The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations

Tsuyuki, Kiyomi; Surratt, Hilary L.; Levi-Minzi, Maria A.; O’Grady, Catherine; Kurtz, Steven P.

doi:10.1007/s10461-014-0856-2

Cited by 24 publications

(15 citation statements)

References 48 publications

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“…32–34 Increasing evidence also suggests that ARV drugs are shared or channeled into illicit markets in some settings, which could compromise ART adherence and expanded use of PrEP. 32,35,36 More research is needed to understand how Black MSM acquire and use ARV drugs. The findings in this report also indicate an urgent need to educate Black MSM about the appropriate use of ARV drugs, to expand the availability of health services for diagnosing and treating HIV in this population, and to ensure that health services are acceptable and effective for Black MSM.…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral Drug Use and HIV Drug Resistance Among HIV-Infected Black Men Who Have Sex With Men

Chen

Connor

Clarke

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND HPTN 061 enrolled Black men who have sex with men in the United States. Some men with low/undetectable HIV RNA had unusual patterns of antiretroviral (ARV) drug use or had drugs detected in the absence of viral suppression. This report includes a comprehensive analysis of ARV drug use and drug resistance among men in HPTN 061 who were not virally suppressed. METHODS The analysis included 169 men who had viral loads >400 copies/mL at enrollment, including three with acute infection and 13 with recent infection. By self-report, 88 were previously diagnosed, including 31 in care; 137 men reported no ARV drug use. Samples from these 169 men and 23 seroconverters were analyzed with HIV genotyping and ARV drug assays. RESULTS Forty-eight (28%) of the 169 men had ≥1 drug resistance mutation (DRM); 19 (11%) had multi-class resistance. Sixty men (36%) had ≥1 ARV drug detected, 42 (70%) of whom reported no ARV drug use. Nine (23%) of 39 newly-infected men had ≥1 DRM; 10 had ≥1 ARV drug detected. Unusual patterns of ARV drugs were detected more frequently in newly-diagnosed men than previously-diagnosed men. The rate of transmitted drug resistance (TDR) was 23% based on HIV genotyping and self-reported ARV drug use, but was 12% after adjusting for ARV drug detection. CONCLUSIONS Many men in HPTN 061 had drug-resistant HIV and many were at risk of acquiring additional DRMs. ARV drug testing revealed unusual patterns of ARV drug use and provided a more accurate estimate of TDR.

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Section: Discussionmentioning

confidence: 99%

Antiretroviral Drug Use and HIV Drug Resistance Among HIV-Infected Black Men Who Have Sex With Men

Chen

Connor

Clarke

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The issue of ART for sale in illicit markets is not limited to Ethiopia. A study from South Florida found that HIV medicines were for sale in black marketplaces, and reasons for this comprised having limited access to HIV care, to replace lost or ruined medicines, and to have a backup stock [50]. Similarly, a study from South Africa also reported this [51].…”

Section: The Paradoxical Perception That Art Is Expensivementioning

confidence: 99%

“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

Gesesew

Lyon

Ward

et al. 2020

IJERPH

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Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains.

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“…Even given these limitations, we believe that our findings of misinformation about PrEP among highly vulnerable MSM—together with research describing widespread street markets in ARVs 7,8 —point to important public health policy concerns. First, the diversion and misuse—driven by drug cost—of approved medications to prevent epidemic life-threatening infectious disease would appear to be unprecedented in developed countries.…”

Section: Resultsmentioning

confidence: 86%

Misunderstanding of Pre-Exposure Prophylaxis Use Among Men Who Have Sex with Men: Public Health and Policy Implications

Kurtz

Buttram

2016

LGBT Health

Self Cite

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Purpose: Street markets in antiretroviral medications for HIV have been documented, but sources of demand are not well understood. We report unexpected findings from qualitative research suggesting that some demand is for informal pre-exposure prophylaxis (PrEP).Methods: Focus groups with young men who have sex with men (N = 31) yielded information on their understanding and use of PrEP.Results: Of those who had heard of it, few understood PrEP to be a physician-prescribed regimen; most believed it to be a pill taken before and/or after sex and acquired on the street or through HIV-positive friends.Conclusion: Implications for PrEP rollout and public health policy are discussed.

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The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations

Cited by 24 publications

References 48 publications

Antiretroviral Drug Use and HIV Drug Resistance Among HIV-Infected Black Men Who Have Sex With Men

Antiretroviral Drug Use and HIV Drug Resistance Among HIV-Infected Black Men Who Have Sex With Men

“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

Misunderstanding of Pre-Exposure Prophylaxis Use Among Men Who Have Sex with Men: Public Health and Policy Implications

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