{"id":264,"date":"2023-07-01T12:00:50","date_gmt":"2023-07-01T12:00:50","guid":{"rendered":"http:\/\/moomango.co.uk\/ttfa\/?page_id=264"},"modified":"2023-07-03T14:50:53","modified_gmt":"2023-07-03T14:50:53","slug":"3-drug-users-and-hiv-overview","status":"publish","type":"page","link":"https:\/\/i-base.info\/ttfa\/7-drug-users-and-hiv\/3-drug-users-and-hiv-overview\/","title":{"rendered":"7. 3 HIV and people who use drugs"},"content":{"rendered":"

\u201cAccess to HIV treatment should not be artificially restricted due to political or social constraints. Specifically there should be no categorical exclusion of injection drug users (IDUs) from any level of care. [Anyone] who meets eligibility criteria and wants treatment should receive it, including IDUs, sex workers and other populations.\u201d<\/strong> \u2013 WHO, 2004<\/p>\n

Injecting drug use as the main route of HIV transmission<\/h2>\n

In many countries, injecting drug use is still linked to the majority of new HIV infections.<\/strong><\/p>\n

These include: Russia, Ukraine, Central Asia, some countries in Eastern Europe, South East Asia, North Africa, Iran, Afghanistan, Pakistan, Nepal, Indonesia, Portugal and the Southern Cone of Latin America. In addition, drug use can also lower inhibitions and increase the risk of sexually transmitted HIV.<\/p>\n

People at risk of becoming HIV positive through injection drug use are often among vulnerable or disadvantaged\u00a0sections of society. People who inject drugs are already often socially marginalised and stigmatised by being\u00a0from ethnic minorities, or from being unemployed, homeless, youth, migrants or sex workers.<\/p>\n

Globally, an estimated 1.4 million people who inject drugs are also living with HIV. Approximately 1 in 10 new infections each year are linked to injecting drug use.<\/p>\n

Hepatitis C virus (HCV), which is bloodbourne, is a common coinfection among people who acquired HIV from injection drug use; globally, an estimated 72% have been infected with HCV. HIV\/HCV coinfection is also more prevalent among gay and bisexual men, prisoners and female sex workers.<\/p>\n

Recreational drugs and interactions with ART<\/h2>\n

Although there are potential interactions between <\/strong>illicit<\/strong> drugs, <\/strong>opioid agonist<\/strong> therapies<\/strong> and some HIV drugs, there is limited research on these interactions.<\/strong><\/p>\n

This is also complicated because street drugs can be cut with other chemicals. Increasingly, drugs are being contaminated with different substances, such as xylazine (“tranq”; a veterinary tranquiliser that causes skin ulcers and abscesses), and fentanyl, \u00a0Isotonitazenean, and other very potent synthetic opioids which have led to unintentional overdose.<\/p>\n

Although this was initially reported in North America, contaminated drugs have also been found in Asia, Europe, and Oceana.<\/p>\n

This is also complicated because street drugs can be cut with other chemicals.<\/p>\n

Despite the potential for drug interactions, these are mainly with earlier and less-used HIV drugs. Modern ART using integrase inhibitors plus two NRTIs is unlikely to have these interactions.<\/p>\n

The free online Liverpool HIV Drug Interaction checker has the most detailed information about likely interactions.
\nhiv-druginteractions.org\/checker<\/a><\/p>\n

People who use drugs are excluded from some ART programmes<\/h2>\n

In some countries, people who use drugs are routinely excluded from access to ART.<\/strong><\/p>\n

This is because of a false\u00a0belief that they are less likely to take ART\u00a0and less likely to have a good response.\u00a0But there is ample evidence that this is not the case. Nonetheless, some doctors still believe that ART should be withheld from people who use drugs.<\/span><\/p>\n

Not providing ART to people who inject drugs sometimes includes those on medically prescribed opioid agonist therapy, such as methadone or buprenorphine. It can also include people who used drugs in the past.<\/p>\n

Why it is essential for people who use drugs to access ART<\/h2>\n

In the past, some doctors thought that people who use drugs would forget to take HIV medicines. This belief that it was okay to withhold treatment was based on prejudice rather than science. <\/strong><\/p>\n

Although there is ample evidence that people who use and inject drugs can adhere and respond well to ART, some doctors are reluctant to provide it. Asking for a referral from other people who use drugs who have a good relationship with their GP is a way to avoid this.<\/p>\n

Several studies suggest that people who use drugs can achieve high levels of adherence and that they benefit from ART just like other people with HIV. This is especially when ART is given with adherence, social and medical support.<\/p>\n

Numerous studies have confirmed that adherence to ART is similar among \u00a0people who use and inject drugs and people who do not.<\/p>\n