Krieger School for the Arts and Sciences, Johns Hopkins University, Baltimore, USA.
School of Medicine, Johns Hopkins University, 1550 Orleans St, CRBII 1M11, Baltimore, MD, 21207, USA.
Harm Reduct J. 2023 Jul 21;20(1):90. doi: 10.1186/s12954-023-00834-6.
Opioid use disorder (OUD) is overrepresented among people with criminal justice involvement; HIV is a common comorbidity in this population. This study aimed to examine how formerly incarcerated men living with HIV and OUD in South Africa experienced HIV and OUD services in correctional facilities and the community.
Three focus group discussions were conducted with 16 formerly incarcerated men living with HIV and OUD in Gauteng, South Africa. Discussions explored available healthcare services in correctional facilities and the community and procedural and practice differences in health care between the two types of settings. Data were analyzed thematically, using a comparative lens to explore the relationships between themes.
Participants described an absence of medical services for OUD in correctional facilities and the harms caused by opioid withdrawal without medical support during incarceration. They reported that there were limited OUD services in the community and that what was available was not connected with public HIV clinics. Participants perceived correctional and community HIV care systems as readily accessible but suggested that a formal system did not exist to ensure care continuity post-release.
OUD was perceived to be medically unaddressed in correctional facilities and marginally attended to in the community. In contrast, HIV treatment was widely available within the two settings. The current model of OUD care in South Africa leaves many of the needs of re-entrants unmet. Integrating harm reduction into all primary care medical services may address some of these needs. Successful HIV care models provide examples of approaches that can be applied to developing and expanding OUD services in South Africa.
在有刑事司法涉入的人群中，阿片类药物使用障碍（OUD）的患病率过高；在这一人群中，HIV 是一种常见的合并症。本研究旨在探讨南非感染 HIV 且患有 OUD 的曾被监禁男性在监禁场所和社区中经历 HIV 和 OUD 服务的情况。
在南非豪登省，对 16 名感染 HIV 且患有 OUD 的曾被监禁男性进行了 3 次焦点小组讨论。讨论内容包括监禁场所和社区中现有的医疗保健服务，以及两种环境下卫生保健在程序和实践方面的差异。使用比较的视角对数据进行了主题分析，以探讨主题之间的关系。
参与者描述了监禁场所中缺乏 OUD 医疗服务，以及在监禁期间没有医疗支持而导致的阿片类药物戒断的危害。他们报告称，社区中 OUD 服务有限，而且可用的服务与公共 HIV 诊所没有联系。参与者认为监禁和社区 HIV 护理系统很容易获得，但他们表示，不存在正式的系统来确保释放后的护理连续性。
OUD 在监禁场所被认为没有得到医学上的治疗，在社区中也只是得到了有限的关注。相比之下，HIV 治疗在这两个环境中都广泛可用。南非目前的 OUD 护理模式未能满足重新进入者的许多需求。将减少伤害纳入所有初级保健医疗服务中可能会满足其中一些需求。成功的 HIV 护理模式提供了一些可以应用于南非开发和扩大 OUD 服务的方法。
