Work

Addressing Violence and Overdose Among Women Who Use Drugs—Need for Structural Interventions

Year: 2020

Type: article

Abstract: People who use drugs (PWUD) across diverse global contexts are facing an unprecedented overdose crisis, with rates of overdose-related morbidity and mortality continuing to increase in many settings.Although opioid-related overdoses represent an urgent public health and social emergency that affect men, women, and gender-diverse individuals, our current understanding of gendered experiences and needs in the context of the overdose crisis remains limited. 1 To inform robust responses to the overdose crisis, research, policy, and interventions must carefully consider genderbased experiences, including the unique harm reduction and addiction service needs of women who use drugs.2,3 For example, harm reduction services tend to be male-oriented spaces, and women often report highly gendered barriers to accessing harm reduction, including the unique and overlapping stigmas faced by women who use drugs, concerns regarding safety, and the threat of violence in and beyond service delivery settings.4 Sex workers are overrepresented among PWUD 2,3,5 and face disproportionate health and social inequities, including a high burden of HIV and sexually transmitted infections, 2,3 as well as workplace violence, criminalization, and stigma.3,6 The current study by El-Bassel and colleagues 7 provides a novel contribution by examining the association of various forms of violence-including intimate partner violence and other forms of gender-based violence-with nonfatal overdose among female sex workers who use drugs in Kazakhstan.Given that little is known regarding the overdose experiences of women who use drugs, sex workers in low-income and middle-income countries, or the associations of these with gender-based violence, this work has important implications for the design of harm reduction and other health and social services for women who use drugs and sex workers.Using baseline data from a cluster randomized clinical trial of a combination HIV risk reduction and microfinance intervention with 400 sex workers who use drugs, this cross-sectional study 7 reported a high burden of overdose among this population, with 37.5% of women reporting lifetime overdose and 18% of them reporting an overdose in the past 3 months, with most overdoses linked to heroin or nonmedical use of prescription opioids.Both incarceration and multiple forms of violence experienced by women sex workers were associated with an increased burden of nonfatal overdose.The data highlight the severe structural violence faced by women sex workers who use drugs-89.7%reported lifetime exposure to violence, 51.5% experienced recent intimate partner violence, and 40% experienced gender-based violence by other perpetrators (eg, clients, police, and drug dealers or suppliers).7 One-third reported lifetime incarceration, which was the factor most strongly associated with nonfatal overdose, conferring a substantial 4.34-fold increased risk of nonfatal overdose after adjustment for other factors.Although scale-up of evidence-based addiction and harm reduction services are well documented as being essential for reducing overdose-related morbidity and mortality, this evidence also suggests that structural interventions that address the severe burden of violence and criminalization faced by women who use drugs, including sex workers, remains a crucial and often missing element of public health responses.For example, multilevel interventions that include harm reduction and addiction services, sex worker-specific support, and structural policy reforms, such as the decriminalization of possession of illicit drugs as well as sex work, are recommended.Criminalization of drug use and sex work create dual, intersecting vulnerabilities for sex workers who use drugs; this provides police with broad leverage to arrest, +

Source: JAMA Network Open

DOI: 10.1001/jamanetworkopen.2020.21066

Author: Shira M. Goldenberg

Institution: Simon Fraser University

Language: English

Topic: HIV, Drug Use, Sexual Risk

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Gender equality, Peace, justice, and strong institutions, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,000