Young and invisible: a qualitative study of service engagement by people who inject drugs in India
Objectives The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services....
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BMJ Publishing Group
2021-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/9/e047350.full |
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| author | Kenneth H Mayer Vinita Verma Lakshmi Ganapathi Shruti H Mehta Aylur K Srikrishnan Clarissa Martinez Gregory M Lucas Allison M McFall Areej Hassan Shobini Rajan Conall O’Cleirigh Sion Kim Harris Sunil S Solomon |
| author_facet | Kenneth H Mayer Vinita Verma Lakshmi Ganapathi Shruti H Mehta Aylur K Srikrishnan Clarissa Martinez Gregory M Lucas Allison M McFall Areej Hassan Shobini Rajan Conall O’Cleirigh Sion Kim Harris Sunil S Solomon |
| author_sort | Kenneth H Mayer |
| collection | DOAJ |
| description | Objectives The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services.Setting We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics.Participants PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants’ narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum.Results Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.Conclusions Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services. |
| format | Article |
| id | doaj-art-8030e8d3222d4b55978a7d7d0a81efd9 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8030e8d3222d4b55978a7d7d0a81efd92025-08-20T02:18:34ZengBMJ Publishing GroupBMJ Open2044-60552021-09-0111910.1136/bmjopen-2020-047350Young and invisible: a qualitative study of service engagement by people who inject drugs in IndiaKenneth H Mayer0Vinita Verma1Lakshmi Ganapathi2Shruti H Mehta3Aylur K Srikrishnan4Clarissa Martinez5Gregory M Lucas6Allison M McFall7Areej Hassan8Shobini Rajan9Conall O’Cleirigh10Sion Kim Harris11Sunil S Solomon12The Fenway Institute, Boston, Massachusetts, USANational AIDS Control Organisation, New Delhi, IndiaDivision of Infectious Diseases, Boston Children`s Hospital, Boston, Massachusetts, USA1 Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAYR Gaitonde Centre for AIDS Research and Education, Chennai, IndiaSchool of Medicine, City University of New York, New York, New York, USADivision of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAHarvard Medical School, Boston, Massachusetts, USANational AIDS Control Organisation, New Delhi, IndiaFenway Institute, Boston, Massachusetts, USAHarvard Medical School, Boston, Massachusetts, USA1 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAObjectives The HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services.Setting We conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics.Participants PWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants’ narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum.Results Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.Conclusions Development of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.https://bmjopen.bmj.com/content/11/9/e047350.full |
| spellingShingle | Kenneth H Mayer Vinita Verma Lakshmi Ganapathi Shruti H Mehta Aylur K Srikrishnan Clarissa Martinez Gregory M Lucas Allison M McFall Areej Hassan Shobini Rajan Conall O’Cleirigh Sion Kim Harris Sunil S Solomon Young and invisible: a qualitative study of service engagement by people who inject drugs in India BMJ Open |
| title | Young and invisible: a qualitative study of service engagement by people who inject drugs in India |
| title_full | Young and invisible: a qualitative study of service engagement by people who inject drugs in India |
| title_fullStr | Young and invisible: a qualitative study of service engagement by people who inject drugs in India |
| title_full_unstemmed | Young and invisible: a qualitative study of service engagement by people who inject drugs in India |
| title_short | Young and invisible: a qualitative study of service engagement by people who inject drugs in India |
| title_sort | young and invisible a qualitative study of service engagement by people who inject drugs in india |
| url | https://bmjopen.bmj.com/content/11/9/e047350.full |
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