INPUD Summary Report: WHO Key Populations’ Values & Preferences for HIV, Hepatitis and STIs Services
This report is a summary of our key findings that will be used to update the Consolidated Guidelines with the values and preferences of people who inject drugs.
INPUD would like to thank Annie Madden and Judy Chang for serving as the Principal Investigators of this study, as well as the Regional Focal Points who helped recruit and facilitate the involvement of people who inject drugs in the focus group discussions and semi-structured interviews: Olga Belyaeva, Matthew Bonn, Angela McBride, Charity Monareng, Richard Nininahazwe, Kassim Nyuni, and Louise Vincent
Notable findings from the research:
- Peer-based and drug user-lead services and health interventions are fundamental to ensuring that the design, development and delivery of interventions align with community and individual needs. Participant responses in this study reflected what INPUD consistently hears: that peer navigators are too often being asked to be part of programmes that are hostile to their very presence, and where people who inject drugs are not welcome. This fundamentally needs to change.
- Structural barriers such as criminalisation, stigma, discrimination and violence on the health, rights and dignity of people who inject drugs are a pervasive, routine, and relentless aspect of their everyday realities constantly reinforced through harmful, punitive and repressive laws and policies. For too long we have allowed these injustices to continue despite longstanding evidence of how they diminish the capacity of people who inject drugs to access vital services.
- While discussing enabling interventions such as peer-led responses, community mobilisation, decriminalisation and reducing and/or eliminating stigma and discrimination is critical, there is still a question of how such change will be realised when comprehensive access to evidenced-based HIV and HCV interventions is still yet to be seen in many contexts. Realising the right to health for people who inject drugs will require not only the removal of harmful and punitive laws, policies and practices, but also the appropriate funding and scale-up of community-led interventions and services that properly recognise the value of peer-led interventions among people who inject drugs.
- People who inject drugs want immediate, fast and affordable access to DAA HCV treatment with minimal barriers including: funding for DAA treatments, a ‘Test to Treat’ approach, multiple low-threshold access points, peer-based Point of Care (PoC) PCR testing, diagnosis and DAA treatment service models, removal of discriminatory barriers such as cessation/abstinence from drug use as a treatment criterion and recognition of harm reduction as an integral part of HCV treatment services.
- ‘Chemsex’, which is widely practiced among people who inject drugs beyond gay and bisexual men, should be re-contexualised as ‘sexualised drug use’ to encourage safe, supportive cultures of care that enable people who inject drugs to ‘plan to be safe’ when using drugs to enhance sexual experiences.
- There is a need for more targeted research and discussion into best practice approaches to PrEP among people who inject drugs. PrEP should never be seen as a bio-medical ‘silver bullet’ or be provided in place of existing, evidence-based harm reduction approaches such as NSP, OAT, male and female condoms and other harm reduction supplies.
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