Abstract
Background
Cisgender women and transgender people with problematic drug use face greater barriers to accessing drug services and poorer health outcomes than cisgender men. These inequalities are particularly relevant in harm reduction (HR) programs, which aim to reduce adverse consequences of drug use but have traditionally been designed from an androcentric perspective, often failing to address the specific needs of these populations. A better understanding of their sociodemographic characteristics, health status and patterns of drug use is key to inform gender‑responsive HR interventions and reduce existing inequalities in access and care.
Methods
A descriptive cross-sectional study analysed sociodemographic and health characteristics of cisgender women and transgender people accessing at least one HR program in Barcelona who completed a questionnaire in 2025. Drug use patterns were examined using registered inhaled or injected consumption episodes from Drug Consumption Rooms (DCR) in 2025. Data were obtained from the Harm Reduction Registry of the Public Health Agency of Catalonia.
Results
The questionnaire sample included 441 cisgender women and 13 transgender people. Most were aged 30–49 years (67%), 58% were born in Spain, and 60% were experiencing homelessness. Approximately 35% reported being in treatment for drug use, and 12% self-reported HIV and/or HCV. Among DCR users, 245 cisgender women accounted for 11,470 consumption episodes, mainly involving methamphetamine (46%), cocaine (25%) and heroin (18%). Among seven transgender users, 245 episodes were recorded, 95% involving methamphetamine.
Conclusions
Cisgender women and transgender people using HR programs experience marked social and health vulnerability and high-risk patterns of drug use, underscoring the need for gender-responsive HR strategies to reduce barriers to access and drug-related health risks.
Key messages
• Cisgender women and transgender people in harm reduction programs face high social and health vulnerability, highlighting the need for gender‑responsive strategies to reduce barriers to care.
• Cisgender women and transgender people remain underrepresented in HR programs and experience high homelessness, infectious disease exposure and intense stimulant use, requiring tailored responses.