Barriers in utilization of harm reduction services for HIV/AID prevention among injecting drug users in Karachi : a qualitative study exploring users and management perspectives

Barriers in utilization of harm reduction services for prevention of HIV/AIDS among injecting drug users in Karachi: A qualitative study exploring users and management perspectives. Background: HIV/AIDS is a major public health issue, and is among the leading cause of death and disability in the world. IDUs are at highest risk of acquiring HIV/AIDS among vulnerable populations. Among 16 million injecting drug users, three million are HIV positive which constitutes a major proportion to global burden of HIV. The MDG 6 focuses on halting the spread of HIV. The concept of Harm reduction programs emerged to decrease the harmful effects of injection drug use. Harm reduction program mainly focuses on provision of safe needles and condoms along with behavior change communication. The prevalence of HIV among general population in Pakistan is less than 0.1% however concentrated epidemic has been established among high risk groups including IDUs. Despite the available services of harm reduction to IDUs in Pakistan the prevalence of HIV among IDUs has increased from 16 to 32 % at the national level in last seven years and 43% in Karachi. Due to the bridging characteristic of the IDUs with other high risk groups including female sex workers there is a potential threat of HIV spread to low risk populations. Purpose: The aim of this study is to inform about the barriers in utilization and gaps in existing harm reduction program by exploring the views of users and program managers. Methodology: A qualitative exploratory study design was used to explore the views of users and program managers about the existing strategies and reasons of low utilization of HRP. Purposive sampling technique was adopted for selection of participants. Key informant interviews were conducted with IDUs and program managers while FGDs were conducted with outreach workers using semi structured interview guide. Data was collected till theoretical saturation for IDUs, while both program managers were interviewed. Real time data analysis was done with help of QSR NVivo version 10. Results Majority of the participants considered harm reduction program effective in limiting the prevalence of HIV among IDUs however they perceived that it is alone not sufficient in reducing the threat of HIV spread to the low risk population. The identified barriers were classified into individual, system and societal level. Lack of resources to reach to the spot was the main individual level barrier in utilization of HRP while the reported system level barriers were lack of opioid substitution therapy, and low coverage. Behavior of the society was considered the prominent societal level barrier in utilization of harm reduction program. Conclusion: Harm reduction program is an effective strategy for limiting the prevalence of HIV/AIDS among IDUs. However for better outcomes of the program, integration of harm reduction services with other preventive programs of the country and inclusion of OST in the existing harm reduction strategies is recommended