Accessibility of Needle and Syringe Programs and Injecting and Sharing Risk Behaviors in High Hepatitis C Virus Prevalence Settings

Abstract

Background: Access to healthcare services is a basic human right. Objective: The main purpose of this study is to assess the association between accessibility of needle and syringe programs (NSP) and injecting and sharing risk behaviors. Methods: A cross-sectional study employed respondent-driving sampling (RDS) to recruit a sample of 634 people who inject drugs (PWID) from three provinces, Golestan, Ardabil, and Sistan and Baluchestan, in Iran between November 2018 and February 2019. Participants completed a questionnaire based on the WHO Drug Injecting Study Phase II survey. Results: Participants reported their accessibility of NSP services as low (6%), middle (19%), and high (75%) in the past 2 months at the time of the survey. PWID who had increased access to NSP services were less likely to report utilization of used cooker (aOR = 1.40; CI 95% 0.99–1.82), cotton (aOR = 1.30; CI 95% 0.79–1.81), and water (aOR = 1.07; CI 95% 0.89–1.26), receptive needle/syringe sharing (aOR= 1.86, 95% CI 1.69–2.03), and distributive needle/syringe sharing (aOR= 1.09, 95% CI 0.81–1.37). Conclusions/Importance: There is evidence of inequality in PWID’s access to health care as they relate to the prevention of HCV transmission. An understanding of both the social determinants and prevention of injecting and sharing risk behaviors seeks to connect HCV risk reduction within the context of human rights and vulnerability.

Keywords:

• Accessibility
• needle and syringe program
• health care
• risk behaviors
• HCV