FACT SHEET
People who use drugs living with HIV and Viral Hepatitis Co-infection
BARRIERS • Punitive laws that criminalize people who use drugs create barriers between people and available services and supports by forcing people to conceal their use of drugs and related health concerns from providers. • Negative social attitudes regarding illegal drugs and people who use them prevent access to treatment, care and support. Racial discriminatory practices, including prejudices against cultural norms, often impede people from accessing treatment services. • A failure to maintain patient privacy protection exists for certain populations, causing reluctance to access treatment services. Some individuals are often put in the position where accessing treatment and services may come at the expense of having their confidentiality compromised. • A lack of specialized services, support, knowledge and expertise exists among service providers in Canadian prisons, as well as rural and remote areas, results in interruptions in treatment access, lowered adherence and poor treatment outcomes.
• Effective HIV medication management and care requires a certain level of readiness, will and commitment. Substantial and complex lifestyle changes are necessary to accommodate strict treatment requirements, making it difficult to adhere to treatment. • Experiencing increased rates of issues pertaining to mental health can result in negative and potentially damaging coping strategies, such as alcohol and drug abuse, which further deter individuals from seeking treatment and support services.
Proportion of positive HIV test reports among adult males and females (≥15 years), by exposure category, 2011 ADULT MALES
ADULT FEMALES
• Gender-based inequities limit to access health services, adhere to treatment, and manage overall health and well-being. Gender roles assigned to women, such as the primary caregiver role, perpetuates treatment access issues. • Violence against women who use drugs inhibits women from seeking health services and support tools, limits adherence to medications, as well as decreases women’s ability to escape violent and vulnerable relationships. • Poverty, low income, unemployment, homelessness and unstable housing are common among people living with HIV who use drugs, all which can impact treatment access through a general condition of vulnerability and hardship that does not allow for adequate disease management. • Low self-esteem, depression, post-traumatic stress symptoms and cognitive issues are common among people living with HIV and who use drugs, jeopardizing their ability to adhere to prescribed treatment or follow-up with providers on managing responsibilities of treatment and side-effects. • Continuing cuts to services pushes people to the margins of service provision and decreases available resources for managing HIV and co-infections. Funding cuts limit availability of harm reduction services that reflect best practices and available services and staff in hospital settings.
MSM 61.4%
Heterosexual contact 64.5%
MSM/IDU 2.3%
Other 4.2%
IDU 13.6%
IDU 29.9%
Blood/blood products 0.4%
Blood/blood products 1.4%
Heterosexual contact 20.5% Other 1.8% (Source: Public Health Agency of Canada, 2011)
• Culturally insensitive service provisions and negative treatment by service providers who dismiss traditional healing practices and marginalize people who use drugs inhibit access to holistic forms of treatment.
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TOOLS FOR ACTION • Advocate and support greater access to harm reduction and social support resources, such as peer-based mentoring services, that speak to the social realities of people who use drugs.
• Encourage involvement in research dialogue and study design. Ensure research on HIV among these groups of people employs the Greater Involvement of People Living with HIV and AIDS (GIPA) principles and is evidence-based.
• Offer culturally appropriate programming for Indigenous people who use drugs, incorporating peer-based approaches into programming that link Indigenous people with resources to address residential school and intergenerational trauma.
• Providers must increase their awareness of culturally competent care and support holistic forms of treatment, engage in meaningful dialogue with patients regarding psychosocial and medical factors and include patients in all aspects of decision making.
• Link people who use drugs with psycho-social support services and programs that are reflective of the needs of this particular population and foster compassionate and equitable treatment. • Involve people who use drugs living with HIV in designing services. Develop specific forums and spaces to engage people in dialogue regarding access barriers and programs for addressing them. • Provide a range of information on treatment options and support them through the decision making process around treatment regimens and treatment initiation. Linking people to the appropriate services and resources is essential. • Develop and provide adherence support programs that are reflective of the unique challenges facing this population, including support for managing side effects of treatment and complications associated with drug use. • Promote specialized co-infection services for people incarcerated in federal and regional prisons. Facilitate and help generate resources for legal support for such people facing criminal charges and legal complications. • Provide referrals to legal and social supports for people who experience violence or who are at risk of violence if you cannot provide them through your service centre. Provide additional support to ensure referral appointments are followed through. • Provide housing and shelter resources for those who require it and support initiatives promoting greater access to housing in your community.
• Health care institutions should adopt and comply with privacy and confidentiality policies that are routinely enforced, with evaluation and surveillance mechanisms set in place. • Strengthen social support networks and enhance community engagement to positively impact healthy coping mechanisms and strategies to help overcome the effects of stigma and discrimination. • Increase awareness and advocate for social change that foster gender-equitable and social determinants of health approaches. Treatments and programs need to be reflective of people’s living conditions and how it impacts their journey through the course of treatment.
Intersections of Stigma homelessness and unstable housing
involvment in commercial sex
mental health
race and culture
sexual preference
HIV and HIV/ Hepatitis C Co-infection
substance use
• Promote public health policies and programs that facilitate knowledge transfer and exchange among providers, policy researchers and other decision makers.
The Canadian Treatment Action Council is Canada’s national civil society organization led by and for people living with HIV and viral Hepatitis co-infection focusing on access to treatment, care and support. www.ctac.ca • www.facebook.com/CTAC.CCSAT • twitter.com/CTAC_CCSAT 555 Richmond St. W. Suite 612, Toronto, Ontario, M5V 3B1 • 1-877-237-2822
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