Amsterdam 2015
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| Abstract #2039 - Treatment adherence | ||||
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Session: 48.3: Treatment adherence (Parallel) on Friday @ 09.00-10.30 in C002 Chaired by Kendra Blackett Dabinga, Aoife Molloy Authors: Presenting Author: Prof Steven Kurtz - Nova Southeastern University, United States |
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| Additional Authors: | ||||
| Aim: Recent studies have documented widespread street markets in diverted antiretrovirals (ARVs) for HIV infection. Non-adherence among diverters and unsupervised use of ARVs by purchasers increase risks of treatment failure, drug resistance, and disease transmission. Among a sample of HIV-positive patients, we examined the individual characteristics of ARV-diverting and -non-diverting MSM, as well as aspects of the markets in which the drugs are traded. | ||||
| Method / Issue: Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in Miami, Florida between 2010 and 2012 (n = 503), of whom 147 were MSM. Eligibility requirements: age 18+, recent substance use, confirmed HIV-positive serostatus, and current prescribed ARV treatment. Structured interviews collected data on demographics, substance use, sexual risk behaviors, and ARV diversion and adherence. Chi-square and t statistics tested for differences in individual characteristics between MSM diverters (n=82) and non-diverters (n=65). Frequency statistics examined diverters’ reasons for selling their ARVs, as well as the products, prices and purchasers in the transactions. | ||||
| Results / Comments: Mean age was 45 Race/ethnicity: 21.1% White, 24.5% Latino, 51.0% Black, 3.4% other. Mean years of education: 12.7 years. MSM who had diverted their ARV prescriptions in the past 90 days, compared to those who had not, were more likely to report drug dependence (65.9% vs. 44.6%, p<.01) and lower incomes (less than $1000 per month 82.9% vs. 58.5%, p<.001), and were less likely to reach 90% ARV adherence levels (43.9% vs. 73.8%, p<.001). Differences in race/ethnicity, age, education, and healthcare access and utilization were not observed. Past 90-day sexual risk behaviors were elevated for MSM diverters, including more frequent condomless sex (11.4 events vs. 4.1,p <.01), trading sex (60.8% vs. 36.9%, p<.01), and buying sex 60.8% vs. 33.8%, p<.001). The most frequently diverted ARVs were Truvada (n=36), Norvir (n=32) and Atripla (n=31). The most common reasons for selling ARVs were to get money for drugs (n=61) or living expenses (n=18). ARV buyers were most commonly pill brokers (n=69), street drug dealers (n=34), and personal ARV users (n=27). Median sales prices ranged from $80 to $100 per bottle. | ||||
| Discussion: Although limited studies of ARV diversion among MSM have been published, we believe this to be the first detailed report on the sellers, products, prices and buyers of ARVs in street markets in the U.S. Our findings point most particularly to the health disparities resulting from high prices of ARV medications, which are heavily subsidized for the poor but have great monetary value to others. In this study, MSM ARV diverters were enmeshed in poverty, substance dependence, and survival sex, and less than half were able to meet standard adherence thresholds needed to control their disease. As well, the approved use, but tight control and high prices, of ARVs for HIV prevention (PrEP) creates the potential to increase street market demand, especially among MSM and other at risk populations. Significant public health policy changes are required to address these problems if hopes to stem the epidemic in the U.S. are to be realized. | ||||
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