Creating evidence based, gendered harm reduction resources

The What

Since 2021, we have been delivering a pioneering project working alongside women who use substances and experiencing homelessness through our ‘A Digital Approach to Harm Reduction’ project. Our award winning project has worked alongside women to become digitally included through access to a digital device, connectivity and support and through this connection, has offered paid co-production opportunities to create and design harm reduction resources that are relevant and meaningful to their experiences of using substances and experiencing homelessness in Scotland today. 

The Why

Many of the resources that currently exist are not designed through a gendered lens or speak to some of the unique challenges, barriers and stigma women who use substances face throughout their lives. Additionally, they tend to be designed and written for professionals working in the field as opposed to speaking directly to women’s experiences.

Prior to securing the funding to deliver this project we identified an international gap in resources aimed at women. We sent out an open call to the field and we connected with Exchange Supplies and hosted conversations exploring this area with Jane, which can be accessed as part of their online training resources.  We also began to have early explorative conversations and connections with the Women’s Harm Reduction International Network (WHRIN) to allow us to begin to create resources that spoke to – not only women in Scotland – but women across the world’s shared experiences around substance use, stigmatisation, discrimination and lack of access to gendered evidence based resources and service responses. 

Through Phase 1 of ‘A Digital Approach to Harm Reduction’ we worked alongside 100 women to understand their experiences, their views, their hopes and their frustrations in accessing care and support. We critically assessed harm reduction resources that already existed in the field and set about creating resources that were accessible, relevant and meaningful to women’s experiences.  This resulted in us using a range of mediums to create and share – including written material, educational slideshow videos and podcasts.  Time and time again, women told us they wanted a safe and confidential space to share their story, on their terms, to support other women in their position. Up until this point, often their stories and experiences had been framed by professionals working with them, as opposed to through their own words and experiences.  Women spoke of systemic failures, trauma within care systems and barriers to care which had resulted in further exclusion, stigmatisation and separation from their children, their loved ones and their communities. 

The How

One of the key areas women did not have knowledge or evidence based information about was around injecting practices. We spoke to women who had used substances for decades who had never had a meaningful conversation with a professional around safer injecting practices, body autonomy or how best to be well and healthy if and when injecting substances. 

We explored creating two animations – one around self injecting and the other around femoral (groin) injecting. We landed on animations as a medium because short video content was what women felt was most accessible to all learning styles – including people who struggled with literacy.  Women shared how their experiences were often of male partners being involved in their injecting practices, thus creating a power imbalance and lack of control over their use.  We also know that femoral injecting is highly prevalent amongst people experiencing homelessness and can cause significant harm to the person, particularly if they miss their femoral vein. Data from the WAND (Wound Care, Assessment of Injecting Risk, Naloxone and Dry Blood Spot Testing) initiative highlights that 32% of people using substances in Glasgow use their femoral site to inject their substance (2024). 

Currently there are written materials including excellent resources by Exchange Supplies and With You that walk people through the injecting process but nothing that is animated or designed through the lens of gender and living experience.  As far as we know, these resources are unique, pioneering and radical in application and driven by the need to ensure women have access to evidence based, accessible and relevant resources to reduce injecting related harm and complications. 

For each animation we add a disclaimer to the beginning – both written and in the voice over – that speaks to safety, harm reduction and clearly states that these resources are for people already injecting substances. For the femoral injecting animation, we have put a disclaimer at the beginning and end of the animation and clearly stated that this is a high risk practice and we would always recommend a person uses a lower risk site before injecting into the femoral vein. From our broad consultation with women we know that women’s reasons for what area they use when injecting substances is often very personal to them and we aim to provide a resource that provides factual information to promote safety and harm reduction to women accessing these resources. The animations have been independently checked by a harm reduction nurse working within Scottish Drugs Forum, NHSGGC and through the WHRIN advisory board.  While these animations may seem radical to some, this is very much the living experience of people that we support and resources that aim to promote safety and autonomy over women’s bodies – something that is widely needed in the field. These resources are the first of their kind worldwide and have the potential to reach women from all over the world, reduce harm and promote safety, dignity and rights. 

The When 

We have been working alongside Everything, WHRINs advisory board and our women’s group to co-design and co-create the storyboards for each animation. We are delighted to be launching these animations on 1st November 2024 – International Drug User Day that are being shared widely through WHRIN’s social media platforms and the animations will be hosted on WHRIN’s website and By My Side, both videos have been translated into numerous languages, including Swahili, Ukrainian, Spanish, Russian and Indonesian. The animations are innovative and the first of their kind in the harm reduction field. Created alongside women, with two of the women involved in the women’s group and project providing the voice over and with the option to be translated into different languages through subtitles, these animations will have international appeal and reach for women that use substances. 

Special thank you to all of the women who have shared their experiences, expertise and given their time to create these resources and ensure they are true to women’s experiences and offer the information needed and asked for. Also to the many partners and collaborators who have provided guidance, medical and practical advice and support throughout this process – with special thanks to WHRIN, Scottish Drugs Forum, NHSGGC, and Exchange Supplies for their guidance, support and collaboration. 

To find out more about ‘A Digital Approach to Harm Reduction’, our approach and learning please read A Digital Approach to Harm Reduction Report. 

If you would like to find out more please contact us Hello Simon Scotland