A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice

Abstract

Rationale: Women on opioid substitution treatment (WOST) are at high risk for sexually transmitted infections and blood-borne viruses (HIV, Hepatitis B and C). This heightened risk is rooted in social and health inequities. Experiencing stigma is considered to have an important role in maintaining these inequities and is a barrier to promoting sexual health.

Objective: The aims of this study were to examine (1) the experiences of stigma of WOST, and (2) how experiencing stigma may influence WOST' sexual health.

Method: Twenty semi-structured interviews with WOST were conducted between October 2016 and April 2017 in South West England (UK). Data were analysed using Framework Analysis.

Results: Women's narratives highlighted the intersection of stigma associated with distinct elements of women's identities: (1) female gender, (2) drug use, (3) transactional sex, (4) homelessness, and (5) sexual health status. Intersectionality theory and social identity theory are used to explain sexual health risks and disengagement from (sexual) health services among WOST. Intersectional stigma was related to a lack of female and male condom use and a lack of access to (sexual) health services.

Conclusion: The approach taken goes beyond individualistic approaches of health promotion and provides suggestions to improve future research, policy and practice. It identifies stigma as a crucial element to address when promoting sexual health among WOST. Importantly, this study focuses on tackling social and health inequities and in doing so advocates for human and women's rights.

Keywords: Blood-borne viruses; Inequalities; Intersectional stigma; Intersectionality theory; Opioid substitution treatment; Sexual health; Sexually transmitted infections; Women's studies.