1 Care for Injection Drug Users (IDUs) with HIV HAIVN Havard Medical School AIDS Initiative in Vietnam

2 By the end of this session, participants should be able to: Present the common misconceptions between healthcare workers (HCW) and IDUs Identify issues concerning IDUs Describe models of treatment and care for IDUs Explain the strategies of clinics regarding HCWs and patients’ families Learning objectives

3 HCWs often assume that IDUs: Are violent Always lie Are medication-seeking Do not care about their health Do not care about their families Common misconceptions of HCWs regarding IDUs

4 IDUs often assume that doctors, nurses: Do not care about IDUs Do not believe that IDUs have pain Do not treat pain for IDUs In addition, IDUs: fear having their HIV status ‘discovered’ fear abandonment (by family, by the clinic / HCWs) because of drug use The common misconceptions of IDUs regarding HCWs

5 Behaviors of patients Preconceived notions of medical staff Treatment outcomes Knowledge of addiction and mental health Stigma Support methods from family and society Important issues

6 Drug use is commonly seen in: Persons who have untreated psychological problems and/or Persons who have emotional trauma HIV/AIDS can worsen the problem due to: Depression Physical weakness Toxicity of ARV Social stigma The economic burden for the family and society Learn about the IDUs

7 When taking care of IDUs, need to understand: Intoxication and withdrawal Circumstances: Do not have permanent home, homeless Crime, abuse of prescribed drugs Patient’s mood: Anxiety, hostility, agitation Disorientation leads to difficulty in arranging time Drug abuse could lead to problems with adherence Learn about the IDUs (2)

8 When taking care of IDUs, need to understand: Disease progression is not different between IDUs and non IDUs IDUs often seek care late Need urgent care services more IDUs are less likely to have regular health checks Learn about the IDUs (3)

9 Delay in seeking / receiving treatment ARV therapy and Substitution therapy with methadone Negative attitudes and lack understanding of the clinic staff Lack of trust Fear of pain Barriers in caring for IDUs

HIV treatment models for IDUs Two separate clinics Medical care at an HIV clinic Treat addiction at a rehabilitation clinic Model 1 Treat addiction and HIV at one clinic Model 2 Comprehensive primary care for IDUs in settings that support addiction treatment Model 3

11 Have separate meetings in the clinic for IDUs in order to: Learn more about patient characteristics Reduce the impact of drug abuse Help HCWs to better understand IDUs’ behaviors Prevent establishment of friendships among the IDUs Strategy of clinics (1)

12 Establish support commitment between patient and caregiver Maintain care Have respect between staff and patient Facilitate communication between staff and patient Strategy of clinics (2)

13 Have mental health care and social workers for counseling and social support services Emphasize counseling on drug usage to evaluate treatment readiness Efforts in supporting: Transportation assistance childcare support for mothers with young children Strategy of clinics (3)

14 Provide materials (if any) to encourage patients to have regularly scheduled check-ups: Food? Travel allowance? Organize the clinic to provide better services? Legal/social advice? Strategy of clinic (4)

15 Addiction treatment staff and clinic staff should be trained on HIV and stigma to feel comfortable with the challenges of patients Knowledge of disease progression Drug interactions and adherence Diagnosis of both HIV and mental illness Collaboration of support from family and treatment program(s) Coordinate activities to develop, integrate care plans Strategy of clinic (5)

16 Training about addiction will lessen the fear of HCWs when taking care of IDUs The collaboration on treatment will encourage and possibly change the behavior of difficult patients. HCWs who have knowledge of diagnosis can integrate care plans (medical services, nursing, social) Relating to medical staff

17 Encourage family and friends Acceptance instead of denial Care efforts of family help reduce the denial of illness and addiction Stress benefits for patients on treatment Patient may be more open if the patient knows that he/she is not isolated Encourage family support (1)

18 Build strong loving relationships, decrease the gaps (with family and with HCWs) Including behavior at home and at the clinic Counsel to encourage family unity Reduce loneliness / isolation Provide better care (including HIV care) Encourage family support (2)

19 Both HCWs and IDUs have misconceptions that lead to misunderstandings HCWs should evaluate to understand more about the patient’s situation and condition before treatment In Vietnam, there are 3 important models in HIV care for IDUs Each clinic has different strategies to help deliver optimal patient care Key points

20 Thank you! Questions?