Women who inject drugs: barriers to their access of Needle Exchange services, and gendered experiences

<p>This thesis examines the gendered experiences of women who inject drugs, and barriers they face when accessing needle exchange services. Globally, studies suggest women access needle exchange services less than men. In New Zealand, the evidence suggests a similar situation. From the little that is known about women’s experiences in this context, studies are often quantitative, medically-based, or lack the voices of women who inject. This thesis aims to understand the gendered factors affecting the experiences of women who inject drugs. This study is a feminist, qualitative study, and employed semi-structured interviews as the data collection method. Five key participants who had injected drugs and four key informants who work with people who inject drugs were interviewed. The data from the interviews were analysed using thematic analysis. This study found that stigma presented as an overwhelming, pervasive barrier to the participants, not only in their access to needle exchange services, but also as a harm in other facets of their lives. Additionally, other barriers such as location also affected their access. The data confirms the significance of gender in their experiences and how, within a drugs context, gendered issues mirror wider society. The findings provide a platform for further research in this field and contribute to the academic understanding of a marginalised and stereotyped population. They also support the implementation of women-sensitive initiatives within needle exchange services.</p>

Women who inject drugs: barriers to their access of Needle Exchange services, and gendered experiences

<p>This thesis examines the gendered experiences of women who inject drugs, and barriers they face when accessing needle exchange services. Globally, studies suggest women access needle exchange services less than men. In New Zealand, the evidence suggests a similar situation. From the little that is known about women’s experiences in this context, studies are often quantitative, medically-based, or lack the voices of women who inject. This thesis aims to understand the gendered factors affecting the experiences of women who inject drugs. This study is a feminist, qualitative study, and employed semi-structured interviews as the data collection method. Five key participants who had injected drugs and four key informants who work with people who inject drugs were interviewed. The data from the interviews were analysed using thematic analysis. This study found that stigma presented as an overwhelming, pervasive barrier to the participants, not only in their access to needle exchange services, but also as a harm in other facets of their lives. Additionally, other barriers such as location also affected their access. The data confirms the significance of gender in their experiences and how, within a drugs context, gendered issues mirror wider society. The findings provide a platform for further research in this field and contribute to the academic understanding of a marginalised and stereotyped population. They also support the implementation of women-sensitive initiatives within needle exchange services.</p>

“I would rather do it myself”: injection initiation and current injection patterns among women who inject drugs in Tijuana, Mexico

Background Women who inject drugs (WWID) experience unique risks and adverse health outcomes related to injection initiation and patterns of injection drug use. However, there is limited information on injection initiation experiences and injection patterns among women and the protective strategies employed to limit injection-related harms, especially in low- and middle-income settings. Therefore, this study sought to explore injection initiation and current injection patterns (e.g., relying on someone else to inject) among women who inject drugs and engage in sex work in Tijuana, Mexico. Methods Semistructured in-depth interviews were conducted with 30 WWID on the following topics: injection initiation, current injection patterns, places where women inject, and protective strategies (i.e., risk reduction). All interviews were audio-recorded, transcribed, and de-identified. An inductive thematic analysis was conducted to identify and compare common themes and patterns across participants. Results The interviews revealed that the vast majority of study participants were first initiated by another person who injects drugs (PWID), often a male sexual partner. However, the majority of the women transitioned to become self-injectors in order to avoid risks associated with relying on others for injection, including overdose, interpersonal violence, sexual abuse, and wounds. Those who relied on others indicated that they would prefer to inject themselves without assistance from others if they were able to. Conclusions The narratives uncovered in this study reveal the importance of multiple risk environments in shaping perceived risks associated with injection drug use among women in Tijuana, Mexico. Specifically, the interviews elucidate the connection between interpersonal relationships with other PWID and protective strategies used to minimize risk and harm. These findings highlight the need for women-centered harm reduction programs to facilitate the development of safer drug use environments among WWID in Tijuana, Mexico.

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

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.

Healthcare beliefs, health information seeking, and healthcare setting preferences among women who inject drugs by community supervision status

Objective Women on community supervision who inject drugs have significant unmet healthcare needs. However, it remains unclear how the intersection of community supervision and injection drug use influences healthcare experiences and service setting preferences. The present study examines whether the intersection of community supervision and injection drug use is associated with differences in women’s healthcare beliefs, healthcare experiences, and service setting preferences. Methods A secondary analysis was conducted on a previously collected sample of women who inject drugs recruited from a syringe exchange and social service organization for a cross-sectional survey. Participants (N = 64) were mostly White (75%), and more than a quarter were currently on probation or parole (26%). Results Independent samples t-tests and chi-square tests revealed no significant differences on sociodemographic variables by community supervision status. There were no significant differences by community supervision status across seven indicators of healthcare confidence (ps > .05). However, results revealed significant differences in past experiences and beliefs about healthcare, health information seeking, and healthcare setting preferences by community supervision status (ps < .05), where women on community supervision less frequently sought health information and medical care outside of emergency departments. Conclusions Findings provide preliminary evidence about differences in the healthcare experiences and setting preferences of women who inject drugs on community supervision.