Fertile outcomes from the crossover between prevention and care services and research among people who inject drugs (PWID), still not translated into much policy change
P. Telles-Dias1,2, K. Page2
1NEPAD/UERJ - State University of Rio de Janeiro, NEPAD, Rio de Janeiro, Brazil, 2University California San Francisco, Department of Epidemiology and Biostatistics, and Global Health Science Program, San Francisco, United States
Issues: HIV research and service goals aimed at PWID can be at odds; intersecting both has positive and negative effects.
Description: Two groups with over 10 years experience working with PWID, compare and contrast how an STI/HIV prevention program in Rio de Janeiro, Brazil and a research study on HIV and HCV in San Francisco, USA, converge research and service provision to establish fertile programs for their target populations.
Lessons learned: Research and service programs aimed at PWID are able to organize around basic ethical, social and scientific principals including respect, beneficence, autonomy, and informed consent to advance their respective goals, and enhance each other. Working together, there are: increased numbers of PWID accessed; opportunities for counseling, testing and treatment; opportunities to deliver intervention strategies; better knowledge of the population being served; and capacity to build trust (essential for a population that is difficult to find and engaged in illegal and socially marginalized activity). Without strong linkage to programmatic resources, research groups must provide a minimal amount of clinical/preventive care, but often lack resources for sustaining these. Prevention programs do not always systematically accrue data that might translate into evidence-based programming. The two organizations here, with different primary missions have had some success in combining both activities. Some frustrations remain, not from lack of symbiosis between the two activities, but from not seeing successful efforts not being translated into substantial policy change. Both groups often feel that they are "swimming upstream", with limited capacity and willingness of public health, clinical and law enforcement organizations to support care, vaccines, clean rigs, and harm reduction.
Next steps: Synergism between service and research activities should be considered when working with PWID. Strong advocacy efforts should be made to support policy changes to provide sustainable and evidence-based prevention and care to this population.
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