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September 2012 |
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International AIDS Conference |
Post-its from Practice
epidemic is occurring in people who inject drugs. I realised again how easy we
have it in the UK and how vital it is that we hang on firmly to the improvements
we have made.
In the main conference, US secretary of state Hillary Clinton headlined the first
plenary session, and although most delegates celebrated her passionate call ‘for a
generation that is free of AIDS’ I was disappointed that she didn’t address some
important issues. While speaking broadly about the need to focus on key populations,
she didn’t directly address injecting drug use and the links to poverty and prejudice.
She said that the administration’s strategy included increasing access to condoms
and HIV testing, and gave special emphasis to three other interventions – treatment
as prevention, voluntary medical male circumcision, and stopping the transmission of
HIV from mothers to children – but she did not address the need to overcome poverty
and stigma, and the need for good healthcare to be accessible to all equally.
Mrs Clinton and the other main speakers did talk about the importance of
focusing more resources on women, children and men of colour, pointing out how
globally AIDS is now the leading cause of death for women of reproductive age
and that black women represent 92 per cent of women living with HIV. She gave a
small mention of marginalised groups, saying ‘humans might discriminate, but
viruses do not’.
The focus of the conference was clearly not on reducing injecting-related HIV,
but it should have had a more prominent place in the programme. HIV in people
who use drugs is both preventable and treatable by using evidence-based
interventions relating to science and knowledge. People who use drugs account
for a third of all new HIV infections worldwide outside sub-Sahara Africa; globally
one in five people who inject are infected with HIV and in countries where
injecting drug use is treated as a criminal offence such as Russia, US and China,
the HIV prevalence in people who use drugs has increased to 37 per cent, 16 per
cent and 12 per cent respectively. This is in comparison to an almost stable HIV
rate in people who use drugs in the UK of less than 2 per cent.
The ‘war on drugs’ is in fact a war on people. In my opinion, for the world to
reach the goal of an AIDS-free generation, AIDS strategies must include people
who use drugs. Most importantly, decision-makers and the rest of the field need
to address this group of people with respect, and we should all fight against their
discrimination and criminalisation.
I suggest changing the slogan, popular at the AIDS conference, from
‘Criminalise hate not HIV’ to ‘Criminalise hate not HIV and people who use drugs’.
Dr Chris Ford is clinical director of IDHDP, www.idhdp.com. IDHDP are on
Facebook and on Twitter @idhdp
I WAS PLEASED
that the recently published
Medications in recovery
report makes it clear that
‘arbitrarily or prematurely curtailing opioid
substitution treatment will not help sustain
recovery’, for while I am keen to see people become
abstinent from illicit drugs, I have never been a
proponent of time limited treatment. I believe that
the individual patient has a much better idea of
where they are and what they are trying to achieve
and my role is to help them to achieve their goals –
although this may occasionally entail a gentle push.
Reflecting on the sensible advice from the
expert group reminded me of Robbie, who first turned up at the practice about
15 years ago. He had been sleeping rough, was underweight, unkempt, had
chewing gum stuck in his hair and the broadest Scouse accent I had heard since
moving down from Liverpool to Birmingham ten years earlier.
Much of his story would be familiar to you. He was estranged from his family in
Liverpool and felt too much shame to return while he was still using drugs. He had
rapidly progressed from smoking heroin to injecting it and as a result of poor
technique his arms were a mass of scars and lumps and he had begun to inject in
his groin.
Over the next few months he stabilised on OST, started a relationship (although
a fairly stormy one!) and generally he felt he was doing well. He would come and
see me every few weeks and after about 18 months he told me he wanted to come
off methadone as he ‘owed it’ to his family and partner. A slow reduction ensued
and the last time I saw him for a while he was down to 5mls of methadone a day.
Somewhat naively at that time I assumed he had simply stopped taking
methadone and not felt the need to come back and see me. I was quickly
disabused of this idea when his name came up on my computer screen and I
went into the waiting room to call him.
Things had deteriorated quickly when he realised that his relationship was not
the source of support he had hoped it would be and, having ended it, he
effectively became homeless. Sofa surfing among ‘old friends’ had led to a
reintroduction to heroin, and guilt-ridden, he was indulging in riskier drug use
than before and his neck veins were now the choice for injecting.
We restarted his methadone and with persistence from his drug worker,
permanent accommodation was found for him. Stable once more, he went off
and did a college course to improve his literacy skills. He started volunteering
with a local church’s mental health support group. After a couple more years he
told me he wanted to come off methadone again, although this time he said he
wanted to do it for himself and not out of a sense of duty to anyone else.
Partway through the reduction he was offered a job and moved to a different
part of the city and off my list. This time I had to hope he would continue to do
well. Many years later there was a Christmas wish from him in my inbox – he had
been off all drugs, including medication, for five years. He was working and still
volunteering, and had found a role in society he had thought impossible to
achieve when we first met.
No one is beyond recovering from problematic drug or alcohol use, but it is their
recovery, not ours, and they define it. We are just lucky enough to share the ride.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP,
www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for the
West Midlands.
Post-its from Practice
One driver
Recovery should only be defined by the
individual, says
Dr Steve Brinksman
‘The ‘war on drugs’ is in fact a
war on people. Inmy opinion, for
the world to reach the goal of an
AIDS-free generation, AIDS
strategies must include people
who use drugs. Most importantly,
decision-makers and the rest of
the field need to address this
group of people with respect.’