Gender-based vulnerability in women who inject drugs in a harm reduction setting

Abstract Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that is available suggests that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe, and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include: stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life-changing and life-affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.

Download Full-text

Developing integrated community-based HIV prevention, harm reduction, and sexual and reproductive health services for women who inject drugs

Reproductive Health ◽

10.1186/s12978-019-0711-z ◽

2019 ◽

Vol 16 (S1) ◽

Cited By ~ 3

Author(s):

Sylvia Ayon ◽

Fatma Jeneby ◽

Faizah Hamid ◽

Abdalla Badhrus ◽

Taib Abdulrahman ◽

...

Keyword(s):

Hiv Prevention ◽

Reproductive Health ◽

Health Services ◽

Harm Reduction ◽

Sexual And Reproductive Health ◽

Reproductive Health Services ◽

Community Based ◽

Women Who Inject Drugs

Download Full-text

Predictors of HIV Risk Behavior in Iranian Women Who Inject Drugs

Journal of Drug Issues ◽

10.1177/0022042617693383 ◽

2017 ◽

Vol 47 (3) ◽

pp. 356-369 ◽

Cited By ~ 1

Author(s):

Mojtaba Habibi ◽

Solmaz Farmanfarmaee ◽

Mohammad Darharaj ◽

Kaveh Khoshnood ◽

Joshua J. Matacotta ◽

...

Keyword(s):

Harm Reduction ◽

Risk Behavior ◽

Risk Behaviors ◽

Hiv Risk ◽

Drug Users ◽

Methadone Maintenance ◽

Peer Group ◽

Hiv Risk Behaviors ◽

Hiv Risk Behavior ◽

Women Who Inject Drugs

This study aimed to investigate predictors of drug-related HIV risk behaviors among women who inject drugs. A total of 163 women were recruited from harm-reduction-oriented drug-treatment centers in Tehran, Iran. Each completed a set of measures that included the Risk Behavior Assessment, Beck Depression Inventory–Second Edition, Revised Self-Efficacy Scale, and Peer Group Beliefs Regarding HIV-related Risk Behaviors Scale. The results indicated that past attempts to abstain from drugs, using methadone maintenance treatment programs, and acceptance of peers’ risky norms were significant predisposing, enabling, and reinforcing predictors of frequency of injection, respectively. Furthermore, predictors of frequency of sharing injection paraphernalia included purchasing drugs jointly with other drug users and peers’ norms conforming injecting drug use behaviors. Harm reduction services that take into consideration cultural and peer norms, as well as the development and implementation of HIV prevention programs, are likely to reduce drug-related HIV risk behaviors in women who inject drugs.

Download Full-text

Slipping through: mobility’s influence on infectious disease risks for justice-involved women in Canada

Health & Justice ◽

10.1186/s40352-021-00157-3 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Susie Taylor ◽

Margaret Haworth-Brockman ◽

Yoav Keynan

Keyword(s):

Public Health ◽

Substance Use ◽

Harm Reduction ◽

Partner Violence ◽

Disease Risk ◽

Health Planning ◽

Incarcerated Women ◽

Public Health Perspective ◽

Sexually Transmitted ◽

Gender Based

Abstract Background The relationship between incarceration and women’s vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI. Results This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare. Conclusions The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.

Download Full-text

Women Who Inject Drugs (WWID): Stigma, Gender and Barriers to Needle Exchange Programmes (NEPs)

Contemporary Drug Problems ◽

10.1177/00914509211035242 ◽

2021 ◽

pp. 009145092110352

Author(s):

Kirsten Gibson ◽

Fiona Hutton

Keyword(s):

Harm Reduction ◽

Drug Users ◽

Qualitative Interviews ◽

Significant Proportion ◽

Needle Exchange ◽

Pharmacy Staff ◽

Women's Voices ◽

The Social ◽

Women Who Inject Drugs ◽

Exchange Programmes

Global evidence suggests that experiences of access to Needle Exchange services are gendered and that women who inject drugs (WWID) access needle exchange services differently to men. Despite being a significant proportion of injecting drug users, women’s voices and experiences have often been silenced in studies around harm reduction service provision, hampering the development of harm reduction services for WWID. This article highlights the experiences of four women and one trans man who have previously injected drugs, in accessing needle exchange programmes (NEPs) in a New Zealand context. Semi-structured qualitative interviews were carried out with five participants and thematic analysis of the interviews produced three core themes: how stigma permeates WWIDs’ lives; barriers in accessing needle exchange services; and how experiences within a drugs context are gendered. Stigma was an overwhelming issue affecting WWID which also acted as a barrier to their access of NEPs. The WWID in our study in terms of Goffman’s original theorizing were “doubly discredited” as well as “precariously discreditable” due to their gender and injection drug using status. The participants keenly felt their stigmatized status through interactions with pharmacy-based needle exchange staff, perceiving that pharmacy staff viewed them as more contaminated than their male counterparts. Gendered relationships were also noted in injection practices, although initiation for this group of WWID was done by intimate partners as well as friends, dispelling the stereotype of WWID as passive victims. Some participants also learnt to self-inject which gave them a sense of empowerment and freedom as they did not have to rely on others to help them. The social structures that support stigmatizing tropes about WWID need to be addressed as well as more local interventions to prevent stigma in NEPs, alongside women focused services.

Download Full-text

A Global Meta-analysis of the Prevalence of HIV, Hepatitis C Virus, and Hepatitis B Virus Among People Who Inject Drugs—Do Gender-Based Differences Vary by Country-Level Indicators?

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz058 ◽

2019 ◽

Vol 220 (1) ◽

pp. 78-90 ◽

Cited By ~ 6

Author(s):

Janni Leung ◽

Amy Peacock ◽

Samantha Colledge ◽

Jason Grebely ◽

Evan B Cunningham ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Human Development ◽

People Who Inject Drugs ◽

Country Level ◽

B Virus ◽

Women Who Inject Drugs ◽

Gender Based

Abstract Background Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. Methods We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Results Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8–4.4) and South Asia (RR, 1.7; 95% CI, 1.1–2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5–.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7–.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. Conclusion HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.

Download Full-text

Gender matters? How does gender shape risk environment for syringe sharing among people who inject drugsin northern Mexico. Results from a cross-sectional survey

Salud Mental ◽

10.17711/sm.0185-3325.2019.022 ◽

2019 ◽

Vol 42 (4) ◽

pp. 165-172

Author(s):

Angélica Ospina-Escobar ◽

Fátima Juárez

Keyword(s):

Harm Reduction ◽

Hiv Prevalence ◽

Syringe Sharing ◽

Significant Variable ◽

Drug Injection ◽

Risk Environment ◽

Cross Sectional Survey ◽

Men And Women ◽

Northern Mexico ◽

Women Who Inject Drugs

Introduction. HIV prevalence among people who inject drugs (PWID) is 5%. Studies have found a HIV prevalence around 10% among women who inject drugs (WWID) and 5% among men. Objective. To describe characteristics of risk environment that play different roles among men and women who inject drugs in Mexico that could be associated with those differentials. Method. In 2012 were interviewed in Hermosillo and Ciudad Juarez in places where population gathered. From them, 824 PWID 74.0% were men and 26.0% were women. Using chi-square test we analyzed associations of gender with demographics characteristics, drug use dynamics, and injecting behaviors. We fitted different generalized linear mixed models with random effects to test the hypothesis that predictors of receptive needle sharing have different effects on men and women. Results. Descriptive analysis showed that women live in conditions of higher vulnerability than men in terms of migration, educational attainment, occupation, and income. Women also reported a higher frequency of drug injection, a higher number of drugs used, and a higher prevalence of sharing needles. Variables significantly associated with the likelihood of sharing needles were: having being injected for someone else at first drug injection (adjusted odds ratio [AOR] = 1.60, 95% confidence interval CI [1.11, 2.25], p < .05); injecting once a day or more (AOR = 1.80, 95% CI [1.17, 2.70], p < .05), using alcohol or drugs at least half of the time at their sexual encounters (AOR = 1.64, 95% CI [1.16, 2.47], p < .05), experience of syringe confiscation by police (AOR = 1.54, 95% CI [1.13, 2.19], p < .05), and perceiving syringe availability as hard or very hard (AOR = 2.29, 95% CI [1.49, 3.32], p < .01). For women the most significant variable associated with syringe sharing was perception of syringe availability (AOR = 3.15, 95% CI [1.25, 7.91], p < .05), while for men was syringe confiscation by police (AOR = 1.74, 95% CI [1.20, 2.50], p < .05). Discussion and conclusion. Results suggests the need to design and implement harm reduction programs that tackle the specific need of WID. Enhancing syringe availability through permanent harm reduction programs, implemented in coordination between public health authorities and community-based organizations, is a basic action to stop HIV spreading among PWID in northern Mexico, along with the decriminalization policies towards these population.

Download Full-text

Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barcelona, Spain

Harm Reduction Journal ◽

10.1186/s12954-020-00429-5 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Sam Shirley-Beavan ◽

Aura Roig ◽

Naomi Burke-Shyne ◽

Colleen Daniels ◽

Robert Csak

Keyword(s):

Literature Review ◽

Harm Reduction ◽

Health Workers ◽

People Who Use Drugs ◽

Service Access ◽

Structural Barriers ◽

Gender Based Violence ◽

Reproductive Health Services ◽

Women Who Inject Drugs ◽

Women Who Use Drugs

Abstract Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that are available suggest that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; and a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life changing and life affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.

Download Full-text