Catalysts for Policy Change to Support Syringe Access Program Implementation: Moving Beyond Research Evidence

Sashamara Perez, Monica Ruiz, Sean Allen, Allison O'Rourke

Background –
Syringe access programs (SAPs) are effective interventions for reducing HIV among people who inject drugs (PWID). However, public funding for SAPs is often politically controversial and may require legislative change before implementation is possible. Building on recent data citing the role of research evidence as a driver of new policy, we examined additional factors that may be influential in policy making, including characteristics of stakeholders championing SAPs, message framing of SAPs as a legitimate policy issue, and windows of opportunity for introducing policy change.

Methodology –
We examined the creation of SAPs in three US cities sharing similar HIV/AIDS epidemic profiles: Philadelphia, Baltimore, and Washington, DC. In-depth semi-structured qualitative interviews were conducted with key stakeholders from each city (N=29). The methodological framework of content analysis was applied, as was Kingdon’s policy window model, to frame the data within a larger policy making context.

Results –
Factors other than research evidence were found to be critical in the establishment of SAP policy, and in program creation and maintenance, within each city. In addition to the factors initially explored, there were differences across cities in the strategies stakeholders used to create specific messaging around SAPs. In Philadelphia, grassroots activism created awareness and political pressure for implementing SAPs as a public health emergency whereas, in Baltimore, change was championed by political appointees and elected officials who created a policy window via community and legislative consensus-building. SAP establishment in DC was hampered by Congressional oversight over municipal budgeting.

Conclusion –
Factors other than research evidence are integral in effecting policy change for controversial issues like SAPs, and these factors are determined by the contexts within which policies are implemented. SAP advocates engaging in policy change processes should consider these factors while incorporating the perspectives of relevant community stakeholders (e.g., SAP providers, PWID).