Social and structural factors associated with HIV disease progression among illicit drug users

Abstract

Objective To systematically review factors associated with HIV disease progression among illicit drug users, focusing on exposures exogenous to individuals that likely shape access and adherence to HIV treatment. Design A systematic review of peer-reviewed English-language studies among HIV-seropositive illicit drug users with at least one of these endpoint of interest: a diagnosis of AIDS; death; changes/differences in CD4 cell counts; or changes/differences in plasma HIV-1 RNA levels. Methods Articles were included if they reported factors associated with an outcome of interest among a group of illicit drug users. Studies were identified, screened and selected using systematic methods. Results Of 2,668 studies matching the search criteria, 58 (2%) met the inclusion criteria, all but one from North America or Western Europe. Overall, 41 (71%) studies contained significant individual-level clinical characteristics or behaviours (e.g., illicit drug use) associated with disease progression. Fifteen studies (26%) identified significant social, physical, economic or policy-level exposures, including incarceration, housing status or lack of legal income. Conclusion While past studies demonstrate important environmental exposures that appear to shape access to care and subsequent disease progression, the limited literature to examine these factors demonstrates the need for future research to consider risk environment characteristics and the role they may play in shaping health outcomes from HIV infection among drug users through determining access and adherence to evidence-based care. (198 words)

Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder

“…Overall, our findings provide important support for the notion of the HIV “risk environment,” which operates to enable or constrain individual level behaviors and contributes to HIV-related vulnerabilities (1, 18). Although we recognize that many other factors, such as psychological distress, addiction severity, social exclusion, disempowerment, and inaccessibility of medical care also have important roles to play in ARV diversion and adherence behaviors [see (22)], this paper sought to understand exposure to a disordered environment as a contributor to poor HIV disease management.…”

“…The past fifteen years have witnessed increasing recognition by public health stakeholders that social and structural factors are key drivers of pervasive health inequalities, with poverty, social exclusion, stress, unemployment, and inadequate living conditions contributing to elevated disease burden among vulnerable populations (1-3). One aspect of the movement toward a social ecological understanding of health has been a growing interest in neighborhood effects on illness and disease, with recognition that neighborhoods exert substantial influence on individuals’ psychological well-being and physical health (4).…”

Factors linked to transitions in adherence to antiretroviral therapy among HIV-infected illicit drug users in a Canadian setting

“…Fortunately, PLWH who use illicit drugs have been shown to attain ART outcomes comparable to individuals in other risk categories given adequate levels of ≥ 95% adherence (Wood, Montaner, et al, 2003b; Wood et al, 2004). Thus, there is an urgent need to promote access and adherence to ART and to introduce interventions that reduce the clinical, behavioural, social, and structural barriers to effective HIV/AIDS treatment and care faced by people who use illicit drugs (PWUD) (Milloy et al, 2012; Wolfe et al, 2010). …”

Exploring the Social Meaning of Curing HIV: A Qualitative Study of People Who Inject Drugs in Guangzhou, China

“…[7][8][9] The risk environment theory argues that people who inject drugs are susceptible to structural and environmental factors that increase their risk for both substance abuse and other healthrelated harms, including HIV infection. [10][11][12] China, in particular, has the largest population of drug users in the world, and injection drug use accounts for 20% of all new HIV infections. 9,13 Furthermore, PWID traditionally have very low rates of linkage to HIV care and may face some of the largest barriers to accessing a potential HIV cure.…”