Testimonies and Healing: Anti-oppressive Research with Black Women and the Implications for Compassionate Ethical Care.

Anti-oppressive qualitative inquiry can be a powerful tool for members of marginalized communities to engage in storytelling that is both therapeutic and transformative. For individuals navigating marginalization due to multiple systems of stigmatization, the process of telling their story offers the opportunity to engage in awareness raising and health promotion that can benefit their communities. Formerly incarcerated Black women are one such community experiencing multilevel marginalization. This essay explores ways in which the qualitative interview can provide contexts for women to name their experiences of oppression, reconstruct the meanings they attach to them, and channel their stories of navigating harm to promote the health of others. Given the legacy of research atrocities that have disproportionately harmed already-marginalized communities, this piece seeks to advance practices of ethical care and compassion in qualitative inquiry that promote greater health and the building of relational trust in both research and clinical settings.

Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women.

Introduction: There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). Methods: We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. Results: Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. Conclusions: Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.

Stigma, surveillance, and wounded healing: Promoting a critical ethics of care in research with formerly incarcerated Black women.

Black women experience myriad challenges post incarceration, from managing stigma within social relationships to navigating surveillance when interfacing with service systems. It is these challenges that also make them vulnerable participants in community-based research. With many of potential research harms not falling under the guidance of Institutional Review Boards, it is critical to explore how communities experiencing stigma and surveillance perceive their engagement in research. As such, this study explores how 28 justice-involved Black women experience the research process. Findings reveal that participants view the research context as spaces for reflecting on surveillance and stigma in ways that promote self-recovery. Moreover, they perceive the interview process to allow them to envision identities as wounded healers who use their pasts as mechanisms to help others. The study's implications for anti-oppressive inquiry underscore the need for researchers to employ ethical care and justice frameworks that center compassion, reflexivity, and equity throughout the process.

"Every time I tell my story I learn something new": Voice and inclusion in research with Black women with histories of substance use and incarceration.

While current ethical procedures aim to minimize risks to imprisoned individuals, there is heightened awareness of the need to protect those who participate in research post-incarceration while under community-based supervision. Formerly incarcerated women, in particular, face myriad challenges to community reintegration which also make them vulnerable participants in research. As such, this study explores how 28 formerly incarcerated Black women experience the qualitative research process. Findings revealed that women engaged in research because these contexts were viewed as therapeutic spaces for raising awareness that can help others. Moreover, the interview process allowed women to share their pasts in ways that promote their recovery from addiction. Participants also reported risks of emotional distress and fears regarding researcher stigma. The implications for trauma-informed interviewing practices underscore the need for greater considerations of the role of the researcher, research environment, and how they contribute to one's personal recovery.

Navigating Intersectional Stigma: Strategies for Coping Among Cisgender Women of Color.

Intersectionality is a critical tool for understanding how socially constructed categories shape multiple dimensions of lived experience. In this study, we apply an intersectional lens to explore how women of color from two different contexts, Hyderabad, India and Chicago, Illinois, manage gendered forms of stigma and oppression as they converge with other devalued statuses, namely living with HIV or having a history of drug use or incarceration. Applying intersectional stigma as our conceptual framework, and drawing from transnational feminist perspectives, we identified two overarching themes. Women in both contexts combat stigma by employing strategies of concealment within their romantic and familial systems. Moreover, women's roles as mothers were critical sources for managing their complex illnesses and for accessing support. Using these experiences of stigma against women of color as our analytic lens, we offer an intersectional framework for qualitative health research involving marginalized cisgender women of color in transnational contexts.

Voice, Counterspaces, and Ethical Care in Research With Black Women With Trauma and Incarceration Histories.

Formerly incarcerated women face diverse challenges to re-entry, which include recovering from health illnesses and trauma to navigating various systems of stigma and surveillance. It is these multilevel challenges to reintegration that also make formerly incarcerated women vulnerable participants in research. As such, this qualitative study explores how 28 formerly incarcerated Black women experience the research interview process. Findings revealed that women participated in research because these contexts were viewed as spaces for "truth telling" and increasing awareness that can effect changes in the lives of communities facing trauma. Moreover, the participants perceived the interview process to allow them to share their pasts in ways that can promote healing and recovery. Participants also discussed risks of emotional distress and anticipatory fears regarding imbalanced researcher-participant dynamics. The implications for antioppressive, compassionate interviewing practices underscore the need for greater considerations of the role of the researcher and how they contribute to women's recovery from complex trauma and illness.

Supporting the end of prostitution permanently (SEPP) prostitution court: examining inter-professional collaboration within alternative criminal justice settings.

Problem-solving courts such as prostitution courts are becoming an important feature of the American court landscape. Internationally, while there is a great deal of skepticism regarding problem solving courts, at least five countries (e.g., England, Scotland, Ireland, Australia, and Canada) are deliberating whether this "revolutionary panacea" which has swept America's criminal justice system is the right approach for them. Few studies have explored the benefits and challenges of problem solving courts (i.e. prostitution court) using an interprofessional collaborative framework. The purpose of this case study is to examine contemporary issues related to prostitution courts using Bronstein's model of interprofessional collaborative framework which identifies five components that facilitate optimum IPC: 1) interdependence, 2)newly created professional activities, 3)flexibility, 4)collective ownership of goals, and 5) reflection on the process. Some benefits of IPC include working collaboratively, adaptability, adjusting expectations, investment in the process and making changes as needed. Some of the challenges of IPC were coercive power, dual roles, bait and switch, hierarchy, and push for outcomes at the expense of clients. As criminal justice systems nationally and internationally contemplate widespread implementation of different kinds of problem-solving courts, these benefits and challenges need to be considered before states and countries adopt these courts.

Promoting Recovery Identities Among Mothers with Histories of Addiction: Strategies of Family Engagement.

Changes in identity are critical to managing transitions to recovery from substance and alcohol addictions. Identity change is particularly important for mothers, whose recovery processes are often in the context of critical but complex family relationships and societal expectations. But research and practice often underestimate the relational dimensions that promote or inhibit changes in one's identity during recovery. Here we analyze data from a study that involved interviews with 30 formerly incarcerated women participating in a community-based substance use treatment program in the Midwest. Drawing from Constructivist Grounded Theory Methods, our analysis identified three factors shaping levels of engagement with family members: (1) the relational consequences of a shared past; (2) ascribing permanence to the old identity of "addict" versus the ability to see women's capacity to change; and (3) the current provision of caregiving support to participants' children. Our analysis supports and extends existing research by highlighting how family can both promote and inhibit a recovery identity process. We discuss potential implications for theorizing "recovery" and "identity" as relational and identify key elements to support practices more attuned to the hidden complexity of family support.

Los cambios de identidad son fundamentales para manejar las transiciones hacia la recuperación de las adicciones a las sustancias y al alcohol. El cambio de identidad es particularmente importante para las madres, cuyos procesos de recuperación son generalmente en el contexto de relaciones fundamentales pero complejas y de expectativas sociales. Pero la investigación y la práctica con frecuencia subestiman las dimensiones relacionales que promueven o inhiben los cambios en la propia identidad durante la recuperación. Aquí analizamos los datos de un estudio que consistió en entrevistas con 30 mujeres previamente encarceladas que participaron en programa comunitario de tratamiento contra el consumo de sustancias en el centro de los Estados Unidos. Basándose en métodos de muestreo teórico constructivista, nuestro análisis identificó tres factores que moldean los niveles de compromiso con los familiares: (1) las consecuencias relacionales de un pasado en común; (2) la atribución de permanencia a la antigua identidad de "adicto" frente a la habilidad de ver la capacidad de las mujeres para cambiar; y (3) la facilitación actual de ayuda con el cuidado de los niños de los participantes. Nuestro análisis respalda y amplía las investigaciones actuales destacando cómo la familia puede promover e inhibir un proceso de identidad de recuperación. Debatimos las posibles implicancias para la teorización de la "recuperación" y la "identidad" como relacionales e identificamos elementos clave para apoyar prácticas más adaptadas a la complejidad oculta del apoyo familiar.

Transforming responses: Exploring the treatment of substance-using African American women.

This article explores how intrapersonal and structural oppression may impact treatment and the recovery process of 23 self-identified African American women with histories of incarceration and substance use. Using a critical consciousness (CC) framework and content-based thematic analysis, researchers systematically coded and extracted themes and patterns from focus group data to evaluate how marginalizing processes-such as race-based discrimination-impact treatment, the therapeutic relationship, and service provision. Results indicate that participants' health and treatment were negatively impacted by oppressive factors, specifically the oppressive process of silencing. The authors discuss research and practice implications.

Survival sex and trafficked women: The politics of re-presenting and speaking about others in anti-oppressive qualitative research.

Qualitative research grounded in a social constructionist epistemology troubles the assumption, integral in positivist research, that a researcher can be neutral and apolitical. In fact, many scholars are drawn to constructionist epistemologies because they situate the research process as a site of ontological resistance and social change. This essay explores the politics of voice and representation in anti-oppressive qualitative research. Using an example from one author's research on stigma management among formerly incarcerated women, and the particularly pernicious stigma women faced if they had engaged in sex work, we detail the benefits and pitfalls of either re-presenting research participants in their exact words or changing participants' words, a process we refer to as re-languaging. Drawing upon philosophical and social scientific scholarship on the "crisis of representation" in qualitative research and recent scholarship and news articles about human sex trafficking, we underscore the powerful political effects of language. We argue that researchers' choices about language are neither inherently liberatory nor oppressive, but they are always political. We call for a more reflexive scholarly dialog on voice in qualitative social work research and press scholars to explicitly engage the question of whom and what we represent when we claim to represent marginalized others.

"That's not me anymore": Resistance strategies for managing intersectional stigmas for women with substance use and incarceration histories.

Significant previous research has focused on how individuals experience stigma when interacting with the public sphere and service agencies; the purpose of this grounded theory study is to explore how formerly incarcerated mothers with histories of substance use experience stigmas from their intimate relationships with family and romantic partners. Using an intersectionality lens, this study reveals that the women perceived multiple stigmas due to their previous substance use, incarceration, and other addiction-related behaviors that challenged their roles as mothers and romantic partners. Compounding the behavioral-related stigmas were race and class-based stereotypes of black criminality that also challenged women's ability to embody key motherhood and womanhood roles. As a result, the women employed resistance strategies to safeguard against stigma and preserve their recovery. The implications for practice underscore the significance of addressing personal experiences of stigma, complex relational dynamics, and understanding the needs of support systems that are also shaped by the women's cycles of incarceration and illness.

"Not human, dead already": Perceptions and experiences of drug-related stigma among opioid-using young adults from the former Soviet Union living in the U.S.

BACKGROUND: Young people from the former Soviet Union (FSU) in the U.S. are engaging in opioid and injection drug use (IDU) in substantial numbers, paralleling nationwide trends. Yet opioid-using FSU immigrants face distinctive acculturation challenges, including perceived stigmatisation as drug users within their immigrant communities, which may exacerbate the negative health and psychosocial consequences of such use. METHODS: This qualitative study draws on semi-structured interviews with 26 FSU immigrant young adults (ages 18-29) living in New York City who reported opioid use in the past month and/or were currently in treatment for opioid use disorder. Interviews probed youths' drug use histories, immigration/acculturation experiences, family and peer relationships, and service utilisation. Interviews or focus groups were also conducted with 12 FSU mothers of opioid-using youth and 20 service providers familiar with the FSU population. In a content-based thematic analysis, verbatim transcripts were coded for salient themes. RESULTS: All three participant groups emphasized that stigma towards drug users within the FSU community is pervasive and acute, in contrast to the cultural acceptance of heavy drinking, and is rooted in punitive Soviet-era drug policies, fostering widespread ignorance about drugs and addiction. Young adults and service providers reported instances in which anticipation of community stigmatisation deterred youth from accessing drug treatment and harm reduction services. Similarly, stigma contributed to parents' failure to recognize early signs of their children's opioid problems and their reluctance to seek drug treatment for their children until opioid use had become severe. Young adults described how drug-use stigma is frequently internalized, leading to shame and loss of self-esteem. CONCLUSION: Findings indicate an urgent need for community-wide education about drugs within FSU immigrant communities, and suggest specific service modalities that may be less stigmatizing for youth, such as peer-delivered syringe exchange and harm reduction education, and technology-based interventions that can be accessed privately and discreetly.

Perceived Advantages and Disadvantages of Using Pre-Exposure Prophylaxis (PrEP) among Sexually Active Black Women: An Exploratory Study.

Knowledge of pre-exposure prophylaxis (PrEP) continues to remain scarce among Black women who are disproportionally affected by HIV in the United States. A thematic analysis of open-ended questions from a sample of Black women (n=119) who completed a mix-methods, online, e-health study was conducted to examine the perceived advantages and disadvantages of using PrEP. Being a female controlled method, empowerment, option for women with risky sex partners, and serodiscordant couples were advantages described. Disadvantages of PrEP were identified as the complexity of the choice, encouragement of sex with risky partners, increased burden, promotion of unprotected sex, and newness of the drug.

Intra-group Stigma: Examining Peer Relationships Among Women in Recovery for Addictions.

This grounded theory study explores how women with histories of addiction perceive stigma while in treatment. In-depth interviews were conducted with 30 women participating in a residential drug treatment center. Previous research has found that support from peers during recovery can be critical to managing illnesses. In fact, researchers have postulated that peers can be a more effective form of support than even family. This study extends existing literature indicating that peer support systems can be supportive, however they can also can be perceived as negative support that impose stigmas. Findings reveal that women perceive stigmas due to how various types of drug use violate societal expectations and conflict with notions of deservingness. Specifically, the "hard users" (i.e., women who use heroin or crack cocaine) perceive stigmas regarding how their drug use violates norms of womanhood. Moreover, the "soft users" (i.e., those who use alcohol or marijuana) perceive stigmas that their drug use is considered undeserving of support. This paper explores the factors that contribute to stigma amongst populations who potentially face marginalization from larger society. Implications for treatment and group work are discussed.

Prescription Drug Diversion: Predictors of Illicit Acquisition and Redistribution in Three U.S. Metropolitan Areas.

OBJECTIVE: Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors. METHODS: Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions. RESULTS: While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion. CONCLUSION: Findings suggest that predictive characteristics vary according to diverter group.