Paradoxes in antiretroviral treatment for injecting drug users: Access, adherence and structural barriers in Asia and the former Soviet Union

Human rights and access to hepatitis C treatment for people who inject drugs

“…Fear of discrimination within health settings, however, is cited by PWID as a primary deterrent to treatment seeking (ANPUD, 2011). For their part, providers of HIV and drug dependence treatment report skepticism about treating PWID whom they label ''untrustworthy,'' ''cunning,'' or for women who inject drugs, ''hysterical'' and ''unstable'' (Bobrova et al, 2006;Kirtadze et al, 2013;Wolfe, 2007). Another disabling form of stigma, common in both high-income countries and MICs, is the belief that referring PWID to treatment is futile, since they will not come OSF, 2015).…”

“…Experience with HIV demonstrates the degree to which treatment rationing is tied to medicine price, with cost containment masked as concern with patient adherence. When the price of combination HIV antiretroviral therapy (ART) exceeded US $10,000 per year, the head of the US Agency for International Development famously observed that ART would not be useful in Africa since Africans ''do not know what watches and clocks are'' (US House of Representatives, 2001), and treatment guidelines in multiple countries excluded PWID (Wolfe, 2007). The entry into the market of generic HIV medicines that reduced price to under US $1000 was accompanied by a commitment to universal access, and articulation of global treatment targets to measure progress (WHO, 2005).…”

“…Many countries, for example, require PWID to report their drug use to authorities, yet penalize those who do so with treatment exclusion. The names of PWID seeking health services in multiple countries of Eastern Europe, Central Asia and Southeast Asia are tracked in government registries shared by law or practice with police, with those registered subjected to body searches and urine testing (Csete & Wolfe, 2013;Rahman & Crofts, 2013;Wolfe, 2007). Registration can result in HCV treatment denial: a 2014 survey in Russia found that internal regulations prohibited treatment of PWID in all provinces surveyed on the grounds that they were ''socially unreliable'' (Bivol & Sarang, 2014).…”

Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand

“…Unfortunately, in many countries needle and syringe programs (NSP), including needle exchange, are politically unpopular and inaccessible for the majority of those who need it [3,4]. Relatively few countries make it a priority to ensure affordable and evidence-based treatment of drug dependence to all who need it [5]. …”

The Experience of Active Injection Drug Use on Adherence to Antiretroviral Treatment in Aboriginal People Living in Prince George - A Qualitative Perspective.

“…The provider based barriers to HAART adherence found in the literature describe that among healthcare providers, there is an underlying assumption that people who use injection drugs are not capable of achieving the high levels of adherence needed for viral suppression, and therefore clients should not be started on HAART until addiction issues are resolved (Wolfe, 2007;Strathdee et al, 1998;Celentano et al, 1998;Peretti-Watel et al, 2006). In a longitudinal study of 404 people who use injection drugs, Celentano and colleagues found that half of whom reported being actively involved in injection drug use -49% (199) of the HAART-eligible participants reported taking no antiretrovirals at all (1998).…”