scholarly journals Women and Barriers to Harm Reduction Services: A Literature Review and Initial Findings From a Qualitative Study in Barcelona, Spain

2020 ◽  
Author(s):  
Sam Shirley-Beavan ◽  
Aura Roig Forteza ◽  
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 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.

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

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.

Using reproductive health services to address sexual and gender-based violence in post-conflict northern Uganda.

2019 ◽  
Author(s):  
Keneth Opiro ◽  
Francis Pebolo Pebalo ◽  
Neil Scolding ◽  
Charlotte Hardy
Keyword(s):  
Reproductive Health ◽  
Health Service ◽  
Health Workers ◽  
Northern Uganda ◽  
Gender Based Violence ◽  
Reproductive Health Services ◽  
Service Workers ◽  
Post Conflict ◽  
Gender Based ◽  
And Gender

Abstract Abstract Background Sexual and gender-based violence (SGBV), including rape and child sexual abuse, remains a significant challenge in post-conflict northern Uganda, including within refugee settlements. Many victims have never sought help from health-related services. Consequently, the scale of the problem is unknown, and SGBV victims’ injuries, both psychological and physical, remain undetected and unaddressed. We hypothesized that health workers in rural Reproductive Health Services could provide a valuable resource for SGBV screening and subsequent referral for support. Methods Our project had three elements. First, Reproductive Health Service workers were trained in the knowledge and skills needed to screen for and identify women who had experienced SGBV, using a questionnaire-based approach. Second, the screening questionnaire was used by reproductive health workers over a 3-month period, and the data analysed to explore the scale and nature of the problem. Third, victims detected were offered referral as appropriate to hospital services and/or the ActionAid SURGE (Strengthening Uganda’s Response to Gender Equality) shelter in Gulu. Results 1656 women were screened. 778 (47%) had a history of SGBV, including 123 victims of rape and 505 victims of non-sexual violence. 1,254 (76%) had been directly or indirectly affected by conflict experiences; 1066 had lived in IDP camps. 145 (9%) were referred at their request to Gulu SGBV Shelter under SURGE. Of these, 25 attended the shelter and received assistance, and a further 20 received telephone counselling. Conclusion Undetected SGBV remains a problem in post-conflict northern Uganda. Reproductive Health Service workers, following specific training, can effectively screen for and identify otherwise unreported and unassisted cases of SGBV. Future work will explore scaling up to include screening in hospital A&E departments, incorporate approaches to screening for male victims, and the impact of taking both screening and support services to rural communities through local clinics with mobile teams.

scholarly journals “Women Never Use Drugs Alone”: Assessing Stigma & Access to Care among Women who Use Drugs.

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Amanda Essex ◽  
Carrie Lawrence, Ph.D. CFLE CHES ◽  
Brooklyn Sean Turner
Keyword(s):  
Health Outcomes ◽  
Access To Health Care ◽  
Substance Misuse ◽  
Structured Interview ◽  
Physician Education ◽  
People Who Use Drugs ◽  
Mandated Reporting ◽  
Structural Barriers ◽  
Childbearing Age ◽  
Women Who Use Drugs

Background Substance misuse remains a significant health threat in communities across Indiana. Despite the 2015 HIV outbreak in Scott County, Indiana’s health systems continue to lack the capacity to reduce health harms associated with substance misuse. Unlike general patient populations, people who use drugs (PWUD) face various social and structural barriers that impede access to health care and result in poorer health outcomes. Such impediments are of more significant concern for pregnant women who use drugs (PWWUD) who experience greater stigma, complex health needs, and require more specialized care. The purpose of this study was to assess access to healthcare and related services among women of childbearing age with a history of substance misuse. Methods For this qualitative study, participants (n=20) completed a sociodemographic questionnaire and semi-structured interview. Interview questions included perceptions of their overall health, healthcare experiences, and how to improve access to and retention in these services. Results The results reported reflect a thematic analysis of the interview transcripts. Two key care barriers identified were: (1) experiences of stigma related to professionals’ attitudes towards PWWUD and (2) fear of losing custody of their child as a result of physician mandated reporting to child welfare. Conclusions and Recommendations Addressing social and stigma related barriers experienced by PWWUD are key to increased linkage to and retention in care as well as improved health outcomes. Additionally, our findings call for mandated student and physician education on patients who use drugs as well as reform of mandated reporting laws to reduce barriers and increase care access among PWWUD.

scholarly journals Women’s multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Geoff Bardwell ◽  
Taylor Fleming ◽  
Ryan McNeil ◽  
Jade Boyd
Keyword(s):  
Qualitative Interviews ◽  
Urban Setting ◽  
Supportive Housing ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Response Button ◽  
Gender Based Violence ◽  
Emergency Situations ◽  
Housing Environment ◽  
Gender Based

Abstract Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.

scholarly journals Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach

2021 ◽  
pp. 003335492199939
Author(s):  
Elizabeth Noyes ◽  
Ellis Yeo ◽  
Megan Yerton ◽  
Isabel Plakas ◽  
Susan Keyes ◽  
...  
Keyword(s):  
Young Adults ◽  
Harm Reduction ◽  
Community Care ◽  
Control Measures ◽  
Adolescents And Young Adults ◽  
People Who Use Drugs ◽  
Staff Members ◽  
Infection Control Measures ◽  
Semistructured Interviews ◽  
High Level

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

scholarly journals The role of partners in promoting self-care for misoprostol and subcutaneous DMPA in Pakistan

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Qudsia Uzma ◽  
Nausheen Hamid ◽  
Rizwana Chaudhri ◽  
Nadeem Mehmood ◽  
Atiya Aabroo ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Private Sector ◽  
Healthcare System ◽  
Sexual And Reproductive Health ◽  
Health Workers ◽  
Self Care ◽  
Essential Element ◽  
Scaling Up ◽  
Reproductive Health Services

Abstract Background Pakistan is among a number of countries facing protracted challenges in addressing maternal mortality with a concomitant weak healthcare system complexed with inequities. Sexual and reproductive health and rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. A prospective qualitative study design was used and a semi-structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include the use of misoprostol for postpartum hemorrhage and the use of subcutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephone follow-up calls. Results Nine of the 13 partners consulted for the study responded. The two selected self-care interventions are mainly supported by private sector partners (national and international nongovernmental organizations) having national or subnational existence. Their mandates include all relevant areas, such as policy advocacy, field implementation, trainings, supervision and monitoring. A majority of partners reported experience related to the use of misoprostol; it was introduced more than a decade ago, is registered and is procured by both public and private sectors. Subcutaneous DMPA is a new intervention, having been introduced only recently, and commodity availability remains a challenge. It is being delivered through health workers/providers and is not promoted as a self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation; however, no beneficiary data was collected for the study. Training approaches differ considerably, are standalone or integrated with SRHR topics and their duration varies between 1 and 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support, as well as the leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting are required together with integration of self-care in routine capacity building activities (pre- and in-service) on sexual and reproductive health in the country.

scholarly journals Civil society involvement in harm reduction drug policy: reflections on the past, expectations for the future

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Aileen O’Gorman ◽  
Eberhard Schatz
Keyword(s):  
Civil Society ◽  
Harm Reduction ◽  
Lived Experience ◽  
Political Institutions ◽  
Drug Policy ◽  
Policy Development ◽  
Policy Decision ◽  
People Who Use Drugs ◽  
Annual Conference ◽  
Health Crisis

Abstract Background A range of civil society organisations (CSOs) such as drug user groups, non-governmental/third sector organisations and networks of existing organisations, seek to shape the development of drugs policy at national and international levels. However, their capacity to do so is shaped by the contexts in which they operate nationally and internationally. The aim of this paper is to explore the lived experience of civil society participation in these contexts, both from the perspective of CSOs engaged in harm reduction advocacy, and the institutions they engage with, in order to inform future policy development. Methods This paper is based on the presentations and discussions from a workshop on ‘Civil Society Involvement in Drug Policy hosted by the Correlation - European Harm Reduction Network at the International Society for the Study of Drugs Policy (ISSDP) annual conference in Paris, 2019. In the aftermath of the workshop, the authors analysed the papers and discussions and identified the key themes arising to inform CSI in developing future harm reduction policy and practice. Results Civil society involvement (CSI) in policy decision-making and implementation is acknowledged as an important benefit to representative democracy. Yet, the accounts of CSOs demonstrate the challenges they experience in seeking to shape the contested field of drug policy. Negotiating the complex workings of political institutions, often in adversarial and heavily bureaucratic environments, proved difficult. Nonetheless, an increase in structures which formalised and resourced CSI enabled more meaningful participation at different levels and at different stages of policy making. Conclusions Civil society spaces are colonised by a broad range of civil society actors lobbying from different ideological standpoints including those advocating for a ‘drug free world’ and those advocating for harm reduction. In these competitive arena, it may be difficult for harm reduction orientated CSOs to influence the policy process. However, the current COVID-19 public health crisis clearly demonstrates the benefits of partnership between CSOs and political institutions to address the harm reduction needs of people who use drugs. The lessons drawn from our workshop serve to inform all partners on this pathway.

scholarly journals Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lesley Rose Ninsiima ◽  
Isabel Kazanga Chiumia ◽  
Rawlance Ndejjo
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Sexual And Reproductive Health ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Inclusion Criteria ◽  
Reproductive Health Services ◽  
Factors Influencing ◽  
Sub Saharan ◽  
Youth Friendly

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

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