hit populations. The present paper aims to provide a comprehensive discussion and evaluation of COVID-19 related issues specific to PwID/ASD-HSN.

Commentary on available literature and analysis of new preliminary data on PwID/ASD-HSN’s physical and psychic vulnerability factors. This knowledge is fundamental to provide families and caregivers special advice to counteract the risks associated with the current pandemic.

PwID/ASD-HSN represent one of the most vulnerable population to the COVID-19 outbreak and the associated factors of mental distress for several reasons, including multimorbidity, low levels of health literacy, difficulties to understand and communicate, reliance on other people for care, low compliance with complex hygiene rules, the strong need of routine/sameness and low adaptive skills.

In the present work, the authors analyze the specific factors of physical and mental vulnerability in PwID/ASD-HSN, corroborating the dissertation with a discussion on the first data published worldwide and with preliminary data collected on the Italian territory for what concerns prevalence rates of COVID-19 and complications in persons with PwID/ASD-HSN and signs and symptoms of psychic distress during the mass quarantine period.

Within-prison drug injection (WPDI) is a particularly high HIV risk behavior, yet has not been examined in Central Asia. A unique opportunity in Kyrgyzstan where both methadone maintenance treatment (MMT) and needle-syringe programs (NSP) exist allowed further inquiry into this high risk environment. The paper aims to discuss these issues.

A randomly selected, nationally representative sample of prisoners within six months of release in Kyrgyzstan completed biobehavioral surveys. Inquiry about drug injection focused on three time periods (lifetime, 30 days before incarceration and during incarceration). The authors performed bivariate and multivariable generalized linear modeling with quasi-binomial distribution and logit link to determine the independent correlates of current WPDI.

Of 368 prisoners (13 percent women), 109 (35 percent) had ever injected drugs, with most (86 percent) reporting WPDI. Among those reporting WPDI, 34.8 percent had initiated drug injection within prison. Despite nearly all (95 percent) drug injectors having initiated MMT previously, current MMT use was low with coverage only reaching 11 percent of drug injectors. Two factors were independently correlated with WPDI: drug injection in the 30 days before the current incarceration (AOR=12.6; 95%CI=3.3-48.9) and having hepatitis C infection (AOR: 10.1; 95%CI=2.5-41.0).

This study is the only examination of WPDI from a nationally representative survey of prisoners where both MMT and NSP are available in prisons and in a region where HIV incidence and mortality are increasing. WPDI levels were extraordinarily high in the presence of low uptake of prison-based MMT. Interventions that effectively scale-up MMT are urgently required as well as an investigation of the environmental factors that contribute to the interplay between MMT and WPDI.

The purpose of this study is to explore the contextual determinants of HIV risk among people who inject drugs (PWID) in public settings in Nigeria.

In-depth, individual interviews were conducted with 29 street-based PWID recruited through snowball sampling in Uyo, Nigeria. Interviews were tape-recorded, transcribed, coded and analysed hematically.

Homelessness and withdrawal pains encouraged consumption of drugs in public spaces (e.g. bunks, public parks). Conversely, the benefits of participation in street drug-use scenes, including reciprocity norms that guarantee free drugs during withdrawal and protection during overdose, fostered a preference for public injecting. Although participants recognized the need to inject with sterile syringes, scarcity of syringes compelled them to improvise with old syringes or share syringes, increasing risk for HIV transmission. HIV risk was exacerbated by unlawful and discriminatory policing practices, which deterred possession of syringes and encouraged risky behaviours such as rushing injection and sharing of equipment.

Contextual factors are key determinants of HIV risk for street-based PWID. Implementation of needle and syringe programmes as well as reforming legal frameworks and policing practices to support harm reduction are needed responses.

This is one of very few qualitative studies that explore risk factors for HIV transmission among PWID in West Africa. The focus on scarcity of sterile syringes and HIV risk is unique and has important policy implications.

The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID).

A review of the literature was conducted, followed by a discussion.

No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ.

Research is needed to further current understanding of these issues.

An awareness of these issues amongst practitioners and other key members of a PWID’s system is important.

This is the first review and commentary on these issues.

Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue.

The authors reviewed the literature on compulsory drug treatment in seven Asian countries.

The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates.

The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease.

Many countries are spending vast amounts of funding on ineffective treatments for drug users.

Funding should be directed to community-based drug treatments that have been shown to work.

This is the largest review of compulsory treatment of drug users to date.

The diagnosis and management of cancer in people with intellectual disabilities (PWIDs) are fraught with difficulties. The purpose of this paper is to present a case study to highlight these difficulties.

The present case analysis describes the presentation of a 56-year-old man with a profound intellectual disability, who developed recurrent chest infections and died as a result of obstructive pneumonitis.

Despite a presentation over several years and numerous chest X-rays demonstrating a consistent lung abnormality, it was only on postmortem examination that a right-sided lung carcinoma was detected.

The papers have provided an update on the topic in light of recent legislations and management strategies which need to be applied to clinical practice if any improvement is to happen in the care of PWID.

Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues.

The authors compared yield and costs of routine and targeted screening in a narcotic prison in Indonesia. Routine HIV screening was done for all incoming prisoners from August 2007-February 2009, after it was switched for budgetary reasons to targeted (“opt-out”) HIV screening of inmates classified as people who inject drugs (PWIDs), and “opt-in” HIV testing for all non-PWIDs.

During routine screening 662 inmates were included. All 115 PWIDs and 93.2 percent of non-PWIDs agreed to be tested, 37.4 percent and 0.4 percent respectively were HIV-positive. During targeted screening (March 2009-October 2010), of 888 inmates who entered prison, 107 reported injecting drug use and were offered HIV testing, of whom 31 (29 percent) chose not to be tested and 25.0 percent of those tested were HIV-positive. Of 781 non-PWIDs, 187 (24 percent) came for testing (opt-in), and 2.1 percent were infected. During targeted screening fewer people admitted drug use (12.0 vs 17.4 percent). Routine screening yielded twice as many HIV-infected subjects (45 vs 23). The estimated cost per detected HIV infection was 338 USD for routine and 263 USD for targeted screening.

In a resource limited setting like Indonesia, routine HIV screening in prison is feasible and more effective than targeted screening, which may be stigmatizing. HIV infections that remain unrecognized can fuel ongoing transmission in prison and lead to unnecessary disease progression and deaths.

People with an intellectual disability are much more likely to be sexually violated and the violation is less likely to be reported. Despite this being high-lighted at least 3 decades ago and improvements in both safeguarding and national reporting processes, under-reporting remains a problem. This paper explored under-reporting alongside prevention possibilities using safeguarding alerts raised in a Community Learning Disability Team within a UK NHS trust.

Using a combination of authentic but anonymised case vignettes and descriptive data drawn from the safeguarding team, under-reporting was examined through the lens of an ecological model. Safeguarding alerts raised in a particular year were compared with the number expected if all (estimated) cases of abuse were disclosed and reported.

Only 4.4 per cent of expected abuse cases were reported to the team, which is lower than the reporting level the authors had expected from the literature. There is evidence in the literature of the under-reporting of sexual assault for all kinds of people. Arguably, the implications of under-reporting for PwID are even more traumatic.

Constraints included the lack of standardisation in data collection within the statutory services that report to the Birmingham Safeguarding Adults Board. One key recommendation is that the national provider of data for the NHS in the UK requires more complex and standardised audit information that would allow each local authority to benchmark their practice against a higher protection standard. Another recommendation is that compliance to quality standards sits within a comprehensive strategy.

This paper explored the extent to which the previously documented under-reporting concern remains an issue. Certainly eye-balling safeguarding compliance data in the NHS organisation we worked in led us to a concern that reporting might be even lower than implied in the literature. This together with a renewed spot-light on sexual violence (e.g, NHS England, 2018) led us to decide that it was timely to re-examine the problem.