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Eastern Europe and Central Asia (EECA) is home to 21% of the world’s population of people who inject drugs and it is the region with the fastest-growing HIV epidemic. HIV prevalence among women who inject drugs is significantly higher than among men in EECA. Even in places with high coverage of needle syringe programmes and HIV testing and treatment, women’s access to opioid substitution treatment is lower than men, and women’s sexual and reproductive health needs remain unaddressed. EECA has a unique system of drug registries that store the personal data of people who use drugs. Registration lowers the chances of employment and access to education and for women and increases the risk of losing custody of their children. The system of drug registries contributes to drug-related stigma. Breaches of confidentiality of drug registry data lead to the further marginalisation of women who use drugs. Criminalisation, past experience of police violence and poverty contribute to healthcare access barriers for women. There is a need for legislative changes to improve personal data protection, decriminalise drug use and reduce police violence. The positive effects of these changes would only be seen in the long term. In the interim, women need special access programmes that are designed specifically to address their needs, that provide free-of-charge services and that ensure the safety and confidentiality of personal data.

Global drug policy has undergone significant change over the past decade, especially with the advent of the 2016 UN General Assembly Special Session (UNGASS) on drugs. This was a catalyst moment both in highlighting the need for a gender perspective in drug policy, and in initiating a review of the indicators used to evaluate progress in drug policy.

To date, the UN has not adequately tracked gender-specific data in drug policy. This is symptomatic of the lack of focus granted to the specific vulnerabilities and needs of women in the illicit drug trade. This has resulted in a knowledge and understanding gap in relation to the issues faced by women worldwide.

The importance of quantitative and qualitative data and analysis of how and why women are involved in the illicit drug trade, and how this relates to their age, ethnicity, socio-economic status, family situation and history of trauma, violence and mental illness cannot be understated. Without adequate indicators on the underlying factors of their engagement in the trade, the differentiated impacts that both drugs and drug policies have on their lives, and the vulnerabilities they may face, policy makers will be unable to design and implement drug policies that are truly effective.

This chapter provides a historic overview of how data on women has so far been tracked by the UN. The chapter will then look to the future, focussing on opportunities to identify more meaningful indicators within a revised Annual Reports Questionnaire, and also by leveraging the Sustainable Development Goals, UN human rights mechanisms and civil society research.

This chapter discusses how ‘hidden’ populations of women who use drugs (WWUD) in coastal Kenya became ‘visible’ through accessing health, harm reduction and rights services. This effort was facilitated by the Muslim Education and Welfare Association (MEWA) and their work with community leaders. Mapping undertaken by MEWA outreach workers identified women who use opioids and other substances in isolated drug use settings. MEWA introduced daily meals in identified sites, needle and syringe services and residential rehabilitation services for opioid withdrawal. The introduction of residential adherence services for HIV and tuberculosis and the provision of methadone enabled compliance with the 90-90-90 UN HIV cascade. These services achieved sustained HIV viral load suppression at 83% and a 100% cure rate for tuberculosis among WWUD. In addition, disclosure and partner risk tracing was established in the ‘drug dens’ for women who test positive for STIs. The introduction of women-only hours once per week at the drop-in centre contributed to a better understanding of drug dependency among outreach workers and clinicians. Policies on gender-based violence were also refined, leading to an increase in reported cases. Programmes targeting families were introduced to promote effective communication and improve parenting skills. Access barriers to social security programmes were tackled by a network of paralegal officers in partnership with Kenyan authorities. Finally, entrepreneurship training and mentorship programmes were implemented to build resilience among WWUD.

This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

Recent studies have shown that people who attend electronic dance music events and use drug checking services (DCS) are a predominantly white male, highly educated middle-class population. However, there is still a lack of data beyond sociodemographic characteristics that must be addressed. This paper aims to describe the drug use patterns and protective behavior strategies (PBS) used by testers and nontesters at Boom Festival 2018 and analyze the relationship between these behaviors and the decision to use the DCS.

This is an exploratory research based on a cross-sectional design using baseline data collected at the Boom Festival from testers (N = 343) and nontesters (N = 115).

Nontesters presented, in general, slightly higher frequencies of use for most drugs, whereas testers tended to adopt PBS more frequently. Moreover, testers planned their drug use more often than nontesters and set more limits on the amount of drugs they used in one session. Both of these behaviors work as predictors for using the DCS.

Our data suggest that DCS might not be easily accessible to all people who use drugs, reaching almost exclusively highly educated people that already apply several harm reduction strategies. Actions should be taken to promote service accessibility.

To the best of the authors’ knowledge, this paper is the first to compare the demographics, drug use and PBS adoption of DCS users with nonusers who attended the same festival.

This chapter examines the structure and sentiment of the Twitter response to Nathan Broad's naming as the originator of an image-based sexual abuse incident following the 2017 Australian Football League Grand Final. Employing Social Network Analysis to visualize the hierarchy of Twitter users responding to the incident and Applied Thematic Analysis to trace the diffusion of differing streams of sentiment within this hierarchy, we produced a representation of participatory social media engagement in the context of image-based sexual abuse. Following two streams of findings, a model of social media user engagement was established that hierarchized the interplay between institutional and personal Twitter users. In this model, it was observed that the Broad incident generated sympathetic and compassionate discourses among an articulated network of social media users. This sentiment gradually diffused to institutional Twitter users – or Reference accounts – through the process of intermedia agenda-setting, whereby the narrative of terrestrial media accounts was altered by personal Twitter users over time.

This chapter examines how darknet drug marketplaces operate within platform capitalism. While capitalist power relations remain underexplored in research on digital drug markets, the analysis shows that the basic foundation of cryptomarkets relies on the infrastructure of platform capitalism. The authors use the concept of platform capitalism to explore cryptomarkets in an ideology-critical way. Platforms are infrastructure for the mediation of buyers and vendors; however, they are designed to extract data on the activities of their users. Platform capitalism refers to the process by which the vast collection of user data feeds into the accumulation of capital. The authors use a dialectical method to examine the constellation of digital drug platforms by disclosing a threefold contradiction: state control and self-regulation; visibility and concealment; and legality and illegality. The analysis reveals that darknet drug platforms make a profit not only from the trade of illicit drugs and the collection of user data, but also based on the illegal status of drugs, the associated ideology, and the closed ecology of darknet platforms. Power relations in cryptomarkets thereby mimic those observed in platform capitalism in general. Finally, the authors discuss the implications of platform capitalism for online drug markets.

Despite increasingly persuasive women-focused marketing of gambling products, there has only been limited investigation around women sports betting. Men remain the focus of much of the conversation about sports betting as they have generally been found to be the most active sports bettors and the most at risk of experiencing harms associated with their behaviour. This chapter aims to fill this gap by exploring the characteristics of young women sports bettors in the United Kingdom and the relationship between sports betting and the experience of gambling harms. To do this, we created two models of analysis. Our analysis is based on data from the first wave (2019) of the Emerging Adults Gambling Survey (EAGS) dataset (n = 3,549). The EAGS is a non-probability longitudinal survey that includes individuals between the ages of 16 and 24 who were residents in Britain at the time of data collection. Firstly, we examined the associations between women sports bettors and several factors identified as important predictors of sports betting. Secondly, we sought to understand the relationship between women's sports betting and the harms associated with this activity. From these models, we found that women's sports betting was most reliably predicted according to fandom and peer influence. We also found that women sports bettors were more at risk of experiencing harms associated with difficulties with family and friends than women gamblers using other products.