Identifying barriers and facilitators to accessing harm reduction services in prisons: A systematic narrative...

Area of Science:

• Public Health
• Criminology
• Sociology

Background:

• Drug use is a significant issue within global carceral settings.
• Comprehensive harm reduction services (HRS) for people in prison (PIP) are internationally recommended but underimplemented.
• Limited access to prison-based HRS hinders effective public health interventions.

Purpose of the Study:

• To systematically synthesize evidence on barriers and facilitators to accessing harm reduction services in prisons.
• To identify factors influencing the uptake of HRS among incarcerated populations.
• To inform strategies for improving HRS implementation in carceral environments.

Main Methods:

• Systematic narrative synthesis of studies published in MEDLINE, PsycINFO, SCOPUS, and CINAHL.
• Inclusion of studies evaluating various HRS (condoms, PrEP, PEP, OAT, NSP, HBV vaccination) in prison settings.
• Qualitative content analysis using the Socio-Ecological Model and constant comparative methods.

Main Results:

• Analysis of 94 studies revealed multi-level barriers: individual (fear of repercussions), interpersonal (negative perceptions), institutional (resource allocation), and societal (rigid policies).
• Facilitators included education on risk prevention, positive prior HRS experiences, and support from prison leadership.
• Most studies (85%) were from high-income countries, indicating a potential gap in global representation.

Conclusions:

• Multi-level factors significantly impact access to and utilization of prison-based HRS.
• Enhancing HRS uptake requires comprehensive education for PIP and staff, peer-led awareness initiatives, and strong prison leadership support.
• Dedicated resource allocation and policy reforms promoting HRS are crucial for improving health outcomes in carceral settings.