Grant: Travel Awards - Institute Community Support

Social and structural factors such as drug law enforcement and economic marginalization have previously been identified as critical determinants of access and adherence to HIV treatment among people living with HIV (PLHIV) who use drugs. This qualitative meta-synthesis aims to better understand the ways in which these social and structural forces intersect to impact HIV treatment access and adherence globally for PLHIV who use drugs. We conducted a systematic literature search of peer-reviewed qualitative literature on HIV treatment and access among PLHIV who use drugs. To be included in this meta-synthesis articles must focus on HIV treatment and access, include a sample >50% of PLHIV who use drugs, and have been published since 1998. A total of 33 articles met this inclusion criteria, and were analyzed by three team members. Our analysis found that access and adherence to HIV treatment are negatively impacted by: (1) drug criminalization and resulting law enforcement strategies (e.g. policing near clinics); (2) interpersonal stigma associated with drug use that undermined doctor-patient relationships; and (3) structural vulnerabilities (e.g. homelessness, incarceration) acting as barriers to treatment. These findings demonstrate that complementary drug policy reforms (e.g., drug decriminalization) and structural interventions (e.g., expansion of social housing) are necessary to optimize HIV-treatment outcomes among PLHIV who use drugs. These complementary approaches may prove necessary to achieve 90-90-90 targets among PLHIV who use drugs.