Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA.
BMJ Open. 2021 Sep 21;11(9):e047350. doi: 10.1136/bmjopen-2020-047350.
The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services.
We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics.
PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants' narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum.
Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.
Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.
印度的艾滋病毒疫情集中在重点人群中，如注射毒品者（PWID）。年轻的 PWID（≤30 岁）新感染艾滋病毒的人数很高，他们很难获得服务。我们评估了年轻 PWID 的观点，以指导制定针对青年的具体服务。
我们在印度三个城市的场所进行了焦点小组讨论（FGD），这些场所为 PWID 提供服务，代表了历史和新兴的毒品使用流行情况。
如果 PWID 年龄在 18 至 35 岁之间，青少年或年轻成人开始注射，并且在其网络中认识青少年 PWID，则有资格参加 FGD。43 名 PWID（81％为男性，19％为女性）和 10 名工作人员参加了 FGD。使用半结构化访谈指南来引出参与者关于注射起始经验，寻求减少伤害服务的障碍，服务提供差距以及促进参与的建议的叙述。使用主题分析来开发整个注射连续体中每个时间阶段的服务参与解释模型。
注射起始于非注射类阿片依赖。在注射前起始阶段，缺乏针对非注射类阿片依赖的服务是一个关键差距。缺乏知识并依赖非正式来源获取注射设备是在注射前阶段未参与的关键原因。此外，低风险感知导致寻求服务的动力不足。社会心理和结构性因素影响了建立注射后的参与。住房和食品不安全以及污名化不成比例地影响了女性 PWID，而缺乏对青少年友好的保密服务则阻碍了青少年 PWID 的参与。
为印度的年轻 PWID 开发针对青年的特定服务将需要解决每个注射连续体阶段的独特脆弱性和服务差距。需要为年轻的女性 PWID 和青少年扩大定制服务，包括预防注射起始的干预措施以及提供保密的减少伤害服务。
