Theme: Social Science & Policy Research Year: 2024
Background: North America is experiencing a syndemic of HIV and overdose, which is disproportionately affecting structurally vulnerable people living with HIV (PLHIV) who use drugs. Innovative programs have been established in response to the ongoing overdose crisis, with some including the provision of “safer supply” medications (e.g., diacetylmorphine, tablet hydromorphone) as alternatives to the unregulated drug supply to reduce overdose risk. These programs can involve coordinated daily dispensing or witnessed consumption of safer supply and other medications (e.g., antiretroviral therapy; ART), positioning them to support the management of health needs including HIV care. This study examines how engagement with safer supply interventions influence the management of HIV and other comorbid conditions.
Methods: From April-November 2023 we conducted semi-structured interviews with 53 PLHIV receiving safer supply medications. Data were imported into NVivo and analysed thematically, involving a team-based approach, to identify experiences and impacts of receiving safer supply medications on HIV and other healthcare.
Results: Thirty-two participants were receiving tablet hydromorphone, eight diacetylmorphine, and thirteen a fentanyl formulation (powder, transdermal, or sublingual fentanyl). Most received daily coordinated dispensing (home delivery or program-based witnessed consumption) of ART with safer supply, and explained how coordinated dispensing facilitated HIV treatment adherence and supported efforts to reduce overdose risk. Some described daily dispensing, and especially witnessed consumption, as onerous and stigmatizing. Participants reported a range of impacts from receiving safer supply, including reduced unregulated drug use, financial improvements, and positive impacts to health and wellbeing.
Conclusions: Our findings demonstrate the significant potential of integrating safer supply and HIV care on treatment engagement and the management of other health concerns including overdose risk. Our findings also illustrate how innovations in harm reduction and drug treatment can have the potential to enhance HIV treatment and care, and improve the lives of PLHIV who use drugs.
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