Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barc
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RESEARCH
Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barcelona, Spain Sam Shirley‑Beavan1* , Aura Roig2, Naomi Burke‑Shyne1, Colleen Daniels1 and Robert Csak1
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 envi‑ ronmental, social and individual factors affecting women, which also affect their ability to engage in health promot‑ ing 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; genderbased 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 expe‑ rience 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. Keywords: Harm reduction, Women, Prison, Europe, Barcelona, Spain, Gender-based violence Introduction There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs [1]. Accounting for the concealing effects of criminalisation, gender power imbalances and stigma, this number is likely to be an underestimate [2]. The *Correspondence: [email protected] 1 Harm Reduction International, 61 Mansell Street, London E1 8AN, UK Full list of author information is available at the end of the article
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 [3]. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which al
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