Subsistence difficulty and health vulnerabilities among drug-using women

Background: Unmet subsistence needs (eg., food, shelter) threaten health and social justice at a fundamental level. We examined the influence of unmet subsistence needs in a sample of poor, drug-using women in San Francisco.

Methods: Drug-using women (N=322) were recruited via respondent driven sampling. In a 5-item scale, participants rated frequency of difficulty meeting needs for food, shelter, personal hygiene, clothing and bathroom access. A score >15 on the 20-point scale was defined as frequent subsistence difficulty (FSD). Data were also collected regarding health care, experiences of violence and sexual risk behavior.

Results: FSD was reported by 19% of participants. Women with FSD were more likely to be uninsured (51% vs. 37%, p=.04) and to lack a primary health care provider (62% vs. 47%, p=.03) than women with less frequent difficulty. Sexual assault in the past 6 months was more common among women with FSD (49% vs. 26%, p<.01), as was physical assault (49% vs. 31%, p<.01). Women with FSD reported a higher prevalence of unprotected vaginal sex with multiple partners (70% vs. 54%, p=.02) and trading sex for money or drugs (77% vs. 57%, p<.01) than women with less frequent difficulty. Drug treatment and emergency department utilization in the past 6 months did not vary by level of subsistence difficulty, nor did self-reported mental illness.

Conclusions: Women with FSD had the poorest outcomes in terms of primary care access, sexual risk and violent victimization. Addressing basic needs is vital to reducing health risks among marginalized women.