A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs

Harm Reduction Journal

Anders Hammarberg¹  Anna Mia Ekström²  Niklas Karlsson³  Susanne Strömdahl⁴  Malin Värmå Falk⁵  Helena Dahlborn⁵  Martin Kåberg⁶ 

[1] Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden;Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden;Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden;Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden;

关键词: Harm reduction;    Women who inject drugs;    Needle exchange program;    Sexual and reproductive services;    Injection drug use;    Needle syringe program;   

DOI  :  10.1186/s12954-020-00425-9

来源: Springer

【 摘 要 】

BackgroundWomen who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting HIV and hepatitis C (HCV). Compared to men, WWID are also less present in harm reduction programs such as needle exchange programs (NEP). The aim of this study is to investigate reasons for, and barriers to, participation in NEP among WWID in Sweden, and to identify measures that could be taken to strengthen the program and increase participation among WWID.MethodIn-depth interviews (IDIs) were conducted with 20 WWID who had participated in the Stockholm NEP for at least six months and was over 18 years old. IDIs were audio recorded and transcribed et verbatim. Qualitative content analysis was used to identify themes.ResultsThe need for sterile injection equipment was identified as the main driver to join and remain in the NEP program. Continuous participation in the NEP was further driven by easy access to a multitude of health-related services. The most valued service was the sexual and reproductive health services (SRHR), allowing participants to access contraceptives, cervical cancer screening and sexually transmitted infections testing (STI-testing). NEP staffs’ respectful treatment of participants further contributed to program participation. However, participants also expressed a number of concerns around NEP participation, which created barriers to joining. These included losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area and fear of receiving positive HIV/HCV test results. Practical barriers included limited opening hours and travel distance to the NEP. To strengthen the program, most participants requested additional SRHR services. Most participants also proposed some form of “women only” access to the NEP, to strengthen the feeling of the NEP as a safe space.ConclusionThis study identified factors that may increase uptake of NEP among WWID. Additional SRHR services and “women only” access are recommended to be implemented and evaluated as part of NEP. These findings may inform and improve the current scale-up of NEPs in Sweden to ensure equal access to services.

【 授权许可】

CC BY