Understanding the need for gender-responsive harm reduction services for women, trans and non-binary people who use drugs (WTNB-PWUD): A community report

Women, trans, and non-binary people who use drugs (WTNB-PWUD) face gendered and intersecting barriers to accessing harm reduction and supervised injection services (SIS), including stigma, discrimination, and exposure to gender-based violence in spaces often experienced as male dominated. This community report examines what a gender-responsive SIS model can look like, and which features enhance access and support health, HIV/HCV prevention and care, and broader wellbeing for WTNB-PWUD. We draw on 35 semi-structured interviews with WTNB-PWUD in Toronto (January 2023–February 2024), including people who had accessed the Women, Trans and Non-binary (WTNB) Day pilot at Regent Park Community Health Centre and/or other SIS. Thematic analysis identified four core elements of gender-responsive SIS: (1) fostering social connection and community; (2) creating a calm, caring, welcoming environment; (3) providing access to wraparound supports responsive to gendered needs; and (4) improving safety by reducing exposure to gender-based violence. Findings underscore the importance of low-barrier, relationship-centred, collaboratively designed services shaped by ongoing feedback from WTNB-PWUD. In the context of SIS closures in Ontario, this report highlights the urgent need to sustain and scale service models that enhance safety, dignity, and access for WTNB-PWUD.