“Not on the Agenda”: A Qualitative Study of Influences on Health Services Use among Poor Young Women Who Use Drugs in Cape Town, South Africa

Highlights

• Young women who use AODs are absent from HIV and AOD policy which impacts on the provision of women-specific services.
• The risk environment of poor young women who use AODs influenced their uptake of health and AOD services.
• Gender inequality and stigma led to the exclusion of young women from opportunities to reduce their health risks.
• Community poverty resulted in the emergence of perverse social capital that limited social support for treatment.
• The health care system was unresponsive to the multiple service needs of young women.

Background

Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women's use of health services.

Methods

We conducted four focus groups with young women (aged 16 to 21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women's use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach.

Results

The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women.

Conclusion

To reach young women who use AODs, interventions need to take cognisance of young women's risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda.

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By:   Bronwyn Myers, Tara Carney, Wendee M. Wechsberg

Affiliations

Alcohol, Tobacco and Other Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa

Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road, Observatory, 7900, South Africa

Correspondence

Corresponding author at: Alcohol, Tobacco and Other Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa. Tel.: +27 21 938 0993.

  

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