Women who inject drugs (WWID): Stigma, gender and barriers to needle exchange programmes (NEPs) (2021)

Global evidence suggests that experiences of access to Needle Exchange services are gendered and that women who inject drugs (WWID) access needle exchange services differently to men. Despite being a significant proportion of injecting drug users, women's voices and experiences have often been silenced in studies around harm reduction service provision, hampering the development of harm reduction services for WWID. This article highlights the experiences of four women and one trans man who have previously injected drugs, in accessing needle exchange programmes (NEPs) in a New Zealand context. Semi-structured qualitative interviews were carried out with five participants and thematic analysis of the interviews produced three core themes: how stigma permeates WWIDs' lives; barriers in accessing needle exchange services; and how experiences within a drugs context are gendered. Stigma was an overwhelming issue affecting WWID which also acted as a barrier to their access of NEPs. The WWID in our study in terms of Goffman's original theorizing were "doubly discredited" as well as "precariously discreditable" due to their gender and injection drug using status. The participants keenly felt their stigmatized status through interactions with pharmacy-based needle exchange staff, perceiving that pharmacy staff viewed them as more contaminated than their male counterparts. Gendered relationships were also noted in injection practices, although initiation for this group of WWID was done by intimate partners as well as friends, dispelling the stereotype of WWID as passive victims. Some participants also learnt to self-inject which gave them a sense of empowerment and freedom as they did not have to rely on others to help them. The social structures that support stigmatizing tropes about WWID need to be addressed as well as more local interventions to prevent stigma in NEPs, alongside women focused services.