Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
J Behav Health Serv Res. 2024 Jan;51(1):44-56. doi: 10.1007/s11414-023-09859-y. Epub 2023 Sep 11.
Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.
南方艾滋病毒服务组织（SHSOs）是采用和实施减少伤害作为解决艾滋病毒和阿片类药物流行的方法的有希望的场所。然而，迄今为止，很少有研究确切地研究了减少伤害在 SHSO 内部和之间是如何运作的。本研究使用计划评估数据（即组织评估数据和与 SHSO 工作人员进行的半结构化定性小组访谈数据），旨在描述寻求 SUSTAIN 中心减少伤害能力建设援助（即培训、辅导、资金）的 SHSO 中减少伤害的组织实施情况。作者采用了收敛混合方法设计，其中同时使用定量和定性方法，以便同时深入了解减少伤害在 SHSO 中的运作方式以及当地环境如何影响实施。比较了每个组织评估领域的平均值和比例。对小组访谈记录的主题分析检查了 SHSO 工作人员对其各自社区中减少伤害实施的看法。定量结果表明，SHSO 最常将减少伤害运作在宣传、倡导和原则领域，但在服务和组织基础设施方面却难以做到这一点。定性结果表明，SHSO 当地环境中的各种因素，如社区缺乏对减少伤害的了解和理解、减少伤害服务有限以及充满挑战的社会政治环境，都会影响 SHSO 对减少伤害的实施。总的来说，分析表明：（1）SHSO 花费大量精力开展外展活动，因为南方社区通常不了解减少伤害；（2）SHSO 在充满挑战的社会政治环境中不断倡导减少伤害；（3）由于外部、环境因素，SHSO 提供的减少伤害服务较少，并且将减少伤害纳入其组织基础设施的程度也较低。这种混合方法研究提供的组织层面数据和 SHSO 工作人员的见解，对政策倡导、资助倡议和能力建设工作具有影响。
