title: Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study.
abstract: BACKGROUND
  Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care.
  
  
  METHODS
  Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically.
  
  
  RESULTS
  Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival.
  
  
  CONCLUSIONS
  This study highlights how adopting comprehensive harm reduction services can serve to improve access and equity in palliative and supportive care for drug-using populations.
authors.affiliation: British Columbia Centre or Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; rmcneil@cfenet.ubc.ca.
authors.forename: Ryan
authors.initials: R
authors.lastname: McNeil
authors.affiliation: Faculty of Education, Simon Fraser University, Burnaby, Canada.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dilley
authors.affiliation: Faculty of Human Sciences, Saint Paul University, Ottawa, Canada.
authors.forename: Manal
authors.initials: M
authors.lastname: Guirguis-Younger
authors.affiliation: Centre for Inner City Health Research of the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: British Columbia Centre or Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors.forename: Will
authors.initials: W
authors.lastname: Small
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D016320:Substance Abuse Treatment Centers / Q000379:methods* / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*
keywords: HIV/AIDS; harm reduction; highly active antiretroviral therapy; palliative care; qualitative research; supervised drug consumption services