Key findings


In their Global State of Harm Reduction: 2019 updates, HRI note that the spread of harm reduction services is still stalling globally in continuation of a trend observed since 2012. The 2018 Global State of Harm Reduction 2018 briefing, highlights that although women are estimated to account for one third people who use drugs globally and are consistently reported to have less access to harm reduction services and to be at higher risk of HIV and hepatitis C infection, robust data on this subject is scarce, and research on drug use and related health issues rarely produces information about women. While tools exist to enable harm reduction services to institute a gender lens and gender mainstreaming in their programming in order to improve relevance and reach to women who use drugs, services that have introduced such approaches are thin on the ground. Where they do exist, there is not necessarily scope to document and promote experience. In order to leverage greater accountability from governments that have endorsed UN guidelines and resolutions around provision of services for women who use drugs, it is important to document and promote such services where they do exist, so that models of replication can be resourced and established at other harm reduction programmes, while pressure builds to reverse the stalling of actions that improve respectful access to health for women who use drugs. With this in mind, WHRIN undertook a survey, in order to attempt a ‘mapping’ of women friendly services around the world.


Regional focal points identified among membership worked with WHRIN coordinator to create survey participant lists targeting two well networked women who use drugs and two additional key informants (KI) with a good understanding of harm reduction services in their country. Per country (or state/province in Canada, US and Australia). Separate short survey monkeys were created per region, applying the same 7 questions aimed to identify key barriers to service access and to ‘map’ harm reduction services designed for women who use drugs.



Region Month 2020
Asia April
W Europe May
Oceania Aug
N America/Canada Sept
Africa (E,W,S) Oct
Latin America Nov


WHRIN acknowledge some limitations to the approach of relying primarily on participation from membership and other recommendation contacts where available. In some cases, a country or state respondent could not be identified, or there was not a full complement of 4 respondents for every state/country. The survey was short and simple and may not have delivered on required specificity in all cases. For these reasons, the survey reports cannot be said to be exhaustive, but they do serve a role in beginning to map and promote services for women who use drugs around the world.



In total, 15 people responded to the survey, and were either women who use drugs (WUD) or other key informants. Participants were based in the following countries; Greece, Netherlands, Italy, Spain, Sweden, England, Portugal, Germany. The majority of the respondents (80%) identified as WUD.

Harm reduction services for women

Out of the 15 respondents, 43% knew of harm reduction services designed for WUD. These services were based in Sweden, Germany and Spain. WUD and key informants from Italy, Greece, Netherlands, Portugal and England reported the absence of such services. The survey identified the following harm reduction services designed for women who use drugs in W Europe:


  1. Low threshold services for women who use drugs and involved in sex work.
  2. Harm Reduction services for women and girls. Wide spectrum of services, from consultation to housing.
  3. Support and help for women who use drugs, offered by the Catholic church in Germany. As an extra to usual offers, there is a cafe in Cologne for WUD and involved in sex work.
  4. Services for WUD in Stuttgart.
  5. Services for pregnant WUD and WUD with Children.
  6. Different services for WUD with children in Nürnberg.
  7. Support and services for WUD sex workers in Hamburg.
  8. Low threshold services for WUD in Hannover.


Key barriers to access

When asked to rate the top three barriers to accessing harm reduction services for WUD, 80% of respondents listed criminalization of drug use in their top three. The domination of male clients in service centres, lack of relevant services (eg sexual and reproductive health care) and gender-based violence also scored highly. WUD vs other key informant responses were not widely divergent on the top three barriers.


Other barriers were mentioned as follows:


Key service gaps



The results of this survey suggest that despite progress in some European countries for the provision of harm reduction services for women who use drugs, the majority are still lacking women-specific design. Moreover, even within countries that do offer such services, there are still service gaps that need addressing including a lack of adequate funding, holistic services that can address wider issues such as mental health and institutional discrimination and violence. It is imperative that policy makers within Western Europe invest in harm reduction services that prioritizes the health and human rights of women who use drugs.

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