A Qualitative Study Among Injection Drug Using Women in Rhode Island: Attitudes Toward Testing, Treatment, and Vaccination for Hepatitis and HIV

Abstract

HIV and hepatitis C virus infection are serious and prevalent health conditions among many women who inject drugs. Qualitative interviews with 20 injection drug using women at a short term drug treatment center in Rhode Island revealed six primary barriers and facilitators for testing and receiving results and treatment for hepatitis and HIV, as well as for hepatitis vaccination. The primary barriers were prioritization of drug use; low level of diseases-pecific knowledge; stigmatization; accessibility of testing, results and treatment; and psychological factors. The primary facilitator was interest in promoting one's health. Our findings indicate that injection drug using women experience multiple barriers to HIV and hepatitis testing, results, treatment and vaccination. Methods for improving the motivators for health, facilitating infectious disease prevention, and decreasing unnecessary disease complications of injection drug using women need to be utilized. These methods should include strategies that minimize stigma and facilitate accessibility of health care.

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…Two studies included the views of health professionals involved in the care of PWIDs; one as the sole study participants (Perry & Chew-Graham, 2003) and one, in addition to the views and experiences of PWID (Munoz-Plaza, Strauss, Astone, Jarlms, & Hagan, 2004). Most studies specifically examined views and experiences in relation to HCV infection only, though two studies (Gyarmathy, Neaigus, Ujhelyi, Szabo, & Racz, 2006;Lally, Montstream-Quas, Tanaka, Tedeschi, & Morrow, 2008) explored viral hepatitis infection more broadly alongside sexually transmitted infections such as HIV (table 1). **INSERT TABLE 1 ABOUT HERE** The included studies covered testing and the impact of diagnosis, including barriers and facilitators to testing, experiences of testing, reactions to diagnosis, and the impact of diagnosis on behaviour, and stigma as a barrier to testing uptake and disclosure.…”

“…Negative views and experiences of testing and diagnosis were contextualised in many cases by the limited provision of information by health professionals, and an individual awareness of incomplete or partial knowledge of HCV by PWID. A lack of knowledge of HCV symptoms and transmission were common among PWID Rhodes, Davis, & Judd, 2004;Gyarmarthy et al, 2006;Lally et al, 2008;Ellard, 2007), particularly among those who had not previously been tested . Such gaps contributed to delays in seeking testing (Strauss et al, 2008;Swan et al, 2010;Lally et al, 2008;Southgate, Weatherall, Day, & Dolan, 2005) and individual barriers to testing uptake among PWID, such as fear, were often related to incomplete knowledge about HCV.…”

“…) Experiences of being informed on the outcome of testing were generally poor. Many PWID remained unclear about the meaning of a diagnosis and experienced limited and inadequate information provision by health professionals, leading to substantial gaps in knowledge (Copeland, 2004;Cullen, Kelly, Stanley, Langton, & Bury, 2005;Faye & Irurita, 2003;Khaw et al, 2007;Lally et al, 2008;Rhodes et al, 2004;Southgate et al, 2005;Strauss et al, 2008;Sutton & Treloar, 2007;Swan et al, 2010;Temple-Smith, Gifford, & Stoové, 2004;Tompkins et al, 2005). A policy of not informing 8 PWID of the outcomes of testing ("a no news is good news approach"), as described in two drugs services , also produced anxiety.…”

“…140) Responses to a positive diagnosis depended on individual circumstances (Craine, Walker, Carnwath & Klee, 2004) but feelings of unconcern or denial among some PWID were commonly underpinned by a lack of knowledge. In many studies PWID had experienced difficulties in obtaining reliable information following testing, regardless of whether they received a positive or negative diagnosis Carrier, LaPlante, & Bruneau, 2005;Copeland, 2004;Lally et al, 2008;Rhodes et al, 2004).…”

“…Participants in many studies had experienced HCV testing opportunistically as part of routine health assessments (Craine et al, 2004;Lally et al, 2008;Munoz-Plaza et al, 2005;Rhodes et al, 2004;Swan et al, 2010; and among those unlikely to deliberately seek testing, had been an important facilitator of testing uptake Temple-Smith et al, 2004 …”