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Rapid assessment cross-sectional surveys and qualitative interviews were conducted among people who inject drugs (PWID) in Burundi and Uganda, as well as key informants working with drug users, to assess risk associated with HIV and hepatitis C (HCV). A total of 127 PWID were recruited in Burundi and 125 in Uganda of which the majority were male and aged between 24 and 26 years. Blood samples were collected in Burundi to test for antibodies to HIV, HCV and B Surface Antigen (HBsAg). Heroin was mainly injected in Uganda and Burundi with a small minority injecting crack/cocaine. Half of participants in Burundi, and 86% in Uganda had been HIV tested. The minority had been tested for HCV in any site (5-7%). HIV prevalence from the serological testing in Burundi indicated that 10% tested positive for antibodies to HIV, 6% to HCV and 9% to HBsAg. Qualitative data suggested that structural factors including costs of needle/syringes as well policies prohibiting pharmacies selling injecting equipment to PWID were related to reuse and sharing of needles/syringes among PWID, despite awareness HIV transmission risk. Police arrest was common in Burundi and Uganda and the use of bribes by police compounded existing high levels of poverty. Findings accentuate the need for policy shifts to enable easier access to clean injecting equipment, increased availability of HIV and HCV testing and increased access to affordable drug treatment and introduction of opioid substitution therapy. Specific attention is needed to the potential for sexual transmission of HIV among this population.

Background: Peer outreach harm reduction initiatives are being developed with and for people who use drugs inDakar, Senegal. This is in response to growing injecting drug use across the West Africa region and linked emergingepidemics of HIV and hepatitis C. We undertook formative qualitative research to explore the feasibility andpotential of peer outreach in this context and in particular how outreach could be linked to fostering communitylevelprocesses of change.Methods: We undertook a total of 44 semi-structured qualitative interviews. Thirty-four interviews were with peoplewho used drugs (comprised of 25 participants who had injected at least once in their life) and included 11 peereducators who delivered “awareness-raising” harm reduction activities. We also interviewed 10 service providersinvolved in the planning and monitoring of peer outreach initiatives. We used thematic analysis to identify keycharacteristics of how peer-led outreach is being delivered, beneficiary need, and the nature of the social networksin which the awareness-raising activities operate.Results: Through interviews with peer educators, people who use drugs, and service providers, four mainoverlapping themes are identified as follows: peer educators as a bridge to responsibilization through awarenessraisingactivities, awareness-raising activities as an enactment of recovery, awareness raising through social networkdiffusion, and the contexts and constraints of peer outreach engagement through awareness-raising activities.Conclusions: The study results suggest that peer education is on a trajectory to develop into a central role forharm reduction interventions in Dakar, Senegal. This research shows how peer education is bound in processes ofresponsibilization and self-change, which link to varying possibilities for risk reduction or recovery. For peereducation to achieve a range of significant goals, broader structural and system changes should be implemented inthe region. We caution that without such changes, awareness-raising activities and the role of peer educators mayinstead become part of state- and agency-sponsored processes of seeking to responsibilize individuals for healthand harm reduction.

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. Method The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum). Results Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. Discussion & conclusions While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world.