Injection Drug Users’ Utilization of Health Care in New York City: Abstract: Through the principles of harm reduction, the Harm Reduction Coalition addresses the adverse affects of drug use. To better advocate for the health care needs of injection drug users, the student intern conducted a pilot study at syringe exchange programs. The pilot study included topical literature research, the formation of a community advisory board, a focus group, the administration of two surveys, and interviews with current and former injection drug users on their health care experiences. In addition, the student intern also videoed select interviewee’s anecdotes regarding health care for advocacy purposes. The student intern completed the design of the focus group moderator guide and interview protocol, design of the surveys, facilitation of the board, conduction of the focus group and interviews, video editing, and quantitative and qualitative research using the gathered data. The results will be compiled in a report to be used by the organization for advocacy purposes.

1. Harm Reduction Coalition
Injection Drug Users’
Utilization of Health Care in
New York City
Melicia Laroco-Molter

2. Harm Reduction Coalition
Mission Statement
The Harm Reduction Coalition is a national advocacy
and capacity-building organization that promotes the
health and dignity of individuals and communities
impacted by drug use. HRC advances policies and
programs that help people address the adverse effects
of drug use including overdose, HIV, hepatitis
C, addiction, and incarceration. We recognize that the
structures of social inequality impact the lives and
options of affected communities differently, and work
to uphold every individual's right to health and well-
being, as well as in their competence to protect
themselves, their loved ones, and their communities.

3. Principles of
Harm Reduction
Harm reduction is a set of
practical strategies that reduce
negative consequences of drug
use, incorporating a spectrum
of strategies from safer use, to
managed use to abstinence.
Harm reduction strategies
meet drug users "where
they're at," addressing
conditions of use along with
the use itself.
1. Clean Bottle 7. Cotton Balls
2. Bleach 8. Syringes
3. Bandages 9. Injection Instructions (Spanish &
4. Sterile Water English)
5. Tourniquet 10. Alcohol Swabs
6. Bottle Cap/Cooker

4. Abstract
Through the principles of harm reduction, the Harm Reduction
Coalition addresses the adverse affects of drug use. To better
advocate for the health care needs of injection drug users, the
student intern conducted a pilot study at syringe exchange
programs. The pilot study included topical literature research, the
formation of a community advisory board, a focus group, the
administration of two surveys, and interviews with current and
former injection drug users on their health care experiences. In
addition, the student intern also videoed select interviewee’s
anecdotes regarding health care for advocacy purposes. The
student intern completed the design of the focus group moderator
guide and interview protocol, design of the surveys, facilitation of
the board, conduction of the focus group and interviews, video
editing, and quantitative and qualitative research using the
gathered data. The results will be compiled in a report to be used
by the organization for advocacy purposes.

5. Introduction
Learning Objective 1 Learning Objective 2
Identify health care utilization and barriers Employ quantitative techniques to
among IDUs at SEPs in New York City analyze surveys mentioned in LO1.
Activity 1a: Develop survey(s) with Activity 1a: Perform
advisory committee that will be descriptive analysis on data
administered to the community.
Activity 1b: Administer surveys to
collected in LO1-1b.
the community. Activity 2b: Perform
Activity 1c: Interview stakeholders multivariate analysis to
in the community regarding health examine relationship
care utilization and barriers.
between health care barriers
Activity 1d: Conduct focus group(s)
within the community. and health care utilization
Activity 1e: Pull main themes from among IDUs in New York
conducted interviews and focus City.
groups.

6. Health Problem and Justification
• Injection drug use is • The NHBS conducted in
associated with 36% of 2009 noted that 16% of
HIV/AIDS cases in the NYC’s IDUs are infected
US with HIV/AIDS
• Among IDUs with • They also noted that
HIV/AIDS, 50-90% are 51% of NYC IDUs used
also infected with HCV speedballs and 70% of
• In NYS, there are a NYC heroin IDUs
quarter million injected daily
IDUs, 35-50% with
HIV/AIDSdrug use also increases the chances of overdose,
Injection
collapsed veins, soft skin and bacterial infections,
endocarditis (heart infection), and septicaema (blood infection).

7. Intern’s Roles
The intern’s project was a
preliminary, mixed methods
research project that focused
on the health care utilization
of injection drug users (IDUs)
that patronize New York
City’s syringe exchange
programs (SEPs).
The intern’s roles included:
• A topical literature
research
• The formation and
facilitation of a community
advisory board
• Moderating a focus group
• Administration of two
surveys
• Conducting interviews with
current and former IDUs
on health care experiences
• Coordination with NYC
SEPs

8. Research Methods
• Topical literature • Survey development
search
• Site visits at • SEP administration
participating SEPs of surveys
– Stationery • Conduct interviews
programs
– Mobile Units • Video selected
• Formation of advisory interviewees’
board retelling of health
• Focus group care experiences

9. Surveys

10. Results
Physical Health Survey
• N=187 • 18.7% experienced barriers to
• 24.1% female (N=45) 56.1% health care over a 12 month
male (N=105) 2.7% period
transgendered (N=5) • 15% of Spanish survey
• 80.2% (N=150) in English respondents saw a health care
19.8% Spanish (N=37) professional compared to 50%
• Age range of 25 and 64 (76% of English survey respondents
or N= 142) • Spanish respondents fours
• 75% indicated a diagnosis of times more likely to be
HIV/AIDS or HCV unaware of places to go for
services
• Spanish respondents 1.6 times • Overall, respondents cited lack
more like to de diagnosed with of transportation (1.8 times) &
HCV or diabetes lack of insurance (1.556 times)
• Twice as like to seek care at as a barrier health care
the ER

11. Results
Mental Health Survey
• N=24 • 20.8% (N=5) experienced
• 29.2% female (N=7) barriers to receiving mental
54.2% male (N=13) health care
• 95.8% (N=23) in English • Respondents cited provider
4.2% (N=1) in Spanish not speaking the person’s
• Age range of 25 and 64 primary language (41.7%;
(87.5% or N= 21) N=10), past poor treatment
(16.7%; N=4), and the lack
• 20.8% (N=5) received of transportation (16.7%;
mental health care in the N=4) as barriers to receiving
past 12 months mental health care
• 41.7% (N=10) received care
either while incarcerated or
at a medical van

12. Results
Interviews
Health & Health Care Stigma & Treatment
• “Emergency rooms and being treated • “…I went to a hospital here…I always
horribly and all kinds of stuff comes to had abdominal pain…they’d give me
mind. But also just keeping yourself Maalox, send me home…this time my
well, having a regular doctor. I think of abdominal pain was so bad I got off
the positive aspects of health care in the table and I saw these scissors and
my life and what I think what is I was trying to kill myself cause I
supposed to happen is usually that you couldn’t take the pain. So when they
have a primary care doctor and he can [the clinic personnel] saw that, they
lead you around the rest of the phalanx decided to take me seriously and
to you know get the resources you
need…”(Mary, Caucasian, 30s) send me to [a hospital. When I
walked in there, I had a gall bladder
that was getting ready to erupt along
• “Money…to get good health care you with seven gall stones – they told me
gotta have a lot of money. You need an the size of golf balls. Now, I’ve been
operation…you need a liver transplant going to the doctor all these
or something like that, you know you years…nobody tried to figure out why
gotta have Apple [a computer is she having all this abdominal pain.
company+ kind of money…I’m so low on
the scale. I have no income. I’m Because I was using drugs. And that
basically homeless so that I can go into [the lack of appropriate health care]
a hospital ad get relatively good health almost killed me… *She saw+ maybe
care *via Medicaid+…”(Bob, African four or five *doctors+…”
American, 40s) (Peggy, African American, 40s).

13. Results
Interviews
Incarceration Disclosure
• “some people think that • Many stated the importance of
disclosing either their current or past
because you went to jail or injection drug use. They cited the
because you use drugs in complications of drug
the past or whatever, that interactions, the need for appropriate
pain medication, and the possibility
they are so-called ‘better of their drug use as the cause of a
than you’ but it’s not that health problem as reasons.
way…” (Bill, Latino, 60s) • Those that did not disclose their drug
use cited the fear of poor treatment
Bill discovered that he has or the lack of necessity as reasons
diabetes during a dental visit – Bob disclosed his drug use to his
while in jail; the dentist found dentist in order to receive
that he had loose teeth, a sign appropriate pain medication, but
of gum damage due to did not disclose to his eye doctor.
diabetes. Since then, he lost – Hamilton, a Caucasian man in his
many of his teeth and sees a 30s, did not disclose his drug use
to his allergist because he has
doctor monthly to control his “known him since *he+ was 12
diabetes. years old and he was [his] doctor
when *he+ was growing up.”

14. Limitations
• Pre-Survey Focus Group
– Though useful, more time may have yielded richer data.
• Communication
– Though the intern attempted to reduce miscommunication
among participating SEPs, additional project support &
time could mitigate complications.
• Language Barriers
– There is a particular need for those with
Spanish, Russian, Yiddish, and Chinese (Mandarin or
Cantonese) language skills.
• Cultural Barriers
– This is particularly true in order to better serve the Chinese
and Hasidic Jewish communities

15. Recommendations for
Future Research
• The transgendered portion of the IDU
community
– Though the intern was unable to conduct
interviews with self-identified transgendered
persons, the intern noted the presence of the
community at SEPs.
– Injection drug use within the transgendered
community is a growing concern, especially since
the injected drugs may also be non-prescribed
hormones and other items which SEPs may not
have prior experience.