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C27. Avoiding and Caring for Street Wounds. A Community Intervention for Female Sex Workers Who Inject Drugs and Have Unstable Housing

Avoiding and Caring for Street Wounds. A Community Intervention for Female Sex Workers Who Inject Drugs and Have Unstable Housing

Learner category:

  • Novice Level

Learning objectives:

  • Participants will be able to describe three essential components of the prevention of soft tissue traumas for those who inject drugs and are experiencing unstable housing
  • Participants will be able to state three harm reduction measures to be used for treatment of soft tissue traumas from injecting drug use experienced by those with unstable housing.


Problem: There is a lack of knowledge of prevention and treatment of soft tissue trauma (STT) and abscesses among women who engage in sex work, inject drugs, and have unstable housing. Evidence Appraisal: Female sex workers who inject drugs and have unstable housing have increased risks for STT. Women tend to have more difficulty injecting due to smaller veins, are often injected by others, or use after another person, and this increases their risk of STT and abscesses. Implementation Strategies: In-person presentations with question and answer sessions were performed at two weekly group meetings of 77-100 women who engage in sex work and inject drugs. Vein care, safer injection sites, risk factors for STT, prevention and early intervention measures of STT, and when to seek medical care rather than perform self-care for their wounds were taught to the women. Also discussed were outcomes of complications of untreated or inadequately treated STT and abscesses. Evaluation: The women were aware of single-use syringe and to not share materials but were unaware of site selection, use of alcohol before injection, and there was a great deal of misinformation about preventing and treating STT. Harm reduction measures and home treatment of wounds were the focus of the questions asked by the women. Lessons Learned: Engagement in educating at-risk women includes discoursing about less than preferred treatment. The use of peer-to-peer information and correction of misinformation must be ongoing and tailored to each woman’s situation.


Kimberly Dion
PhD, RN, CNE, CARN University of Massachusetts Amherst College of Nursing

Kimberly Dion PhD, RN, CNE, CARN is a Clinical Associate Professor at the University of Massachusetts Amherst College of Nursing. Her research focuses on persons with a substance use disorder, a population she has worked with for 20 years. She is a harm reductionist and certified naloxone train the trainer for Massachusetts. She performs educational sessions on reducing stigma toward those with substance use disorder, harm reduction practice, and recognition of an opioid overdose.

Comments (19)

  1. Shari Harding

    I really appreciated this presentation, thank you for your work.

    1. Kimberly Dion

      Thank you, Shari!


    Great presentation and you seems to impact the women’s life. Thank you for your work

    1. Kimberly Dion

      Thank you for your kind words. Yes, the women were very much impacted by this harm reduction approach.

  3. Ruthanne Palumbo

    Wonderful presentation Kimberly, thank you for sharing your work!

    1. Kimberly Dion

      Thank you, Ruthanne! I appreciate your kind words.

  4. Lauren Carpenter, RN, CARN

    Good evening! Thank you so much for this presentation and the focus on harm reduction and “meeting them where they are at,” I currently work in Holyoke, MA and I would love to connect with you regarding professional growth as well as learning more about how you came to present to these women. I would absolutely love to be involved with that! Thanks so much!!

    1. Kimberly Dion

      Hi Lauren,
      Feel free to email me at

  5. Anita Covington

    Very informing and so true, unfortunately many women seem more vulnerable to health concerns than men. Thank you for this information, it will be useful.

    1. Kimberly Dion

      Thank you, Anita. This group of women are certainly vulnerable and it was a pleasure to be invited to speak with them.

  6. Trish HAFFORD

    Thank you Shari, really good to see this education, care and empowerment for women.

    1. Kimberly Dion

      Thank you, Trish. The women were quite engaged in the content and several in the group provided additional information to their peers because they were former health care providers themselves. This empowerment had a positive impact as these individuals became leaders outside of this teaching session.

  7. Rachel Shuster, BSN, RN, CARN, CAAP

    Fantastic work and presentation. I am always ecstatic to hear the work being done in Massachusetts because I feel the state is often leading the way in regards to progressive and innovative care of people who use substances. From a fellow harm-reductionist: thank you for your work and for ensuring harm reduction has a spotlight at #IntNSA2020!

    1. Kimberly Dion

      Thank you, Rachel. I absolutely agree that our state has been progressive in their work with people who use drugs. We have been working with law enforcement and they are including harm reduction in their work!

  8. Adam Searby

    Thanks for this presentation Kimberley. Just curious – did your education around neck and groin injecting reduce the incidence of using these sites? I ask this because this is something we often see in the injecting room in Melbourne – it is accepted, although education is provided around vein care and the dangers of this practice. However, it seems we have a cohort with no or difficult access apart from the groin/neck veins. Adam.

    1. Kimberly Dion

      HI Adam,
      Since this wasn’t a study, I did not collect data about changes in behavior. The person who injects is a population that I do a lot of work with and I agree that injecting in the neck and groin is something that is hard to change because of access. What I have done is to provide an alternative way such as booty bumping (inserting the drug into the rectum). The usual questions pertain to the similarity or difference to injecting. When I approach this technique as a harm reduction approach (not injecting in the neck when there is poor lighting or one is rushed), the women were receptive to using this approach when needed. I did have a couple of the women tell me that they tried booty bumping and do it all the time now because it is easier and they have less visible wounds that interferes with their sex work.

  9. Jacqueline Johnson

    Thank you,
    I found this presentation useful and informative.
    I may have the opportunity to this webinar for a community outreach in a couple of weeks.

    1. Kimberly Dion

      Thank you, Jacqueline. I hope that this information will be useful to you in your community outreach.

  10. Cheneen Austin

    Wonderful intervention. Thank you for sharing this with us. This type of non-judgmental, educational intervention goes right to the heart of harm reduction.

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