School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, United States.
British Columbia Centre on Substance Use, 400 - 1045, Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400 -1045, Howe Street, Vancouver, BC V6Z 2A9, Canada.
Health Place. 2020 May;63:102327. doi: 10.1016/j.healthplace.2020.102327. Epub 2020 Mar 25.
While gendered experiences of drug use have been well-established, understanding how women resist structures that constrain their agency is important for mitigating drug-related harms, especially as overdose has become North America's leading cause of accidental death. Drawing on the intersectional risk environments of WWUD, this ethnographic study examined how gendered expectations of women's drug use, appearance, and comportment influenced vulnerability to overdose within the context of a fentanyl-driven overdose crisis. This community-engaged ethnography, conducted in Vancouver, Canada from May 2017 to December 2018, included in-depth interviews with 35 marginally-housed WWUD (transgender-inclusive) and approximately 100 h of fieldwork in single room accommodation (SRA) housing and an established street-based drug scene. Data were analyzed thematically with attention to embodiment, agency, and intersectionality. Findings highlight how gendered expectations and normative violence impacted women's use of space, both in the drug scene and SRAs. To resist efforts to 'discipline' their bodies, participants engaged in situated gender performances. Physical appearance was also deemed critical to managing drug use disclosure. Participants adopted gendered embodied practices, including altered consumption methods or injecting in less visible areas, to conceal their use from peers and at times, their partners. To resist harms associated with involuntary disclosure, participants often used alone in SRAs or in public spaces. While such practices allowed women to exert agency within constraining systems, they concurrently heightened overdose risk. Findings demonstrate how women engaged in everyday acts of resistance through embodied drug use practices, which increased their agency but elevated overdose risk. Implementing gender-specific programs that increase bodily agency and control (e.g. low-threshold services for personal care, women-focused harm reduction support) are needed to reduce risk of overdose for WWUD.
虽然已经充分了解了药物使用的性别差异，但理解女性如何抵制限制其行动能力的结构对于减轻与药物相关的危害非常重要，尤其是因为过量用药已成为北美导致意外死亡的首要原因。本民族志研究借鉴了 WWUD 的交叉风险环境，探讨了女性对药物使用、外表和举止的性别期望如何在芬太尼驱动的过量用药危机背景下影响她们易受过量用药的影响。这项在加拿大温哥华进行的社区参与民族志研究于 2017 年 5 月至 2018 年 12 月进行，包括对 35 名居住在简陋住房中的 WWUD（包括跨性别者）进行深入访谈，以及在单间住宿（SRA）住房和已建立的街头毒品场所进行大约 100 小时的实地工作。数据通过对身体、能动性和交叉性的关注进行了主题分析。研究结果强调了性别期望和规范暴力如何影响女性在毒品现场和 SRA 中的空间使用。为了抵制规范其身体的努力，参与者在现场性别表演中进行了抗争。外表也被认为对管理药物使用披露至关重要。参与者采用了性别化的身体实践，包括改变消费方式或在不太可见的区域注射，以向同龄人隐瞒使用情况，有时甚至向其伴侣隐瞒。为了抵制与非自愿披露相关的伤害，参与者经常在 SRA 或公共场所独自使用。虽然这些做法允许女性在限制系统中行使能动性，但同时也增加了过量用药的风险。研究结果表明，女性通过身体药物使用实践进行了日常反抗行为，这增加了她们的能动性，但也增加了过量用药的风险。需要实施针对女性的特定计划，增加身体能动性和控制（例如，为个人护理提供低门槛服务、针对女性的减少伤害支持），以降低 WWUD 过量用药的风险。
