The opioid epidemic has been declared as a national health emergency, with many rural areas across the country being strongly afflicted. Yet, many rural areas face disparities in healthcare resources, access to harm reduction,... [ view full abstract ]
The opioid epidemic has been declared as a national health emergency, with many rural areas across the country being strongly afflicted. Yet, many rural areas face disparities in healthcare resources, access to harm reduction, and vulnerability to rapid transmission of infectious disease via injection drug use (Van Handel et al. 2016). Syringe exchange programs (SEP) serve as a mechanism for reducing unsafe injection practices, and thus, the transmission of infectious diseases such as human immunodeficiency virus and hepatitis C (e.g. Wodak and Cooney 2006). However, given these vulnerabilities many rural communities face, relatively few SEPs exist in rural areas. A 2015 report from the CDC shows only 20% of SEPs in the United States are located in rural communities, despite data suggesting over 50% of persons who inject drugs (PWID) reside outside urban areas (Des Jarlais et al. 2015). Additionally, much of the harm reduction literature focuses primarily on urban areas. This paper will examine PWID experiences with, and perceptions of, a SEP operating within a rural community.
This paper utilizes qualitative data gathered from an exploratory study conducted in response to an HIV outbreak with the purpose of gaining information about potential processes of transmission, and experiences with the response effort, primarily as it pertains to the then recently implemented SEP. The study collected data through semi-structured private interviews and focus groups (N=56) among PWID in the community. Purposeful location based and snow ball sampling techniques were used to recruit participants. The recruitment process placed an emphasis on information rich participants who would collectively yield a sample representative of key characteristics of interest for the HIV outbreak. Interviews were digitally recorded, transcribed, cross-checked, and coded and prepared for analyses using NVivo 10 software. The data utilized in this paper examines how a rural context influences SEP experiences and facilitators and barriers to utilization. It examines the role of a mobile delivery service in addressing transportation barriers, the stigma associated with utilizing the SEP, and general participant experiences with the SEP.
Findings suggest the mobile delivery service helped bridge transportation related barriers to accessing harm reduction supplies, and it alleviated fears of the stigma associated with visiting the SEP in person. Some participants reported concern of the stigma associated with being seen using the SEP, and others reported similar attitudes among within their network. General experiences with the SEP were positive overall; however, concerns of limited hours of operation are indicative of capacity constraints rural areas face in higher proportions. Given the unique challenges the opioid epidemic presents for rural areas, and the lack of literature and resources concerning the epidemic in rural communities, this paper will provide valuable insight for organizations seeking to address the opioid epidemic in rural communities.
