An investigation into the development and content of HIV prevention and harm reduction policies in Nova Scotia: Do they address the needs of women who inject drugs?

Abstract

Background: Women who inject drugs continue to represent a disproportionate percentage of new cases of HIV in Canada (PHAC, 2006). However, in Nova Scotia, HIV has still not been conceptualized as a major health issue, especially among women (Gahagan, Rehman & Baxter, 2006). At the same time, recent research findings suggest that female injection drug users in Nova Scotia are engaging in unsafe injection and sexual practices and often lack access to harm reduction-based programming and resources (Ploem, 2000; PHAC, 2006; Jackson et al., 2010; Parker et al., 2011; Hodder, 2011). In a provincial context of high prevalence of injection drug use and HIV risk behaviours, preventing increasing rates of HIV infection will depend on the development of proactive and gender-informed HIV prevention policies.

Purpose: This study had two main aims. First, it aimed to chart the development of provincial HIV prevention and harm reduction policies and to identify how, and if, the policy development processes address the HIV prevention needs of women who inject drugs. Its second aim was to identify key barriers and facilitators to developing HIV prevention policy for women who inject drugs in Nova Scotia.

Methods: This study involved a review of key HIV prevention and harm reduction policy documents as well as interviews with 27 key informants directly involved with HIV prevention and/or harm reduction policy decision-making.

Findings/Discussion: The existing Nova Scotia-based policy development network, their policies, their processes and the context within which they have functioned over the past ten years do not appear to be supporting the development of HIV prevention and harm reduction policy which addresses the needs of women who inject drugs. Policy committee composition lacked inclusivity and organizations that work directly with women who inject drugs held less influence in policy processes. In addition, gender was not prioritized by decision-makers and therefore not comprehensively addressed in policy content. As a result, the needs of women who inject drugs have not been prioritized in policy processes and subsequently few targeted resources are going to the community-based organizations that provide services to these women.