The Opinions of Injecting Drug User (IDUs) HIV Patients and Health Professionals on Access to Antiretroviral Treatment and Health Services in Valencia, Spain

Abstract

The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient's likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor-patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient-provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.

Understanding HIV‐positive drug users’ experiences of taking highly active antiretroviral treatment: Identity–Values–Conscious engagement model

“…These external influences undermined their ability to consciously manage HAART taking. These findings fit with existing evidence that HIV‐positive drug users were more likely to miss doses (de la Hera et al, 2011; Harzke et al, 2004; Mimiaga et al, 2010; Witteveen & Ameijden, 2002). On the other hand, by consciously and strategically engaging in HAART taking, participants were able to adapt to the external influences and regularly take HAART.…”

“…There remains a paucity of qualitative evidence on HIV‐positive drug users’ experiences of taking HAART globally. Only 11 qualitative studies from USA, Canada, Russia, Ukraine, Spain and India were identified prior to this study (Batchelder et al, 2013; Chakrapani, Velayudham, Shunmugam, Newman, & Dubrow, 2014; de la Hera, Davo, Ballester‐Añón, & Vioque, 2011; McNeil et al, 2017; Mimiaga et al, 2010; Pach, Cerbone, & Gerstein, 2003; Rhodes & Sarang, 2012; Small, Wood, Betteridge, Montaner, & Kerr, 2009; Ware et al, 2005; Witteveen & Ameijden, 2002).…”

“…A multitude of factors have been identified in the aforesaid 11 studies to influence their adherence to HAART, including stigmatisation, active drug use, motivation, side effects of HAART, accessibility, healthcare professionals’ attitude towards drug users and forgetfulness (Batchelder et al, 2013; Chakrapani et al, 2014; de la Hera et al, 2011; McNeil et al, 2017; Mimiaga et al, 2010; Pach et al, 2003; Rhodes & Sarang, 2012; Small et al, 2009; Ware et al, 2005; Witteveen & Ameijden, 2002). While these studies provide insight into the factors that can influence HIV‐positive drug users’ adherence to HAART, the findings tend to be descriptive in nature and little is known about the mechanisms that influence their adherence through a theoretical lens.…”

Disparities in HIV clinic care across Europe: findings from the EuroSIDA clinic survey

“…Additionally, even in settings where ART is widely available, a multitude of social and institutional factors may influence people’s willingness and ability to adhere to treatment and remain engaged in clinical care. In Valencia, Spain, for example, people who inject drugs (PWID) identified their ongoing drug use as a barrier to adhering fully to ART and reported that a lack of social support hindered adherence as well [ 12 ]. In a cohort of African-American men taking ART, adherence was found to be lower among men who experienced stigmatizing attitudes about HIV from members of their social networks [ 13 ].…”

Assessing the effectiveness of antiretroviral regimens in cohort studies involving HIV-positive injection drug users

“…Consequently, healthcare providers often take into consideration a patient’s potential for non-adherence such as housing instability, consumption of opioids and alcohol, or the presence of comorbidities when selecting a HAART regimen in this setting [5-9]. Thus, a history of injection drug use (IDU) is a confounder by indication in nonrandomized studies assessing HAART’s effectiveness [9-11]. …”