Transcript Slide 1

HIV and Injecting Drug Users
Sophie Strachan
[email protected]
Project lead for prisons and family & children
Our History
Started in 1987 by 2 HIV+ former
drug users using their front rooms
as a place for meetings.
Registered as a charity in 1992
Our Ethos has always been peer
led support.
All frontline staff and volunteers are
living with HIV themselves. Some
with direct experience of former
drug use and being in prison.
We have been delivering peer led
support in Holloway prison since
1993.
HIV in Prison
• We currently provide outreach in 5 London prisons
• HMP:
• Holloway
• Downview
• Bronzefield
• Pentonville
• Brixton
and provided advocacy for people detained in detention centres.
• Outreach in London Hospitals
• Royal free, Royal London, Newham, St. Marys, Ealing, Northwick
Park, Chelsea & Westminster, Homerton.
Issues for HIV+ drug users
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Multiple identities
Trauma of active addiction and diagnosis
Cross addicted: including sex addiction
Denial of problematic drug use and denial of status
Lack of engagement to providers of support
Multiple discrimination (society and institutions)
Stigma (drug user, HIV status, sex worker, gay, gender)
Co infection with Hep B and Hep C, managing treatment
Poverty, homelessness, social isolation, children in care, high
income, peer pressure
• HIV,ARV’s and interaction with drugs (methadone, ecstasy, cocaine)
• Drug mules (both men & women)
The London Gay Scene
• High risk practices amongst MSM, Lesbians and heterosexual male
and female friends
• Injecting crystal meth, Tina, mephedrone, annihilation very common
practice (known as slamming, common practice at chill out
parties/sex parties)
• Statistics in recent Lancet report state 80% service users are
injecting drug users, 70% sharing needles. CODE clinic + Club
Drug clinic.
• Antidote statistics: Of crystal meth, GBL and Mephedrone users:
• 95% are using to facilitate sex
• 80% are injecting (Meth and Meph
The London Gay Scene
• Statutory services expert at Opiate injecting advice, but ignorant of
safer injecting advice for meth and meph.
• 75% are HIV positive
• 60% report non compliant with ARV’s while ‘High’
• 90% attribute diagnosis to use of drugs and alcohol
• Of the HIV negative clients, more than half have had one or more
courses of PEP in the last year.
• Thank you Antidote for sharing.
What we see
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Unable to negotiate condom use
Practising unsafe sex knowing status and potential consequences
No self worth/esteem, looks for validation through sex
Rape occurring but client feels unable to report as states ‘put myself
in situation’ or in black out.
Frequent drug use, injecting crystal meth, GBL, cocaine,
mephedrone, and using annihilation.
Very poor mental health, increased isolation.
High income fuels cross addicted addicts (can only engage in sex if
high, preferring escorts and privacy/ isolation within home or sex
parties.
Blasé approach to re infection and almost non existent knowledge of
developing resistance (meds/different strain)
Non adherence to ARV’s
Findings in prisons
• Illegal drug use by needles or other use takes place throughout
prison system, practice is prolific and taking place within knowledge
of prison staff.
• One prison stated it felt they had gone backwards by 10 years
regarding level of stigma/discrimination from inmates and staff, and
in other area’s no progression at all, lack of commitment to improve
HIV care from Governing bodies.
• Stigma a barrier to people testing, disclosing, and engaging with
healthcare and peer support.
• Prison officers remaining in room with prisoner breaches
confidentiality and freedom to talk, known fact they will not disclose
drug use so appropriate/effective clinical care compromised. Also
highlights issues of authority This was also reported by clinicians in
hospital setting when seeing prisoner.
Findings in Prison
• Inconsistent practice across prison system regarding prison officers
duty to remain present in the consultation. More senior officers more
flexible in being able to facilitate psychological intervention.
• Drug services unaware of interaction of ARV’s –OST, Methadone
and recreational drugs, ecstasy and cocaine.
• Prison is a time when people living with HIV access health care,
quite a few re-offending clients only engage with us when back in
prison.
• Good practice was evidenced within some prisons regarding
confidentiality, as people do not want to be seen going down to
healthcare escorted by prison officers as it raises questions from
inmates and potential breach of confidentiality.
• Presentations of depression and other mental and physical health
problems not being dealt with (assessed or referred quickly enough)
Findings in prisons
• Some prisoners found little support when on probation or guidance
for reintegration in to society, increased drinking patterns, increasing
sense of isolation and loneliness. Financially very difficult as had to
rely on benefits.
• While imprisoned some prisoners have found new direction and
motivation but once released they have been left to their own
devices and found it very difficult to re integrate and find
employment and career, leading to boredom, social isolation,
substance abuse, increase in depressive features and depressive
episodes.
• Quote from previous prisoner: Prison does not cater for the health
needs of people living with HIV, peer support was a vital lifeline and
having that weekly visit helped me massively, and they were there to
help me as I was preparing to leave prison, they have continued to
support me ever since.
Findings in prisons
• Every stakeholder in a clinician role expressed lack of awareness
regarding ARV’s from the nurses and the importance of adherence.
In action by nurses.
• Access to treatment sporadic.
• Confidentiality compromised by having to get medication at the
hatch.
• Private prison had opted out from having specialist HIV clinician
attend. On our first outreach day 7 women presented themselves
wanting peer support, bullying was rife, as was access to treatment,
one women waited 6 months from being detained before receiving
treatment, she had been on ARV’s prior to being sentenced.
• Another prison now engaging with us providing peer led support
since research project
Insight to the bigger picture
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Policy issues working against people living with HIV in prisons:
Low clarity around HIV in prison orders
Lack of implementation of existing policies
Lack of popular support for prison reform
Lack of awareness of needs of people living with HIV, including
emotional and psychological needs
Systemic challenges within prisons:
Lack of understanding of prison practices around confidentiality and
disclosure.
Poor adherence support
Information within the prison out of date
Guidelines on HIV are too flimsy