The gendered impacts of drug stigma - a qualitative study with 10 street-involved women who use drugs in Porto

This qualitative research was based on the implementation of ten semi-structured interviews with street-involved women (9 ciswomen, 1 trans woman) who use drugs in marginalized social contexts in Porto. The age of these women varied between 28-62 years old; most didn’t complete the basic education (n=7), and 8 were mothers. All the participants referred to their street-involvement, participating in marginalized drug use and trafficking scenes (n=10), being homeless (n=8), and being involved in survival sex work and begging (n=7). The interview script was focused on their biographies and life experiences – their political and civic participation and drug use trajectories - in three main phases: childhood, adolescence and youth, and adulthood. The data was analyzed by using the NVivo qualitative data analysis software. In terms of their life trajectories, 7 women reported adverse childhood experiences (domestic and gender-based violence, poverty, institutionalization), school dropout (n=7), child labor (n=7), teenage pregnancy (n=3), and early drug use (n=6). Five participants reported that their drug use became more problematic after the separation/ institutionalization of their children (n=5). All women referred to their daily experience of stigma, describing situations of rejection, social humiliation, policing, and social control in public spaces (e.g., in the street, in the supermarket). All of them described situations of discrimination and institutional violence when attending health and social services. Some participants also referred to discrimination related to drug stigma in their workplaces that led to their unemployment and increased economic vulnerability. All the mothers (n=8) reported that drug stigma, poverty, and their lack of literacy regarding parenting rights led to the institutionalization of their children and the consequent aggravation of their social disorganization and vulnerabilization. Three participants were participating in a peer-led and mutual support group of women who use drugs (promoted by CASO in Porto). This group promoted women-specific capacitation, empowerment, civic and political participation, and mutual support activities. The three women participating in these activities referred to the beneficial impacts of this group in their daily lives, reporting contributing to their internal destigmatization, social organization, increased literacy regarding their health and social rights, and self-regulation of their drug use. This study has relevant implications from drug policies, highlighting the critical role of intersectional inequalities and drug stigma in the development of problematic drug use patterns and trajectories. Considering that drug policies, research, and intervention are mainly focused on health indicators, this research demonstrates that the experience of stigma, the low levels of education, and political and civic literacy increase the vulnerabilization processes of women who use drugs.