HIV/AIDS Treatment and Care : Clinical protocols for the European ...

° bacterial pneumonia
° endocarditis
° septicaemia
• overdoses
• alcohol dependence and alcohol-related liver disease
• polysubstance dependence
• psychiatric comorbidity, including depression.
HIV/AIDS TREATMENT AND CARE FOR INJECTING DRUG USERS
Some IDUs have a long history of mental illness without proper diagnosis or treatment. There are
some mental conditions that may result from, or be exacerbated by, the use of substances such
as alcohol, cocaine and opioids. These substances may also be used by individuals as a form of
self-medication for symptoms of mental illness and substitute for effective treatment. A substantial
increase in the frequency of major depression and suicide in HIV-positive IDUs is apparent, even
above the elevated rates associated with advanced HIV infection and AIDS (37–39).
Other frequent injecting related prolems include:
• deep venous thrombosis (DVT) or pulmonary embolism (PE)
• local soft tissue and vascular injuries, including skin abscesses and thrombophlebitis
• increased risk of respiratory and smoking-related illnesses and chronic diseases.
2.2. Social problems
Common perceptions that drug users do not adhere to HAART may overlook the confounding
effects of social instability, poverty, psychiatric morbidity, human rights violations and poor patient–physician
relationships that characterize many drug users’ lives.
IDUs’ most prevalent social problems include:
• stigmatization, discrimination and social marginalization
• poverty
• homelessness
• unemployment
• family and social dysfunction
• criminal behaviour and imprisonment.
2.2.1. Stigmatization, discrimination and social marginalization
Drug use is a prevailing source of stigmatization and discrimination beyond that associated with
positive HIV status.
• The stigma attached to drug use is often reinforced because it is typically an illegal and covert
activity, with no legal protection available to people who use drugs.
• Drug users are often reluctant to attend medical facilities because of stigmatization and discrimination.
Fear of discrimination may discourage HIV-infected drug users from revealing their
drug use to HIV/AIDS care specialists, leading to a greater risk of misdiagnosis, or of pharmacological
interactions between the HIV treatment regimens and the substances used (4).
• Many IDUs live on the economic and social fringes, and may be rejected by their families.
• People who are most vulnerable to the impact of poverty, racial discrimination, poor health, lack
of education and employment are also those most vulnerable to drug use.
• Social problems, including the stigma and discrimination associated with drug use and being
HIV-positive, in turn exacerbate drug use.
2.2.2. Prison
The economic pressure of supporting drug dependence and the crime that results mean that in most
countries, a large proportion of drug users are periodically incarcerated. Many countries have some
form of compulsory detoxification or abstinence-based treatment in closed settings as the predominant
type of treatment for drug use. There is no evidence that such approaches are effective as forms
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