A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice

Medina-Perucha, Laura; Scott, Jennifer; Chapman, Sarah; Barnett, Julie; Dack, Charlotte; Family, Hannah

doi:10.1016/j.socscimed.2019.01.022

Cited by 32 publications

(36 citation statements)

References 59 publications

(68 reference statements)

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“…Intersectionality research instead aims to unpack how an individual's oral health is simultaneously impacted by multiple social elements, and in particular, can theorize how certain intersections predispose people to greater risk of poor oral health or indeed offer protective factors. Adopting an intersectional framework enables us to identify populations who are more likely to be a target of stigma, experience exclusion from dental services, likely to self‐stigmatize and disengage from services 74 . Intersectionality adds and offers a new dimension to consider how we view and work with people suffering multiple forms of discrimination.…”

Section: How Could Oral Health Research Benefit From Adopting An Intementioning

confidence: 99%

What is intersectionality and why is it important in oral health research?

Muirhead

Milner

Freeman

et al. 2020

Comm Dent Oral Epid

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This paper is the second of two reviews that seek to stimulate debate on new and neglected avenues in oral health research. The first commissioned narrative review, “Inclusion oral health: Advancing a theoretical framework for policy, research and practice”, published in February 2020, explored social exclusion, othering and intersectionality. In it, we argued that people who experience social exclusion face a “triple threat”: they are separated from mainstream society, stigmatized by the dental profession, and severed from wider health and social care systems because of the disconnection between oral health and general health. We proposed a definition of inclusion oral health and a theoretical framework to advance the policy, research and practice agenda. This second review delves further into the concept of intersectionality, arguing that individuals who are socially excluded experience multiple forms of discrimination, stigma and disadvantage that reflect intersecting social identities. We first provide a theoretical and historical overview of intersectionality, rooted in Black feminist ideologies in the United States. Our working definition of intersectionality, requiring the simultaneous appreciation of multiple social identities, an examination of power and inequality, and a recognition of changing social contexts, then sets the scene for examining existing applications of intersectionality in oral health research. A critique of the sparse application of intersectionality in oral health research highlights missed opportunities and shortcomings related to paradigmatic and epistemological differences, a lack of robust theoretically engaged quantitative and mixed methods research, and a failure to sufficiently consider power from an intersectionality perspective. The final section proposes a framework to guide future oral health research that embraces an intersectionality agenda consisting of descriptive research to deepen our understanding of intersectionality, and transformative research to tackle social injustice and inequities through participatory research and co‐production.

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Section: How Could Oral Health Research Benefit From Adopting An Intementioning

confidence: 99%

What is intersectionality and why is it important in oral health research?

Muirhead

Milner

Freeman

et al. 2020

Comm Dent Oral Epid

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“…Health inequities occur where there are preventable differences between groups in access to services and resources that improve health outcomes [ 4 ]. Women are demonstrably subject to health inequities with regard to access to harm reduction services.…”

Section: Introductionmentioning

confidence: 99%

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

Shirley-Beavan¹,

Roig²,

Burke-Shyne³

et al. 2020

Harm Reduct J

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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.

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“…However, this was not always applied in practice. The way some pharmacists talked about WOST showed how ingrained stigma towards PWUD is (23,(29)(30)(31)(32). The fact that CPs may not even be aware of their own stigmatizing attitudes may increase the complexity of stigma reduction strategies for community pharmacy.…”

Section: Trust and Humanity: Building Positive Rapport And Good Commumentioning

confidence: 99%

Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

Medina-Perucha

Scott

Chapman

et al. 2020

European Journal of Public Health

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Background Women on opioid substitution treatment (WOST) are at heightened risk for the sexual transmission of sexually transmitted infections and blood-borne viruses. This study aimed to explore the opportunities to promote their sexual health in community pharmacies in UK. Methods Semi-structured interviews were conducted with 20 WOST and 14 community pharmacists (CPs). A focus group was run with three CPs. Participants were recruited in drug services and a service for sex workers (WOST), and in CP. Data collection took place between October 2016 and September 2017. Data were analyzed using Framework Analysis and directed Content Analysis. Results CPs could play a role in promoting sexual health among WOST. Sexual health screening, treatment and condom supply were suggested as potential ways of delivering pharmacy-based sexual health services. These services should be actively offered to WOST, delivered in a private space and free of cost. We identified several challenges to overcome in order to design and implement sexual health services for WOST in community pharmacies. Conclusions This study highlights the potentially key role CPs can have promoting sexual health and addressing health inequities among WOST. Improvements in pharmacists’ training are required in order to address stigma towards WOST, and promote trust and positive rapport. Structural changes are also needed to broaden the services available for this group of women and improve their access to healthcare.

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A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice

Cited by 32 publications

References 59 publications

What is intersectionality and why is it important in oral health research?

What is intersectionality and why is it important in oral health research?

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

Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

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