Using an Evidence-based Framework to Guide the Implementation of Syringe Services Programs in Jackson, Mississippi

Abstract

The opioid epidemic in the United States (U.S.) has been coupled with increases in blood-borne infections, including viral hepatitis and human immunodeficiency virus (HIV), which can be spread through injection drug use. The Department of Health and Human Services (HHS) recommends syringe services programs (SSPs) as an evidence-based intervention to address the spread of infectious diseases and to link people who inject drugs (PWID) to appropriate care. Jackson, Mississippi, has one of the highest HIV infection rates in the U.S., yet the city is the only urban area among the top ten incident areas for HIV infections that does not have a sanctioned SSP. The Mississippi State Legislature can request an ‘at-risk’ designation from the Centers for Disease Control and Prevention (CDC), granting them power and funding to establish a SSP to help address increasing blood-borne infections among populations of people who inject drugs. This evidence-based commentary follows the Consolidated Framework for Implementation Research (CFIR) to outline the necessary steps and implementation challenges toward the development of a SSP in Jackson, Mississippi. This framework-based analysis revealed that SSPs have few weaknesses and carry many strengths: SSPs are adaptable, cost-effective, and beneficial for individuals and communities engaged with the programs. SSP development does come with complex political and legal obstacles that have to be untangled, particularly in states like Mississippi, where syringes are classified as drug paraphernalia. In addition to revising laws relating to syringe exchange, implementation of a SSP in Jackson must be accompanied by a grassroots, broad-based marketing and communication campaign led by public health experts who can discuss the benefits of SSPs and combat stigma surrounding injection drug use.