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

Valencia, Jorge; Álvaro-Meca, Alejandro; Troya, Jesús; Gutiérrez, Jorge; Rodríguez, Antonio Pérez; Vázquez-Morón, Sonia; Resino, Salvador; Moreno, Santiago López-Ríos; Ryan, Pablo

doi:10.1371/journal.pone.0230886

Cited by 24 publications

(17 citation statements)

References 27 publications

(32 reference statements)

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“…Results from the study show that 88% of women who use drugs reported having ever suffered emotional or psychological damage, 71% indicated having experienced at least one incident of serious physical injury by a male partner and 49% having ever suffered sexual abuse. Similar to other studies, results show the syndemic of substance abuse, partners violence, HIV, mental illness and social instability [ 54 ]. In comparison with men, women who use drugs have considerably more frequent and intense experiences with interpersonal violence, sexual abuse and trauma.…”

Section: Methodssupporting

confidence: 89%

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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Section: Methodssupporting

confidence: 89%

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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show abstract

“…Overall, PAIP clients were more likely to be female and Indigenous compared to the general SCS population. From the interviews, gender did not emerge as a prominent factor, which contrasts with the administrative data as well as with the extant literature regarding women who use drugs (26,27). It is unclear why these participants indicated they provided and/or received assistance from those of the same and other sex, when the quantitative data indicates there are far more male-to-female assists occurring than female-to-female and male-to-male.…”

Section: Discussioncontrasting

confidence: 73%

“…However, Kennedy et al (30) suggest that SCS use is not a protective factor against violence for women, whereas it is associated with lower rates of violence against men. It is also possible that gender-based power imbalances were accepted as the norm (including the SCS as a gendered and racialized space) and that participants do not question that this oppressive structure governs their lives, thus unwittingly (31) or reluctantly (27) participating in it while also suffering under it because of dependence on a partner for basic needs (26).…”

Section: Discussionmentioning

confidence: 99%

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

Pijl-Zieber

Oosterbroek

Motz

et al. 2020

Preprint

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Background: Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, BC, clients were prohibited from injecting their peers; only recently has this practice been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations. Methods: In this qualitative study, participants (n=16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data was used to provide context and to describe the study population, comprised of people in the PAIP (n=248) Results: PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients. Conclusions: Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practise lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.

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“…Overall, PAIP clients were more likely to be female and Indigenous compared to the general SCS population. From the interviews, gender did not emerge as a prominent factor, which contrasts with the administrative data as well as with the extant literature regarding women who use drugs [ 26 , 27 ]. It is unclear why these participants indicated they provided and/or received assistance from those of the same and other gender, when the quantitative data indicates there are far more male-to-female assists occurring than female-to-female and male-to-male.…”

Section: Discussioncontrasting

confidence: 67%

Peer-assisted injection as a harm reduction measure in a supervised consumption service: a qualitative study of client experiences

et al. 2021

View full text Add to dashboard Cite

Background Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, Canada, clients were prohibited from injecting their peers; only recently has this practise been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations. Methods In this qualitative study, participants (n = 16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data were used to provide context and to describe the study population, comprised of people in the PAIP (n = 248). Results PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients. Conclusions Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practice lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.

show abstract

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

Cited by 24 publications

References 27 publications

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

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

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

Peer-assisted injection as a harm reduction measure in a supervised consumption service: a qualitative study of client experiences

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