Injecting on the Island: a qualitative exploration of the service needs of persons who inject drugs in Prince Edward Island, Canada
Tóm tắt
Few studies have investigated the service needs of persons who inject drugs (PWID) who live in less populated regions of Canada. With access to fewer treatment and harm reduction services than those in more urban environments, the needs of PWID in smaller centres may be distinct. As such, the present study examined the needs of PWID in Prince Edward Island (PEI), the smallest of Canada's provinces. Eight PWID were interviewed about the services they have accessed, barriers they faced when attempting to access these services, and what services they need that they are not currently receiving. Participants encountered considerable barriers when accessing harm reduction and treatment services due to the limited hours of services, lengthy wait times for treatment, and shortage of health care practitioners. They also reported experiencing considerable negativity from health care practitioners. Participants cited incidences of stigmatisation, and they perceived that health care practitioners received insufficient training related to drug use. Recommendations for the improvement of services are outlined. The findings indicate that initiatives should be developed to improve PWID's access to harm reduction and treatment services in PEI. Additionally, health care practitioners should be offered sensitisation training and improved education on providing services to PWID. The findings highlight the importance of considering innovative alternatives for service provision in regions with limited resources.
Tài liệu tham khảo
Deng Q, Tang Q, Schottenfeld RS, Hao W, Chawarski MC: Drug use in rural China: a preliminary investigation in Hunan province. Addiction. 2012, 107: 610-613. 10.1111/j.1360-0443.2011.03648.x.
Havens JR, Walker R, Leukefeld CG: Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users. Drug & Alcohol Dependence. 2007, 87: 98-102. 10.1016/j.drugalcdep.2006.07.008.
Leukefeld CG, Logan TK, Farabee D, Clayton R: Drug use and AIDS: estimating injection prevalence in a rural state. Subst Use Misuse. 2002, 37: 767-782. 10.1081/JA-120004282.
Liu W, Chen J, Rodolph M, Beauchamp G, Mâsse B, Wang S, Li R, Ruan Y, Zhou F, Leung MK, Lai S, Shao Y, Jackson JB: HIV prevalence among injection drug users in rural Guangxi China. Addiction. 2006, 101: 1493-1498. 10.1111/j.1360-0443.2006.01557.x.
Hanlon N, Skedgel C: Cross-district utilization of general hospital care in Nova Scotia: policy and service delivery implications for rural districts. Soc Sci Med. 2006, 62: 145-156. 10.1016/j.socscimed.2005.05.018.
Schoo AM, Stagnitti KE, Mercer C, Dunbar J: A conceptual model for recruitment and retention: allied health workforce enhancement in Western Victoria, Australia. Rural Remote Health. 2005, 5: 477-
Bourgeault IL, Sutherns R, Haworth-Brockman M, Dallaire C, Neis B: Between a rock and a hard place: access, quality and satisfaction with care among women living in rural and remote communities in Canada. Research in the Sociology of Health Care. 2006, 24: 175-202.
Harrold J, Jackson LA: Hurry up and wait: the experiences of young women in rural Nova Scotia accessing specialized care. Can J Rural Med. 2011, 16: 83-88.
Parker J, Jackson L, Dykeman M, Gahagan J, Karabanow J: Access to harm reduction services in Atlantic Canada: implications for non-urban residents who inject drugs. Health Place. 2012, 18: 152-162. 10.1016/j.healthplace.2011.08.016.
Gustafson DL, Goodyear L, Keough F: When the dragon's awake: a needs assessment of people injecting drugs in a small urban centre. Int J Drug Policy. 2008, 19: 189-194. 10.1016/j.drugpo.2008.01.005.
Jackson LA, Dykeman M, Gahagan J, Karabanow J, Parker J: Challenges and opportunities to integrating family members of injection drug users into harm reduction efforts within the Atlantic Canadian context. Int J Drug Policy. 2011, 22: 385-392. 10.1016/j.drugpo.2011.05.011.
Statistics Canada: Land and freshwater area, by province and territory. [http://www40.statcan.ca/l01/cst01/phys01-eng.htm]
Statistics Canada: Canada's population estimates. [http://www.statcan.gc.ca/daily-quotidien/110622/dq110622a-eng.htm]
Patten S: Environmental Scan of Injection Drug Use, Related Infectious Diseases, High-risk Behaviours, and Relevant Programming in Atlantic Canada. 2006, Halifax: Public Health Agency of Canada
Government of Prince Edward Island: Prince Edward Island Methadone Maintenance Treatment Program. 2008, Charlottetown: Department of Health
CBC News: Province ready to take over needle exchange. [http://www.cbc.ca/news/canada/prince-edward-island/province-ready-to-take-over-needle-exchange-1.850447]
CBC News: Needle exchange opens in Alberton. [http://www.cbc.ca/news/canada/prince-edward-island/needle-exchange-opens-in-alberton-1.969464]
CBC News: Needle exchange office coming to Montague. [http://www.cbc.ca/news/canada/prince-edward-island/needle-exchange-office-coming-to-montague-1.1055669]
Strike C, Cavalieri W, Bright R, Myers T, Calzavara L, Millson M: Syringe acquisition, peer exchange and HIV risk. Contemporary Drug Problems. 2005, 32: 319-340.
Strauss A, Corbin J: Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 1990, Thousand Oaks: SAGE
Baker SE, Edwards R: How Many Qualitative Interviews is Enough? Expert Voices and Early Career Reflections on Sampling and Cases in Qualitative Research. 2012, Swindon: Economic & Social Research Council (ESRC)
Boyatzis R: Transforming Qualitative Information: Thematic Analysis and Code Development. 1998, Thousand Oaks: SAGE
Marshall C, Rossman GB: Designing Qualitative Research. 1995, London: SAGE
Galea S, Ahern J, Vlahov D: Contextual determinants of drug use risk behavior: a theoretical framework. J Urban Health. 2003, 80: iii50-iii58. 10.1007/BF02417842.
Rhodes T: Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009, 20: 193-201. 10.1016/j.drugpo.2008.10.003.
Rhodes T: The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002, 13: 85-94. 10.1016/S0955-3959(02)00007-5.
Treloar C, Laybutt B, Jauncey M, van Beek I, Lodge M, Malpas G, Carruthers S: Broadening discussions of “safe” in hepatitis C prevention: a close-up of swabbing in an analysis of video recordings of injecting practice. Int J Drug Policy. 2008, 19: 59-65.
Andresen MA, Boyd N: A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. Int J Drug Policy. 2010, 21: 70-76. 10.1016/j.drugpo.2009.03.004.
Navarro C, Leonard L: Prevalence and factors related to public injecting in Ottawa, Canada: implications for the development of a trial safer injecting facility. Int J Drug Policy. 2004, 15: 275-284. 10.1016/j.drugpo.2004.03.003.
Snead J, Downing M, Lorvick J, Garcia B, Thawley R, Kegeles S, Edlin BR: Secondary syringe exchange among injection drug users. J Urban Health. 2003, 80: 330-348. 10.1093/jurban/jtg035.
Islam MM, Conigrave KM: Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): a review. Harm Reduction J. 2007, 4: 14-10.1186/1477-7517-4-14.
Bryant J, Hopwood M: Secondary exchange of sterile injecting equipment in a high distribution environment: a mixed method analysis in south east Sydney, Australia. Int J Drug Policy. 2009, 20: 324-328. 10.1016/j.drugpo.2008.06.006.
Klein A: Sticking Points: Barriers to Access to Needle and Syringe Programs in Canada. 2007, Toronto: Canadian HIV/AIDS Legal Network
Kirby M, Keon W: Mental Health, Mental Illness, and Addiction: Overview of Policies and Programs in Canada. 2004, Ottawa: Standing Senate Committee on Social Affairs, Science and Technology
Day C, Ross J, Dolan K: Hepatitis C-related discrimination among heroin users in Sydney: drug user or hepatitis C discrimination?. Drug Alcohol Rev. 2003, 22: 317-321. 10.1080/0959523031000154463.
Ploem C: Profile of Injection Drug Use in Atlantic Canada. 2000, Halifax: Population and Public Health Branch
Clingerman E: An insider/outsider team approach in research with migrant farmworker women. Community Health. 2007, 30: 75-84.
O'Conner P: The conditionality of status: experience-based reflections on the insider/outsider issue. Aust Geogr. 2004, 35: 169-176. 10.1080/0004918042000249476.
Sherman SG, Latkin CA, Gielen AC: Social factors related to syringe sharing among injecting partners: a focus on gender. Subst Use Misuse. 2001, 36: 2113-2136. 10.1081/JA-100108439.
Montgomery SB, Hyde J, De Rosa CJ, Rohrbach LA, Ennett S, Harvey SM, Clatts M, Iverson E, Kipke MD: Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse. 2002, 28: 453-475. 10.1081/ADA-120006736.
Statistics Canada: Population and dwelling counts: Newfoundland and Labrador, Census metropolitan area (CMA) and Census agglomerations (CA). [http://www.stats.gov.nl.ca/statistics/Census2011/PDF/POP_Dwellings_CMA_CA_2011.pdf]
Statistics Canada: Economic indicators, by province and territory. [http://www40.statcan.gc.ca/l01/cst01/indi02b-eng.htm]
Dolan AH, Taylor M, Neis B, Ommer R, Eyles J, Schenider D, Montevecchi B: Restructuring and health in Canadian coastal communities. Ecohealth. 2005, 2: 195-208. 10.1007/s10393-005-6333-7.
Government of Nova Scotia: Withdrawal management. [http://waittimes.novascotia.ca/procedure/addictions-withdrawal-management]