Barriers to use of Needle and Syringe Programmes in a high drug use area of Sydney, New South Wales

Abstract: Objective:: Most surveillance of injecting drug users (IDUs) in Australia is done with samples of participants drawn from those who attend Needle and Syringe Programmes (NSPs). We investigated the barriers and preferences to NSP access of a group of IDUs who do not use NSPs as their primary source of injecting equipment from a defined geographical area in Sydney, which has been estimated to house the highest number of IDUs in Australia. Method:: A cross-sectional, interviewer-administered questionnaire was completed by 294 participants, most of whom were recruited through the personal and extended networks of peer interviewers. Participants were considered in two groups: those who did not use NSPs (non-NSP users) and those who used NSPs infrequently (infrequent NSP users). Results:: Infrequent NSP users were more likely than non-NSP users to report reasons of convenience and NSP operation as barriers to access. Non-NSP users reported barriers related to lack of awareness of NSPs and that they did not need to access NSPs. Fixed locations and vending machines were most frequently endorsed by both groups as the “best way” to distribute injecting equipment. However, issues of stigma and maintaining anonymity were concerns for participants in both groups. Compared to non-NSP users, infrequent users were more likely to reside in areas with a large drug user population, obtain safe injecting information from health workers, have injected drugs for longer, have injected alone, have been tested for blood borne viruses, report greater connectedness to drug user networks and be less concerned about contacting NSP staff. Conclusion:: Understanding the preferences of IDU, including those who do not attend NSP, is central to providing health services which meet their needs and in developing hepatitis C prevention programmes which reach this target group. The effects of stigma on the health care choices of IDUs must be recognised in planning developments in NSP service, or alternatives to NSPs. [Copyright &y& Elsevier]