MSc Thesis Defence By Jessica McCann Date: Tuesday, April 21, 2015 Time: 2:00 pm Place: CH&E Classroom, Room 409 Title: Community Based Service Provider Perspectives on ART Adherence and HIV-Positive Injection Drug Users Enrolled in Methadone Maintenance People who are living with human immunodeficiency virus (HIV) infection and who use injection drugs are often faced with difficult life circumstances and comorbidities. Antiretroviral therapy (ART) is the only treatment available for HIV. Long-term adherence to ART medication is problematic in most populations, but even more so among IDUs because they are often coping with other challenges such as homelessness, lack of education and employment, incarceration, and greater likelihood of participating in high-risk practices. Methadone maintenance therapy, an opiate substitution treatment, has been shown to improve health outcomes and medication adherence in IDUs living with HIV. Community based programs such as methadone clinics, needle exchanges, and health clinics, are essential to providing support for both IDUs and people living with HIV/AIDS. The objective of this study was to gain an in-depth understanding of the barriers and facilitators that affect ART adherence from the perspective of service providers who work with HIV-positive IDUs. These barriers and facilitators could include structural, including policies, stigma, and service delivery, or contextual, including homelessness, education, and drug use. Eleven service providers were recruited from agencies and organizations in Halifax, Nova Scotia who work with or support individuals living with HIV and injection drug addictions and were interviewed about their perspectives on the structural and contextual facilitators and barriers that they and their clients encounter on a daily basis. Interviews were transcribed, coded, and analyzed using constant comparative analysis with a grounded theory approach. Seven themes were identified: program support, resources, stigma, systemic barriers and IDU lifestyle, service availability, ART and MMT adherence, and policy. These factors all interact and influence each other to shape the environment in which HIV-positive IDUs receive services. The programs that are working to provide support for the population are generally underfunded and have limited resources. When these factors are combined with the clients’ difficult life circumstances, they may not receive adequate support and therefore face worse health outcomes. This research shows that the population of HIV-positive IDUs in Halifax needs more readily available access to services for housing, transportation, and addiction treatment. There also needs to be greater education for the general public as well as service providers about HIV and IDU. Committee: Drs. Susan Kirkland, Jacqueline Gahagan, Natasha Hanson A copy of the Thesis can be viewed in the Main Office, Room 420
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