Southern African HIV Clinicians Society Guidelines for Harm Reduction

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Southern African HIV Clinicians Society Guidelines for Harm Reduction Southern African Journal of HIV Medicine ISSN: (Online) 2078-6751, (Print) 1608-9693 Page 1 of 34 Guideline Southern African HIV Clinicians Society guidelines for harm reduction Authors: Andrew Scheibe1,2 Table of contents Goodman Sibeko3 Shaun Shelly1,2 Executive summary ���������������������������������������������������������������������������������������������������������������������� 3 Theresa Rossouw4 Vincent Zishiri5 1. Introduction ���������������������������������������������������������������������������������������������������������������������������3 Willem D.F. Venter5 1.1 Harm reduction ������������������������������������������������������������������������������������������������������������3 Affiliations: 1TB HIV Care, Cape Town, 1.2 Drugs and drug use �������������������������������������������������������������������������������������������������������4 South Africa 1.2.1 Patterns of use �������������������������������������������������������������������������������������������������4 2Department of Family 1.2.2 Methods of drug use ����������������������������������������������������������������������������������������4 Medicine, University of Pretoria, Pretoria, 1.2.3 Drug classifications and common drugs �����������������������������������������������������������5 South Africa 1.2.4 Epidemiology of drug use in southern Africa ���������������������������������������������������6 3Department of Psychiatry and Mental Health, 1.2.5 Drug-related harms ������������������������������������������������������������������������������������������6 University of Cape Town, Cape Town, South Africa 1.2.6 Reasons for drug use ����������������������������������������������������������������������������������������6 1.2.7 The relevance of harm reduction ���������������������������������������������������������������������7 4Department of Immunology, University of Pretoria, 1.3 Stigma, discrimination and human rights ���������������������������������������������������������������������7 Pretoria, South Africa 2. Evidence-based interventions �����������������������������������������������������������������������������������������������7 5Ezintsha, Faculty of Health Sciences, University 2.1 A guiding framework ����������������������������������������������������������������������������������������������������7 of the Witwatersrand, Johannesburg, South Africa 2.2 Assessing a person’s needs �������������������������������������������������������������������������������������������7 Corresponding author: 2.2.1 Screening and brief intervention for common mental disorders and Andrew Scheibe, harmful substance use �������������������������������������������������������������������������������������8 [email protected] 2.2.1.1 Screening �������������������������������������������������������������������������������������������8 Dates: Received: 28 Aug. 2020 2.2.1.2 Brief interventions �����������������������������������������������������������������������������9 Accepted: 28 Aug. 2020 Published: 17 Dec. 2020 2.2.1.3 Referral for treatment �����������������������������������������������������������������������9 How to cite this article: 2.3 HIV prevention ������������������������������������������������������������������������������������������������������������10 Scheibe A, Sibeko G, Shelly S, Rossouw T, Zishiri V, 2.3.1 Condoms and lubricant ����������������������������������������������������������������������������������10 Venter WDF. Southern 2.3.2 Pre- and post-exposure prophylaxis ���������������������������������������������������������������10 African HIV Clinicians Society guidelines for harm 2.3.3 Voluntary medical male circumcision �������������������������������������������������������������11 reduction. S Afr J HIV Med. 2020;21(1), a1161. https:// 2.4 Harm reduction interventions ������������������������������������������������������������������������������������11 doi.org/10.4102/sajhivmed. v21i1.1161 2.4.1 Needle-and-syringe services ��������������������������������������������������������������������������11 Copyright: 2.4.2 Opioid substitution therapy ���������������������������������������������������������������������������12 © 2020. The Authors. Licensee: AOSIS. This work 2.4.3 Overdose services ������������������������������������������������������������������������������������������13 is licensed under the Creative Commons 2.4.4 Emerging and ancillary interventions �������������������������������������������������������������15 Attribution License. 2.4.4.1 Harm reduction for people who use stimulants ������������������������������15 Read online: Scan this QR 2.4.4.2 Drug consumption rooms ����������������������������������������������������������������15 code with your smart phone or 2.4.4.3 Drug-checking services ��������������������������������������������������������������������15 mobile device to read online. 2.5 HIV testing, treatment and care ���������������������������������������������������������������������������������16 http://www.sajhivmed.org.za Open Access Page 2 of 34 Guideline 2.5.1 HIV testing and counselling ����������������������������������������������������������������������������16 2.5.2 Antiretroviral therapy �������������������������������������������������������������������������������������16 2.5.3 Prevention of mother-to-child transmission of HIV ���������������������������������������16 2.6 Prevention and management of coinfections and comorbidities �������������������������������17 2.6.1 Tuberculosis services ��������������������������������������������������������������������������������������17 2.6.2 Viral hepatitis services ������������������������������������������������������������������������������������17 2.6.3 Mental health services �����������������������������������������������������������������������������������18 2.6.4 Sexual and reproductive health services ��������������������������������������������������������18 2.7 Critical enablers ����������������������������������������������������������������������������������������������������������18 2.7.1 Supportive law and policy ������������������������������������������������������������������������������18 2.7.2 Countering stigma and discrimination �����������������������������������������������������������18 2.7.3 Enabling community empowerment ��������������������������������������������������������������19 2.7.4 Acting against violence �����������������������������������������������������������������������������������19 3. Special considerations ���������������������������������������������������������������������������������������������������������19 3.1 Young people who use drugs ��������������������������������������������������������������������������������������35 3.2 Women who use drugs �����������������������������������������������������������������������������������������������20 3.3 Substance use in the context of sexual encounters ����������������������������������������������������21 3.4 Prison settings ������������������������������������������������������������������������������������������������������������21 4. Recommendations...............................................................................................................22 5. Acknowledgements �������������������������������������������������������������������������������������������������������������23 Glossary ������������������������������������������������������������������������������������������������������������������������������24 References �������������������������������������������������������������������������������������������������������������������������25 Appendix 1: Common myths about drugs use ���������������������������������������������������������������������������28 Appendix 2: Assessing patients during first and subsequent encounters ����������������������������������29 Appendix 3: Guidelines for opioid substitution therapy �������������������������������������������������������������30 Appendix 4: Psychosocial and mental health interventions �������������������������������������������������������34 http://www.sajhivmed.org.za Open Access Page 3 of 34 Guideline Executive summary Scope and purpose of the guidelines We support public-health-focused interventions, as opposed • Review evidence of the harm reduction approach to recovery-focused interventions� We support the • Briefly review the epidemiology of drug use and its decriminalisation of drug use as much as we oppose the consequences criminalisation of sex work, mandatory HIV disclosure and • Present clinical guidance for harm reduction interventions policing of sexual preferences� aligned with the framework developed by the World Health Organization In South Africa, despite existing policy that embraces drug • Provide guidance around brief screening and harm reduction, population- and individual-level interventions related to drug use interventions have focused largely on the singular goal of • For each harm reduction intervention, provide: a abstinence� This greatly impacts the human rights of people summary of evidence, main principles and links to related who use drugs and their communities� The failure of guidelines countries to implement comprehensive harm reduction • Highlight special considerations for young people who measures violates their obligations in international human use drugs, women who use drugs, substance use and rights law and public health� sexual encounters and drug use within prison settings • Provide selected recommendations
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