A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs.
A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs.
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DOI：
10.1186/s12954-020-00425-9
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发表时间：
2020-10-22
影响因子：
4.4
通讯作者：
Hammarberg A
中科院分区：
文献类型：
--
作者：
Värmå Falk M;Strömdahl S;Ekström AM;Kåberg M;Karlsson N;Dahlborn H;Hammarberg A
与男性相比，注射毒品(WWID)的女性表现出更高的注射风险行为，使她们面临感染艾滋病毒和丙型肝炎(丙型肝炎)的风险。与男性相比，WWID在针头交换计划(NEP)等减少伤害计划中的比例也较低。这项研究的目的是调查瑞典WWID参与NEP的原因和障碍，并确定可以采取的措施，以加强该计划和增加WWID的参与。对参加斯德哥尔摩NEP至少六个月且年满18岁的20名WWID进行了深入访谈。IDIS被录音和转录，并逐字记录。定性内容分析用于确定主题。无菌注射设备的需求被确定为加入和保留NEP计划的主要驱动因素。由于容易获得大量与健康有关的服务，继续参与国家卫生计划的工作进一步得到推动。最有价值的服务是性和生殖健康服务(SRHR)，使参与者能够获得避孕药具、宫颈癌筛查和性传播感染检测(STI测试)。NEP工作人员对参与者的尊重进一步促进了项目的参与。然而，与会者也对NEP的参与表示了一些担忧，这给加入造成了障碍。这些包括失去对子女的监护权或探视权，男性伴侣嫉妒和暴力，不愿在等候区花费时间，以及害怕收到艾滋病毒/丙型肝炎病毒检测阳性结果。实际的障碍包括有限的开放时间和到新机场的旅行距离。为了加强该计划，大多数参与者要求提供额外的SRHR服务。大多数与会者还提议以某种形式的“仅限妇女”进入新环境保护计划，以加强新环境保护计划作为一个安全空间的感觉。这项研究确定了可能增加WWID人群NEP摄入量的因素。建议将额外的SRHR服务和“仅限妇女进入”作为国家卫生计划的一部分加以实施和评估。这些调查结果可能有助于并改进瑞典目前扩大非国家非政府组织的规模，以确保平等获得服务。
Women 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. In-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. The 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. This 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.
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