(P35) Barriers and facilitators to participate in a needle exchange program for women who inject drugs
Malin Värmå Falk  & Susanne Strömdahl *, Anna-Mia Ekström , Martin Kåberg , Niklas Karlsson , Anders Hammarberg  *Shared first authorship
 Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.  Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden & Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.  Department of Public Health Sciences, Global health (IHCAR), Karolinska Institutet, Stockholm, Sweden  Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden  Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden  Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Background: The sharing of unsterile injection equipment, i.e. injecting risk behaviour (IRB) contributes significantly in maintaining the high prevalence of hepatitis C (HCV) and HIV infections among people who inject drugs (PWID). Several studies have concluded that women who inject drugs (WWID) show higher levels of IRB and that WWID are less present in harm reduction programs (HR) such as needle exchange programs (NEP) compared to men. No previous studies have had a specific focus on factors that serve as barriers versus facilitators for participating in a NEP for WWID in a Nordic context. There is also a lack of knowledge regarding the optimal content of NEP as expressed by WWID themselves.
Aims: The aim of this study was to investigate reasons for and barriers to take part in NEP for WWID as well as their needs and preferences for services related to harm reduction.
Methods: In depth interviews (IDIs) were conducted with 20 WWID who had been participants for at least six months in the only existing NEP in Stockholm, Sweden. FGDs were audio recorded and transcribed verbatim. Content analysis was used to determine themes.
Results: Most important reasons for the first visit to the NEP were receveing sterile injecting equipment, HIV and HCV testing, vaccination, naloxone pick-up, HCV treatment and social support. The main reasons expressed for continuous participation were the easy access to available services at the NEP such as being able to visit a nurse, doctor or the midwife and help with dressing wounds. A very important reason for participants was the manner in which the staff treated WWID and such created a climate in which participants felt comfortable, safe and respected.
The most important barriers for NEP participation, mentioned by most participants, were the fear of being reported to the social services, of loosing custody of children and the perceived risk of getting supervised visitation rights revoked. Fear of jealous partners and the risk of being exposed to violent acts due to visiting the NEP was the other prominent barrier. Other barriers were feelings of stigma and fear of loss of confidentiality. WWID also expressed some practical barriers such as geographical distance to the NEP, short opening hours and a negative experience of the waiting room area.
Suggestions for improvements of the NEP were related to practical factors such as extended opening hours and the need for more NEPs within the Stockholm region. Other suggestions concerned increased information regarding the NEP at for example other public authorities. Lastly, factors specifically expressed related to being a woman such as increased access to a midwife or a NEP for women only.
Conclusion: In conclusion, the present study identified important factors to consider regarding how to optimize the services offered at a NEP from the perspective of WWID. This may be especially important in countries like Sweden who is in a process of a rapid scaling up of HR-interventions such as NEP.