Theme: Epidemiology & Public Health Research Year: 2024
Background: There has been an increase in the number of women who use drugs (WWUD) globally. However, a far lower proportion of women seek and access treatment for substance use disorders. In South Africa, there is a Community Orientated Substance Use Programme (COSUP) providing access to funded opioid substitution therapy (OST). In 2021, a local study reported that less than 10% of women were initiated on OST. This study explored the perceptions and experiences of WWUD when accessing OST in the Tshwane District in Gauteng, South Africa.
Methods: A qualitative research study was conducted at three COSUP sites (April-July 2023). Purposive sampling was used. Eleven participants were invited to be interviewed. Data were transcribed and manual thematic analysis was done.
Results: The median age of the 11 participants was 40 years. Most participants were unemployed. Three themes using an analogy of a mirror with reflections from the participants about themselves and others, were identified. “Looking Into” reported the personal reflections of WWUD with long waiting periods when accessing OST. Fear of withdrawals, perceived poor physical appearance and fear of negative treatment were identified as barriers to accessing antenatal care when pregnant. With “Looked At”, participants shared their experiences of stigma; they were often labelled as sex workers. Gender-based violence was also reported. “Looked After” highlighted their experiences with healthcare services. Participants reported positive experiences at COSUP sites but also negative treatment at health care facilities and by the police who appeared to not fully support the needle syringe programme.
Conclusion: Women who use drugs are a marginalised population that experience barriers to accessing OST. Bottlenecks to reduce the long waiting periods should be addressed. Harm reduction programmes should include maternal health and GBV services. The training and sensitisation of the police and health care services to harm reduction is essential.