Values and preferences
The International Network of People who use Drugs (INPUD) has just (27 August) published a new report which is part of a major global study by the World Health Organisation. The study examined the values and preferences of key populations, including people who inject drugs, for HIV, Hepatitis and STIs services. The findings of this study will inform the update of the WHO 2016 Consolidated Guidelines for HIV prevention, diagnosis, treatment and care for key populations, which are used to inform countries on the design and implementation of health packages for key populations (people who inject drugs, gay and bisexual men and other men who have sex with men, female, male and trans sex workers and trans people).
INPUD conducted eight regional focus group discussions and ten semi-structured interviews with people who use drugs from 27 total countries, all held online using Zoom. During the focus group discussions and interviews, participants were asked a series of questions designed to gauge the values and preferences of their community regarding the delivery of HIV, Hepatitis and Sexually Transmitted Infection (STI) services. You can read the full study here.
However, the most notable findings from the research are:
- Peer-based and drug user-lead services and health interventions are fundamental to ensuring that the design, development and delivery of interventions align with community and individual needs. Participant responses in this study reflected what INPUD consistently hears: that peer navigators are too often being asked to be part of programmes that are hostile to their very presence, and where people who inject drugs are not welcome. This fundamentally needs to change.
- Structural barriers such as criminalisation, stigma, discrimination and violence on the health, rights and dignity of people who inject drugs are a pervasive, routine, and relentless aspect of their everyday realities constantly reinforced through harmful, punitive and repressive laws and policies. For too long we have allowed these injustices to continue despite longstanding evidence of how they diminish the capacity of people who inject drugs to access vital services.
- While discussing enabling interventions such as peer-led responses, community mobilisation, decriminalisation and reducing and/or eliminating stigma and discrimination is critical, there is still a question of how such change will be realised when comprehensive access to evidenced-based HIV and HCV interventions is still yet to be seen in many contexts. Realising the right to health for people who inject drugs will require not only the removal of harmful and punitive laws, policies and practices, but also the appropriate funding and scale-up of community-led interventions and services that properly recognise the value of peer-led interventions among people who inject drugs.
- People who inject drugs want immediate, fast and affordable access to DAA HCV treatment with minimal barriers including: funding for DAA treatments, a ‘Test to Treat’ approach, multiple low-threshold access points, peer-based Point of Care (PoC) PCR testing, diagnosis and DAA treatment service models, removal of discriminatory barriers such as cessation/abstinence from drug use as a treatment criterion and recognition of harm reduction as an integral part of HCV treatment services.
- ‘Chemsex’, which is widely practiced among people who inject drugs beyond gay and bisexual men, should be re-contexualised as ‘sexualised drug use’ to encourage safe, supportive cultures of care that enable people who inject drugs to ‘plan to be safe’ when using drugs to enhance sexual experiences.
- There is a need for more targeted research and discussion into best practice approaches to PrEP among people who inject drugs. PrEP should never be seen as a bio-medical ‘silver bullet’ or be provided in place of existing, evidence-based harm reduction approaches such as NSP, OAT, male and female condoms and other harm reduction supplies.