The development of healthcare services for drug misusers and prostitutes

With the advent of human immunodeficiency virus (HIV) and the increase of drug misuse in the UK, the Government wishes primary care to play a greater part in treating drug problems in the hope of preventing the spread of HIV. Drug misusers do not avail themselves of traditional services and many are not registered with general practitioners. In response to this Liverpool Health Authority and Family Health Service Authority commenced a new salaried post to provide primary care services to special groups such as injecting drug misusers and prostitutes. Judgemental attitudes towards drug misusers, their high mobility and being a transient population play a part in the reasons why drug misusers find it difficult to access primary healthcare. Drug misusers have high morbidity related to their drug misuse. Many of these conditions, if treated early, can prevent the need for more intensive intervention. Although drug misusers may present with a condition requiring immediate treatment, the opportunity is used to provide other healthcare such as hepatitis B vaccinations, sexually transmitted infection screening, contraception and HIV/hepatitis B testing. The sero prevalence of anti-HBc in injecting drug misusers is 45.5%. Due to their high morbidity and associated costs, the requirements of these groups may conflict with the objectives of budget-holding practices. If general practitioners are unable to respond to their problems, then health care providers and purchasers will have to consider similar schemes in areas which have a higher prevalence of drug misuse in order to provide appropriate healthcare for these vulnerable groups.