Table 2 Facilitators and barriers to harm reduction services, stratified by dimensions of access
Dimension of access | Description of dimension | Facilitators | Barriers |
|---|---|---|---|
Accessibilityb | Getting to service (i.e., location, transportation issues) | Mobile SSPsa Outdoor services Mailing equipment | COVID-19 screening No cell phone coverage Inclement weather Masking requirements on buses Changing locations |
Availabilityb | Supply and demand | Relaxed policies SSPs sharing supplies | Stricter adherence to 1:1 needle exchange Increased drug use Lack of safe supply |
Acceptabilityb | How clients perceive service | Face to face outreach Trust established before pandemic Relaxed policies Mobile outreach | Masking Social distancing policies (i.e., waiting in line) Stigma Lack of trust/difficult to establish trust under lockdown Law enforcement |
Affordabilityb | Ability of clients to pay for service | Relaxed policies (i.e., elimination of 1:1 needle exchange) | Unemployment Higher drug costs Requiring one-for-one needle exchange |
Accommodationb | Hours of service provision, structure of services, facilities | Community resilience/Staff working more hours COVID-19 screening | Limited service hours Appointment-only for health services |
Awarenessc | Communication and information about services | Outreach Flyers mailed with supplies | Miscommunication around changing policies Changing locations Restrictions on outreach workers in certain locations (i.e., jails) |