JMIR Publications

ABSTRACT

Background:

The HIV risk behavior of women who use drugs is related to myriad psychosocial issues, including incarceration. The experience of incarceration elevates women’s HIV risk by disrupting social networks, housing, employment, and access to health care. During COVID-19, changes in criminal-legal practices resulted in decreased use of incarceration, especially among women. These changes may have produced changes in the HIV risk of women who use drugs, depending on their access to care in the community.

Objective:

This research project seeks to build knowledge about the impact of shifts in criminal-legal practices during COVID-19 on the HIV risk behaviors of justice-involved women who use drugs.

Methods:

Qualitative methods are used to gather and analyze women’s narratives about their life experiences before and during COVID-19, with a focus on individual and structural determinants of HIV risk behaviors. Thirty formerly incarcerated women with a history of substance use are being recruited through collaboration with community partners. Each participant completes a socio-demographic survey and two interviews. The first interview uses a life history instrument that invites participants to reflect on key turning points in their lives. The second interview uses a calendar approach to gather information about participants’ lives during the first year of COVID-19 (March 2020 – March 2021). The interviews, which last one hour each, are audio-recorded and transcribed for analysis. Rapid Qualitative Inquiry and thematic analysis are being used to manage, organize, and interpret the data. The study team will collaborate with a subset of participants to develop digital stories about their COVID experiences, a process that allows for member-checking and triangulation. Findings will be disseminated to program and policy makers in academic venues, community settings, and social service agencies.

Results:

To date, ten women have completed the data collection process. Two themes have been identified in this preliminary data. One, the chaos and instability of participants’ lives increased during COVID-19. Participants reported a wide range of psychosocial and health problems and limited engagement with social service systems. Interaction with criminal-legal systems was rife with uncertainty; participants describe living in a state of limbo, which was extremely stressful. Two, when asked to describe a “turning point” in their lives, many participants attributed their substance use to the traumatic loss of a child due to death, incarceration, or termination of parental rights. During COVID-19, participants’ struggles to cope with these unresolved experiences of grief and loss were intensified by the widespread death and dying of the pandemic.

Conclusions:

Preliminary findings suggest that HIV risk factors increased for participants during COVID-19 and invite further investment in community-based harm reduction programs, especially housing, that support women who use drugs. Interventions that address experiences of maternal grief and loss may reduce women’s substance use.