Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America.
PLoS One. 2012;7(9):e44249. doi: 10.1371/journal.pone.0044249. Epub 2012 Sep 18.
Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature.
We evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals.
Approximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis. Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release. Fourteen percent of participants reported suicidal ideation over the previous two weeks.
We identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality. Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health.
在整个亚洲，吸毒者被关押在被称为强制戒毒和康复中心的设施中。这些中心的透明度和可及性有限，这给直接评估被拘留者和拘留条件带来了重大挑战。尽管艾滋病毒在这种封闭环境中高度流行，但文献中尚未报道直接评估艾滋病毒感染者和他们获得医疗保健的情况。
我们评估了马来西亚最大的两个强制戒毒和康复中心的 100 名感染艾滋病毒的成年男性被拘留者的健康状况及其获得医疗保健的情况。
在每个拘留中心，大约有 80%的感染艾滋病毒的被拘留者接受了调查。大多数参与者报告有多种未经治疗的医疗状况。没有人报告在拘留期间能够获得抗逆转录病毒疗法，只有 9%的人报告接受过任何与艾滋病毒相关的临床评估或护理。近四分之一的人筛查出有结核病活动的症状，但没有人报告接受过结核病评估。尽管 95%的参与者在拘留前符合阿片类药物依赖的标准，但没有人报告在拘留期间能够获得阿片类药物替代疗法，86%的人报告目前对阿片类药物有渴望，87%的人预计释放后会重新使用毒品。14%的参与者报告在过去两周内有过自杀念头。
我们发现，在马来西亚六个指定关押感染艾滋病毒者的强制戒毒和康复中心中的两个中心，无法获得抗逆转录病毒疗法，而且感染艾滋病毒的被拘留者存在严重的、未得到满足的健康需求。在这种情况下被监禁的人面临着相当高的发病和死亡风险。我们的发现强调了迫切需要制定基于证据的毒品政策，这些政策尊重吸毒者的权利，并寻求改善而不是破坏他们的健康。
