A Positive Perfect Storm": Creation and Development of Hawai‘i's Syringe Exchange Program-Harm Reduction in Action?

Abstract

Hawai'i has a syringe exchange program (SEP) that has been in operation for over 25 years. However, little is known of the factors that led to the creation, development, growth, and success of this program, while similar programs are actively opposed in many parts of the U. S. This study delves into the perceptions of the factors that led to the creation, development, and growth of Hawai'i’s SEP. This study uses a purposeful sample, using a snowball technique, in which 22 key informants (K. I.) are recruited and interviewed. This is a mixed methods study; two methods of data collection are used, K. I. interviews and deductive directed content analysis. Discussions with K. I. provide perceptions about the factors leading to the creation, development, and growth of Hawai'i’s SEP. The deductive directed content analysis, using a harm reduction (HR) approach of five principles—pragmatism, humanistic values, focus on harms, balancing costs and benefits, and priority of immediate goals—is tested against data from Hawai'i SEP annual reports. Statistical analysis is performed to measure the frequency HR principles are used. Study findings reveal dynamic personalities played a major role in the factors leading to the creation, development, and growth of Hawai'i’s SEP. This study identifies two major themes—fear, and knowledge is power. A retrospective deductive directed content analysis is conducted on the annual reports of 1995 through 2015, plus the Operational Manual for 2016. The findings reveal the most common HR principle is priority of immediate goals; balancing costs and benefits ranked second in frequency; focus on harms ranked third; humanistic values ranked fourth, and pragmatism ranked fifth. This study provides recommendations that could improve public health in Hawai'i.