Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Harm Reduct J. 2020 Oct 22;17(1):84. doi: 10.1186/s12954-020-00425-9.
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.
与男性相比，注射吸毒女性（WWID）表现出更高水平的注射风险行为，使她们面临感染艾滋病毒和丙型肝炎（HCV）的风险。与男性相比，WWID 也较少参与到诸如针具交换计划（NEP）等减少伤害的项目中。本研究旨在调查瑞典 WWID 参与 NEP 的原因和障碍，并确定可以采取哪些措施来加强该项目并增加 WWID 的参与度。
对 20 名至少参加过斯德哥尔摩 NEP 六个月且年龄在 18 岁以上的 WWID 进行了深入访谈（IDIs）。IDIs 进行了音频录制和逐字转录。采用定性内容分析法识别主题。
需要无菌注射设备被认为是加入和留在 NEP 项目的主要驱动因素。NEP 还可以方便地获得多种与健康相关的服务，从而进一步促进了持续参与。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 检测）。NEP 工作人员对参与者的尊重也有助于项目的参与。然而，参与者也表达了对 NEP 参与的一些担忧，这对加入造成了障碍。这些包括失去对孩子的监护权或探视权、男性伴侣的嫉妒和暴力、不愿意在等候区花费时间以及担心获得 HIV/HCV 检测结果呈阳性。实际障碍包括 NEP 的有限开放时间和前往 NEP 的距离。为了加强该项目，大多数参与者要求增加额外的 SRHR 服务。大多数参与者还提议以某种形式为 NEP 提供“仅限女性”的访问权限，以加强 NEP 作为安全空间的感觉。
本研究确定了可能增加 WWID 对 NEP 参与度的因素。建议实施并评估额外的 SRHR 服务和“仅限女性”访问权限，作为 NEP 的一部分。这些发现可能为瑞典 NEP 的当前扩展提供信息并加以改进，以确保平等获得服务。
