Thursday, March 19, 2015

Recreational Markets for HIV Treatment

Because of advances in antiretroviral therapy, HIV infection is no longer the fatal juggernaut it once was.  Diagnosis still heralds the beginning of a difficult new chapter of life for HIV carriers, but that chapter is much longer than it once was and some HIV patients can live for several meaningful decades if they are diligent about adherence to their treatment regimens.  However, not everyone takes antiretroviral treatment so seriously.  A publication in the scientific journal AIDS and Behavior published in 2014 explored the incorporation of HIV medications into recreational or otherwise non-prescribed drug usage with a particular focus on a South African hodgepodge drug cocktail known as "whoonga" or "nyaope."

Non-prescribed use of anti-HIV drugs appears in several different contexts.  Some of the substances included in prescribed HIV treatment schemes that are not antiretrovirals have market value for other purposes, such as pain relief, hormone-induced growth, erectile dysfunction, or psychotropic effects.  By acquiring these medications through their own prescriptions but selling them on a "black market" instead of taking them, HIV patients can make money individually but drive up the costs and limit the supply of these medications in the legal market, creating barriers to treatment access for other patients.  The market for anti-HIV medication does not end there.  Antiretrovirals can be sold on the black market for their intended purpose--treating HIV infection--to individuals who are not receiving treatment in a formal medical context and they can be sold for alternative purposes like breast enhancement or the extension and amplification of the effects of other recreational drugs like methamphetamine and ecstasy.  Similar problems of cost and supply for legal HIV treatment are produced by this external market for antiretrovirals, but an added complication arises:  viral resistance.  More casual, less consistent use of antiretroviral medication by a wide array of people creates an ideal environment for the collective enrichment of HIV strains that are resistant to these drugs.  When resistant strains infect new people, diligent adherence to a prescribed treatment regimen has much less power to improve quality of life and extend lifespan.

The paper by Rough et. al. is the first to reveal the market for antiretroviral drugs acquired through HIV treatment programs.  The research team stumbled upon this finding largely by accident through conducting interviews with 43 HIV-positive treatment-positive individuals in the Soweto region of Johannesburg, South Africa with the original purpose of seeking a better understanding of why people refuse HIV treatment.  Eight of these 43 interviewees mentioned the recreational market for HIV drugs without being asked about it directly.   These interviewees suggested the antiretrovirals are typically crushed, mixed with more traditional recreational drugs, and smoked.  In fact, the demand for these mix-ins is so substantial that some drug dealers identify HIV-positive individuals, figure out when they have scheduled medical appointments in which they will receive antiretroviral treatment, and rob the patients of their pills.  One example of an antiretroviral being repurposed for recreational use in South Africa is efavirenz, which acts on brain receptors that are also stimulated by LSD and thereby produces visual hallucinations, impaired motor ability and manic episodes.

Read the full article and learn more about whoonga in South Africa here: http://link.springer.com/article/10.1007%2Fs10461-013-0683-x#page-1

--Laurie

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