Article Commentary: Women and Substance Use Disorders in Low- and Middle-Income Countries: A Call for Advancing Research Equity in Prevention and Treatment

Abstract

Although the prevalence of substance use disorders (SUDs) is higher among men, women with SUDs in low-and middle-income countries (LMICs) face unique challenges. Poverty and adversity, inequality of women, and disparities in access to treatment and prevention services exacerbate biological, psychological and social correlates of substance use disorders for women living in low-resource settings. Increasing the inclusion of women in research has long been a goal, though even high income countries struggle to achieve parity. In LMICs, women with SUDs are often neglected from global research due to underreporting and the disproportionate focus of global substance use research on men. We will discuss risk factors for SUDs that are particularly relevant for women residing in LMICs in order to gain insight into neglected areas of research and opportunities for prevention and treatment.

Treatment barriers among young adults living with a substance use disorder in Tshwane, South Africa

“…Stigma (which is a contextual factor that in uence individual behaviour) emerged as one of the most signi cant barriers to help-seeking and treatment among young adults living with SUDs. This nding is consistent with ndings in earlier research done in South Africa [15] and internationally that stigma is one of the most signi cant treatment barriers facing substance users [42]. This barrier theme forms a con uence with other systems in Bronfenbrenner's socio-ecological model [42].…”

“…Typical of most disorders or illnesses that reach epidemic proportions (e.g., HIV and AIDS), the labelling of and discrimination against victims ultimately drive the victims to hide their illness to avoid discrimination, and this prevents them from seeking healthcare [14]. In South Africa, more stigma is associated with people who abuse substances than with people who live with other mental disorders, and this is partly attributed to personal culpability associated with SUDs [15]. The use of heroin, locally known as nyaope or whoonga, is highly stigmatised, leading to marginalisation of users, and rejection by their families and communities [16].…”

Structural gender inequality and gender differences in adolescent substance use: A multilevel study from 45 countries

“…Besides the potential impact of restrictive gender norms, there are several other explanations for these findings. First, girls in more gender unequal countries may experience more practical barriers to substance use ( Slabbert et al, 2020 ). Girls may have more difficulties purchasing substances or be less likely to find themselves in social situations (e.g., going out at night) that create opportunities to smoke or drink, for example, through stricter parental monitoring or lower parental acceptance of substance use.…”

“…Societal gender inequality may influence boys' and girls' health behaviours and outcomes through prevailing traditional gender norms within countries and through societal restrictions on boys' and girls' behaviour ( Slabbert et al, 2020 ). From a social constructionist perspective, adolescents act in accordance with normative expectations that reinforce gender roles ( Kimmel, 2000 ).…”

“…From a social constructionist perspective, adolescents act in accordance with normative expectations that reinforce gender roles ( Kimmel, 2000 ). In countries where traditional gender norms prevail, adolescent boys may be more likely to exhibit behaviours that are considered ‘masculine’ (according to these norms) such as substance use, whereas girls in these countries are less likely to exhibit these behaviours ( Slabbert et al, 2020 ). At the same time, girls in these countries may encounter more practical barriers to engaging in specific behaviours, ranging from membership in sports clubs and getting access to substances to experiencing difficulties regarding their position in the labour market, their reproductive health, and possibilities for empowerment ( Heise et al, 2019 ).…”