Treatment and Care for Injecting Drug Users

HIV positive Injecting Drug Users: The Unpopular Customers of Health Services

Dave Burrows talked about the double stigma of HIV and IDU faced by HIV positive IDUs, they were often seen as the "unpopular customers of health services". They often faced an increased sense of frustration, rejection and hopelessness and health services felt challenged by the illegality of injecting drug use if HIV positive IDU were admitted to hospitals and hospices.There is an estimated 15 and 20 million IDUs in the world today and approximately one to two million of them are HIV positive These HIV positive IDUs often face the additional problems of inadequate pain management, a higher level of weight loss and wasting, higher risk of TB and a greater risk of a wide range of infections. However the limited amount of research involving HIV positive IDU does not generally show any difference in HIV disease progression between HIV positive IDU and non-IDU PLWHA.Burrows believed that a specific continuum of care from new and current health services is needed to provide effective care to HIV positive IDU that is accessible, adapted to HIV positive IDU and includes attitudinal training for health workers and addresses the specific needs of HIV positive women. Three other speakers that gave examples of specific programs that are providing care to IDUs.

Kwong Lew of Malaysian Care told of how their program provided rehabilitation care to only three HIV positive IDU clients out of a total of 86 in 1989, compared to 33 HIV positive IDU clients out of 170 in the year 2000. They found that the involvement of PLWHA altered the dynamics of their church funded program, including creating practical problems, such as HIV positive clients having difficulty in complying with strict time and activity regimes. Suresh Kumar from the Sahai Trust in Chennai, India told of their Buprenorphine sublingual substitution program, which was commenced as a pilot project in New Delhi in 1993 and now includes seven NGOs in five cities, dealing with over 6,000 IDU clients. Suresh pointed out that the program faced ongoing challenges of sustainability with the cost of the program equalling one Australian dollar per day per client, with little government support. However some great outcomes have been seen among the clients in the Madras arm of the program, including reduced criminal behaviour, reduced illicit drug use, reduced HIV-related risk behaviour and increased occupational functioning.

Savita Luka Masih of Sharan of India, which is an organisation committed to helping the urban poor, provided an excellent example of a comprehensive holistic care program for IDU, including HIV positive IDU. The program includes employing peer workers. Two case studies were included in the talk, which displayed the difficulties in providing care to HIV positive IDU in a resource poor setting.