Hepatitis C awareness and anonymity in harm reduction vending machines

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VEnd machines have proven to be an unexpected but widely effective risk reduction tool in many countries. In jurisdictions such as New York and the capital of Canada Ottawa, various groups set up the machines – which usually provide supplies for free, rather than selling them – to give drug users key tools such as syringes, pipes and naloxone. They have the added benefit of anonymity, that some people who use drugs prefer to interact with another person to get the items.

There are also other potential benefits. New search of Australia, published in the harm reduction journal, suggests that vending machine locations could be a point of contact between people who use drugs and hepatitis C testing and treatment. In short, members of medical or harm reduction organizations could install near machines and offer people referrals or contact information for hepatitis C services. In the research, some respondents expressed support for this idea. However, others seemed discouraged by the presence of people there, indicating that they considered the machines to be private spaces and preferred to avoid any personal involvement in this setting.

“We were just trying to see if we could better understand the people using the machine,” said Carolyn A. Day, associate professor of addiction medicine at the University of Sydney and one of the paper’s authors. Filtered.

The teams included peer workers and offered vouchers for research participation or hepatitis C testing and treatment uptake.

The research began in 2020. It focuses on a particular harm reduction vending machine located near the emergency department and public opioid treatment program at the Royal Prince Alfred Hospital, a large teaching hospital in downtown Sydney. Established in 2013, the machine provides free sterile syringes with the aim of preventing the transmission of blood-borne diseases through shared needles.

First, the team looked at footage from a nearby CCTV camera – present because the machine is in a hospital – over a random two-week period to get an idea of ​​how many people have used the machine and the hours of the day. they used it. According to Day, the images did not contain enough detail to identify the people using the machines.

Researchers saw 428 instances of people using the machine over the two-week period, mostly between around 8 a.m. and 8 p.m., with Saturday being the busiest day. The next step in the study was to have the researchers sit near the machine, mostly at times when the most traffic was expected, for a period of 10 weeks.

These teams included peer workers and offered vouchers for research participation or hepatitis C testing and treatment uptake. They either asked to investigate or question the people using the machine, or, if the person seemed to apprehend their presence, left them alone. “If someone clearly, through their body language, didn’t want someone to talk to them, we respect that,” Day said. “But in general we tried to reach a lot of people. Our response rate was not necessarily what we would have hoped for because some people just wanted to stay private.

In all, the researchers walked away with 70 survey responses and 15 interviews. In the surveys, 61% of respondents said they had been tested for hepatitis C in the past six months and 38% said they had received treatment for hepatitis C. Additionally, from the work of field, researchers have found that it is possible to use harm reduction vending machines as a way to interact with people who use drugs and refer them to treatment or testing for hepatitis C .

Some people approached the researchers and engaged in long conversations. Sometimes they recognized the peers who were present, and sometimes, the researchers write, “peer expertise regarding injection practices was gratefully received by people using the [machines] and helped build trust.

For many people, it is the very anonymity of the machines that makes them accessible.

However, the researchers also found that most people using the machine were unwilling to interact with it. As they noted in their published paper, previous research “suggests that women may encounter gender-specific barriers [hep C] health care and may be reluctant to access face-to-face health services due to stigma and child protection concerns.” And respondents in some of the interviews expressed concerns about privacy.

“I just try to be as quick as possible and look around and avoid being seen by people,” Kate, a 49-year-old woman who uses heroin, told researchers.

“There’s cops all over the sidewalk outside smoking or whatever and I’m just out of my chops and thinking, ‘Look, I just don’t want to talk to them today’ “said Paul, a 41-year-old man who uses methamphetamine.

There have even been occasions when researchers believed their presence may have deterred a person from using the machine. As such, trying to offer hepatitis care at these locations could be seen as an encroachment – ​​for many people, it is the very anonymity of the machines that makes them accessible.

According to Day, research suggests that harm reduction vending machines should continue to be available inconspicuously, and more of them may also be needed in more private locations to meet people’s needs. However, it could also be useful to put information about hepatitis C treatment and testing on the machines themselves – possibly available via a QR code – or with the items in the machines.

“From a service perspective, it’s this balance between fully respecting people’s desire to be anonymous, [enabling them to use the machines] in a way that protects their anonymity,” she said. “But at the same time, we want to make sure that we provide them with enough information and enough opportunities for low-threshold access to some of the services if that’s what they want.”


Photograph via US Department of Veterans Affairs

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