A qualitative investigation of antiretroviral therapy among injection drug users

Recent advances in antiretroviral therapy for HIV/AIDS have improved the quality of life and life expectancies of many with this fatal disease. Nevertheless, a significant proportion of individuals from disadvantaged groups, which traditionally have had difficulty accessing high-quality health care in the United States, have not benefited from these treatments. For example, injection drug users (IDUs), now a principal source of new cases of AIDS, have received antiretroviral therapy at significantly lower rates than other groups. Whereas numerous studies have described this group quantitatively, few studies have examined in depth the influences that lead to IDUs' problematic relationship with HIV/AIDS treatment. The study described here is based on a longitudinal survey of 516 IDUs. A quantitative analysis was conducted with 103 HIV-positive IDUs and an in-depth qualitative analysis was performed with a subsample of 34 HIV-positive IDUs. This paper presents findings on the consequences of antiretroviral therapy use and nonuse among these individuals, focusing on their perspectives regarding this treatment regimen. Findings suggest that problematic access to, and usage of, antiretroviral therapy is related to wider societal problems of drug abuse, access to health care and housing, and the social and historical divisions that impact the lives of IDUs and their communities. Efforts to improve the availability and the adherence to antiretroviral therapy among IDUs should involve these individuals as a critical component in the design of culturally appropriate and supportive health care services.