摘要：The high cost of life-saving antiretroviral (ARV) therapy for HIV represents an expense that impedes accessibility and affordability by patients. This price structure also appears to motivate the diversion of ARVs and the targeting of HIV-positive patients by pill brokers in the illicit market. Our field research with indigent, HIV-positive substance abusers links ARV diversion to high levels of competing needs, including psychiatric disorders, HIV stigma, and homelessness. Interventions to reduce diversion must address the needs of highly vulnerable patients. Medication adherence is critical in the management of many chronic illnesses, including HIV. 1 Antiretroviral (ARV) nonadherence increases the risk of treatment failure, drug resistance, and disease transmission. 2 Our recently completed field research among HIV-positive patients in urban south Florida documented modest levels of ARV adherence and a related, yet understudied, phenomenon: the diversion of ARV medications. Diversion—the unlawful channeling of regulated pharmaceuticals from legal sources to illicit markets 3 —has typically been studied in relation to prescription opioids and other medications with significant abuse potential. 4 Nevertheless, the diversion of ARVs by patients is apparent in south Florida 5 and has direct implications for nonadherence, making it a critical issue for patient care and public health. We examined factors that affect vulnerability to ARV diversion among highly marginalized HIV-positive individuals.
