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