Operational Research of Barriers and Facilitators to Harm Reduction Services for IDUs (including female IDUs)

Georgia belongs to group of countries with low HIV/AIDS prevalence (0.5% (0.4-0.6%)1 among adult population but with a high potential for the development of a widespread epidemic. The epidemic is concentrated among key affected populations (KAP), specifically among people who inject drugs (PWID) and men who have sex with men (MSM). The harm reduction programs have been operating in Georgia since 2005 with the aim to reduce the health, social and economic harms of substance use to individuals, communities and societies2.

The aim of this study was to evaluate barriers and facilitators to Harm Reduction services for IDUs (including female IDUs) and develop policy recommendations for improving quality of services and overcoming those barriers.

Qualitative study using in-depth interviews was conducted during September-November 2017; the study participants were providers and beneficiaries of harm reduction services. The study was conducted in Tbilisi, Gori, Kutaisi and Batumi. Overall 12 providers and 35 IDUs participated in the study. Appropriate ethical considerations were adopted in conducting the research. Prior to implementing the study, IRB approval was sought from the Georgian nongovernmental organization (NGO) “Health Research Union”.

The study results showed that stigma and discrimination is one of the leading barriers hindering access to harm reduction services, which is even much greater against female IDUs. Anonymity and confidentiality are among the most important factors for IDUs when using harm reduction services. Existing strict drug policy considerably limits access to NSP services. The issue concerning the take away dosages was named as an important barrier for joining as well as for retaining in OST programs. The study revealed that there is a geographical accessibility barrier to all harm reduction services in regions.

IDUs face financial barriers when using private harm reduction programs as well as high financial burden for transportation costs. According to the study results there is a lack of awareness of NSP while awareness of OST programs is very high among IDUs. The leading factor encouraging IDUs to get harm reduction services is a free service that was common for all programs. Positive, friendly attitude towards IDUs is another facilitator to attracting them to harm reduction services. Providers and beneficiaries of all harm reduction programs underlined the importance of rehabilitation services as well as the need to support IDUs’ employment.

Based on the study results the following recommendations are elaborated to improve the access to Harm Reduction services:

  • Implement measures to reduce stigma and discrimination. The target groups for these activities should include:
    o General population,
    o Medical Personnel,
  • IDUs (work on IDUs’ self-stigma, as well as work with male IDUs to remove discriminatory attitude towards female IDUs);
  • Implement service of take away dosages at OST programs;
  • Provide society with proper information on the positive role of substitution therapy and other harm reduction services;
  • Raise awareness of IDUs on NSPs;
  • Increase geographic accessibility of NSP and OST programs in regions;
  • Share the experience of some NSP centers offering separate working hours/days to female IDUs and implement this practice within OST programs;
  • Incorporate rehabilitation services in all OST and NSP centers;
  • Support employment of IDUs;
  • Integrate Hep C treatment services within NSP centers;
  • Ensure the sustainability of existing Harm Reduction services;
  • Ensure the sustainability of low threshold services for IDUs after the transition from GF funding towards fully national funding;
  • Continue active work towards advocating for the liberal drug policy.

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