Abstract

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.

Highlights

  • Women who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting Human immunodeficiency virus (HIV) and hepatitis C (HCV)

  • Värmå Falk et al Harm Reduct J (2020) 17:84 women who inject drugs (WWID) show higher levels of injection risk behaviours compared to men [1,2,3,4,5,6], a difference noted in the Scandinavian context [7, 8]

  • To mitigate the harms of injecting drug use, several recommendations have been made [14, 15] including the scale-up of harm reduction (HR) services, which include services that focus on mitigating possible harms when injecting drugs while accepting the behaviour

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Summary

Introduction

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). WWID are less present in harm reduction programs such as needle exchange programs (NEP). Värmå Falk et al Harm Reduct J (2020) 17:84 women who inject drugs (WWID) show higher levels of injection risk behaviours compared to men [1,2,3,4,5,6], a difference noted in the Scandinavian context [7, 8]. Societal norms and gender inequalities further exacerbate women’s vulnerability and perpetuate risk behaviour in terms of both injecting and sexual risk behaviours for hepatitis and HIV, as well as willingness among WWID to engage in prevention measures and care [4, 10,11,12,13]. In accordance with Swedish law, NEP participants must show identification at admission, which may be an additional barrier

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