An assessment of the HIV prevention needs of injection drug users in Montana

Background: The purpose of this study was to assess the HIV prevention needs of individuals living in Montana who use injection drugs (IDUs). Gaps between prevention needs and existing services were identified. Recommendations for overcoming barriers to accessing prevention services as well as barriers to implementing prevention and treatment services are described. Methods: A qualitative case study approach was used. Data collection methods included: 1) twenty in-depth interviews with current IDUs; 2) twelve interviews with key informants; and 3) retrieval and review of documents and archival records. Interviews were recorded, transcribed and analyzed using a qualitative content analysis approach. Documents, archival records, and research literature were reviewed and analyzed for information that could add to or support the interview data. Results: Two major prevention needs were identified. The first was the need for affordable and accessible substance abuse treatment. The second need related to harm reduction services, including free HIV/Hepatitis C testing and access to clean syringes. Barriers to meeting these needs included lack of funding for treatment, state and federal laws that discourage access to clean needles, stigma and discrimination regarding injection drug use, and lack of agency networking. Conclusions: A necessary first step in building Montana's capacity to address the economic, political, and social barriers to HIV prevention for IDUs is the development of local coalitions. Through utilizing the strength of community coalitions, policy issues can be researched, social norms can be challenged, stigma reduced, and additional funding can be secured to improve HIV prevention efforts in Montana.