“We would love to offer everything:” findings from a qualitative study of syringe exchange program staff on integrating sexual and reproductive health care into New York State syringe exchange programs

Abstract Background People who use drugs (PWUD) are a marginalized population who face barriers seeking reproductive health care in a culture that stigmatizes both drug use and reproductive health care. Syringe Service Programs (SSPs) were created to slow the spread of HIV among PWUD and have expanded to support other fundamental necessities under a harm reduction framework. This study aimed to assess SSP staff capability to provide services that met PWUD reproductive health needs. Methods Semi-structured open-ended interviews were conducted with SSP leadership and staff. Thematic analysis was used to analyze interview notes on the programs’ reproductive health education, counseling, supplies, onsite care, and referrals for contraception, prenatal care, abortion, and STI’s and to determine future goals in this area. Results Managers, Clinicians, and frontline staff of 14 SSPs reported onsite sexual health services, particularly around HIV prevention. Respondents highlighted how rapport-building and trust between staff and PWUD was essential to participant acceptance of services. Staff described reproductive health services as responses to individual participants’ crises rather than built into regular program services, sharing that their ability to provide reproductive health services was limited by facilities, supplies, funding and training. SSPs had few pregnant participants, and respondents noted that women and pregnant PWUD might avoid SSPs due to fears of stigma and of child protective service interventions. SSP staff wished to provide a broader range of care onsite. Conclusions When reproductive health needs arise among women and pregnant SSP participants, this underrepresented and stigmatized population faces extreme hardships. Harm reduction settings have unique opportunities to reach this population yet face several barriers to providing reproductive health care. This study revealed how greater training in reproductive health and additional funding can help harm reduction programs meet their desire to meet the intersecting needs of women, pregnant, and parenting PWUD through a one-stop-shop approach.