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Improved treatment access requires end to portrayal of drug abusers as already dead
Date:7/21/2010

seventh that of addressing social and medical costs of untreated drug use.

"Our analysis focused on two treatments: provision of anti-viral therapy (ART) for and provision of methadone or buphenorphine for HIV-infected drug users. We found that both are highly cost-effective. Unfortunately, many barriers limit their use," said Shepard.

Systemic barriers to ART and OST provision include stigmatisation of IDUs in health settings, medical treatment separated by specialties, bans on treatment of active IDUs, hidden or collateral fees, and multiple requirements for initiation or modification of treatment for IDUs. In the five countries considered, fewer than 2% of IDUs have access to opiate substitution treatment.

Structural barriers to treatment provision result from wholesale criminalization of drug users. Barriers include sharing the names of IDUs seeking treatment with police, arrest and harassment of IDUs in or around clinical settings, and harassment of physicians who prescribe opioids. Even in Asian countries praised for initiation of OST programs, far greater numbers of IDUs are detained for years in "treatment and rehabilitation" settings that offer no medical evaluation, right of appeal, or evidence-based treatment or rehabilitation. ART and OST in these detention centres are largely unavailable. Incarceration of drug users, and interruption of ART and OST in prison, is also commonplace.

"Compared to detention policies in many countries, these treatments not only save lives, they also save money," said Shepard.

A necessary measure to improve ART coverage for IDUs is improved data collection, including an "equity ratio" to assess whether IDUs are receiving a fair share of antiretroviral treatment. The authors highlight that the Global Fund to Fight AIDS, Tuberculosis and Malaria, which between 2001 and 2008 has awarded about $180 million for HIV prevention in IDUs, does not ask grantees to detail IDU-related
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Contact: Laura Gardner
gardner@brandeis.edu
781-736-4204
Brandeis University
Source:Eurekalert

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