“In their perception we are addicts”: Social vulnerabilities and sources of support for men released from drug treatment centers in Vietnam

Abstract

Background Amid the global transition to treat opioid addiction as an illness, many people who inject drugs (PWID) face heterogeneous legal environments that include both punitive and harm reduction measures. In Vietnam, many PWID, who have a high burden of HIV, are sent to drug treatment centers, or “06 centers”, for compulsory detoxification, vocational training, and labor for up to four years. This study investigates the challenges and facilitators of reentry into community and family life among men who are released from “06 centers” and provides insights and recommendations for developing policies and interventions that address special needs of this vulnerable population. Methods In-depth interviews were conducted in 2011 by trained interviewers among a sample of 43 male PWID released within the past 2 years from “06 centers” in Hanoi, Vietnam to investigate the above issues and to recommend potential interventions. Participants were recruited from outpatient HIV clinics that serve PWID (n=22) and through peer referral from self-help groups for PWID (n=21). Interviews were audiotaped, transcribed, translated, entered into Atlas. TI qualitative data analysis software and analyzed for key themes. Results The interviews revealed persistent drug-related stigmatization, frequently paired with HIV-related stigmatization and discrimination, which hindered employment, increased participants’ social isolation and exacerbated their struggles with addiction. Families were participants’ primary source of financial, employment, and emotional support, but addiction-related family tensions also had negative psychological effects. Participants identified methadone maintenance treatment as an effective means of overcoming addiction, yet few could fully benefit from this treatment due to its limited availability. Conclusion Our study suggests that PWID released from “06 centers” would greatly benefit from the scale-up of community-based harm reduction measures that include addiction and HIV treatment, coupled with employment-support and family-centered mental health services.

Co-calibration of two self-reported measures of adherence to antiretroviral therapy

“…The first source is data from five studies within the Seek Test Treat and Retain (STTR) consortium funded by the National Institute of Drug Abuse(Chandler et al, 2015). The 5 studies included in these analyses were selected based on simultaneous collection of both adherence measures (described below) and were grouped into categories based on their study populations: criminal justice (CJ) (Carda-Auten et al, 2014; Gordon, Kinlock, McKenzie, Wilson, & Rich, 2013), international (Tomori et al, 2014; Wechsberg et al, 2014), or other vulnerable populations (VP) (Glenn et al, In press ). The second data source is the University of Washington site of the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS)(Kitahata et al, 2008) cohort, a longitudinal observational study of PLWH in primary care.…”

Prevalence and correlates of psychological distress among drug users in Phnom Penh, Cambodia

“…In addition, strengthening the collaboration between mental health outreach teams and police departments (Girard et al, 2014) can mitigate some systemic and structural factors that cause or exacerbate mental distress such as frequent arrests and incarceration. The long-term goal should be to move from institutional to family-centered and community-based mental health services (Tomori et al, 2014), and in this context, outside of rehabilitation centers. Our findings demonstrate a clear link between past treatment at rehabilitation centers and higher levels of psychological distress.…”

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“…Social and family support are very important for drug addicts to achieve abstinence from opioid addiction. It was reported that patients who had relatives on methadone treatment had a higher retention rate, thus indicating that family ties have a huge influence on individuals' drug use behaviors 27 . The MMT program in CCSC incorporated psychosocial interventions such as group and family counseling to improve the retention rate among opioid abusers.…”