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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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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