Respuesta :
Answer:
Explanation:
People who use drugs by injection (IDU) are a priority population for HIV prevention, care, treatment and support in BC. HIV infections among IDU have been identified since the beginning of the HIV epidemic in BC, and slowly increased in number during the late 1980s and early 1990s. In 1992, the number of new positive tests in IDU began to increase dramatically, indicating an outbreak of HIV among IDU was underway, rising to a peak in 1994‐1996. While initially centred on IDU living in Vancouver’s Downtown East side (DTES) neighborhood, HIV quickly spread to affect IDU in all parts of the province.
Factors at multiple levels contribute to the HIV epidemic among IDU in BC. At the most immediate level,the likelihood of HIV infection among IDU is related to the exchange of blood through sharing of injection drug use equipment such as syringes and other drug paraphernalia (including pipes used for smoking crack cocaine), and to sexual risk factors for HIV acquisition. At the individual level, mental health issues, including drug dependence, and limited access to harm reduction supplies are key vulnerabilities for HIV infection. At a social and population level, issues such as poverty, homelessness, societal attitudes regarding substance use, access to appropriate health services, and stigma are key determinants of HIV infection in this population. As a result, provincial and regional HIV prevention control strategies for IDU emphasize the importance of strategies that target determinants at these multiple levels, often under the framework of a blood‐borne pathogens approach (with the objective of reducing both HIV and hepatitis C).
In BC, the provincial response to the epidemic of HIV among IDU has been multi‐pronged and sustained, including
- distribution of harm reduction supplies such as sterile needles and condoms to IDU;
- research studies for tracking the epidemic and risk behaviours among IDU;
- innovations such as supervised injection and research trials of prescribed opioids;
- expansion of mental health and substance use services, including opioid (e.g., methadone)
- maintenance treatment;
- provision of HIV primary and specialist care, including the provision of Highly Active Antiretroviral Therapy (HAART);
- maximally assisted/directly observed therapy programs for HAART;
- initiatives to reduce poverty and homelessness;
- outreach programs (e.g., street outreach, Corrections); and
- initiatives to increase HIV testing.
