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首页> 外文期刊>The International journal of drug policy >Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union.
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Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union.

机译：注射吸毒者抗逆转录病毒治疗中的悖论：亚洲和前苏联的获取，坚持和结构性障碍。

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摘要

Offered proper support, injection drug users (IDUs) can achieve the same levels of adherence to and clinical benefit from antiretroviral treatment (ARV) as other patients with HIV. Nonetheless, in countries of Asia and the former Soviet Union where IDUs represent the largest share of HIV cases, IDUs have been disproportionately less likely to receive ARV. While analysis of adherence amongst IDUs has focused on individual patient ability to adhere to medical regimens, HIV treatment systems themselves are in need of examination. Structural impediments to provision of ARV for IDUs include competing, vertical systems of care; compulsory drug treatment and rehabilitation services that often offer neither ARV nor effective treatment for chemical dependence; lack of opiate substitution treatments demonstrated to increase adherence to ARV; and policies that explicitly or implicitly discourage ARV delivery to active IDUs. Labeling active drug users as socially untrustworthy or unproductive, health systems can create a series of paradoxes that ensure confirmation of these stereotypes. Needed reforms include professional education and public campaigns that emphasize IDU capacity for health protection and responsible choice; recognition that the chronic nature of injecting drug use and its links to HIV infection require development of ARV treatment delivery that includes active drug users; and integrated treatment that strengthens links between health providers and builds on, rather than seeks to bypass, IDU social networks and organizations.
机译：通过提供适当的支持，注射毒品使用者（IDU）可以获得与其他HIV患者相同的抗逆转录病毒治疗（ARV）依从性和临床受益。尽管如此，在亚洲和前苏联国家中，注射毒品者占艾滋病病例的最大比例，注射毒品者接受抗逆转录病毒药物的可能性大大降低。尽管对注射吸毒者之间依从性的分析侧重于个别患者遵守医疗方案的能力，但艾滋病治疗系统本身需要进行检查。向注射毒品使用者提供抗逆转录病毒药物的结构性障碍包括相互竞争的垂直护理系统;强制性药物治疗和康复服务，通常不提供抗逆转录病毒药物或化学依赖的有效治疗;缺乏阿片替代治疗证明增加了对ARV的依从性;以及明确或暗中阻止将ARV交付给活动IDU的策略。将活跃的吸毒者标记为对社会不信任或生产力低下的卫生系统会产生一系列悖论，以确保对这些刻板印象的确认。需要进行的改革包括强调IDU在健康保护和负责任选择方面的能力的专业教育和公共运动;认识到注射毒品的长期性质及其与艾滋病毒感染的联系需要发展包括主动吸毒者在内的抗逆转录病毒疗法的提供;以及旨在加强卫生服务提供者之间联系的综合治疗，并建立而不是企图绕开IDU社交网络和组织。

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