Social Science Department, ENSP/FIOCRUZ, Rio de Janeiro, Brazil,
Curr HIV/AIDS Rep. 2014 Mar;11(1):52-62. doi: 10.1007/s11904-013-0196-2.
HIV-positive people who use drugs (PWUDs) are particularly vulnerable for suboptimal access to highly active antiretroviral therapy (HAART). We conducted a systematic review to identify factors associated with suboptimal HAART access among this population. Studies evaluating HAART access among active PWUDs as a primary outcome, presenting multivariate analysis and conducted after January 1997 were included. Of 122 studies matching the search criteria, only 14 (11.4 %) met the inclusion criteria. All selected studies were prospective cohorts and included young adults, 13 were conducted in North America or western Europe and one in Ukraine. Selected studies measured HAART access using different strategies, however, all identified PWUDs as less likely to receive HAART, when compared to those who never used drugs or former PWUDs. Additional factors associated with suboptimal HAART access include: recent incarceration, lack of health insurance, unstable housing, depression, non-white ethnicity, female PWUDs, and health professionals stigma/prejudice. Factors associated with higher rates of HIV-treatment access included: alcohol and/or drug addiction treatment (especially methadone maintenance therapy), regular source of primary care, treatment and care from the same provider (most of the time) and larger physician experience in HIV-management. PWUDs face a synergy of social and structural factors that influence their suboptimal access to HAART, struggling with poor living conditions, inadequate access to specialized care and stigma/discrimination from health professionals. Renewed strategies and effective interventions should be developed and scaled-up, in order to assure equitable HAART access, decrease morbidity and mortality among PWUDs.
HIV 阳性的吸毒者（PWUD）在获得高效抗逆转录病毒治疗（HAART）方面特别容易受到不利影响。我们进行了一项系统综述，以确定与该人群中 HAART 获得不足相关的因素。评估作为主要结局的活跃 PWUD 中 HAART 获得情况的研究，提出了多变量分析，并于 1997 年 1 月后进行，包括在内。在符合搜索标准的 122 项研究中，只有 14 项（11.4%）符合纳入标准。所有选定的研究都是前瞻性队列研究，包括年轻人，其中 13 项在北美或西欧进行，1 项在乌克兰进行。选定的研究使用不同的策略来衡量 HAART 的获得情况，但所有研究都发现与从未使用过毒品或曾经的 PWUD 相比，PWUD 获得 HAART 的可能性较低。与 HAART 获得不足相关的其他因素包括：最近监禁、缺乏健康保险、住房不稳定、抑郁、非白种人、女性 PWUD 和卫生专业人员的污名/偏见。与更高的 HIV 治疗获得率相关的因素包括：酒精和/或药物成瘾治疗（特别是美沙酮维持治疗）、有规律的初级保健来源、来自同一提供者（大多数情况下）的治疗和护理以及更大的医生在 HIV 管理方面的经验。PWUD 面临着影响他们获得 HAART 不足的社会和结构性因素的协同作用，他们挣扎于恶劣的生活条件、无法获得专门护理以及卫生专业人员的污名/歧视。应该制定和扩大新的策略和有效的干预措施，以确保 PWUD 公平获得 HAART，降低发病率和死亡率。
