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

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.

Inequitable Access of People Who Injected Drugs to HCV Care in Tangier, Morocco: An Explorative Qualitative Study

“…An emerging result of our study, in line with previous studies (45), is that female PWID suffers more from social stigma, gender based violence, and additional risks related to drug use combined with sex work, both criminalised in Morocco. Access to HCV care is not the priority of female PWID who often have to care for her children in addition to seeking resources for their daily drug use.…”

“…Access to HCV care is not the priority of female PWID who often have to care for her children in addition to seeking resources for their daily drug use. This explains why women reorganizes her priorities to provide her sibling for their primary physiological needs in addition to drug use (46) (47) (45).…”

Women Mobilizing for Change: Resisting State Violence from Repressive Drug Policies

“…Instead, women face disproportionate prison sentences, a systematic overuse of pretrial detention, lack of access to legal aid, the denial of alternatives to incarceration, and an overall dearth of gender-sensitive responses (Cots Fernández & Nougier, 2021). Women who use drugs and are deprived of their liberty are at heightened risk of health harms, but in the limited number of countries where harm reduction services do exist in prisons, these are generally only available for men (Shirley-Beavan et al, 2020).…”

Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery

“…Stigmatization can come from health professionals [2]. This is increased for women [3] and further magnified for people who may be involved in transactional sex [4]. This is often, but not exclusively, women.…”