Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers

Ayón, S Milder; Ndimbii, James; Jeneby, Fatma; Abdulrahman, Taib; Mlewa, Onesmus; Wang, Bangyuan; Ragi, Allan; Mburu, Gitau

doi:10.1080/09540121.2017.1394965

Cited by 47 publications

(70 citation statements)

References 30 publications

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“…In addition, IDIs and FGDs were audio-recorded and lasted between 45 and 60 min. Additional details regarding the primary data collection and analysis have been reported in a series of several primary manuscripts [16,[25][26][27].…”

Section: Aims Setting and Methodology Of Primary Data Collectionmentioning

confidence: 99%

“…The social demographic profile of the sample has been published the above primary papers [16,[25][26][27]. In brief, the sample was relatively young (mean age 28.5 years), and poorly educated, with a fifth (18%) not having had formal education.…”

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

“…Most had at least one child, and did not use contraception, nor attend antenatal care when they got pregnant [25,26]. Their access to sexual and reproductive health services was prevented by user fees, transport costs, and stigma [16,25].…”

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

“…Despite the importance of gender in determining harms of drug use [15], and the increasing emphasis on injecting drug use within the national HIV program, relatively little data exists related to social contexts of injecting drug use among women [16]. In Kenya, elaborating the vulnerabilities to HIV among female drug users is particularly pertinent as women are generally more affected by HIV [4].…”

Section: Introductionmentioning

confidence: 99%

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HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

2019

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Background: Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in East Africa, where injecting drug use is on the rise. Methods: This study aimed to document the nature of HIV risks encountered by women who inject drugs in the Mombasa and Kilifi, Kenya. Secondary data analysis was conducted on an existing dataset from a 2015 primary qualitative study involving 24 interviews and 3 focus group discussions with 45 women who inject drugs. These were complemented with five interviews with key stakeholders involved in the provision of services to women who inject drugs. Guided by the social ecology theory, a thematic analysis was conducted to identify the nature of HIV risks and their underlying determinants.Results: HIV risk behaviours fell into two broad categories: unsafe injecting and unprotected sex. These risks occurred in the form of sharing of needles, unprotected oral, anal, and vaginal sex, sexual assaults, injecting drug use during sex, sex work, and other types of transactional sex. The primary determinants underlying these risks were a low-risk perception, inequitable gender power, economic pressures, and poor availability of needles and condoms. These social-ecological determinants did not exist in isolation, but intersected with each other to create powerful influences which exposed women to HIV. Social-ecological determinants exerted constant influence and created a persistent 'HIV risk environment' that was involuntarily experienced by women.Conclusion: Individual, interpersonal, and societal-structural factors intersect to produce HIV risk behaviours. As a minimum, these risks will require a combination of multifaceted micro-level interventions including self-efficacy training, risk assessment skills, couple counselling, and universal access to the recommended harm reduction package. In addition, the current focus on micro-level interventions in Kenya needs to shift to incorporate macro-level interventions, including livelihood, employability, and gender norms-transforming interventions, to mitigate economic and gender-related drivers of HIV risks. In the Kenyan context, injecting drug use during sex work is emerging as an increasingly important HIV risk behaviour needing to be addressed.

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Section: Aims Setting and Methodology Of Primary Data Collectionmentioning

confidence: 99%

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

2019

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“…At present, there is a lack of research on women who inject drugs in Kenya that could inform potential RMNCH interventions for this sub-population [27]. In response to this knowledge gap, the aim of this study was to document the RMNCH experiences and needs of women who inject drugs in coastal Kenya.…”

mentioning

confidence: 99%

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Ndimbii

Ayón

Abdulrahman³

et al. 2018

Sexual & Reproductive Healthcare

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Highlights Globally there is limited research concerning women who inject drugs. This paper reports important insights related to the experiences, needs and barriers preventing the utilisation of reproductive maternal, neonatal and child health services among women who inject drugs in coastal Kenya. Findings from this study will inform the development of equitable, comprehensive, and family-centered RMNCH interventions targeting women who inject drugs, including the integration of RMNCH services within harm reduction programs. ABSTRACT Introduction:The Kenyan government has committed to increasing access to comprehensive reproductive, maternal, neonatal and child health (RMNCH) services. However, inequalities still exist.Women who inject drugs are an important sub-population for public health interventions, yet their RMNCH needs have largely been overlooked. Additionally, there is a lack of research to inform RMNCH interventions for this sub-population. Methods:In 2015, we undertook interviews and focus group discussions with 45 women who inject drugs and five key stakeholders to understand these women's RMNCH experiences and needs. Results:Women' access to essential services across the RMNCH continuum was low. Two thirds of the women were not using contraception. Many discovered they were pregnant late, due to amenorrhea of drug use, and thus were unable to enroll for antenatal care early. Facilitybased deliveries were limited with many choosing to deliver at home. Following delivery, women's attendance to immunization services was sub-optimal. Stigma from healthcare workers was a major factor impeding women's use of existing RMNCH services. The prospect of experiencing withdrawals at health facilities where waiting times were long, deterred utilization of these services. Additionally, women faced competing priorities, having to choose between purchasing heroin or spending their money on health-related costs. Conclusions:Several barriers disrupted women's access to services across the RMNCH continuum.Consequently, there is a need to develop equitable, comprehensive, and family-centered RMNCH interventions tailored to women who inject drugs, through a combination of supplyand demand-side interventions. For optimal impact, RMNCH services should be integrated into harm reduction programs.

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Healthcare needs of people living with human immunodeficiency virus: A qualitative descriptive study

et al. 2021

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The ambitious target to end Human Immunodeficiency Virus (HIV) epidemic by 2030 requires serious attention, strong commitment, and effective interventions to mitigate and stop new transmission, as well as to treat and recover those who are already infected.Indonesia is the most populated country in South-East Asia region with about 640,000 people living with HIV (PLWH) infection in 2018, followed by Thailand 480,000, Myanmar 240,000, and Nepal 30,000 (UNAIDS, 2019). Although the national prevalence of new cases has decreased from 63,000 (2010) to 43,000 (2018), the proportion of young people among new HIV infection is the third highest number in Asia and Pacific region. In addition, the number of Acquired Immunodeficiency Syndrome (AIDS)-related deaths was increasing since 2010 to 2018 (UNAIDS, 2019). However, linkage to treatment and care services was poor, and more than half of people who knew their HIV status were not accessing antiretroviral therapy in 2018. In many sites, the percentages of patients

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Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers

Cited by 47 publications

References 30 publications

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Healthcare needs of people living with human immunodeficiency virus: A qualitative descriptive study

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