“这是一种负担，一种麻烦。我真希望我没有这些其他疾病”：不列颠哥伦比亚省温哥华的老年艾滋病毒感染者兼吸毒者共病管理的定性研究。
"It's a burden, it's a nuisance. I wish I didn't have these other ailments": a qualitative exploration of comorbidities management among older people living with HIV who use drugs in Vancouver, British Columbia.
机构信息
British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
J Int AIDS Soc. 2021 Oct;24(10):e25785. doi: 10.1002/jia2.25785.
INTRODUCTION
People living with HIV (PLHIV) who use illicit drugs (other than or in addition to cannabis) are living longer due to antiretroviral therapy (ART). Older PLHIV who use drugs have an increased risk for comorbidities, and managing multiple health conditions is a growing concern among this population. However, in-depth understandings of the lived realities and complexities of living with HIV alongside comorbidities among older PLHIV who use drugs remain limited. We sought to explore how older PLHIV who use drugs manage their comorbid conditions in a setting with universal ART access.
METHODS
Between January 2019 and March 2020, semi-structured, in-depth interviews were conducted in Vancouver, Canada with 42 older PLHIV who use drugs and were living with at least one comorbidity. All participants were currently on ART, and had initiated treatment at least 2 years prior to the interviews. Data were analysed using inductive and deductive approaches.
RESULTS
Several themes were identified through this analysis. First, comorbidities were perceived as more urgent health concerns and prioritized over HIV. Second, stigma and discrimination hindered access to care for comorbidities. Third, the concurrent management of HIV and comorbidities was often challenging due to unmanaged or poorly managed comorbidities. Fourth, the potential impact of ART on the development of comorbidities was a source of concern and frustration. Finally, integrated treatment approaches facilitated engagement with HIV and comorbidities care.
CONCLUSIONS
Our findings underscore the need for HIV care to shift from a primary focus on managing HIV to an integrated, patient-centred approach that addresses both HIV and non-HIV-related health needs, as well as an equitable and non-judgemental delivery of such care for an ageing population of PLHIV who use drugs.
简介
由于抗逆转录病毒疗法（ART）的应用，感染艾滋病毒（HIV）的人（除大麻外还使用其他非法药物或同时使用大麻和其他非法药物）的寿命得以延长。使用毒品的老年 HIV 感染者患合并症的风险增加，同时管理多种健康状况是该人群日益关注的问题。然而，对于使用毒品的老年 HIV 感染者在普遍获得 ART 治疗的环境下如何管理合并症的生活现实和复杂性，我们的了解仍很有限。我们试图探讨在普遍获得 ART 治疗的环境下，使用毒品的老年 HIV 感染者如何管理其合并症。
方法
2019 年 1 月至 2020 年 3 月期间，在加拿大温哥华对 42 名使用毒品且患有至少一种合并症的老年 HIV 感染者进行了半结构式深入访谈。所有参与者均正在接受 ART 治疗，并且在接受访谈前至少 2 年就已开始接受治疗。使用归纳和演绎方法对数据进行分析。
结果
通过此分析确定了几个主题。首先，合并症被视为更紧急的健康问题，并优先于 HIV 考虑。其次，耻辱感和歧视阻碍了合并症的治疗。第三，由于未管理或管理不善的合并症，同时管理 HIV 和合并症常常具有挑战性。第四，ART 对合并症发展的潜在影响是关注和沮丧的原因。最后，综合治疗方法促进了对 HIV 和合并症的治疗。
结论
我们的研究结果强调需要将 HIV 护理从主要关注管理 HIV 转变为以患者为中心的综合方法，以满足 HIV 和非 HIV 相关的健康需求，并以公平和非评判的方式为使用毒品的老年 HIV 感染者提供这种护理。
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