Perceptions about supervised injection facilities among people who inject drugs in Philadelphia
Section snippets
Background
Injection drug use is a longstanding source of population harm. Despite considerable progress expanding harm reduction interventions, people who inject drugs (PWID) remain at high risk for infectious diseases such as HIV and hepatitis C (HCV) (Van Handel et al., 2016, Wejnert et al., 2016). Injection-related skin and soft tissue infections (SSTI) are common, and when medical care is delayed, costly and difficult to treat. With observed prevalence rates just over 30% among active PWID, these
Methods
Data collection began with a freelisting exercise with PWID (n = 42) and healthcare providers (n = 20), who were all recruited from a syringe exchange program (SEP) that provides clinical and social services in the Philadelphia area. Freelisting is an ethnographic tool used to explore individuals’ notions of health practices or conditions, and differences between healthcare providers and lay person’s perceptions. The approach identifies salient domains among people who have a shared experience,
Results
Qualitative interview participants identified as male (n = 9) and female (n = 10). Fifteen (n = 15) identified as White (n = 15); the remainder identified as Latino (n = 1), and Black (n = 3). Median age was 39 years (range: 27–59 years). Median time injecting drugs was 14 years (range: 2.5–20 years). Although not systematically elicited, in unstructured discussion, access to housing emerged as an important factor in participant decision-making and perceptions, with just over half of the participants
Discussion
Harm reduction services remain underfunded and unnecessarily impeded in many parts of the U.S. In places where syringe exchange is reasonably supported, there has been considerable progress in reducing the spread of disease. Most SEPs offer more services than just sterile syringes by providing counseling, naloxone kits and training, and a welcoming setting where PWID can connect with social and medical services. For many PWID, these services provide enough support to avoid or at least manage a
Conclusions
This study builds off previous work focused on the risk environment as experienced by PWID. As in past studies, our participants confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and overdose. Our participants described being forced to sometimes or always inject in public spaces, which exposed them to risks that they understood and acknowledged, but could not avoid. The idea of a SIF was supported by PWID as a way to escape what
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