Abstract
BackgroundPeople who use drugs are an important priority for HIV programs. However, data related to their utilization of HIV services are limited. This paper reports patterns of HIV testing, drug use, and risk and service perception among people who use drugs. Study participants were receiving HIV and harm reduction services from a community-based program in Phnom Penh, comprised of itinerant peer-led outreach and static drop-in centers.MethodsThis was a mixed-methods study conducted in 2014, comprising of a quantitative survey using a structured questionnaire, followed by two focus group discussions among a sub-sample of survey participants. Participants were recruited from hotspots in five HIV high-burden communes using a two-stage cluster sampling method. Quantitative descriptive analyses and qualitative thematic analyses were performed.ResultsThis study included 151 people who use drugs with a mean age of 31.2 (SD = 6.5) years; 77.5% were male and 39.1% were married. The most common drugs used were methamphetamines (72.8%) and heroin (39.7%), and 38.0% injected drugs in the past 3 months. Overall, 83.3% had been tested for HIV in the past 6 months, of whom 62.5% had been tested by peers through community-based outreach. However, there were ongoing HIV risks: 37.3% were engaging in sex on drugs, only 35.6% used a condom at last sexual intercourse, and 10.8% had had a sexually transmitted infection in the last 6 months. Among people who reported injecting drugs in the past 3 months, 27.5% reported re-using needles/syringes. Almost half (46.5%) perceived themselves as being at lower risk of HIV compared to the general population. Qualitative results contextualized the findings of low perception of HIV risks and suggested that although services were often unavailable on weekends, at night, or during national holidays, peer-led community-based outreach was highly accepted.ConclusionsA peer-led community-based approach was effective in reaching people who use drugs with HIV and harm reduction interventions. To mitigate ongoing HIV risks, expanding access to combination prevention interventions and implementing strategies to enable people who use drugs to objectively assess their HIV risks are required. Additionally, community-based programs should collect data along the care continuum, to enable decentralized tracking of progress towards 90–90–90 goals at local levels.
Highlights
People who use drugs are an important priority for human immunodeficiency virus (HIV) programs
The UNAIDS 90–90–90 targets, which aim to ensure that 90% of all people living with HIV know their status, 90% of all diagnosed people living with HIV receive antiretroviral therapy (ART), and 90% of all persons receiving ART achieve viral suppression [8], capture this paradigm shift
We report patterns of HIV testing, drug use, and sexual behaviors among people who use drugs who were receiving HIV and harm reduction services from a community-based HIV program in Phnom Penh
Summary
People who use drugs are an important priority for HIV programs. data related to their utilization of HIV services are limited. The UNAIDS 90–90–90 targets, which aim to ensure that 90% of all people living with HIV know their status, 90% of all diagnosed people living with HIV receive ART, and 90% of all persons receiving ART achieve viral suppression [8], capture this paradigm shift. Achievement of these global goals will depend on their attainment among all people living with HIV and key populations including people who use drugs [9]. In Cambodia, where the national HIV prevalence is 0.3% among the general population, people who use drugs are disproportionately affected, with a prevalence of 4.0% among people who use non-injecting drugs and 24.8% among individuals who inject them [14]
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