背景
根據台灣疾管署調查，近三年來從事 MSM 性行為者，使用藥物助性的比例為 18%，且逐年攀升。調查也揭露，有使用成癮藥物者篩檢結果為 HIV 陽性率較高（5.4%＞1.2%），故可以得知，有使用成癮藥物者感染 HIV 的可能性較高。在藥愛群體的不斷擴大的前提下，若要達到控制愛滋疫情的目的，著手於照護藥愛群體無疑勢在必行。
方法
在進行愛滋感染者合併藥愛者的處遇工作時，我們取徑於減少傷害心理治療的概念，不僅只是關注個體的物質使用狀況而已。因為藥癮議題具有繁複的因素交織，所以在減害治療的過程中，我們也會將這些個體所處的社會背景、環境與身心狀況納入評估的環節。換言之，若從台灣脈絡進行理解，這些愛滋感染者合併藥愛者所歷經的，其實是多面向的壓力，由於華人家庭倫理重視傳承子嗣，因此同志身分在家庭關係中接納度低，再疊加感染者在社會中歷經的重重汙名，與藥癮帶來的欣快與罪惡的自我拉扯，都顯示著台灣愛滋合併藥癮情況的錯綜嚴峻。我們透過政府防治與照顧策略的資源挹助，並以減害概念作為主軸，逐步建構跨專業的多元處遇，以回應愛滋暨藥愛者減害與戒治的複雜需求。本研究以治療性社區處遇的情境協助個案透過矩陣的日程規劃，一起從事農務、學習多元主題的課程，並在專業社工及同儕管理員的協助下，培養覺察自我與藥物和他人關係狀態，關照生理、心理、人際、社會與靈性等全人層面，提昇自我認同、自我效能與自我價值感，特別著重個體的創傷知情處遇及修復自我與人際關係，以長短期併行及全家協力參與的方式復元，並同時進行跨專業之療效因子研究，以評估治療指標和多元課程介入的成效。
結果
在兼顧軟硬體建構並結合減害暨跨專業處遇下，自 2019 年至 2023 年底，我們共協助 529 位藥癮者及其家庭，且據 APGAR 家庭功能評估表評測，每位個案之家庭功能指數在我們介入處遇前跟後，平均上升 1.6，而以 SDS 成癮嚴重程度來看，則平均下降 2.8。值得一提的是，有 90% 的個案在離開治療性社區後仍持續與我們的服務保持聯繫。步履至此，業已逐步勾勒具體的復元路徑，並提出相關處遇策略以協助藥癮者復元，愛滋暨藥愛減害處遇本土化透過上述歷程已有顯著成效。
結論
藥愛復元歷程複雜且困難，但經過我們的介入，於深度上，所發展出的處遇方法是跨專業合作已有見的，個案之復發用藥混亂程度降低；於廣度上，我們期許能為心理衛生領域貢獻此藥癮多元介入的行動知識，並樹立起華人社區應用減害之典範。
(English Version)
Exploring the Multidisciplinary Approach to Individuals Living with HIV and Chemsex: A Case Study of Harm Reduction Therapeutic Community in Taiwan
Background
Recent surveys by the Taiwan Centers for Disease Control indicate a rising trend in sexualized drug use among MSM, with the prevalence reaching 18% over the past three years. The survey also revealed a higher HIV positivity rate among individuals who use substances (5.4% compared to 1.2%), suggesting a greater likelihood of being HIV-positive in this group. Given the expanding population of people engaging in chemsex, providing care for them is essential in responding to the HIV epidemic.
Methods
This study focuses on a harm reduction approach, encompassing more than just monitoring an individual's substance use. It considers the complex interplay of factors inherent in substance use disorders, including the social, environmental, and psychological contexts of everyone. Particularly in Taiwan, these individuals face multifaceted pressures. In traditional Chinese families, the focus on lineage can lead to less acceptance of LGBTQ+ individuals, adding to the societal stigma and internal conflict experienced by those living with HIV and substance use disorders. Backed by government funds, our harm reduction strategy for HIV and substance use disorders builds a multidisciplinary model. The study utilized a therapeutic community setting to aid clients through structured daily routines, engaging in agricultural work, and learning various thematic subjects. Social workers and peer counselors facilitated the development of self-awareness about substance use and interpersonal relationships. This holistic approach focuses on comprehensive care, including physical, mental, social, and spiritual well-being, while emphasizing trauma care and relationship restoration. It employs both short and long-term recovery strategies, involving families.
Results
From 2019 to 2023, our program supported 529 individuals and their families, enhancing average family function by 1.6 points as per the APGAR assessment. Addiction severity, measured by the SDS, decreased by 2.8 points. Notably, 90% of individuals maintained contact with our services after leaving our therapeutic community. This study outlines effective recovery strategies for substance use disorders, highlighting the success of localized harm reduction treatments for HIV and substance use.
Conclusions
Acknowledging the recovery challenges, our initiatives have reduced relapse severity and drug use disorder. Our collaborative, multidisciplinary methods have significantly contributed to mental health and established a harm reduction model in Chinese communities.
引用方式
Lin, X. R., & Hsu, S. C. P. (2024, July 22–26). Exploring the multidisciplinary approach to individuals living with HIV and chemsex: A case study of harm reduction therapeutic community in Taiwan [Poster presentation]. 25th International AIDS Conference, Munich, Germany.
