People who use drugs (PWUD) across diverse global contexts are facing an unprecedented overdose crisis, with rates of overdose-related morbidity and mortality continuing to increase in many settings.
Although opioid-related overdoses represent an urgent public health and social emergency thataffect men, women, and gender-diverse individuals, our current understanding of genderedexperiences and needs in the context of the overdose crisis remains limited.
To inform robust responses to the overdose crisis, research, policy, and interventions must carefully consider genderbased experiences, including the unique harm reduction and addiction service needs of women who use drugs.2,3 For example, harm reduction services tend to be male-oriented spaces, and women often report highly gendered barriers to accessing harm reduction, including the unique and overlapping stigmas faced by women who use drugs, concerns regarding safety, and the threat of violence in and beyond service delivery settings.
Sex workers are overrepresented among PWUD2,3,5 and face disproportionate health and social inequities, including a high burden of HIV and sexually transmitted infections,2,3 as well as workplace violence, criminalization, and stigma.3,6 The current study by El-Bassel and colleagues7 provides a novel contribution by examining the association of various forms of violence—including intimate partner violence and other forms of gender-based violence—with nonfatal overdose among female sex workers who use drugs in Kazakhstan. Given that little is known regarding the overdose experiences of women who use drugs, sex workers in low-income and middle-income countries, or the associations of these with gender-based violence, this work has important implications for the design of harm reduction and other health and social services for women who use drugs and sex workers.
Using baseline data from a cluster randomized clinical trial of a combination HIV risk reduction and microfinance intervention with 400 sex workers who use drugs, this cross-sectional study7 reported a high burden of overdose among this population, with 37.5% of women reporting lifetime overdose and 18% of them reporting an overdose in the past 3 months, with most overdoses linked to heroin or nonmedical use of prescription opioids. Both incarceration and multiple forms of violence experienced by women sex workers were associated with an increased burden of nonfatal overdose.
