Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland
Abstract Background Sexual minority women (SMW) experience higher rates of substance use relative to heterosexual women in the U.S. but remain an under-studied population. SMW who inject drugs (SMWWID) navigate an unpredictable drug market and may experience complex relationships within their social...
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BMC
2025-07-01
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| Series: | Harm Reduction Journal |
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| Online Access: | https://doi.org/10.1186/s12954-025-01257-1 |
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| author | Jennifer L. Glick Leanne Zhang Aimee Huang Megan Nguyen Danielle German |
| author_facet | Jennifer L. Glick Leanne Zhang Aimee Huang Megan Nguyen Danielle German |
| author_sort | Jennifer L. Glick |
| collection | DOAJ |
| description | Abstract Background Sexual minority women (SMW) experience higher rates of substance use relative to heterosexual women in the U.S. but remain an under-studied population. SMW who inject drugs (SMWWID) navigate an unpredictable drug market and may experience complex relationships within their social spheres. We explore cisgender SMWWID’s strategies to maintain safety while injecting drugs, and the influence of their social support systems on those strategies. Methods We conducted N = 16 phone-based, semi-structured, in-depth interviews with SMWWID in Baltimore, Maryland between June-October 2021. The interviews explored participants’ sexual orientation and gender identities, social networks and support systems, drug use behaviors and HIV risk, and experiences accessing services. Using an inductive thematic analysis approach, we examined emergent themes related to drug use, social support, safety, and HIV and identified key safety strategies and social support experiences for SMWWID. Results SMWWID employed various strategies to “stay safe,” which they primarily interpreted as ensuring overdose safety (i.e., using drugs in the presence of others, carrying Naloxone, purchasing strategies), and additionally as infectious disease safety (i.e., avoiding syringe sharing, using sterile syringes) and avoiding threats of violence (i.e., maintaining situational awareness while using drugs). Romantic or sexual partners, family and friends, and the wider community were sources of social support for overdose safety, and family and friends also provided material support (e.g., financial, housing). Syringe sharing with romantic partners and threats of violence from people in the community detracted from SMWWID’s safety. Conclusion SMWWID in this sample reported strong safety prioritization while using drugs, often facilitated by their social support systems. Harm reduction interventions that consider SMWWID’s relationships, including those that aim to improve social connectedness, may better meet the needs of SMWWID, thereby enhancing safety. |
| format | Article |
| id | doaj-art-61fb8a401cbc4a7cafc022be7dda9d00 |
| institution | Kabale University |
| issn | 1477-7517 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj-art-61fb8a401cbc4a7cafc022be7dda9d002025-08-20T03:45:52ZengBMCHarm Reduction Journal1477-75172025-07-0122111310.1186/s12954-025-01257-1Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, MarylandJennifer L. Glick0Leanne Zhang1Aimee Huang2Megan Nguyen3Danielle German4Community Health Science and Policy (CHSP), School of Public Health, Louisiana State University Health Sciences Center (LSUHSC)Community Health Science and Policy (CHSP), School of Public Health, Louisiana State University Health Sciences Center (LSUHSC)Mongan Institute, Massachusetts General HospitalHerbert Wertheim School of Public Health, University of California, San DiegoDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthAbstract Background Sexual minority women (SMW) experience higher rates of substance use relative to heterosexual women in the U.S. but remain an under-studied population. SMW who inject drugs (SMWWID) navigate an unpredictable drug market and may experience complex relationships within their social spheres. We explore cisgender SMWWID’s strategies to maintain safety while injecting drugs, and the influence of their social support systems on those strategies. Methods We conducted N = 16 phone-based, semi-structured, in-depth interviews with SMWWID in Baltimore, Maryland between June-October 2021. The interviews explored participants’ sexual orientation and gender identities, social networks and support systems, drug use behaviors and HIV risk, and experiences accessing services. Using an inductive thematic analysis approach, we examined emergent themes related to drug use, social support, safety, and HIV and identified key safety strategies and social support experiences for SMWWID. Results SMWWID employed various strategies to “stay safe,” which they primarily interpreted as ensuring overdose safety (i.e., using drugs in the presence of others, carrying Naloxone, purchasing strategies), and additionally as infectious disease safety (i.e., avoiding syringe sharing, using sterile syringes) and avoiding threats of violence (i.e., maintaining situational awareness while using drugs). Romantic or sexual partners, family and friends, and the wider community were sources of social support for overdose safety, and family and friends also provided material support (e.g., financial, housing). Syringe sharing with romantic partners and threats of violence from people in the community detracted from SMWWID’s safety. Conclusion SMWWID in this sample reported strong safety prioritization while using drugs, often facilitated by their social support systems. Harm reduction interventions that consider SMWWID’s relationships, including those that aim to improve social connectedness, may better meet the needs of SMWWID, thereby enhancing safety.https://doi.org/10.1186/s12954-025-01257-1Sexual minority women (SMW)Social supportDrug useHarm reductions strategiesBaltimore, MarylandQualitative research |
| spellingShingle | Jennifer L. Glick Leanne Zhang Aimee Huang Megan Nguyen Danielle German Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland Harm Reduction Journal Sexual minority women (SMW) Social support Drug use Harm reductions strategies Baltimore, Maryland Qualitative research |
| title | Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland |
| title_full | Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland |
| title_fullStr | Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland |
| title_full_unstemmed | Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland |
| title_short | Qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in Baltimore, Maryland |
| title_sort | qualitative insights into drug use safety strategies and social support among sexual minority women who inject drugs in baltimore maryland |
| topic | Sexual minority women (SMW) Social support Drug use Harm reductions strategies Baltimore, Maryland Qualitative research |
| url | https://doi.org/10.1186/s12954-025-01257-1 |
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