Drug and alcohol dependence · 2026
Reproductive health considerations for HIV prevention integrated care models for women who inject drugs: Qualitative perspective of participants and providers in HIV Prevention Trials Network 094.
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Albano Maggie, Schmidt Rose A, Tsuyuki Kiyomi, Shoptaw Steve, El-Bassel Nabila, Smith Laramie R, Lake Jordan E, Harris-Wisecarver Jayla, Andrew Philip, Denis Cecile, Yellin Hannah, Bornstein Sydney, Redd Rashaunna, Meyers-Pantele Stephanie A
Аннотация
BACKGROUND: Cisgender women who inject drugs (WWID) face gendered health inequities and unique barriers to accessing healthcare services. We explored WWID's sexual and reproductive health (SRH) needs to inform the development of integrated care for this population.
METHODS: The HPTN 094 (INTEGRA) study tested the efficacy of delivering mobile integrated services for people who inject drugs. Semi-structured interviews were conducted with 116 INTEGRA participants and staff to identify barriers and facilitators for medication for opioid use disorder (MOUD) and HIV prevention and treatment. We conducted a thematic analysis of qualitative data from 38 interviews (n = 23 participants; n = 15 staff; n = 31 cisgender women; n = 3 cisgender men; n = 3 nonbinary) containing narratives around WWID's SRH. Findings were contextualized within the Sexual and Reproductive Justice Framework (SRJF) to understand WWID's SRH experiences and to inform equitable integrated care.
RESULTS: We identified three themes related to SRJF. First, aligned with the justice-based perspective (i.e., the socio-structural factors impacting SRH), participants detailed the "real-life" implications of being a WWID, including the disproportionate reproduction, parenting, and household management responsibilities (i.e., "responsibility of care") that impede SRH service utilization. Second, participants highlighted how systemic barriers (i.e., limited access to specialized providers and pervasive stigma) undermine care. Third, aligned with the rights-based perspective (i.e., promoting reproductive freedom), participants underscored the importance of centering WWID's voices to inform equitable SRH services.
DISCUSSION: Findings highlight the disproportionate responsibility of care WWID face, how this responsibility and stigma negatively impact SRH access, and the need for mobile, integrated care options that address the needs of WWID.
METHODS: The HPTN 094 (INTEGRA) study tested the efficacy of delivering mobile integrated services for people who inject drugs. Semi-structured interviews were conducted with 116 INTEGRA participants and staff to identify barriers and facilitators for medication for opioid use disorder (MOUD) and HIV prevention and treatment. We conducted a thematic analysis of qualitative data from 38 interviews (n = 23 participants; n = 15 staff; n = 31 cisgender women; n = 3 cisgender men; n = 3 nonbinary) containing narratives around WWID's SRH. Findings were contextualized within the Sexual and Reproductive Justice Framework (SRJF) to understand WWID's SRH experiences and to inform equitable integrated care.
RESULTS: We identified three themes related to SRJF. First, aligned with the justice-based perspective (i.e., the socio-structural factors impacting SRH), participants detailed the "real-life" implications of being a WWID, including the disproportionate reproduction, parenting, and household management responsibilities (i.e., "responsibility of care") that impede SRH service utilization. Second, participants highlighted how systemic barriers (i.e., limited access to specialized providers and pervasive stigma) undermine care. Third, aligned with the rights-based perspective (i.e., promoting reproductive freedom), participants underscored the importance of centering WWID's voices to inform equitable SRH services.
DISCUSSION: Findings highlight the disproportionate responsibility of care WWID face, how this responsibility and stigma negatively impact SRH access, and the need for mobile, integrated care options that address the needs of WWID.