Evidence of Limited Access to Harm Reduction Services in England, Wales and Northern Ireland in 2020 as a Result of COVID-19 Restrictions

Author: Sara Croxford Eva Emanuel Claire Edmundson Lucinda Slater Monica Desai

Theme: Epidemiology & Public Health Research Year: 2022

People who inject drugs (PWID) are a marginalised group disproportionately affected by infectious
diseases and who experience barriers to accessing care. We describe the impact of the coronavirus
disease (COVID-19) pandemic restrictions on the accessibility of harm reduction services in England,
Wales and Northern Ireland (EW&NI).
The Unlinked Anonymous Monitoring (UAM) Survey is an annual bio-behavioural survey recruiting
people who have ever injected psychoactive drugs through drug and alcohol services across EW&NI.
In June 2020, in addition to providing a dried blood spot sample and completing a behavioural
questionnaire, participants were asked to complete a brief enhanced COVID-19 questionnaire, with
questions on how easy it was to access harm reduction services (equipment to use/inject drugs,
opioid substitution therapy (OST), naloxone, HIV/hepatitis testing) in 2020 compared to 2019. We
characterise PWID reporting difficulties accessing these services compared to those reporting no
difficulties (chi2; p<0.10).
In 2020, 498 PWID completed the enhanced COVID-19 questionnaire; 71% (n=353) indicated need
for harm reduction services, reporting access to these services to be easier, the same or more
difficult in 2020 compared to 2019. Overall, 34% (n=120) of PWID reported difficulty accessing either
equipment (25%), OST (22%), naloxone (13%) and/or HIV/hepatitis testing (22%). Men (37% vs.
women 25%; p=0.039), PWID recruited outside of London (37% vs. London 26%; p=0.058) and those
recruited through hostels/hotels (41% vs. drug services 30%; p=0.043) were more likely to report
difficulties accessing harm reduction services, as well as people reporting sharing needles/syringes in
the last month (53% vs. 32%; p=0.010) and re-using their own equipment in the last month (43% vs.
26%; p=0.030).
PWID reported difficulty accessing essential prevention services in 2020. Continued monitoring is
needed to understand the impact on national HIV and viral hepatitis elimination efforts, and health
inequalities experienced by PWID.
Disclosure of Interest Statement
No conflicts of interest to disclose.

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