Sexual Minority Women Who Use Drugs: Prejudice, Poverty, and Access to Care

Abstract

Access to care is a critical issue for ameliorating the health and social impact of marginalization. Research indicates that sexual minority women experience low utilization of medical care overall, combined with high levels of substance abuse and lack of access to culturally appropriate services. This study uses qualitative data to examine factors that affect access to services for sexual minority women who use(d) heroin or crack cocaine. Semi-structured interviews were done with 34 sexual minority women drug users, of diverse sexual identities, recruited from community-based agencies. Interviews explored factors shaping service utilization, including basic life history, self-assessed needs, positive and negative experiences with service providers, and barriers to care. Analysis explored prejudice and discrimination at institutional and interactional levels, the role of social policy, the interactional dynamics surrounding gender presentation, and how these institutional and social processes shape individual experience. The women who participated in this study described multiple layers of marginalization that limited access to—and discouraged use of—a range of vital services, but their stories simultaneously demonstrated the power of personal networks and low-threshold agencies to share resources, provide bridges to services, and build supportive communities.