Uptake of needle and syringe program services in the Kyrgyz Republic: Key barriers and facilitators.

Abstract

In Kyrgyzstan, injection drug use accounts for the majority of HIV infections. Needle and syringe programs (NSPs) are one of three core HIV interventions for people who inject drugs (PWID). However, in Kyrgyzstan all persons diagnosed with drug dependence are subject to compulsory registration for governmental drug dependence treatment services, which creates barriers for PWID to access any health services, including NSPs. In 2015, we conducted an assessment at 19 NSP sites in six cities to identify barriers and facilitators that affect PWID uptake of NSP services in Kyrgyzstan. The study involved the conduct of 10 focus groups with 99 PWID (62 males/37 females) and individual interviews with 24 full-time NSP staff. We found that access of PWID to NSPs was limited by stigma and discrimination around drug use, fear of police encounters, inconvenient hours of operation, lack of information and motivation from PWID to use NSP services and a limited menu of available injection supplies. At the same time, availability of outreach services and additional health services were highly valued by PWID. Stigma and discrimination, combined with the criminalization of drug use and the requirement for official registration of PWID remain key barriers to effective NSP utilization. Law enforcement and health care providers need to be sensitized about the unique context and needs of PWID.