Street-involved Women Research Articles

Cannabis use for pain relief in the context of health service barriers: Accounts of street-involved Nigerian women suffering chronic pain.

This study explored cannabis use for pain relief among socially marginalised Nigerian women in the context of barriers to pain management. The study was designed as a qualitative exploratory study of pain experience and management. Sixteen in-depth, individual interviews were conducted with street-involved women who use drugs and had chronic pain. Transcripts were coded and analysed thematically. Pain was experienced as a pervasive feature of everyday life that disrupted daily routines, affected economic activities, strained social relationships and had adverse effects on health and wellbeing. Participants sought treatment in health facilities, but faced social and health system barriers to service utilisation including financial cost of services, dismissal of symptoms by providers, stigma due to physical appearance, substance use and lack of social support. These barriers encouraged disengagement from services and reliance on cannabis (along with heroin and diverted prescription opioids) for pain management. Cannabis use relieved pain and improved daily functioning, enabling participants to undertake economic activities. However, using cannabis to enhance the effects of opioids and heavy and long-term use owing to pain chronicity and disability generated concerns about harms. Findings show the therapeutic benefits of cannabis in the face of barriers to pain management. This support calls to explore the potentials of cannabis for pain management for socially marginalised populations and to develop medical guidelines to reduce the risk of adverse health consequences. Therapeutic cannabis, provided based on medical guidance, could improve pain management for socially marginalised populations.

Nuancing Drug Harms: Exploring the Context of Substance Use Among Street-Involved Women in Uyo, Nigeria

Recent studies on women’s substance use have emphasized the role of structural and environmental contexts in shaping substance use patterns and harms, but the dynamics constitutive of specific substance use contexts are seldom unpacked. This study works with Cameron Duff’s elaboration of context as an assemblage of space, embodiment and practice to explore the contextual dynamics that mediate substance use practices among socially marginalized women. In-depth interviews were used to gather data from a purposive sample of street-involved women who use drugs ( n = 16) in Uyo, Nigeria. Data revealed that substance use was mediated by actors, social norms and processes within social networks developed in street environments. The women used substances to achieve particular affective states such as pleasure, stress relief and coping with trauma. Social network dynamics combined with the use of drugs to manage trauma and social stress, within a wider context of social and material deprivations, to foster substance use practices that created risk for harm. Drug harms were not inherent to the substance use experience or incidental to benefits and pleasures. Instead, they were unintended, but inevitable, outcomes of the embodied practices of beneficial substance use. On the other hand, corporeal techniques of controlled drug use served to minimize drug harms. Findings indicate a need to address the contextual dynamics that influence harmful patterns of substance use, and to leverage the harm reducing potentials of controlled use practices.

Safe abortion service utilization and associated factors among insecurely housed women who experienced abortion in southwest Ethiopia, 2021: A community-based cross-sectional study.

Insecurely housed women are more vulnerable to physical and mental health issues than the general population, making access to a safe abortion more difficult. Though Ethiopia has a penal code regarding safe abortion care, there has been a dearth of studies investigating the safe abortion care practice among those insecurely housed women. Thus, this study aimed at assessing the magnitude of safe abortion service uptake and its determinants among insecurely housed women who experienced abortion in southwest Ethiopia. A community-based cross-sectional study was conducted in three towns in southwest Ethiopia from May 20-July 20, 2021. A total of 124 street-involved women were included in the study. They were selected by snowball sampling technique and data was collected through a face-to-face interview. The data were entered into Epi-data Version 3.1 and exported to SPSS 21 for analysis. A bivariable and multivariable logistic regression analyses were performed to determine the association of independent variables with the outcome variable. The level of significance was determined at a p-value <0.05. To determine whether the model is powerful enough in identifying any significant effects that do exist on the dependent variables, a power analysis was performed via a Post-hoc Statistical Power Calculator for Multiple Regressions. The magnitude of safe abortion service utilization among insecurely housed women was found to be 27.9% [95% CI: 20.1, 34.2]. Average daily income [AOR:3.83, 95% CI: 1.38, 10.60], knowledge of safe abortion services [AOR:3.94; 95% CI: 1.27,9.24], and affordability of the service [AOR: 3.27; 95% CI:1.87, 8.41] were identified as significant predictors of safe abortion service among insecurely housed women. The magnitude of safe abortion service utilization among insecurely housed women in the study area was low. The respective town health offices and health care providers at the facility level should strive to improve awareness about safe abortion service's legal framework, and its availability. In addition, a concerted effort is needed from local administrators, NGOs, and healthcare managers to engage those insecurely housed women in income-generating activities that allow them to access safe abortion and other reproductive and maternal health services.

Decriminalizing Domestic Violence and Fighting Prostitution Abolition: Lessons Learned From Canada’s Anti-Carceral Feminist Struggles

This article offers a cautionary tale for efforts to decriminalize domestic violence through a retrospective analysis of Canadian feminist legal activism to decriminalize sex work. Both domestic violence and sex work are contested terrains of activism, litigation, and scholarship and have come up against the disparate views of criminalization as necessary to protect women from violence, versus criminalization as compounding women’s potential risks for violence. Through the example of Canadian feminist jurisprudence in R v Bedford, wherein the Supreme Court of Canada recognized the endangerment of women as resulting from the criminalization of sex work, I explore the liminal space following this decision, and how regressive legislation was introduced to re-entrench carceralism in the breach of a seeming feminist victory. My focus is on how carceral feminism continues to occupy the liminal space as a force of colonial violence, further endangering Indigenous women. I draw linkages between several violent murders of street-involved Indigenous women and the severing of allyship among feminists, sex workers, and Indigenous women over the potential decriminalization of sex work. Finally, I suggest that opposition to the decriminalization of sex work is successfully argued by an emerging force of carceral feminism: neo-abolitionist feminists who have appropriated a politics of abolition and, yet, may have deepened carceralism in the lives of Indigenous women.

Circumstances of overdose among suburban women who use opioids: Extending an urban analysis informed by drug, set, and setting

BackgroundOpioid overdoses are primarily discussed by the pharmacological properties of the drugs used. Research shows that other factors such as the social/physical environment and the mental/emotional states can have an impact on overdose events. Ataiants and colleagues (2020) used Zinberg's “drug, set, and setting” framework to identify circumstances surrounding overdose experiences of street-involved women in Philadelphia. The aim of this paper is to extend their analysis to a diverse sample of suburban women who experienced overdoses. MethodsThe mixed-methods design consisted of ethnographic fieldwork, in-depth interviews, and brief surveys with 32 suburban women who use opioids. Inductive theoretical reasoning and constant comparative analysis facilitated themes emerging within the “drug, set, and setting” framework. ResultsEighteen out of 32 women identified “drug” as the primary factor involved in their overdose events. Major themes were an inability to identify the synthetic opioid fentanyl, lack of knowledge or control over how much to use, poly-substance use, and an insufficient understanding of risks. Eleven out of 32 women linked “set” to their overdose experiences. Themes included emotional trauma, such as death of a child, child custody issues, and mental health conditions, such as depression. Six out of 32 women associated “setting” with one of their overdose experiences. Themes were related to being with friends or partners that used, and having recently been released from treatment or incarceration. ConclusionFindings show similar themes found among an urban sample, adding insight on the need for effective overdose interventions targeted for suburban populations. The opioid crisis is not confined to the cities, and neither should services aimed at addressing opioid overdose. The knowledge provided here can help policy makers support female-centered harm reduction services not only in urban areas but also in the suburbs.

Lost and Forgotten: Missing and Murdered Sex Workers on Vancouver's Downtown Eastside

From 1978 to 2002, more than 60 women went missing from Vancouver’s Downtown Eastside, an area that has often been described as “Canada’s poorest postal code”. For decades, families of the area’s missing women filed police reports and engaged with the media about their vanished loved ones, however little headway was made in the case until ten years later, when the Vancouver Sun began publishing a series of stories on the women that drew provincial and national attention. Motivated by citizen dissent and accusations of negligence, The Vancouver Police Department and the RCMP finally launched a joint task force, resulting in the arrest and conviction of Robert “Willie” Pickton, a pig farmer from Port Coquitlam, for the serial murders of street-involved women. The subsequent excavation of the Pickton property became the largest criminal investigation in Canadian history, spanning several years and costing tens of millions of dollars. However, the danger and violence that plagued women on the Downtown Eastside remained largely the same for many years after Pickton’s arrest. While media coverage narrated Pickton as a single deranged male, this narrative effectively eliminated the context of the broader social background that thrust these women into harm’s way. In this paper, I will discuss the racialization, spatialization, and class distinctions that heavily influence women's participation in the sex trade, as well the media narratives that enable an understanding of Pickton as a violent outlier. The research shows that despite these narratives, violence against marginalized women is a part of the normative social order, which is precisely what allows violent men to function without apprehension in these communities for so long. As you will read, violence against women cannot be described as simply the action of a few bad apples, but is instead a larger part of a “continuum of violence” enacted against already marginalized women. Keywords: MMIWG, Robert Pickton, sexual violence, street-level sex work

Overdose response among trained and untrained women with a history of illicit drug use: a mixed-methods examination

Little is known about differences in bystander behavior among people who use drugs, trained and untrained in opioid overdose prevention. We examined three types of recommended overdose response – a 911 call, rescue breathing/CPR, and naloxone administration—among Philadelphia-based, predominantly street-involved women with a history of illicit drug use. The study utilized a convergent mixed methods approach integrating data from 186 quantitative survey responses and 38 semi-structured qualitative interviews. Quantitative findings revealed that compared to untrained women, trained women were more likely to administer naloxone (32.9% vs. 5.2%) and use two recommended responses (20.0% vs. 9.5%). No significant differences were found between the two groups in calling 911 or using rescue breathing/CPR. Qualitative findings indicated that barriers to enacting recommended overdose response were either structural or situational and included the avoidance of police, inability to carry naloxone or phone due to unstable housing, and perceived lack of safety on the streets and when interacting with strangers. Our study demonstrated that overdose training improved the frequency of naloxone administration among this sample of predominantly street-involved women. Future efforts need to focus on avoiding intrusive policing, scaling-up naloxone refill sites, and providing secondary naloxone distribution via drug user networks.

Circumstances of overdose among street-involved, opioid-injecting women: Drug, set, and setting

IntroductionCurrent discourses about the causes of the overdose crisis largely focus on the harmful effects of drugs. Prior research, however, indicates that drug use experience is shaped by complex interactions of drugs with physiological and mental “sets” of people who use drugs and the wider social and physical “setting.” Zinberg's “drug, set, and setting” theoretical framework was applied to identify patterns in circumstances leading up to women's overdose. MethodsIn-depth semi-structured interviews were conducted with 29 opioid-injecting street-involved women, clients of a Philadelphia harm reduction program. Qualitative analysis with deductive and inductive coding was utilized to examine transcripts for theory-driven and emerging themes. ResultsTen out of 29 women attributed their overdose to “drugs,” reporting the unpredictable quality of street opioids, concurrent use of benzodiazepines, or chasing the “high.” Thirteen women reported “set” as a type of circumstance where their emotional states were affected by a “good” or “bad” day, leading them to unusual drug consumption practices. Six women described “setting” type of circumstances where their overdose was preceded by a recent change in context, such as release from prison, which prompted unsafe drug use to address physiological or psychological dependence on drugs. ConclusionWhile all overdoses result from the pharmacological action of drugs, some overdoses were triggered by circumstances occurring in women's set or setting. Overdose prevention policies should embrace not only individual-level behavioral interventions, but also structural measures to address stress, social isolation, and risky drug use contexts that plague the lives of street-involved women who inject opioids.

Affective governance among street-involved women and their services providers

ABSTRACTAffect modulates and directs the governance of street prostitution in encounters between street-involved women and their social services and healthcare providers through three nodes on a circuit of affect. The first is the street, constituting a set of geographic and psycho-social phenomena that exert a formative and often intergenerational impact on street-involved women’s lives. The second, selfhood, connects an understanding of trauma as inhibitory to cognitive development with the governmentality of mental health diagnoses. The third, embodied abjection, links the physical states and practices connected with addiction, homelessness, incarceration, and other forms of social suffering, with street-involved women’s abjection.

“Women Make That World Go ‘Round”: the Role of Women’s Sexual Capital in the Gendered Scaffolding of Street Life

While all girls and women experience sexualization, these experiences differ based on a range of individual-level factors to structural contexts. For marginalized populations of women, such as those on the streets, sexualization can take on a particularly pivotal role. Using in-depth interviews with formerly street-involved women, the study explores the processes through which the street context reified the participants’ dependence on their “sexual capital” in order to survive. While they did exercise some agency over their bodies, the ability to make decisions in this regard dissipated as they became more tethered to street life. Dependence on sexual capital preserved street dynamics that disempowered and damaged them vis-a-vis men, a vulnerable status which effectively sustained the arrangement that harmed them. Control over participants’ sexual capital was usurped by others on the streets as they were traded, sold, and victimized by violence. Ultimately, participants’ experiences suggest that sexual capital is central to the gendered scaffolding upon which the street context is constructed.

Strategies for Recruiting Women Living with Human Immunodeficiency Virus in Community-Based Research: Lessons from Canada.

This study sought to describe the recruitment of women living with HIV (WLWH) into the community-based Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), because women are under-represented in HIV research. There were 1,424 WLWH were enrolled from British Columbia, Ontario, and Québec, who completed detailed questionnaires administered by peer research associates (PRAs; WLWH with research training). During screening, participants were asked: "How did you hear about the study?" We describe recruitment strategies by subpopulation and offer reflections on challenges and successes. Of 1,131 participants with complete data, 40% identified as White, 33% African/Caribbean/Black, and 19% Indigenous. The median age was 45 years (interquartile range, 37-51) and 4% identified as trans women. Overall, 35% were recruited through PRAs/peers, 34% clinics, and 19% AIDS service organizations (ASOs). PRAs/peers were the predominant recruitment method in Ontario (49%), compared with clinics in British Columbia (40%), and Québec (43%). Nationally, PRAs/peers were more successful in recruiting WLWH commonly considered to be "harder to reach" (e.g., women identifying as trans, using drugs, not receiving HIV care). Clinics were more effective in recruiting younger women (16-29 years) and women not using ASOs. Recruitment challenges centered on engaging these harder to reach women. Successes included hiring PRAs who built participant trust, linking with clinics to reach women isolated from HIV communities, involving outreach workers to engage street-involved women, and disseminating study information to diverse stakeholders. Having multiple approaches, engaging a diverse team of PRAs, ensuring flexibility, and cultivating reciprocal relationships with community stakeholders were key to recruiting a diverse and representative sample of WLWH.

Health Care Among Street-Involved Women

I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.

Tracing lines of horizontal hostility: How sex workers and gay activists battled for space, voice, and belonging in Vancouver, 1975–1985

In the mid-1970s, indoor sex workers were pushed outdoors onto the streets of Vancouver’s emergent gay West End, where a small stroll had operated for several years. While some gay activists contemplated solidarity with diversely gendered and racialized sex workers, others galvanized a campaign, alongside business owners, realtors, police, city councillors, and politicians to expel prostitution from their largely white, middle-class enclave. Sex workers commanded inadequate capital to thwart the anti-vice, neo-liberal lobby. Instead, an assimilationist, homonormative gay politics played out on the backs of an even more vulnerable and stigmatized sexual minority – the majority of whom were low-income, street-involved women, men, and male-to-female (MTF) transsexuals of colour.

HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine

Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine.

P256 Women in the Shadows (WIS): Impact of a peer-based outreach programme in reaching street-involved pregnant women during a heterosexual syphilis outbreak in Alberta, Canada

P256 Women in the Shadows (WIS): Impact of a peer-based outreach programme in reaching street-involved pregnant women during a heterosexual syphilis outbreak in Alberta, Canada

Identity work among street-involved young mothers

The Youth Pathways Project tracked the life-course trajectories of street-involved young women (n=75) in Toronto over a one-year period. At first contact, 60% of these women had been pregnant, and 29% of those had children. In the interim leading up to the final interview 12 months later, five participants became pregnant and five had given birth. This paper examines the narratives of these 10 recently pregnant and/or newly parenting young women. Our focus is on the ways in which pregnancy and parenting are discursively constructed as a turning point away from street involvement and drug use. Using the concept of identity talk, we examine young women's descriptions of pregnancy and parenting. We note that risky practices that may have precipitated pregnancy are minimised, while the positive and transforming aspects of pregnancy and parenting are emphasised. Pregnancy and parenting are linked with short-term goals of personal change and leaving the street, but the long-term implications of motherhood, including poverty and poor health, are not addressed by participants. Our analysis contributes to a better understanding of the subjective meaning of pregnancy for street-involved young women. We suggest that these insights are important as part of an overall health promotion strategy for this vulnerable group.

Risk, Citizenship, and Public Discourse: Coeval Dialogues on War and Health in Vancouver's Downtown Eastside1

This article is about September 11, 2001, and its narrated effects on the lives of nine street-involved women in Vancouver's Downtown Eastside. I outline the locations from which they spoke about war and health: as consumers and economic agents whose bodies are linked to transnational economic processes; as residents in a local community of shared knowledge and practices; and as marginalized citizens of a nation-state. I hope to emphasize the value of engaging research subjects in coeval dialogues that work against essentializing, state-sanctioned discourses narrated in the context of armed conflict and a public health crisis. To women drug users in Vancouver's Downtown Eastside, the “War against Terror” evokes particular sites of knowledge: the body, the local community, and transnational processes. Their repertoires of war stimulate questions about citizenship and perceptions of risk, challenging dominating medical and political discourses that tend to temporally and spatially localize their engagement with the world.

Surviving the sex trade: A comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs

In Canada, very little is known about the factors and processes that cause drug-related harm among female intravenous drug users (IDUs). Women who inject drugs and participate in the survival sex trade are considered to be at increased risk for sexual and drug-related harms, including HIV infection. Between September 1999 and September 2000, women participating in the VIDUS cohort in Vancouver and the St. Luc Cohort in Montreal completed interviewer-administered questionnaires. Analyses were conducted to compare the demographic characteristics, sexual risk behaviours, risky injection practices and drug use patterns among women who self-identified as participating in the sex trade with those who did not identify as participating in the sex trade. Logistic regression was used to identify factors independently associated with exchanging sex for money or drugs. HIV prevalence at the study visit (September 1999-2000) was 29% for sex trade workers and 29.2% for non-sex trade workers. While patterns of sexual risk were similar, the risky injection practice and drug use patterns between sex trade workers and non-sex trade workers were markedly different. Logistic regression analysis of cross-sectional data revealed that independent behaviours associated with the sex trade included: greater than once per day use of heroin (adjusted OR 2.7), smokeable crack cocaine (adjusted OR=3.3) and borrowing used syringes (adjusted OR=2.0). Creative, client-driven interventions are urgently needed for women who trade sex for money or for drugs.