Injection risk behaviours, i.e. sharing of unsterile injection equipment, signifcantly contribute to maintain the high prevalence of hepatitis C (HCV), HIV and hepatitis B virus (HBV) infections among people who inject drugs (PWID). Several studies have concluded that women who inject drugs (WWID) show higher levels of injection risk behaviours compared to men [1–6], a difference also noted in the Scandinavian context [7, 8]. Higher injection risk behaviours among women may be explained by social, contextual and behavioural factors [1, 9]. In addition, societal norms and gender inequalities further exacerbate women’s vulnerability and perpetuate risk behaviour in terms of both injecting and sexual risk behaviours for hepatitis and HIV, as well as willingness among WWID to engage in prevention measures and care [4, 10–13].
To mitigate the harms of injecting drug use, several recommendations have been made [14, 15] including the scale-up of harm reduction (HR) services, which include services that focus on mitigating possible harms when injecting drugs while accepting the behaviour. Needle exchange programs (NEP), also called needle syringe programs, are one example of a HR program. NEP programs are unevenly distributed worldwide and WWID are less likely to participate in NEP compared to their male counterparts [16]. In Sweden, women constitute approximately one quarter of NEP participants, which suggest an under-representation. However, the exact size and gender distribution of the population of PWID in Sweden is unknown [7, 17]. Several explanations have been suggested, such as perceived stigma in being a WWID at harm reduction facilities, lack of confdentiality and low trust in healthcare providers, who often lack knowledge regarding WWID’s specifc needs [18, 19]. In accordance with Swedish law, NEP participants must show identifcation at admission, which may be an additional barrier.
