Injection drug users on HIV-prevention service delivery: Lessons for building effective syringe access programs

Background Injection Drug Users (IDUs) are at risk for acquiring HIV through shared injection equipment and sexual practices. Extensive research has demonstrated syringe access programs (SAPs) to be an effective HIV-prevention intervention for this population. The effectiveness of services is often measured by numbers of syringes distributed and collected, but participant satisfaction with services is rarely measured. This project seeks to assess IDUs' evaluation of the effectiveness of the SAPs and other HIV-prevention programs utilized. Methods HRC staff conducted eleven focus groups with Injection Drug Users in six states (NJ, HI, CO, NV, ME, AZ). In each location, an HIV-Prevention service provider recruited IDUs by offering incentives such as gift cards. Participants answered open-ended questions about service delivery, injection equipment provided, experiences with law enforcement, pharmacy access, hepatitis C knowledge, and consumer involvement. HRC staff recorded and transcribed sessions, and qualitatively analyzed them using grounded theory. Results Fifty-seven total IDUs participated in eleven focus groups. Focus group participants expressed appreciation for programs and a willingness to access ancillary SAP services such as treatment referrals, vaccination and testing, and medical services. Participants often reported the need for more HCV education and negative experiences with law enforcement and/or pharmacists, and described the risks associated with not receiving adequate amounts of injection equipment in some locations. Conclusions IDUs' favorable descriptions of SAPs underscore the success of programs not only in delivering effective preventative services, but also in utilizing a compassionate, client-centered model of service. Iterative assessment of programs via consumer feedback is recommended.