“He will still know where I live”: harm reduction for women who use drugs and experience Gender-Based violence

Abstract

Background: Treatment for substance use disorders in Spain has traditionally been abstinence-focused and developed from an androcentric perspective, failing to address the specific needs of women who use drugs. Although abstinence-based models continue to predominate, cities such as Madrid and Barcelona now offer a broader range of services, including harm reduction approaches. The intersection between substance use and gender-based violence remains largely overlooked, especially in research and service provision, thereby reinforcing systemic inequalities and limiting access to appropriate resources. This article explores the intersection between drug use and gender-based violence among women, emphasizing harm reduction as a gender-sensitive approach. Method: A qualitative study was conducted based on seventeen semi-structured interviews with women who have used or are currently using psychoactive substances in two major Spanish cities. The sample included women of diverse ages, nationalities, socio-economic backgrounds, and substance use profiles. Recruitment was carried out through a combination of strategies, including social media, snowball sampling, and engagement with a harm reduction center. Data were analyzed thematically using NVivo 14 to identify the types of gender-based violence experienced and the strategies employed to confront it. Results: All participants experienced gender-based violence, including institutional, familial, intimate partner, and sexual violence. Structural violence and stigma further restrict their access to health, social, and legal resources, thereby increasing their vulnerability. Many women used substances as a coping mechanism in response to gender based violence. Conclusions: The study highlights the complex intersection between substance use and gender-based violence among women, emphasizing the need for tailored, intersectional harm reduction interventions and strategies to support women in safely and effectively reporting violence