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The Paradigm of Universal Access to HIV-Treatment and Human Rights Violation: How Do We Treat HIV-Positive People Who Use Drugs?

  • The Science of Prevention (SC Kalichman, Section Editor)
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Abstract

HIV-positive people who use drugs (PWUDs) are particularly vulnerable for suboptimal access to highly active antiretroviral therapy (HAART). We conducted a systematic review to identify factors associated with suboptimal HAART access among this population. Studies evaluating HAART access among active PWUDs as a primary outcome, presenting multivariate analysis and conducted after January 1997 were included. Of 122 studies matching the search criteria, only 14 (11.4 %) met the inclusion criteria. All selected studies were prospective cohorts and included young adults, 13 were conducted in North America or western Europe and one in Ukraine. Selected studies measured HAART access using different strategies, however, all identified PWUDs as less likely to receive HAART, when compared to those who never used drugs or former PWUDs. Additional factors associated with suboptimal HAART access include: recent incarceration, lack of health insurance, unstable housing, depression, non-white ethnicity, female PWUDs, and health professionals stigma/prejudice. Factors associated with higher rates of HIV-treatment access included: alcohol and/or drug addiction treatment (especially methadone maintenance therapy), regular source of primary care, treatment and care from the same provider (most of the time) and larger physician experience in HIV-management. PWUDs face a synergy of social and structural factors that influence their suboptimal access to HAART, struggling with poor living conditions, inadequate access to specialized care and stigma/discrimination from health professionals. Renewed strategies and effective interventions should be developed and scaled-up, in order to assure equitable HAART access, decrease morbidity and mortality among PWUDs.

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Compliance with Ethics Guidelines

Conflict of Interest

Michelle Ralil da Costa declare that she has no conflict of interest.

Francisco Inácio Bastos has received travel/accommodations expenses covered or reimbursed as a reserach for Imperial College, UK (May-July 2013), sponsored by Brazilian agency for postgraduate studies (CAPES). Monica Malta received support from CAPES (grant 0060/2013) and CNPq (PAPES VI, grant 407780/2012-2).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Social Science Department, ENSP/FIOCRUZ, Rio de Janeiro, Brazil

    Monica Malta

  2. Belo Horizonte Observatory for Urban Health, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Michelle Ralil da Costa

  3. Health Information Department, ICICT/FIOCRUZ, Rio de Janeiro, Brazil

    Francisco Inácio Bastos

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  1. Monica Malta
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  2. Michelle Ralil da Costa
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  3. Francisco Inácio Bastos
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Correspondence to Monica Malta.

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Malta, M., Ralil da Costa, M. & Bastos, F.I. The Paradigm of Universal Access to HIV-Treatment and Human Rights Violation: How Do We Treat HIV-Positive People Who Use Drugs?. Curr HIV/AIDS Rep 11, 52–62 (2014). https://doi.org/10.1007/s11904-013-0196-2

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  • DOI: https://doi.org/10.1007/s11904-013-0196-2

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