Conquering the Divide: Exploring the Connection between Harm Reduction and HIV / Hepatitis Clinical Care

Despite decades of research and twenty-five years of HIV transmissions among IDUs, barriers still exist to providing evidence-based prevention services to injection drug users. Only 5% of IDUs have access to HIV prevention services worldwide (UNAIDS, 2004). Despite the focus on prevention with positives, current care-based programs do little to address the needs of IDUs in reducing the risks of acquiring bacterial and viral infections. Instead, messages focus on abstaining or using clean needles, rather than offering a plethora of options for reducing harm. Little is known about how providers or patients would feel about having harm reduction as part of clinical care. This study sought to explore the perceptions of HIV care providers and their active drug using patients in the possibility of integrating harm reduction into care. Qualitative, semi-structured, individual interviews were conducted in three urban clinics, located in areas of high HIV prevalence and drug use and serving low-income African-American patients. A total of 31 active drug using patients were interviewed, and 7 interviews were conducted with the primary physician and nurse practitioners in each clinic. Thematic analysis of results indicated that patients felt receptive to harm reduction counseling being provided by their clinician. However, clinician results were mixed. The study yielded a conceptual model of the HIV care visit which serves to contextualize the often complicated ‘physician-patient relationship' when the patient is an active drug user living with HIV and/or hepatitis. Similarly the model reveals important challenges and barriers which must be addressed prior to implementation.