People who inject drugs are 35 times more likely to have HIV than people who don’t. Drug use is criminalised in many countries which makes people who use drugs fearful of accessing HIV services. Making HIV services more accessible along with decriminilisation is vital to reducing new infections.
What discourages people who use drugs from HIV services?
People who use drugs often face a high level of stigma and discrimination when they visit healthcare facilities. This discourages them from seeking HIV services.
Tendai says: "People who use drugs worry about being judged or labelled by healthcare providers. When they are treated badly they avoid healthcare services altogether. The fear of being stigmatised and discriminated against are a great and significant barrier... They worry about being judged, labelled, or being treated poorly by the healthcare service providers.”
Drug use is illegal in many countries meaning people who use drugs fear being arrested or prosecuted if they visit healthcare facilities.
“When drug use is criminalised, it creates a climate of fear and mistrust,” says Tendai.
"Someone who injects drugs, such as heroin, may worry about going to HIV services, because of the legal consequences if the health provider was to publicly identify them."
Negative experiences with healthcare providers erodes trust.
Tendai says: “In 2021 we conducted research with people who use crystal meth in Zimbabwe. The results revealed that most people are hesitant to seek healthcare services due to their lack of trust in the system. It was also revealed that the lack of trust is mainly derived from the prior negative experiences.”
Poverty and financial hardship can mean that people who use drugs are unable to access the HIV services they need.
Tendai says: “Financial barriers such as the cost of healthcare services, medication, and transport can prevent people who use drugs from accessing HIV services. If we were to ask them to do a ranking of their needs, we would notice that they may prioritise immediate needs [such as basic food needs and housing] rather than healthcare.”
How can HIV services be more friendly?
Designing HIV services so that they meet the needs of people who use drugs and are easily accessible means we can reach more of those who need these services most. Here are some tips to improve services:
Treating individuals with dignity and respect is essential for encouraging people who use drugs to engage with HIV services. Recognising that substance misuse is a health issue rather than a moral failing is a good first step.
Tendai says: “A non-judgmental and stigma-free zone can be achieved by training healthcare staff to be empathetic, understanding and obviously non-discriminatory towards people who use drugs. No one wants to access services in an environment where they feel judged and labeled.”
Providing more holistic services, for example integrating harm reduction and opioid agonist services within HIV services, allows people to access more of the health services they need in one place.
Tendai says: "People who use drugs and people living with HIV face multiple health challenges. So they need integrated and holistic care that addresses both the HIV-related needs and the substance use. This includes working with specialists, such as mental health professionals and other social services."
Confidentiality and privacy are vital for people who use drugs. This ensures they feel safe when accessing HIV services.
According to Tendai: “Healthcare facilities should have policies and procedures in place to protect patients’ information and to ensure that HIV status is not disclosed without permission from the patient.”
He stresses the need to "prioritise and protect client information."
HIV service facilities are mostly centralised, but taking these services out to where the people are could make them more easily accessible for people who use drugs.
Tendai says: “These services should be integrated in community outreaches to reach as many people as possible. For example, the use of mobile clinics will enable and enhance the service distribution in locations that are not easily accessible.”
Peer support workers make HIV services more friendly as they share the lived experiences of the people the service is targeting. Peer support workers can provide valuable encouragement, empathy and support to people who use drugs to help them engage with HIV services.
Tendai suggests that: “Peer support workers and patient can relate on a different level from the traditional healthcare service providers, they know the language, they know how to approach people who use drugs hence their involvement in healthcare facilities will enhance the suitability of HIV service facilities for people who use drugs.”
Do you know of any resources to help healthcare workers make HIV services more friendly for people who use drugs? Let us know by getting in touch at: email@example.com