Theme: Social Science & Policy Research Year: 2024
Background: Needle syringe programs (NSPs) are evidence-based strategies that reduce drug-related harms (including HIV/hepatitis C transmission) among people who inject drugs in the community but are not yet widely implemented in prisons worldwide (PNSPs). Despite their availability in Canadian federal prisons, uptake remains low. We aimed to explore the barriers and facilitators to improving PNSP uptake by incarcerated people who inject drugs.
Methods: Participants from nine federal prisons with PNSPs completed focus groups using nominal group technique, a rapid mixed-method consensus strategy that generates and ranks responses. The qualitative component aimed to identify a wide spectrum of barriers and solutions to improving PNSP uptake, which were ranked and coded in the quantitative component to prioritize responses. Participants included incarcerated individuals (peer advocates and potential/current users of PNSPs) and correctional employees (officers and prison healthcare).
Results: Between September 2023 and February 2024, 34 focus groups were conducted with 214 participants (n=97 incarcerated individuals; n=117 correctional employees). Among incarcerated individuals, the top three barriers were confidentiality concerns, fear of affecting parole/release, and stigma or judgment stemming from accessing PNSPs. The top three solutions were education programs, supervised/safe injection sites, and peer-led program delivery. Among correctional employees, the top three perceived barriers to participation in PNSPs were confidentiality concerns, fear of bullying from peers, and fear of targeting by correctional officers and the top three solutions were supervised/safe injection sites, education programs, and simplified enrolment processes.
Conclusion: Multiple modifiable barriers and solutions to improving PNSP uptake in Canadian federal prisons were identified among all key stakeholders. Both participant groups identified the potential for education programs and supervised/safe injecting sites as solution-driven enablers to increasing PNSP uptake among incarcerated people who inject drugs. These data will inform Canadian and international efforts to expand PNSP provision.
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