https://orcid.org/0000-0003-0847-3243
Figures
Abstract
Background
The COVID-19 pandemic amplified the risk environment for people who inject drugs (PWID), making continued access to harm reduction services imperative. Research has shown that some harm reduction service providers were able to continue to provide services throughout the pandemic. Most of these studies, however, focused on staff perspectives, not those of PWID. Our study examines changes in perceptions of access to harm reduction services (e.g., participant reported difficulty in accessing syringes and naloxone) among PWID participating in a longitudinal study conducted through the University of Illinois-Chicago’s Community Outreach Intervention Projects field sites during the COVID-19 pandemic.
Methods
A COIVD-19 survey module was administered from March 2020-February 2022 to participants of an ongoing longitudinal study of PWID ages 18–30, who were English-speaking, and were residing in the Chicago Metropolitan Area. Responses to the COVID-19 survey module were analyzed to understand how study participants’ self-reported access to harm reduction services changed throughout the pandemic. Baseline responses to the survey were analyzed to compare participant-reported drug use behaviors and perceived access to harm reduction services across COIVD-19 time periods. Mixed effects logistic regression was used to examine difficulty in syringe access as an outcome of COVID-19 time period.
Results
Participants had significantly lower odds (AOR = 0.28; 95% CI 0.12–0.65) of reporting difficulty in accessing syringes later in the pandemic. However, the majority of participants reported access to syringes and naloxone remained the same as before the pandemic.
Conclusions
The lack of perceived changes in harm reduction access by PWID and the decrease in those reporting difficulty accessing syringes as the pandemic progressed suggests the efficacy of adaptations to harm reduction service provision (e.g., window and mobile service) during the pandemic. Further research is needed to understand how the COVID-19 pandemic may have impacted PWIDs’ engagement with harm reduction services.
Citation: Kristensen K, Boodram B, Avila W, Pineros J, Latkin C, Mackesy-Amiti M-E (2025) Perceptions of access to harm reduction services during the COVID-19 pandemic among people who inject drugs in metropolitan Chicago. PLoS ONE 20(1): e0293238. https://doi.org/10.1371/journal.pone.0293238
Editor: Andreas Pilarinos, Vancouver Coastal Health Research Institute, CANADA
Received: November 5, 2023; Accepted: October 24, 2024; Published: January 7, 2025
Copyright: © 2025 Kristensen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: BB: 2017-2024 R01DA043484 National Institute of Drug Abuse, NIH https://nida.nih.gov/ BB: 2021-2026 R01AI158666 National Institute of Allergy and Infectious Diseases, NIH https://www.niaid.nih.gov/ Funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
The COVID-19 pandemic has disproportionately affected vulnerable populations, including people who inject drugs (PWID) [1]. PWID are at increased risk for contracting and experiencing severe outcomes from COVID-19 (e.g., hospitalizations and mortality). Comorbidities of drug use (e.g., lung diseases, human immunodeficiency virus (HIV), and cardiovascular conditions) are confirmed risk factors for developing severe COVID-19 [2, 3]. The vulnerability of PWID is further augmented by social factors such as homelessness, incarceration, poverty, and limited access to healthcare due to drug use, stigma, and discrimination [4–10]. Collectively, these risk factors are compounded by economic hardships exacerbated by the COVID-19 pandemic, including food insecurity, housing insecurity, and substandard sanitation conditions [3, 5, 11, 12]. For these and other reasons, research specific to COVID-19 suggests that the pandemic escalated isolation, loss of social support, and mental health decline among PWID [5, 13]. Compliance with public health recommendations such as physical distancing was challenging for PWID, particularly those living in public spaces, shelters, and hostels [14]. Additionally, accessibility to crucial services such as social work, counseling, HIV and hepatitis C (HCV) testing, harm reduction services, and inpatient drug treatment programs was significantly reduced [5, 13]. All of these factors served to heighten the risk environment of PWID during the pandemic, increasing the importance of access to risk mitigating services for PWID.
Harm reduction services, including syringe services programs (SSPs) and naloxone distribution provide significant individual and public health benefits, including preventing deaths from overdoses and preventing transmission of bloodborne infections such as HIV and HCV among PWID and their social networks [15]. These services reduce emergency department visits and costly healthcare services and may provide or facilitate linkage to substance use treatment (e.g., medication for opioid use disorder) [15]. Moreover, these services may reduce stigma associated with drug use, affect social norms among PWID’s social networks, and improve access to essential resources (e.g., housing assistance, food banks, legal aid, mental health services, and employment services) [16–18]. In some cases, COVID-19 mitigation strategies contributed to making SSPs and medications for opioid use disorder (MOUD) treatment more accessible by expanding mobile outreach, delivering equipment via mail, relaxing syringe exchange policies, and loosening regulations on telemedicine [19, 20]. Other COVID-19 mitigation strategies such as social distancing and program resource restrictions (e.g., staff, supply, financial) led to reduced access to harm reduction services, particularly SSPs, resulting in fewer opportunities for HIV testing, HIV counseling, and obtaining sterile injection supplies [21]. Since SSPs also provide a vital location for social interaction and social support, the disruption of service modality (e.g., decreasing hours of operation, number of staff, and face-to-face interactions) has led to increased feelings of isolation among PWID [19]. These findings have been identified across a range of locations, including 27 SSPs spread across the Northeast, Midwest, South, and Western regions of the United States [19].
While existing research offers valuable insights into harm reduction service access during the pandemic, these studies largely focus on the perspectives of service providers [19–21]. Furthermore, the limited data reported directly by PWID are currently confined to single regions of the country, such as in New York, and does not ask participants directly about their perceptions of how the COVID-19 pandemic has affected them [5]. Further research is necessary to determine if the conclusions are consistent in other regions as COVID-19 policies varied greatly by location as well as to understand PWID’s perceptions of harm reduction service accessibility during the pandemic. The present study uses data from a COVID-19 survey module of an ongoing longitudinal study of young PWID and their networks. The present study aims to examine the impact of the COVID-19 pandemic on access to harm reduction services by exploring PWIDs’ perceptions of changes in access to these services over the course of the pandemic in metropolitan Chicago, Illinois.
COVID-19 ordinance
In Illinois, where the study was conducted, a stay-at-home ordinance was issued on March 20th, 2020, requiring non-essential workers to stay at home and non-essential businesses to close. This directive prompted community-based programs such as COIP, which provides critical harm reduction and clinical services to PWID, to modify operations by reducing hours and limiting face-to-face contact. COIP staff continually worked throughout the COVID-19 pandemic within compliance of the state and city ordinances. For example, harm reduction staff wore personal protection gear (e.g., masks, goggles, shields, gloves) and interacted with clients through separation barriers to minimize interruptions to essential harm reduction services they provide to PWID in Chicago. On March 10th, 2020, COIP temporarily reduced public access to essential services (e.g., specialized HIV care, SSP), eliminating two of four sites and reducing hours of operation at open sites by approximately 50%. Dispensing policies for syringes and naloxone did not change, remaining needs based throughout the COVID-19 pandemic. In May 2020, both COIP sites transitioned to a hybrid model of in-person and remote operations and gradually restored mobile services and full staffing at all sites by June 2021, marking a return to pre-pandemic operations. The effects of these changes on the accessibility of services for PWID in metropolitan Chicago have yet to be explored during this period, and to our knowledge, no prior study has examined PWID’s perception of access to harm reduction services during the pandemic.
Material and methods
Study setting
We use data from an ongoing longitudinal study of PWID in metropolitan Chicago that included a COVID-19 specific module in the parent study survey. The aim of the parent longitudinal study was to collect survey data on young PWID and their social networks to examine individuals and contextual factors associated with injection drug use (IDU) risk behaviors, HCV infection, and overdose. The study was conducted at Community Outreach Intervention Projects (COIP), a community outreach and research center within the School of Public Health at the University of Illinois at Chicago. COIP provides harm reduction services, including syringe exchange, naloxone, HIV and HCV counseling and testing, linkage to MOUD, and case management services to PWID and their partners in the Chicago metropolitan area (includes the city of Chicago and its surrounding suburbs that span 16 counties in northeast Illinois, southeast Wisconsin, and northwest Indiana.) COIP also conducts research with PWID to better understand risk factors for HIV and HCV among PWID in Chicago and evaluate interventions aimed at mitigating HIV and HCV transmission among PWID. The study was approved by the University of Illinois Chicago’s Institutional Review Board (Protocol #2017–0388).
Sample and recruitment
The present study uses data from a longitudinal COVID-19 survey initiated during the pandemic as a supplementary component to an ongoing longitudinal network and geographic study that began in October 2018 of young (aged 18–30) PWID and their injection, sexual, and social support network members in Chicago and the surrounding suburbs. Study methods have been previously described [22]. In brief, to be eligible, the primary participant (i.e., egos) had to (i) be between ages of 18–30 years old, (ii) have injected drugs at least once in the past month, (iii) proficiently speak English, and (iv) have resided in the city of Chicago or surrounding suburbs during the past 12 months.
Egos were recruited through the COIP SSP as well as through direct recruitment in drug market areas, community health events, and through social media. Additionally, egos were offered a coupon to refer eligible peers who did not use the COIP SSP or purchase or use drugs in Chicago. Egos were asked to recruit up to five members of their injection networks (i.e., alters); alters were eligible for the study if they were (i) at least 18 years old, (ii) proficiently spoke English, (iii) resided in the city of Chicago or surrounding suburbs during the past 12 months, and (iv) were referred to the study by an ego. Egos and enrolled alters were followed every 6 months for up to 36 months to collect sociodemographic, network, geographic, and biologic (HIV/HCV testing) data.
Participants (egos and alters) completing baseline or follow-up for the parent study were additionally asked to complete a survey on COVID-19 specific questions. These questions explored the effects of the COVID-19 pandemic on PWID, examining its implications on socioeconomic status, housing, IDU behaviors and practices, and access to treatment and services.
We use baseline demographic data from the parent study as well as baseline and follow-up data from the COVID-19 survey. We used city level COVID-19 mitigation strategies as well as COIP’s service changes during the pandemic to inform a descriptive analysis of study participants’ perceptions of the accessibility of syringes and naloxone at different points in the pandemic.
Data collection
The COVID-19 survey was included in the parent study survey from May 2020-December 2022. Ego participants were given the opportunity to retake the COVID-19 survey at each remaining 6-month follow-up visit of the parent study, while alters participated once. Participants were recruited from the COIP field site located on the West side of Chicago. COIP provides services including syringe exchange, substance use counseling, and HCV and HIV testing and counseling as well as conducting research with PWID. The field sites are located in Chicago neighborhoods with high HIV, HCV, sexually transmitted infection incidence rates, and drug-related arrests [12]. Informed consent was obtained from all study participants prior to data collection.
Measures
The present study examines demographic measures from the baseline responses to the Alter-ego parent study survey in addition to measures from the COVID-19 sub-study of drug use behaviors, perceptions of drug use risk during the COVID-19 pandemic, and perceptions of access to harm reduction services during the COVID-19 pandemic. All responses are self-reported.
Demographics.
Demographic characteristics were taken from the baseline parent study survey responses and included age, gender, and race/ethnicity. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic Black, Hispanic, and mixed race/other. Gender was reported using three categories—male, female, transgender; for the purposes of analysis, this measure was dichotomized into the categories of male and non-male.
Drug use behaviors during COVID-19.
Drug use behaviors as assessed in the COVID-19 survey were examined. Participants were asked to report if they were currently using any drugs (yes/no) or currently injecting any drugs (yes/no). Participants were also asked if their injection frequency had changed as a result of COVID-19 (decreased a lot, decreased somewhat, decreased a little, stayed the same, increased a little, increased somewhat, increased a lot) and if their use of new, sterile syringes had changed (decreased a lot, decreased somewhat, decreased a little, stayed the same, increased a little, increased somewhat, increased a lot). For analysis, injection frequency was operationalized to indicate if injection frequency increased as a result of the pandemic (yes/no), and sterile syringe use was operationalized to indicate if sterile syringe use increased as a result of the pandemic (yes/no). For both injection frequency and sterile syringe use, responses of increased a little, increased somewhat, and increased a lot were operationalized as a yes response.
Perceptions of drug use risk during COVID-19.
Two questions in the COVID-19 survey addressed participants’ perceptions of risk related to their drug use. Participants were asked if, since the onset of the COVID-19 pandemic, people are more likely to share syringes (more likely, neither more nor less likely, less likely). Participants were also asked if the COVID-19 pandemic has changed the degree to which they are concerned about overdose (decreased a lot, decreased somewhat, decreased a little, stayed the same, increased a little, increased somewhat, increased a lot). For analysis, syringe sharing was operationalized to indicate if participants thought individuals were more likely to share syringes (yes/no) such that a response of more likely was operationalized as a yes response. Concern about overdose as a result of COVID-19 was operationalized to indicate if concern increased (yes/no) such that responses of increased a little, increased somewhat, and increased a lot were operationalized as a yes response.
Perceptions of access to harm reduction services.
Participants’ perceptions of access to harm reduction services (e.g., sterile syringes, naloxone) as reported in the COVID-19 survey were assessed. Regarding sterile syringe access, participants were asked how their access to syringes now compares to their access prior to the onset of the COVID-19 pandemic (access is less difficult now, access is about the same, access is more difficult now). For analysis, syringe access was operationalized to indicate if participants perceive syringe access as more difficult than prior to the pandemic (yes/no) such that a response of access is more difficult now was operationalized as a yes response. Participants were also asked if their source for obtaining new syringes has changed since the onset of the COVID-19 pandemic (yes/no). Regarding naloxone access, participants were asked if their access to naloxone has changed since the onset of the COVID-19 pandemic (yes/no). Additionally, participants were asked if they were aware of online sources of Narcan/naloxone and harm reduction supplies (yes/no).
Statistical analysis
Data cleaning and descriptive analyses were conducted in SPSS version 28.0.1 and mixed effects logistic regression analysis was conducted in Stata 18.0. Prior to conducting descriptive analyses, we compared the respondents of the parent study baseline survey enrolled prior to the onset of the pandemic to those enrolled after the pandemic began to ascertain if there were any significant differences in their demographic characteristics, drug use, injection behaviors, or harm reduction usage profiles and found none. Demographic data from the baseline was then utilized in combination with the COVID-19 survey module responses for analysis.
Descriptive analysis of baseline COVID-19 survey participants (N = 182) was then conducted. For categorical variables, response frequencies were calculated, and for continuous variables the mean and standard deviation were calculated. For variables that were only relevant to participants who reported engaging in IDU at the time of the survey, frequency percentages were based on the subset of individuals who responded “yes” to the question “Are you currently injecting drugs” (N = 149). For variables that were only relevant to participants currently using drugs, but not specifically injection drug use, frequency percentages were based on the subset of individuals who responded “yes” to the question “Are you currently using drugs” (N = 159).
Next, baseline responses across Chicago COVID-19 time periods were compared using Chi-square and Fisher exact tests for all variables except age, which used independent sample t-tests to compare means. This analysis was conducted to determine if participant responses to measures of interest changed based on when during the COVID-19 pandemic their survey was conducted. Chicago COVID-19 phases were identified using the dates from press releases from the City of Chicago starting in March of 2020 and ending in March of 2022. Four major phases of the COVID-19 policy in Chicago were identified, as displayed in Fig 1. For the purposes of analysis, phases 1 and 2 and phases 3 and 4 were combined to create a pre-vaccine time period and a post-vaccine time period. These phases were combined for analysis because i) phases 1 and 4 were significantly shorter periods of time than phases 2 and 3 and combining these phases resulted in two more equal time periods, and ii) there were many fewer responses to the COVID-19 survey during phase 1 (N = 18) and phase 4 (N = 10). All measures were then compared between the pre-vaccine (N = 96) and post-vaccine (N = 86) time periods using Chi-square and Fisher exact tests and independent sample t-tests.
Results of descriptive analysis suggested that perceptions of specifically access to syringes may have been associated with being in the pre-vaccine or post-vaccine period of the COVID-19 pandemic, suggesting that perceived access to syringes may have changed over the course of the COVID-19 pandemic. To investigate this further, mixed effects logistic regression with random subject intercepts was used to further examine syringe access difficulty in repeated assessments over time as predicted by the COVID-19 time period. We hypothesized that the pre-vaccine time period would be associated with greater odds of perceived difficulty in accessing syringes as COVID-19 ordinances were more restrictive in this time period and syringe programs had not had as much time to adapt policies in response to the onset of COVID-19 to allow for continued operation. In addition to the COVID-19 time period (pre/post-vaccine), other potential covariates were explored using Chi-square and Fisher exact tests and independent sample t-tests to compare frequencies and means by perceived syringe access difficulty for baseline responses. Variables identified through descriptive analysis as being significantly (p < .05) associated with perceived syringe access difficulty at baseline were included in the mixed effects logistic regression analysis as covariates. Additionally, the demographic variables of gender, age, and race/ethnicity were included in order to adjust for differences across these groups. Age was mean-centered in the mixed effects logistic regression. For all variables in the model, the fixed effects of adjusted odds ratios were assessed. Cluster robust variance estimators were used to estimate standard errors and 95% confidence intervals to determine significance of fixed effects in the model.
Results
Baseline descriptive analyses
Table 1 highlights the results of the descriptive analysis of baseline responses to the COVID-19 survey and the comparison of responses by COVID-19 time period. Of the 182 participants that completed baseline COVID-19 surveys, 96 (52.7%) completed these surveys during the pre-vaccine time period and 86 (47.3%) completed these surveys during the post-vaccine time period. The sample was primarily male (70.6%) and non-Hispanic white (57.6%) with a mean age of initiation into parent study at 28.1 years old. Most of the sample reported currently injecting drugs (81.9%), with significantly (p = 0.011) more participants doing so post-vaccine availability (time period 2) (89.5%) than pre-vaccine (time period 1) (75%). A sizeable proportion (32.2%) also reported increasing injection frequency to some degree, though not statistically significant.
(N = 182).
Sterile syringe use did significantly change between time periods, with more participants reporting increased sterile syringe use post-vaccine (23.4%) than pre-vaccine (11.1%). Most participants reported that they were not more likely (77.5%) to share syringes since the onset of the pandemic. Additionally, most (83.4%) participants did not report concern about overdose increasing compared to prior to the pandemic. Most participants (84.6%) reported their syringe source location(s) to be unchanged and access to syringes during the COVID-19 pandemic (72.4%) to not be more difficult. However, there was a significant difference between time periods 1 and 2 (p = .017) in the percentage of participants reporting increased; 18% more participants reported increased difficulty in syringe access in time period 1 of the pandemic than in time period 2.
Descriptive analysis of potential predictors of perceived syringe access difficulty
Table 2 displays the results of exploratory analysis of potential predictors of syringe access difficulty using baseline data. Syringe access difficulty was significantly different across COVID-19 time periods (p = .017). Syringe access difficulty was also significantly related to perceiving people as more likely to share syringes (p < .001). Additionally, a change in the source for obtaining new syringes was significantly associated with increased syringe access difficulty (p < .001). Age, race/ethnicity, and gender were not significantly associated with increased syringe access difficulty.
Mixed effects logistic regression
Table 3 shows the results of a mixed effects logistic regression model with random intercepts. Odds ratios and 95% confidence intervals based on cluster robust standard error estimates are reported. Individuals in the post-vaccine time period had significantly lower odds of reporting increased difficulty in accessing syringes (AOR: 0.28; p = .003). Additionally, a changed source for obtaining new syringes resulted in significantly higher odds of reporting increased difficulty in accessing syringes (AOR: 7.49; p < .0005). Perceiving people as more likely to share syringes also resulted in increased odds of reporting increased difficulty in accessing syringes (AOR: 2.29; p = .040). Gender, age, and race/ethnicity did not significantly change the odds of reporting increased difficulty in accessing syringes.
Discussion
Our study examined changes in perceptions of access to harm reduction during the COVID-19 pandemic among a sample of people who inject drugs in Chicago. Descriptive analysis of baseline survey responses showed that significantly more participants reported using and injecting drugs during the post-vaccine time period of the COVID-19 pandemic than the pre-vaccine time period. The majority of participants did not perceive access to syringes or Narcan to be more difficult during the COVID-19 pandemic. However, we found that fewer participants during the post-vaccine time period of the COVID-19 pandemic in Chicago indicated difficulty in accessing syringes than in the pre-vaccine time period. This finding was supported by mixed effects logistic regression results which showed significantly decreased odds in reporting increased difficulty in accessing syringes during the post-vaccine COVID-19 time period. Changing syringe sources and perceiving individuals to be more likely to share syringes also resulted in increased odds of reporting increased difficulty in accessing syringes. These findings indicated that, among this sample of PWID, access to syringes was perceived as less difficult as the pandemic progressed, and that individuals who reported changing syringe sources and reported that people increased syringe sharing during the pandemic were also more likely to report increased difficulty in accessing syringes.
The change in perceptions of access to syringes across COVID-19 time periods can be interpreted through both changes to Chicago city policy as well as the policy changes at COIP (as described in the Introduction), which is a primary source of harm reduction services for many study participants. The stay-at-home order that was in effect from March, 2020 through the beginning of June, 2020 likely limited both study participants’ ability to access syringe exchange programs as well as programs’ ability to remain staffed and open (as evidenced by limited COIP service provision during the beginning of the stay-at-home order and full return to full services only after vaccines were available). Existing literature shows that many syringe exchange programs in other locations were quick to adapt their programs through window, mobile, and telehealth services to minimize interruptions to service [19–20]. This was the case at COIP as well, where needle exchange services were never stopped, and a window service had been established to continue to provide syringes [19–20]. In addition, as the pandemic progressed, COIP increased their mobile services. These quick policy adaptations at COIP could explain why most participants did not perceive syringe access as changing during the pandemic as COIP is a primary source of services to many of the study participants. Additionally, the stay-at-home order lifting and staff returning to COIP as well as mobile services expanding could explain why more individuals in the beginning of the pandemic reported difficulty in accessing syringes as opposed to later in the pandemic.
The results of this study align with the extant literature on harm reduction access changes during the pandemic from the perspective of service providers [19–21]. The present study’s results indicate that for most PWID in this sample, access to syringes and Narcan did not become more difficult during the pandemic supporting the efficacy of window and mobile syringe programs suggested by previous research. While it is important that individuals did not perceive significant barriers to access to harm reduction services, perceptions in access may not reflect the realities of engagement in the services. Some studies have reported increases in overdose and risk behaviors among PWID in Chicago during the pandemic, suggesting engagement in harm reduction services may be lower as a result of the pandemic despite perceptions of access not changing [9, 23]. Factors that influence risk taking behaviors and engagement in harm reduction such as housing stability, mental health, and social support worsened, which increased barriers to engagement in harm reduction services resulting in poorer health outcomes for PWID [5]. In the case of the present study, individuals who responded to this survey were doing so as part of engagement in a harm reduction service provider (COIP), meaning that these are individuals who were able to receive these services and sought them out. While these individuals mostly reported harm reduction access as remaining the same as prior to the pandemic, they already had the ability to engage in these resources prior to seeking access. While many PWID are able to access essential harm reduction services such as clean syringes and naloxone, it is also essential to understand what barriers during the COVID-19 pandemic may have prevented PWID from engaging with these services.
Furthermore, while the results of this study indicate that adaptations to standard SSP services through window service and mobile service are effective ways of providing harm reduction services to PWID in Chicago, this study did not examine the impacts of the COVID-19 pandemic on participants’ perceptions of access to other services at COIP such as in-person counseling and HIV and HCV care. Prior studies from the perspective of harm reduction providers have shown that these in-person services were greatly reduced during COVID-19 [19]. Future research should consider how the loss of these in-person services may have impacted PWID during the pandemic and specifically how they may have impacted continued engagement in harm reduction services.
Limitations
The current study is primarily limited by its purposive sampling methods, which focus on PWID in the Chicago Metropolitan Area. These sampling methods reduce the generalizability of the results to populations outside of the sample of PWID who participated in the study. Furthermore, this study recruited individuals and administered surveys through a harm reduction service provider (COIP). As a provider of harm reduction services, the necessity of interacting with COIP in order to complete surveys biases the sample toward individuals who are already engaged to some degree in harm reduction services via their contact with COIP. Additionally, measurement error may have limited the validity of study measures since participants were asked to report their perceptions of the impacts of COVID-19 on the accessibility of harm reduction services potentially resulting in different interpretations of, for example, what it means for something to be difficult or increase or decrease. The self-report nature of all survey questions also creates the potential for response bias such as social desirability, particularly given the sensitive topics discussed in the present study.
Conclusion
The present study examined changes in PWID’s perceptions of access to harm reduction services in Chicago throughout the COVID-19 pandemic. Using data from an ongoing longitudinal study of PWID in Chicago and a COVID-19 specific sub study we analyzed participants’ perceptions of access to syringes and naloxone across phases of COVID-19 mitigation policies in Chicago as well as using mixed effects logistic regression to explore predictors of perceived increased difficulty in syringe access. The results of this analysis indicated that study participants perceived access to syringes and Narcan to be similar as compared to prior to the pandemic, while more participants found syringe access more difficult in the early part of the pandemic than later. These findings suggest that policy adaptations by COIP (the main harm reduction service provider of study participants) allowed for minimal disruption in this sample of PWID’s access to syringes and Narcan. Further research is needed to understand the effects of the pandemic on PWID’s access to other essential harm reduction services such as counseling and HIV/HPV testing as well as how the pandemic affected engagement by PWID in all harm reduction services.
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