We fear the police, and the police fear us”: Structural and individual barriers to HIV medication adherence among injecting drug users in Kiev, Ukraine

In 5/2009, two semi-structured foucus groups were conducted witj HIV-infected IDUs seeking treatment at the City AIDS Center, Kiev. The goal was to use this information to adapt and tailor, to Ukrainian culture, an evidence-based intervention for improving adherence to HAART. All 16 participanrts attributed HIV infection to IDU. Their average age was 31.6 (SD=7.0), average time with HIV 5.7 years (SD=4.0), average time on HAART 2.5 years (SD=1.7), average time as IDU 14.6 yeard (SD=6.8), and 88% were on OST.
The most salient themes related to adherence barriers included: (1) harassment and discrimination by police; (2) opiod dependence; (3) complexity of drug regime; (4) side effects; (5) forgetting; (6) co-occuring mental health problems; and (7) HIV stigma. Facilitators of adherence included: (1) cues for pill taking; (2) support and reminders from family,significant other, and friends; (3) OST; and (4) wanting impreved health. Additional factors explored included: 1) knowledge about HAART; (2) storage of medications; and (3) IDU and sexual risk behaviors.Finding highlighted structural and individual barriers to adherence. At the sturctural level, police discrimination and harassment was reported to be a major barrier to adherence to OST and HAART. Privacy and stigma were barriwers at the individual level. Recommendations for adherence interventions included education, training, and identification cards to show police that medication was treatment of HIV, not for abuse; and involving family members and other systems of support for HIV treatment.
Автор: GEORGE WOODY, RICHARD NEEDLE, MATTEW J. MIMIAGA, STEVEN A. SAFREN, S. DVORYAK, SARI L. REISNER: Тип видання: Звіт Рубрика: Профілактика ВІЛ, Лікування ЛЖВС, Зменшення стигми і дискримінації, Ризикована поведінка, Політика і практика, координація, Коінфекція ВІЛ/ТБ, Догляд та підтримка для ЛЖВС