Understanding Contraceptive Needs of Women Who Inject Drugs in Orange County: A Qualitative Study.

OBJECTIVES: Women with opioid use disorder experience higher rates of unintended pregnancy compared with the general US population. Our aim was to examine the factors that may affect access to desired contraception for women who use injection drugs. METHODS: Using purposive sampling, we conducted semi-structured interviews pertaining to contraceptive use with 14 women ages 18 to 44 who were current users of injection drugs living in Orange County, CA between March and December 2019. Interviews were transcribed, coded, and analyzed using grounded theory. RESULTS: Participants discussed logistical barriers, including homelessness and lack of transportation, as well as perceived barriers, such as a belief in the inability to become pregnant while using drugs, that affect access to contraceptive care. Women also discussed the factors that motivate them to use contraception despite these barriers, including the desire for sobriety before becoming pregnant and fear of harming a fetus while using substances. Some participants expressed feeling uncomfortable disclosing substance use to their healthcare providers out of concern for stigmatization. Several points of access for contraceptive care were elucidated, including visits for primary and postpartum care, as well as in carceral spaces. Finally, participants expressed a desire to obtain contraceptive services at a local syringe exchange program due to trusting relationships with providers and increased ease of access. CONCLUSIONS: Our findings highlight several causative factors for the unmet contraceptive need among women who use injection drugs, and suggest that syringe exchange programs represent a unique access point for the provision of contraceptive care for this population.

Homeless Vulnerability During an Opioid Epidemic: Assessing the Mortality Risk Among People Experiencing Homelessness in Southern California.

People experiencing homelessness suffer from a risk of mortality three to four times that of the general population, with drug-induced overdose replacing HIV as the emerging epidemic. This study assessed markers of mortality among people experiencing homelessness (N=157) in Orange County, CA during the Fall of 2016. We utilized the Vulnerability Index, an eight-question survey, to identify factors that may affect mortality risk among individuals experiencing homelessness and included two additional questions to identify potential risk of drug-induced overdose. Eighty-three percent of participants reported more than one heightened mortality risk marker and 64% may be at higher risk of drug-induced overdose. Given the state of the opioid epidemic, there is pressing need to couple public health interventions targeting people experiencing homelessness with harm reduction efforts including naloxone distribution (opioid-induced overdose reversal medication) and syringe exchange programs.

One Night Stan: Feasibility Study of an HIV Prevention and Sexual Risk Reduction Social Card Game for Young Black Women.

OBJECTIVE: To develop and test the feasibility and preliminary impact of the social card game prototype, One Night Stan, a theory-driven and evidence-based human immunodeficiency virus (HIV) prevention intervention for young black women. MATERIALS AND METHODS: The study included the enrollment of 21 young, heterosexual black women (mean age 19) to test the feasibility and preliminary impact of the card game, using a pre/postdesign. Participant satisfaction and gameplay experience were assessed using quantitative and qualitative measures. Knowledge, self-efficacy, and intentions regarding condom use and HIV/sexually transmitted infection partner testing were assessed using standardized assessments. Effect sizes for the change in these outcome variables were calculated to determine the preliminary efficacy of the game. RESULTS: One hundred percent of participants reported that that they would play the game again, 95% liked the way the game looked, 100% enjoyed playing the game, and 100% reported that they would tell their friends to play. Effect sizes were large (ranged from 0.21 to 0.51) for all variables except perceived susceptibility (0.07) and suggest that playing the game can lead to increased self-efficacy and intentions to use condoms and insist that their partners get tested for HIV across time. CONCLUSIONS: One Night Stan is a feasible intervention approach and may be efficacious in helping players develop a pattern of cognitions and motivation that can protect them against the risk of HIV.