Developing integrated community-based HIV prevention, harm reduction, and sexual and reproductive health services for women who inject drugs

Abstract

Background Despite being a priority population for HIV prevention and harm reduction programs, the sexual and reproductive health (SRH) needs of women who inject drugs are being overlooked. Furthermore, models for providing integrated SRH, HIV, and harm reduction services for women who inject drugs are rare. This article reports the development of community-based outreach services that integrated family planning and other SRH interventions with HIV and harm reduction services for this population in coastal Kenya. Methods Using mixed-methods implementation research, a qualitative baseline needs assessment was conducted with women who inject drugs and harm reduction stakeholders using a combination of in-depth interviews and focus group discussions. The qualitative data from participants was subjected to thematic analysis using Nvivo. Based on the baseline needs assessment, integration of SRH into existing HIV and harm reduction services was implemented. After two years of implementation, an evaluation of the program was conducted using a combination of qualitative interviews and review of quantitative service delivery records and other program documents. The process, impacts, and challenges of integrating SRH into a community-based HIV prevention and harm reduction program were identified. Results This article highlights: 1) low baseline utilization of family planning services among women who inject drugs, 2) improved utilization and high acceptability of outreach-based provision of SRH services including contraception among this population, 3) importance of training, capacity strengthening, technical support and financial resourcing of community-based organizations to integrate SRH into HIV prevention and harm reduction services, and 4) the value of beneficiary involvement, advocacy, and collaboration with other partners in the planning, designing and implementing of SRH interventions for women who inject drugs. Conclusions Women who inject drugs in this study had low utilization of family planning and other SRH services, which can be improved through the integration of contraceptive and other SRH interventions into existing outreach-based HIV prevention and harm reduction programs. This integration is acceptable to women who inject drugs, and is programmatically feasible. For successful integration, a rights-based beneficiary involvement, coupled with sustainable technical and financial capacity strengthening at the community level is essential. Electronic supplementary material The online version of this article (10.1186/s12978-019-0711-z) contains supplementary material, which is available to authorized users.

Faith leaders’ perceptions of needle exchange programs in the rural Illinois Delta Region: Religion as a social determinant of health

“…11,12 NEPs are a longstanding harm reduction strategy that have been proven to minimize the reuse of needles and reduce overdose risk and the transmission of bloodborne pathogens. [13][14][15] Research also shows that people who use NEPs or a similar program, syringe services programs, are actually five times as likely to enter a drug treatment program than people who do not use these services. 16 Despite their effectiveness, NEPs remain a controversial topic and face many ongoing social and political obstacles from local communities, government, and law enforcement that are much more nuanced.…”

“…33 Previous studies that have examined religion's effect on substance use have found that religion can have a positive effect on prevention and recovery, as well as, be a major contributor to drug-related stigma. 35,36,39 Although previous studies have provided critical insights into the influence that rural faith-based institutions have on community health and the role of NEPs in the reduction of STI transmission and overdose risk, [13][14][15]35,36,39 there is a lack of research that investigates rural faith leaders' perceptions of harm reduction strategies, specifically NEPs. Exploring the perceptions of key community health leaders who can connect members to key social and health services and influence health programming is paramount.…”

“…PWID experience a disproportionate burden of disease and mortality rates due to the sharing of contaminated needles and syringes with other individuals who inject drugs 11,12 . NEPs are a longstanding harm reduction strategy that have been proven to minimize the reuse of needles and reduce overdose risk and the transmission of bloodborne pathogens 13–15 . Research also shows that people who use NEPs or a similar program, syringe services programs, are actually five times as likely to enter a drug treatment program than people who do not use these services 16…”

Drug Policies and Development

“…incb, 2016, 7 Women also face greater barriers to accessing harm reduction services and treatment in prison (Sander, Shirley-Beavan and Stone, 2019) and in the community. This is not exclusive to Latin America but can be defined as a global problem, with different countries providing different levels and quality of access (Ayon et al, 2019;Médecins du Monde, 2019;Uusküla et al, 2018); furthermore, women who use drugs and are victims of violence are usually denied access to shelters for women victims of violence based on their drug use, either by law or by institutionalised practice, thus leaving them and their children in a situation of further vulnerability due to the actions of state and private institutions (Benoit and Jauffret-Roustide, 2016;hri, 2013).…”

The Gendered Impacts of Drug Policy on Women: Case Studies from Mexico

“…incb, 2016, 7 Women also face greater barriers to accessing harm reduction services and treatment in prison (Sander, Shirley-Beavan and Stone, 2019) and in the community. This is not exclusive to Latin America but can be defined as a global problem, with different countries providing different levels and quality of access (Ayon et al, 2019;Médecins du Monde, 2019;Uusküla et al, 2018); furthermore, women who use drugs and are victims of violence are usually denied access to shelters for women victims of violence based on their drug use, either by law or by institutionalised practice, thus leaving them and their children in a situation of further vulnerability due to the actions of state and private institutions (Benoit and Jauffret-Roustide, 2016;hri, 2013).…”