The Diversion of Antiretroviral Medications to Street Markets

Hilary L. Surratt, Principal Investigator
Steven P. Kurtz, Co-Principal Investigator
James A. Inciardi, Co-Principal Investigator

Project initiated: 2008

Funding Agency: National Institute on Drug Abuse

Project Summary:

Although a number of recent studies have addressed patterns of narcotic analgesic abuse and diversion, the scientific literature has been virtually silent regarding the diversion of antiretroviral medications (ARV) for HIV. ARV diversion appears to be a growing problem among drug-involved individuals in Miami, and is likely occurring in other large urban centers where rates of HIV infection are high. The ramifications of this diversion are potentially significant. Importantly, those prescribed ARV medications may not be consistently adhering to their treatment regimens, resulting in a deterioration of their own health and increasing the potential for the emergence of medication-resistant strains of HIV. From a public health perspective, the widespread transmission of drug-resistant HIV could leave newly-infected individuals with few viable treatments. The overall goals of this 4-year study are to examine the patterns and predictors of ARV diversion among drug-involved HIV-positive individuals in Miami, Florida, and to describe the dynamics of ARV medication diversion to local street markets. Year 1 of the study will involve formative qualitative research designed to describe the key individual, provider, and environmental factors that influence ARV diversion; this will be accomplished by: 1) conducting baseline and follow-up in-depth interviews with 90 drug-involved, indigent, HIV positive ARV diverters and non-diverters to examine motivations for diversion and non-diversion over time; 2) conducting baseline and follow-up in-depth interviews with 30 “pill brokers” to document their ARV diversion activities over time; and, 3) conducting in-depth baseline and follow-up interviews with 45 HIV positive buyers of illicit ARVs to examine motivations for illicit ARV purchases over time. Years 2 through 4 of the study will involve a large-scale quantitative research component designed to compare the key differences between ARV diverters and non-diverters on individual, provider, and environmental level factors, and examine their effects on patterns of ARV medication diversion; this will be accomplished by: 1) recruiting a sample of 500 indigent, HIV positive individuals who are current drug users [250 of whom divert ARV medications and 250 who do not]; and, 2) assessing the constellation of individual, provider and environmental factors hypothesized to predict ARV diversion.