INTE 398 Lecture Notes - Lecture 11: Harm Reduction, Retrovirus, Community Health Center
5 May 2018
School
Department
Course
Professor
Ffar 291/Inte 398 – Intro HIV Class
Lesson 11
11.1 Intro Video
-in many ways, the theme of harm reduction brings together some of themes that spoke about
previously
-approach to transmission prevent or to health improvement to addressing some of the neg
social determinants of health in more holistic way that tries to bridge ind and structural
interventions
-structural - things that can function by altering the context in which health is produced
or reproduced
-what's the context in which someone can make healthier choices or improve their
health
-some cases = personal decision like dieting and exercise
-for some, structural issues impede ind choice - some choices so bounded by
legal choices that they make it harder for inds to make healthy choices
-harm reduction = way to address that prob directly
11.2 IDU Stats and Context Lecture
HIV and IDUs Worldwide
-fairly decent global pic of the prevalence of HIV in ppl who inject drugs
-these figures specific to IV drug users and can see very easily that Eastern Europe and Latin
America are the most hard hit in this context currently w some imp pops in NA and in South
East and East Asian
-gives general ideas of parts of world where this issue is imp
-if live in community where higher prevalence of HIV, the likelihood that gonna be in contact w
HIV are higher bc of basic laws of avg and probability
Some Stats
-16 million injection drug users around the world (estimated - dot hae lear figures)
-1 in 5 of them is HIV+ (whether or not aware of their status is another question)
-7 countries w 25% increase in HIV incidence in the past 15 years, largely due to injection drug
use
-Estimates from 94 reporting low - and middle-income countries suggest that only 8% of ppl
who inject drugs receive some type of HIV prevention service
-Central Asia and Eastern Europe, where nearly 83% of HIV cases are attributed to injecting
drug use, former or current injecting drug users only represented 24% of the ppl on anti-
retroviral treatment at the end of 2004
-only 8% of ppl who inject drugs receive some type of HIV prevention service
-so clear that communities of ppl at high risk and vulnerability of HIV transmission and
less than 10% getting services that might help them either prevent transmission or
prevent themselves from getting infected
-5 countries in particular (China, Malaysia, Russia, Ukraine, and Vietnam) are characterized as
"mega-epidemics" in terms of ppl who inject drugs. Taken together, these countries account
find more resources at oneclass.com
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for an estimated 2 to 4 million cases of HIV infection and constitute the largest concentration
of injecting drug users living w HIV worldwide
-very HIGH incidence of new rates
2012 Report of the Global Commission on Drug Policy
-fear of arrest drives persons who use drugs underground, away from HIV testing and HIV
prevention services and into high risk envs
-restrictions on provision of sterile syringes to drug users result in increased syringe sharing
-prohibitions or restrictions on opioid substitution therapy and other evidence-based
treatment result in untreated addiction and avoidable HIV risk beh
-conditions and lack of HIV prevention measures in prison lead to HIV outbreaks among
incarcerated drug users
-disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV
transmission and increased antiretroviral resistance
-limited public funds are wasted on harmful and ineffective drug law enforcement efforts
instead of being invested in proven HIV prevention strategies
*i a as, the riial otet thats keepig IV drug users from accessing the services
that they need
-they stay away from agencies where have to report - precarious legal position might work
against
-as inds, they are forced to make choice btwn their health and their freedom, to stay away
from criminal justice system, they are sacrificing access to health care
-is health more imp than a criminal justice system? Should we be offering health services to IV
drug users or should we simply imprison them? = ongoing q
Has implications not only directly to IV drug users but also to larger community
11.3 Harm Reduction Defined Lecture
Harm Reduction Defined
-often associated w drug related issues
-harm reduction refers to policies, programs, and practices aimed at reducing drug-related risks
and harms by advancing the health and human rights of ppl who use drugs
-as Harm Reduction International notes, "the defining features are the focus on the prevention
of harm, rather than on the prevention of drug use itself, and the focus on ppl who continue to
use drugs"
-this approach recognizes that "ppl unable or unwilling to abstain from drug use can still make
posi choices to protect their own health in addition to the health of their fams and
communities"
-talking about policies, programs, practices aimed at reducing harms associated w the
possibility of transmission of HIV for ppl that use drugs
-aess to health are shouldt e depedet o hether or ot soeoe uses ijetio drugs
-ideall dot at the to e o drugs ut har redutio suggests that deal w ppl where
they are actually instead of where we want them to be
Harm Reduction International
-human rights apply to everyone
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-people ho use drugs dot forfeit their hua rights, iludig the right to the highest
attainable standard of health, to social services, to work, to benefit from scientific progress, to
freedom from arbitrary detention and freedom from cruel inhuman and degrading treatment
-harm reduction opposes the deliberate hurts and harms inflicted on ppl who use drugs in the
name of drug control and drug prevention, and promotes responses to drug use that respect
and protect fundamental human rights
-for people ho a't or dot aa e astiet - being tested or condom use (condom use =
form of harm reduction)
Accept People Where They Are
-Evidence-based (there is already lots of data and research that demo that they are effective -
much more practical)
-we have already seen evidence previously that messages that aim to instill fear of infection
may be counter-productive, as they make people feel helpless
-easily understood by those it is intended to reach
-implementable: in other words, people have to be willing and able to take the suggested
precautions. To suggest that all sex is risky is to invite denial of any risk attached to sexual
activity
-persuasive, not punitive (encourage someone to change their beh)
-not more disruptive than absolutely necessary
*makes things more practical/possible for people - it's dealing with whats happening now
rather than what the ideal is
-ex dieting - want them to lose weight bc of their long term choices and all kinds of various
reasons but diff btwn wanting that for someone else and making access to care dependent for
that person
-may be an ideal but not possible/interesting/available for everyone
-it's switching from criminal focus around things that society disapprove of to a health focus
-new philosophy
-same arguments can be made around homosexuality
-if cant accept homosexuality, might decide that no one who's gay deserves health care
-making things as safe as possible is better than forcing or imposing a particular beh pattern
11.4 Our Harm Reduction Stories Video
-Regent Park Community
-doctors jumping to conclusions and giving prescriptions without listening to the patients to get
to the "real patients"
-most imp thing you can do is listen
-iggest isoeptio that dos hae aout drug users is that the dot are aout their
health when in reality they actually really do
-has to be realistic and based on what they need
-harm reduction = set of practices that aim to reduce the risk
-if punish people for using drugs, they won't want to come back
-drug users carry lots of stigma
-may take them a while to get off the drugs and docs have to be empathetic about that and to
their patients
-huge need for services that informed by harm reduction principles
-need common sense, understanding or else they will not show up and die in the streets
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find more resources at oneclass.com
Document Summary
In many ways, the theme of harm reduction brings together some of themes that spoke about previously. Approach to transmission prevent or to health improvement to addressing some of the neg social determinants of health in more holistic way that tries to bridge ind and structural interventions. Structural - things that can function by altering the context in which health is produced or reproduced. What"s the context in which someone can make healthier choices or improve their health. Some cases = personal decision like dieting and exercise. For some, structural issues impede ind choice - some choices so bounded by legal choices that they make it harder for inds to make healthy choices. Harm reduction = way to address that prob directly. Fairly decent global pic of the prevalence of hiv in ppl who inject drugs. These figures specific to iv drug users and can see very easily that eastern europe and latin.
