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Care for Injection Drug Users (IDUs) with HIV

HAIVN

Havard Medical School AIDS Initiative in Vietnam

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By the end of this session, participants should be able to:Present the common misconceptions between healthcare workers (HCW) and IDUsIdentify issues concerning IDUsDescribe models of treatment and care for IDUsExplain the strategies of clinics regarding HCWs and patients’ families

Learning objectives

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HCWs often assume that IDUs:• Are violent • Always lie• Are medication-seeking• Do not care about their health• Do not care about their families

Common misconceptions of HCWs regarding IDUs

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IDUs often assume that doctors, nurses:• Do not care about IDUs• Do not believe that IDUs have pain• Do not treat pain for IDUs

In addition, IDUs:• fear having their HIV status ‘discovered’ • fear abandonment (by family, by the clinic /

HCWs) because of drug use

The common misconceptions of IDUs regarding HCWs

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Behaviors of patients Preconceived notions of medical staff Treatment outcomes Knowledge of addiction and mental

health Stigma Support methods from family and

society

Important issues

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Drug use is commonly seen in:• Persons who have untreated psychological

problems and/or • Persons who have emotional trauma

HIV/AIDS can worsen the problem due to:• Depression • Physical weakness • Toxicity of ARV• Social stigma• The economic burden for the family and

society

Learn about the IDUs

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When taking care of IDUs, need to understand:Intoxication and withdrawalCircumstances:• Do not have permanent home, homeless

Crime, abuse of prescribed drugsPatient’s mood:• Anxiety, hostility, agitation• Disorientation leads to difficulty in

arranging timeDrug abuse could lead to problems with adherence

Learn about the IDUs (2)

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When taking care of IDUs, need to understand:

Disease progression is not different between IDUs and non IDUs

IDUs often seek care late• Need urgent care services more

IDUs are less likely to have regular health checks

Learn about the IDUs (3)

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Delay in seeking / receiving treatment• ARV therapy and• Substitution therapy with methadone

Negative attitudes and lack understanding of the clinic staff

Lack of trust Fear of pain

Barriers in caring for IDUs

HIV treatment models for IDUs

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Have separate meetings in the clinic for IDUs in order to:

• Learn more about patient characteristics• Reduce the impact of drug abuse• Help HCWs to better understand IDUs’

behaviors• Prevent establishment of friendships

among the IDUs

Strategy of clinics (1)

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Establish support commitment between patient and caregiver

Maintain care Have respect between staff and

patient Facilitate communication between

staff and patient

Strategy of clinics (2)

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Have mental health care and social workers for counseling and social support services• Emphasize counseling on drug usage to

evaluate treatment readiness Efforts in supporting:• Transportation assistance• childcare support for mothers with

young children

Strategy of clinics (3)

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Provide materials (if any) to encourage patients to have regularly scheduled check-ups:• Food?• Travel allowance?• Organize the clinic to provide better

services?• Legal/social advice?

Strategy of clinic (4)

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Addiction treatment staff and clinic staff should be trained on HIV and stigma to feel comfortable with the challenges of patients• Knowledge of disease progression• Drug interactions and adherence• Diagnosis of both HIV and mental illness• Collaboration of support from family and

treatment program(s)• Coordinate activities to develop, integrate

care plans

Strategy of clinic (5)

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Training about addiction will lessen the fear of HCWs when taking care of IDUs

The collaboration on treatment will encourage and possibly change the behavior of difficult patients.

HCWs who have knowledge of diagnosis can integrate care plans (medical services, nursing, social)

Relating to medical staff

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Encourage family and friends• Acceptance instead of denial

Care efforts of family help reduce the denial of illness and addiction

• Stress benefits for patients on treatment Patient may be more open if the patient knows

that he/she is not isolated

Encourage family support (1)

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Build strong loving relationships, decrease the gaps (with family and with HCWs)• Including behavior at home and at the

clinic Counsel to encourage family unity• Reduce loneliness / isolation• Provide better care (including HIV care)

Encourage family support (2)

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Both HCWs and IDUs have misconceptions that lead to misunderstandings

HCWs should evaluate to understand more about the patient’s situation and condition before treatment

In Vietnam, there are 3 important models in HIV care for IDUs

Each clinic has different strategies to help deliver optimal patient care

Key points

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Thank you!

Questions?