Assistant Professor University of Miami Miller School of Medicine, Florida
Background & Introduction: Cisgender women who inject drugs (WWID) face disproportionately higher risks of severe injection-related infections, infectious diseases, and physical and sexual violence, compared to their male counterparts. In addition to these risks, cisgender WWID encounter significant reproductive health challenges and unintended pregnancies, leading to intergenerational impacts through prenatal drug exposure. These compounded risks not only affect individual health but also contribute to substantial societal costs, increasing demands on healthcare and social services. Despite evidence of these gender-specific challenges and their broader societal impact, addiction research and harm reduction programs often overlook cisgender WWID's unique needs compared to cisgender men. In Florida, where syringe services programs (SSPs) were recently legalized, limited data exists on gender-specific risks among cisgender WWID. This cross-sectional study examined gender-related differences in injection drug use (IDU) behaviors, sexual practices, and infectious disease prevalence among individuals accessing Miami's first legal SSP, with the aim of informing targeted harm reduction services and interventions.
Methods: This study analyzed enrollment data from Florida's first legal SSP, collecting data from its December 2016 inception through July 2022 (N=1,660). Data included sociodemographic characteristics, past 30-day IDU behaviors, recent sexual practices, and HIV and Hepatitis C (HCV) status, assessed through both self-reporting and rapid antibody testing. Chi-square tests examined bivariate associations between gender and participant characteristics. Multivariable logistic regression models estimated associations between gender and key outcomes (IDU behaviors, sexual behaviors, HIV/HCV status), adjusting for age, race/ethnicity, housing status, and enrollment year. All analyses were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC).
Results: Our sample included 1,660 participants, with 432 (26%) identifying as cisgender women and 1,228 (74%) as cisgender men. In terms of injection behaviors, cisgender WWID had significantly higher odds of sharing syringes (adjusted odds ratio [aOR] = 1.61, 95% confidence interval [CI], 1.23-2.10), injecting over five times per day (aOR = 1.33, CI 95%, 1.05-1.70), injecting opioids only (aOR = 1.79, 95% CI 1.35-2.38), and co-injecting opioids and stimulants versus using stimulants alone (aOR = 1.46, CI 95%, 1.03-2.6). Regarding sexual behaviors, cisgender WWID had higher odds of engaging in recent sexual activity (aOR = 1.75, 95% CI, 1.25-2.45) and exchanging sex for money/resources (aOR = 6.60, 95% CI, 4.12-10.57). At enrollment, cisgender WWID were also more likely to test reactive for HCV antibody (aOR = 1.41, 95% CI, 1.10-1.80).
Conclusion & Discussion: This study highlights the increased injection and sexual risks experienced by cisgender WWID accessing a SSP in Florida. Compared to cisgender men, cisgender WWID had higher odds of syringe sharing, frequent injection, transactional sex, and HCV positivity. These findings underscore the urgent need for gender-specific addiction medicine, policy, and harm reduction interventions. To address these heightened risks, harm reduction strategies should include targeted access to syringe exchange services, naloxone distribution, and low-barrier medications for opioid use disorder (MOUD). Additionally, integrating trauma-informed care, education on safer injection and sexual practices, and resources addressing transactional sex and gender-based violence can better meet the multifaceted needs of cisgender WWID. A comprehensive approach that integrates policy, health equity, social determinants of health, and trauma-informed frameworks into addiction services and harm reduction research initiatives is critical. Such efforts are essential not only for improving the well-being of this underserved and highly vulnerable population but also for reducing broader societal costs, including healthcare expenditures and financial burdens on social services such as child welfare, foster care, and court systems. Limitations of this study include the generalizability of findings to broader populations of people who use drugs and gaps in the collection of sex and gender-disaggregated data.
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Learning Objectives:
Upon completion, participants will be able to list and describe the unique health challenges faced by cisgender women who inject drugs, using research data and statistics to support their understanding.
Upon completion, participants will be able to develop gender-specific harm reduction strategies that address the elevated risks of drug-related harms among cisgender women who inject drugs.
Upon completion, participants will be able to demonstrate proficiency in applying statistical methods to analyze large survey data sets, with a focus on sociodemographic factors and health outcomes among people who inject drugs.
