Treatment, care and support

of injecting drug users living with HIV/AIDS:

Implications for Ukraine

A discussion paper prepared for

Médecins Sans Frontières - Holland Ukraine program

Prepared by:

Dave Burrows

Consultant

e: dbsyd@aol.com

July 2000

Contents

1. Executive Summary, Conclusions and Recommendations............................................................. 3

General findings............................................................................................................................................................ 3

Medical aspects of HIV/AIDS among IDUs.................................................................................................................. 3

Psychological and social aspects of HIV/AIDS among IDUs................................................................................... 4

Conclusions and Recommendations................................................................................................................ 5

Acknowledgements....................................................................................................................................................... 6

2. Introduction.................................................................................................................................................................. 7

Background..................................................................................................................................................................... 7

A note on terminology............................................................................................................................................. 7

Methods.............................................................................................................................................................................. 8

Global estimates of IDUs with HIV/AIDS......................................................................................................... 8

3. Medical aspects of HIV/AIDS among IDUs................................................................................................... 10

Aspects of HIV disease in ILWHA......................................................................................................................... 10

Progression to AIDS...................................................................................................................................................... 10

Mortality of ILWHA versus other HIV positive people............................................................................................ 10

Gender differences......................................................................................................................................................... 11

Weight loss...................................................................................................................................................................... 11

Non-HIV related medical aspects............................................................................................................................... 12

Cognitive functioning................................................................................................................................................... 12

Tuberculosis.................................................................................................................................................................... 12

Co-infection with HIV, hepatitis and other viruses................................................................................................. 12

Aspects of HIV treatment in ILWHA................................................................................................................. 13

Access to services........................................................................................................................................................... 13

Medical drug use treatment......................................................................................................................................... 16

Interaction between HIV treatment and other drugs.............................................................................................. 16

Treatment of ILWHA with hepatitis C......................................................................................................................... 18

Pain.................................................................................................................................................................................. 18

Ukraine-specific aspects........................................................................................................................................ 19

4. Psychological and social aspects of HIV/AIDS among IDUs...................................................... 21

Psychosocial aspects of HIV disease in ILWHA......................................................................................... 21

Stigma and social identity........................................................................................................................................... 21

Psychological response to HIV infection.................................................................................................................. 22

Drug use and treatment................................................................................................................................................ 23

Sex..................................................................................................................................................................................... 24

Family and community aspects................................................................................................................................... 25

Psychosocial aspects of HIV disease in ILWHA in Ukraine................................................................ 25

5. Continuum of Care................................................................................................................................................... 27

Self care........................................................................................................................................................................... 28

Care by family and friends.................................................................................................................................. 30

Models of service delivery – medical............................................................................................................ 32

Models of service delivery – non-medical.................................................................................................. 39

6. Conclusions and recommendations for addressing treatment, care and support of ILWHA in Ukraine.................................................................................................................................................................................................... 45

References.......................................................................................................................................................................... 48

1. Executive Summary, Conclusions and Recommendations

General findings

Medical aspects of HIV/AIDS among IDUs

ø There are likely to be more than 10 million injecting drug users (IDUs) worldwide, of whom at least 1 million have HIV or AIDS. Injecting drug use has now been reported in 129 countries, of which 103 have also reported HIV infection among IDUs.

ø There appears to be a similar rate of progression to AIDS for both IDUs living with HIV/AIDS (ILWHA) and other groups such as non-IDU HIV-positive women and gay men. Patterns of drug use, including frequency of drug injection, continuous versus intermittent IDU, do not appear to lead to differences in progression to AIDS, but cocaine users may progress faster than users of other drugs.

ø ILWHA have a higher death rate from causes unrelated to HIV infection than HIV-negative IDUs and a higher rate of non-AIDS mortality than other PLWHA. Leading causes of pre-AIDS deaths among IDUs appear to be:

v Pneumonia

v Liver disease, associated with HIV and hepatitis C and/or B co-infection

v Overdose

v Suicide