Krüsi Andrea, Small Will, Wood Evan, Kerr Thomas
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
AIDS Care. 2009 May;21(5):638-44. doi: 10.1080/09540120802385645.
While there has been growing interest in comprehensive models of treatment and care for individuals living with HIV/AIDS, little attention has been given to the potential role that supervised injecting programs could play in increasing access to prevention and care services for HIV-positive injection drug users (IDU). We conducted 22 semi-structured interviews with HIV-positive IDU regarding a supervised injection program integrated in an HIV focused care facility known as the Dr. Peter Centre (DPC). We also interviewed seven staff members who supervise injections within the facility. All interviews were audio recorded, transcribed verbatim, and a thematic analysis was conducted. Participant and staff reports indicated that the integrated supervised injection program influenced IDUs' access to care by building more open and trusting relationships with staff, facilitating engagement in safer injection education and improving the management of injection-related infections. Participants and staff viewed the program as facilitating the delivery of care through mediating overdose risks, reducing the need to punitively manage drug use on-site and reducing the risks of encountering used syringes on the premises. For some participants, however, feelings of shame and fear of judgment in relation to their drug use limited initial uptake of the program. Our findings identify mechanisms through which integrated supervised injection programs may serve to better facilitate access and delivery of comprehensive care for HIV-positive IDU and highlight the benefits of addressing HIV-positive IDUs' drug use in the context of comprehensive models of healthcare.
尽管人们对为感染艾滋病毒/艾滋病的个人提供全面治疗和护理模式的兴趣日益浓厚，但对于监督注射项目在增加艾滋病毒呈阳性的注射吸毒者（IDU）获得预防和护理服务方面可能发挥的潜在作用，却很少有人关注。我们对艾滋病毒呈阳性的注射吸毒者进行了22次半结构化访谈，内容涉及一个整合在以艾滋病毒为重点的护理机构——彼得医生中心（DPC）内的监督注射项目。我们还采访了该机构内负责监督注射的7名工作人员。所有访谈均进行了录音，逐字转录，并进行了主题分析。参与者和工作人员的报告表明，综合监督注射项目通过与工作人员建立更开放和信任的关系、促进参与更安全的注射教育以及改善注射相关感染的管理，影响了注射吸毒者获得护理的机会。参与者和工作人员认为该项目通过调解过量用药风险、减少在现场对吸毒进行惩罚性管理的必要性以及降低在场所内遇到用过的注射器的风险，促进了护理的提供。然而，对于一些参与者来说，与吸毒相关的羞耻感和对评判的恐惧限制了他们最初对该项目的接受程度。我们的研究结果确定了综合监督注射项目可能有助于更好地促进为艾滋病毒呈阳性的注射吸毒者提供全面护理并增加其获得护理机会的机制，并强调了在全面医疗模式背景下解决艾滋病毒呈阳性的注射吸毒者吸毒问题的益处。
