Multi-Level Barriers to Effective HIV and TB Treatment for IDUs


There are 13 million injection
drug users (IDUs) worldwide and injection drug use remains the second
most prevalent risk factor for contracting HIV. Injection Drug
Use and Infectious Diseases

examined the comprehensive services and systems of care needed to address
the healthcare needs of this population.  

Eric Goosby, MD, emphasized
that antiretroviral treatment (ART) works with IDUs, and they should
not be denied care because of their drug use.

Goosby discussed as well the
manyl challenges in treating IDUs. Despite the evidence to the contrary,
systems of care still often treat addiction as "substance abuse"
rather than a medical disease.  In addition, they lack the continuum
of services necessary to treat it, and so the relapse rate is high.
Meanwhile, complications abound, from psychiatric illness, hepatitis
C, and renal failure to compounding conditions such as unemployment,
homelessness, and decayed family relations.  

Twenty-five percent of IDUs
reside in Eastern Europe — their sheer number posing an additional challenge — and
largely account for the rise in TB and HIV in the countries of
the former Soviet Union.  

Daria Podekareua, PhD, presented
sobering data on both epidemics along with the intersecting barriers
to addressing IDU, TB, and HIV in this region. 250,000 Eastern Europeans
contract TB each year and in Russia alone 30,000 die annually from TB,
while another 30,000 are left disabled.  

Nonetheless, IDU-focused harm-reduction
programs are scarce due to very limited government support, with only
2% of Russian IDUs having access. Also, the decentralized health system
forces IDUs to navigate a complex system, making reliable epidemiology
studies difficult.  

Podekareua insisted an integrated
approach to addressing TB, IDU, and HIV is needed along with support
for harm reduction, improved screening, and access to prophylaxis TB
treatment improved access to ART for IDUs, as well as increased public
education.  

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