Implementing an integrated model of HIV/AIDS care including supervised injection services in Vancouver, BC

ISSUE: Injection and non-injection drug use increase risk of HIV transmission, resulting in high HIV infection rates among drug-using populations. These populations face barriers to accessing HIV treatment and care, such as high levels of poverty and anti-drug policies. Injection and non-injection drug use are consequently linked to accelerated HIV disease progression, poor HIV outcomes, and high rates of AIDS-related mortality. Critical questions confronting HIV/AIDS health service organizations are the following: how can services delivery to injection and non-injection drug users be improved? Furthermore, how can they navigate the local context to implement new strategies? DESCRIPTION: The Dr. Peter Centre (DPC), a community-based HIV/AIDS health care organization in Vancouver, responded by incorporating medically-supervised drug use services (i.e.: use of pre-obtained illicit drugs under nurse supervision) into its integrated model of HIV/AIDS care. DPC initially consulted with experts and local and regional stakeholders, including the provincial college of nurses, and defined medically-supervised drug use as being within the scope of ethical nursing practice. DPC championed this approach when consulting with stakeholders. LESSONS LEARNED: Communication with experts helped to define the parameters of this service delivery model. Ongoing communication is needed with other stakeholder to garner support for medically-supervised drug use services. DPC continues to work toward its goal of achieving buy-in across the entire health system for these services. RECOMMENDATIONS: Organizations need to champion medically-supervised drug use services to a range of stakeholders, including law enforcement, in the initial phases and sustain dialogue during and after implementation to strengthen acceptance.