Barriers to Use of Free Antiretroviral Therapy in Injection Drug Users

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Abstract
THE NUMBER of human immunodeficiency virus (HIV)–infected injection drug users (IDUs) recently increased in Vancouver, British Columbia.1,2 Prevalence and incidence of HIV were reported as 25% and 18.6 per 100 person-years, respectively.2 Advances in antiretroviral therapy (ART) have improved survival in British Columbia3 and elsewhere.4,5 Also, treated subjects experiencing decreases in HIV-1 RNA below detectable levels may be less infectious.6,7 Despite this, physicians may be less likely to recommend ART for IDUs because of the belief that IDUs are less adherent to complex regimens, which could promote selection of drug-resistant strains.8 In British Columbia, all HIV-positive persons eligible for ART according to guidelines9,10 have free access to it through a province-wide HIV/AIDS (acquired immunodeficiency syndrome) drug treatment program. To estimate the proportion of eligible IDUs receiving ART, we linked survey data with data from the drug treatment program. We also attempted to identify barriers to ART utilization.

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