Syringe Service Program Utilization, Barriers, and Preferences for Design in Rural Appalachia: Differences between Men and Women Who Inject Drugs

Abstract

Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.

Keywords:

• Needle exchange programs
• people who inject drugs
• harm reduction
• Appalachia
• rural
• gender

Acknowledgements

We would like to acknowledge the participants involved in this study for sharing their information and experiences with us, as well as the community-based staff who collected the data and community-academic partnership coalitions who provided helped to guide study and survey design.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Availability of data and materials

The data analyzed in this current study is not publicly available due to it containing information that could compromise research participant privacy and consent but are available from the corresponding author on reasonable request.

Authors’ contributions

KEL conceived the manuscript topic, designed the analysis, acquired the data, performed the data analyses, and drafted the manuscript. HLFC and AMY designed the study, provided expert advice regarding the study analyses, assisted with drafting the manuscript, and provided critically important intellectual content during manuscript revisions. CRB, CDM, JFPB assisted with interpretation of the data and provided critically important intellectual content during manuscript revisions. All authors read and approved the final manuscript and take public responsibility for their contributions to the manuscript.

Consent for publication

All authors have read the manuscript and have consented this submission for publication.

Ethics approval and consent to participate

This study was reviewed and approved by the Institutional Review Board at the University of Kentucky. All participants provided informed, written consent prior to participation.

Additional information

Funding

This work was supported by National Institute on Drug Abuse (K01DA048174: PI Lancaster; UG3DA044798: PIs Young and Cooper; and UG3DA044798 02S1: PIs Young and Cooper).