An Invisible Barrier to Integrating HIV Primary Care with Harm Reduction Services: Philosophical Clashes between the Harm Reduction and Medical Models

Abstract

Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

“…30,42 As our study suggests, in order to impact physicians_ intention to prescribe naloxone, several different behavioral motivators must be addressed, including negative attitudes towards IDUs, pessimism in treating drug use, and fear of social or professional disapproval. Robust evidence has now established that harm reducing interventions like overdose prevention, better syringe access, and drug treatment do provide real health benefits to the IDU population and the broader community, including considerable savings in the use of public resources.…”

“…26,27 Approximately two-thirds of individuals with addiction will see a primary care or urgent care physician every six months, and many others are regularly examined by other medical specialists. 26,[28][29][30][31][32] Although systematic research on physicians and IDU care has been limited, 28,30,31,[33][34][35] studies suggest that training, attitudes, and self-efficacy factors influence health care provider participation in harm reduction interventions. 8,27,28,[30][31][32][33][34][35][36] Medical professionals may be uncomfortable treating drug users at all, 37 or view drug abusing patients as a particularly difficult population not amenable to intervention, 31 while fearing that their other patients, colleagues, or society at large will perceive caring for IDUs as Bsoftness^on drug abusers.…”

Getting clean and harm reduction: adversarial or complementary issues for injection drug users

“…On the other hand, Harm Reduction, and its application within the HIV prevention and substance-use treatment arena, has met with a broad range of acceptance throughout the world 2 , particularly among contemporary researchers. Harm Reduction is defined as a set of practical strategies that are used to reduce the negative consequences of substance use.…”

Harm Reduction Outreach Services and Engagement of Chemically Dependent Homeless People Living with HIV/AIDS: An Analysis of Service Utilization Data to Evaluate Program Theory

“…It offers a useful strategy for reducing the barriers inherent within medical models that are based on patient subservience and provider expertise (Heller et al, 2004). At this point, the walls between the harm reduction model and the medical model remain.…”