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[Dr. Frederick L. Altice] Many of the individuals who are within the criminal justice system who have ***,
they do incredibly well while they’re there.
There’s structure, there’s food, there’s no problems with homelessness.
And no active drug use.
And what happens about three months after release is that
their viral loads and CD4 cell counts really go quite amok.
And so the question is, what do you need to do in order to keep them in continuous care?
So a number of the interventions that I’ve been working
with have included things like directly observed therapy.
We’ve been doing some more recent work using buprenorphine as relapse prevention
for opioid-dependent ***-positive drug users.
And we’re now embarking on some other pharmacologic interventions using
depot naltrexone for not only treating opioid dependence, but also for treating alcohol dependence.
So it’s really been a fair amount of pharmacologic interventions
that are used to actually sustain *** treatment outcomes.
Bringing up the issue of culture is always a big one
because many folks point to the U.S. and say that those interventions don’t work elsewhere
and to some extent there is some truth to that.
The basic tenets of the intervention do work, but there needs to be a fair amount of adaptation.
For instance, one of the interventions that we’ve developed that is not pharmacologic,
that is a behavioral intervention, is called HHRP, or the Holistic Health Recovery Project.
It’s one that we developed at Yale and we’ve been adapting it for several different places,
but most recently, we’ve been doing so in Malaysia.
And what’s different about Malaysia is that the – first of all, their religious structure is different.
About 40 percent of them are Muslim.
About 40 percent are either Christian or Buddhist.
And about 20 percent are Hindu.
And so what it means that you have to do is you have to create interventions
that focus on centeredness rather than religiousness.
Spirituality, making sure that the sort of messages that you give around *** prevention
are compatible with those religious norms and also whether it would be acceptable.
Are people offended by the sorts of messages that you give?
Even though it might be to use a *** or to not inject with a contaminated syringe,
it’s how you say it and the wording that you use.
And so that’s been a real challenge and we’ve spent the last full year adapting
this intervention just for this particular setting.
So there’s a fair amount of preparatory work that has to be done before you can
ever roll these sorts of interventions out.
I also think that the extent to which U.S. investigators are magnanimous and
are being involved in the international setting is truly reflective.
I think it goes beyond just the science.
There are issues around just making the world a better place.
I also think that there are some cultural competencies that we learn from our international work.
And they’re competencies that,
when you learn them and you see them in the glaring sort of way that we do,
you bring them back and you think about it in their own sort of multiethnic cultural setting.
And so I think the things that I have learned are really quite representative.
And the other thing that’s really important is that there are a lot of crosscutting similarities.
And so the research in many ways is applicable,
but maybe perhaps with some adaptation, back to the U.S.
So I think that it’s really rich to be thinking internationally when we do the work.