When we talk about women who use drugs it is important to realise how gender power dynamics are at play. Women who use drugs are disproportionately more likely to be HIV positive, compared to men who use drugs because our vulnerability is compounded by gender and other structural imbalances such as poverty or belonging to ethnic minorities.
Some of us, women who use/ have used drugs, may have also been involved in sex work, and some of us may have had transactional sex just to get the drugs. Even if one doesn’t directly exchange sex for drugs or money, negotiating sex on our own term can be difficult when under the effects of drugs and alcohol. Many of us who use/have used drugs may suffer from mental health problems such as depression and low self-esteem often born of traumatic experiences in our childhood. Experiences of child abuse and neglect are very common among people who use drugs. Because of this fragile emotional context some of us may use sex to feel wanted, to cope with loneliness, or just to have warmth and intimacy: enforcing condoms may make us look as ‘fun-spoilers’ or may just bring rejection. All of this enhances our risk of acquiring HIV and other STI. The ‘ritual’ of injecting is often lead by men and women are often last in the line, either being injected by their partner or ‘senior’ drug users. Because women have more fat often it is more difficult to get a vein to inject and it may take several tries before successfully injecting, thus increasing the risk of acquiring HIV and other blood borne viruses. Harm reduction services should be sensitive to all those issues and not only provide clean needles, but also teach women how to inject safely, without having to depend on somebody else. It would be also good if harm reduction services also included sexual health services where women could get support and a safe space to discuss their sexual health needs. Simply handing out condoms is not enough!
Those of us who are HIV positive face a lot of stigma both within HIV services and drug services . Society doesn’t envisage a person who uses drugs as a ‘mother’. Often even within HIV support organizations a woman expecting a baby who is a drug user will be treated in a very negative way, as if she cannot possibly be a good mother. But women who use drugs are women like others, with the same desires and rights as all other women, it is important that we can choose to be mothers and be supported. There is a lot to deal with for us during pregnancy because many of us may live not only with HIV but also with Hepatitis B and C. Living with so many viruses makes our decisions around treatment and pregnancy very complex. It is essential that services for women living with HIV who use drugs are not judgemental and support us understanding complex medical information around HIV, HCV and HBV and also offer us access to Sexual Health and Reproductive Services: this include contraception, abortion services, post abortion support and also support to have babies and be a parent. Those services need to be integrated with HIV services, provision of ARVs, clean syringes, opioid substitution etc. The Ukrainian network of people living with HIV has produced some excellent documentation on how positive women on opioid substitution can go on being good mothers and living satisfying lives. Integrated services should be provided in ‘one-stop’ shop, or very closely located, because one cannot spend a lot of time going from one place to another, especially if she is a mother and a drug user, there is not much free time.
The fact that we use/have used drugs doesn’t mean we are useless, or powerless. Some of us use drugs, often to numb feelings that are too painful, but also because drugs are fun and enjoyable. With the right structure, acceptance, recognition and support drug users can achieve great things. For example Positively Women was founded by two women who acquired HIV through injecting drugs. It was 1987 in London and services available at the time were all structured around the needs of gay men. Those two women, Jaynie and Sheila started a support group in their front room. At the beginning the clinics didn’t even want to publicize their materials because they thought that two ‘junkies’ couldn’t possibly do something useful. They persevered and slowly women started to turn up. Within a few years they were doing educational sessions in schools, outreach in prisons and supporting hundreds of women. The charity still exists and is now called Positively UK: it supports also men but it has maintained an ethos of peer-support and all the services are offered by people living with HIV, including people who use drugs, and with a strong focus in addressing gender issues working with both men and women. If it wasn’t for the group started by Jaynie and Sheila, two women who used drugs, our organization wouldn’t exist.