Treatment Targets for People who Inject Drugs Will Fail without Focus on Privacy, Rights and Prisons

During the 25th International Harm Reduction Conference which was held in Canada this month, it was revealed that reaching certain HIV treatment targets is required in order to keep certain individuals out of prison.

Although HIV was discussed, there were other topics that were brought to light which took the attention away from the subject slightly. This included amphetamine-type substances and how they are used throughout the world, in addition to unsettling suicide rates by overdose in North America.

There are barriers that get in the way in regards to the treatment targets for HIV with patients who inject drugs into themselves, UNAIDS claim. There are programmes in Pakistan and Ukraine that promise to improve antiretroviral therapy (ART) and HIV testing facilities themselves for people that use drugs.

The Eastern Europe Show recently published data that showed there is work underway to improve HIV facilities for those who take drugs, as some shocking statistics emerged from a few locations around the world.

Only 9.7% of people living in St Petersburg, Russia who have HIV and are also using drugs, are getting access to effective antiretroviral treatment. For the same criteria, just 32% is the figure for those that are in Estonia. In addition to the low rates of HIV testing available to those with an addiction, low treatment is overly apparent too. It was revealed that for those with alcohol/drug problems, a larger injecting frequency and a lack of access to medical insurance, HIV care is almost non existent.

WHO is a company that approaches testing and treatment for HIV in a completely different way. They aim to intensify the efforts of HIV testing for different populations and especially where the risk of high levels of HIV-positive patients is high. This approach is set to improve HIV testing strategies where this is needed.

Annette Verster, who works for the company WHO, says that there are a number of limitations in regards to HIV testing and treatment for those individuals that are also using drugs. There are many more costs involved due to the need to register HIV sufferers who also use drugs on databases that have high privacy settings.

There are a number of ways to collect data about HIV testing/treatment for those who take drugs according to Verster. This includes surveillance, case studies, programmatic data but there are many limitations to these methods too. She said that the methods are too expensive, technically difficult to perform, they risk the safety of the individuals in question and they could also be unreliable due to lack of experience on the matter. The challenges associated with getting the testing and treatment for those on drugs with HIV could be compared to addicts that are incarcerated for criminal activity.

Despite this, Annette Verster also argues that despite possible limitations, a lack of data on such individuals should not be a reason not to develop HIV care as much as possible for everyone.

Daniel Wolfe, who is the Director of International Harm Reduction Development Program at the Open Society Foundations said there are certain things that need to be understood by all, in order to effectively tackle testing and treatment for those on drugs with HIV.

A big barrier in regards to access to important data is the high percentage of people with HIV that are in prison. UNAIDS have said that statistics show that between 50-90% of people who use drugs will be incarcerated at some point during their lifetime. Prison gives a big and sometimes permanent block between patients receiving the help that they need from health services and ART.

Being incarcerated can obviously be a long or short term thing but it is very rare for people who are in prison or even going through the trial process, to get access to opiate substitution treatment or other treatment services. Keeping to ART facilities is difficult even if people have been left out of prison because many of these individuals will get put back in again. For this reason, it is vital that improve the access to HIV treatment, keeping individuals out of incarceration should be a big priority.

During the session in question, the various presenters discussed all the barriers in the way of giving HIV sufferers the treatment they need and how to overcome this. The main problem came in the form of drug user registration and the privacy that is required. In regards to those who use drugs and also going through testing or treatment for HIV, their status is owned by both law enforcement agencies and the government and it has to be kept confidential. The registration of drug users on government databases remains to be a big issue and something that needs to be improved upon.

Opioid substitution therapy has much hostility surrounding it, in addition to lack of funding from essential sources. This needs to be changed in order to keep improving HIV care and ART uptake. For those who are on drugs and receiving antiretroviral treatment, better opioid substitution treatment is essential for sustaining patients. This is known to improve ART access although unfortunately, it’s shown that OST treatment for drug users is extremely low.

Although there are no doubt barriers for what has been discussed, there are efforts in many countries to bypass these and give all patients of HIV the necessary ART. Ukraine and Pakistan presenters talked about programes that are effective in helping drug users overcome their addiction, giving them other essential support and access to ART treatment.

Alliance for Public Health in Ukraine has actually developed a programe that tailors HIV testing services using peer networks. If tested positive, patients will go through ART access based on a peer-base case management system. The manager of the programe, Pavlo Smyrnov, says that it gives a big increase in detection of HIV patient and 50% increase in allowing new HIV patients the essential ART access. Finally to end the session in question, there was a short conclusion on how important ART and other services are vital for those with HIV who also use drugs.

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