Patient Perspective: Starting ART and OUD Treatment

My story about my HIV diagnosis is not unusual. I was using heroin for about 3 years before I was diagnosed with HIV. In 2012, I was incarcerated, and at intake, I was tested for HIV and my test came back as positive. My diagnosis really affected me—I hit rock bottom. I was unable to fathom the reality of my situation. How could I be the one with HIV? 

But the good news is that I started HIV treatment. When you’re incarcerated, they make sure you get your medicines. So for the time, while I was in jail, I was taking care of myself. But when I got out, that changed. I went back to using heroin and stopped taking my HIV medicines. It wasn’t that I didn’t want to take them, but once I was home, I didn’t know how to get them. In jail, they gave me everything I needed. After I left jail, I got one package of medicine in the mail. But once that was gone, I didn’t know what to do. So, I was off my meds for at least 6 or 7 months.

Rapid Starts
Later, one of the social workers from jail connected me to my current HIV clinic. When I went to meet my physician, he made an effort to get to know me. He told me to tell him everything about myself because his job was to help me. I was honest with him: I told him that I was on heroin and wanted to get off of it. He told me there were steps that I could take and that I would not have to manage it alone. He helped me sign up for classes, prescribed buprenorphine/naloxone strips, and supported me all along the way. I’m not going to say that I never craved heroin again—because I really did—but I never went back to using. I’ve been using the buprenorphine/naloxone strips since the beginning of 2019 and I have never once failed a urine test.

On that same day, the doctor ran a lot of tests so he could see where I was with my HIV infection. He saw that my T-cell counts were very low, so he prescribed HIV medicine that very day. I was glad to start HIV medicines again when I did. My body had changed. I was down to 117 pounds and was sleeping a lot. I had been in that place before when I was in jail and they had told me that I was about 2 days away from death. I was starting to feel like that again. I knew right then and there, if I wanted to live, then I had to get the HIV medicines and find a way to get them regularly. 

I started HIV medicines and buprenorphine/naloxone strips and put my trust into my doctor because he told me he would guide me through it. He never gave up on me, and that’s what really kept me going, because he noticed that I was giving up on myself when I first came to see him. I doubted him more than he doubted me. He told me he was going to stick with me. He was going to help me get off of heroin. I’m now up to 219 pounds, which is the weight I should be.

Being on buprenorphine/naloxone strips is a big help in keeping me on my HIV medicines. When you are addicted to heroin, you have cravings and your priorities get mixed. The buprenorphine/naloxone strips really keep me focused.

The doctor is a great support. The fact that he is helping me with both my heroin addiction and my HIV is good, because he understands the issues with addiction treatment and HIV treatment. So I listen to him and pay attention.

I can’t leave out the nurses either—they are invaluable. They teach me about my HIV medicine, they talk to me, they helped me get off heroin, they help me with taking my buprenorphine/naloxone strips.

Colocation of Care
I need to emphasize that it is important that my therapy is all in one place. I don’t have to go to one place for my addiction treatment, and another for my HIV treatment, and deal with two doctors who may not know what the other is doing. I can go to my clinic and get everything that I need: I go there to pick up my medicine, I go there for appointments, I even go there if I just have to give blood. I don’t have a vehicle so I have to catch buses to do everything that I do, and I’m coming from a whole other city. I pass a lot of other clinics to get to my doctor’s clinic. But what makes it so great is that I could pass them all up and go to him for everything. It’s worked out really, really well for me.

Your Thoughts
What support does your clinic supply to persons starting both antiretroviral therapy and treatment for substance use disorders? Join the discussion by posting a comment sharing your experiences, and then learn about other key decisions in HIV.