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Protease inhibitors and recreational drugs: a group approach to harm minimisation and medication adherence.
Hedge B; Major B; Andrewes Unit, St Bartholomews Hospital, London, UK.
December 30, 1998
Int Conf AIDS. 1998;12:600 (abstract no. 32391). Unique Identifier :

ISSUES: For many gay men recreational drugs are an integral part of being out and being gay. With the widespread use of protease inhibitors it is probable that a significant number of people with HIV use recreational drugs at some time. The death of a person on protease inhibitors taking MDMA (ecstasy) suggested possible interactions between protease inhibitors and recreational drugs. In the absence of guidelines, it was feared that people, if ignorant of possible drug interactions, might put themselves at risk of negative reactions or if aware, might omit their prescribed medicines when socialising. "Just say no" campaigns have had little success in changing behaviours so a more effectual approach based on increasing current knowledge and its limitations, and enhancing problem solving skills using peer support was needed. PROJECT: In order to minimise the risk of negative drug interactions for people taking protease inhibitors and recreational drugs and to increase adherence to prescribed medication regimes, single session, anonymous, confidential, information and problem solving groups were offered. The aims were: to provide information regarding the principles of drug resistance, individual pharmacokinetic variation and the nature of drug interactions; to encourage a problem solving approach to drug related and lifestyle issues; to increase confidence, enhancing self-esteem and improve self-control of recreational drug taking. RESULTS: Groups were well attended with participants taking an active role. Questioning at end of sessions indicated an understanding of the principles of drug resistance, individual pharmacokinetic variation and the nature of drug interactions. Feedback consistently indicated a subjective improvement in self-control and increased confidence in future decision making in relevant environments e.g. clubs. Groups were judged useful by 75% with requests for further groups and updates. LESSONS LEARNED: Quick responses to HIV related issues can be beneficial, pertinent and resource friendly. A single session, information and problem-solving group intervention increased the ability of people to make informed decisions regarding recreational drug use whilst taking protease inhibitors. The group provided a supportive, non-judgmental forum in which changes to habits and lifestyles could be addressed. It is suggested that increasing people's self control is likely to enhance adherence to drug regimes.

MEETING ABSTRACTS Anti-HIV Agents/ADVERSE EFFECTS/PHARMACOLOGY/*THERAPEUTIC USE Drug Interactions Female Habits Homosexuality, Male/*PSYCHOLOGY Human HIV Infections/COMPLICATIONS/*DRUG THERAPY/PSYCHOLOGY HIV Protease Inhibitors/ADVERSE EFFECTS/PHARMACOLOGY/*THERAPEUTIC USE Life Style Male N-Methyl-3,4-methylenedioxyamphetamine/ADVERSE EFFECTS/ PHARMACOLOGY *Patient Compliance/PSYCHOLOGY Risk-Taking *Social Identification Street Drugs/*ADVERSE EFFECTS Substance-Related Disorders/COMPLICATIONS/PSYCHOLOGY