Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
School of Politics and International Studies, University of Leeds, Leeds, UK.
Lancet Psychiatry. 2022 Aug;9(8):676-688. doi: 10.1016/S2215-0366(22)00159-6. Epub 2022 Jun 21.
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
将与艾滋病病毒相关的护理与物质使用障碍的治疗相结合，为满足同时患有这两种疾病的人群的需求提供了机会。普遍存在的政策、结构性不平等和污名化，使物质使用障碍患者变得格外脆弱。在本系列论文中，我们分析了关于艾滋病毒和物质使用障碍治疗整合设计的现有文献和范围综述中的实证证据，以了解护理整合的障碍和促进因素，并制定前进的方向。我们讨论了整合方法如何解决当前模型中的两个核心差距：在纳入艾滋病毒感染者和吸毒者的观点时，未能考虑人权问题，以及未能批判性地反思决定风险、脆弱性、寻求医疗保健和卫生公平的结构性因素。我们认为，成功的整合需要以人为本的方法，这种方法以人权为基础，全面看待这两个问题，并重新关注潜在的社会、经济和政治不平等。
