title: "Not on the agenda": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa.
abstract: BACKGROUND
  Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women's use of health services.
  
  
  METHODS
  We conducted four focus groups with young women (aged 16-21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women's use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach.
  
  
  RESULTS
  The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women.
  
  
  CONCLUSIONS
  To reach young women who use AODs, interventions need to take cognisance of young women's risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda.
authors.affiliation: Alcohol, Tobacco and Other Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road, Observatory 7900, South Africa. Electronic address: bronwyn.myers@mrc.ac.za.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Alcohol, Tobacco and Other Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa.
authors.forename: Tara
authors.initials: T
authors.lastname: Carney
authors.affiliation: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
mesh_terms: D000293:Adolescent; D019973:Alcohol-Related Disorders / Q000534:rehabilitation; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D011203:Poverty; D012737:Sex Factors; D012931:Social Environment; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D013019:South Africa; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D055815:Young Adult
keywords: Gender; HIV; Health services; Risk environment; Structural context; Substance abuse treatment need; Young women