Sisters spaces: Needs, challenges and services for women who use drugs
By Rafaela Rigoni / Mainline
Drug use, drug policies and drug interventions have historically been narrated and evaluated through men’s experiences. Drug-related research, services, guidelines, and training remain overwhelmingly gender-neutral or male-focused. In most drug-related services, including harm reduction, males make up much of the clientele and services provided are generally tailored to men. Both gender-neutral and male-focused services often perpetuate the “invisibility” of women. Consequently, there is a lack of data on the specific needs and challenges faced by women who use drugs when trying to access care.
A mass of gender-specific obstacles exist for women who use drugs within the care system. Compounded stigma may intersect with gender-based, intimate partner violence and moral assumptions about women and motherhood. State-based violence such as police brutality, punitive medical interventions, and the threat of having parental rights removed due to drug use may also be frequently experienced and act as an obstacle. These can be intensified by race, class, and the criminalization of homelessness and sex work. Besides, services not tailored for women may be perceived as unfriendly towards this population, as they may not have appropriately trained staff nor guarantee the safety and confidentiality of women who use drugs.
Gender inequalities are a persistent reality in services assisting the population who use drugs, and situated strategies are needed to address the gender gap. The present assessment, thus, takes a person-centered approach and focusses on the needs and experiences of women who use drugs’ to identify the barriers and enablers related to access to services which cater to their needs. It provides a detailed assessment of the experiences of women who use drugs and their harm reduction providers in five cities in South Africa - Cape Town, Durban, Ekurhuleni, Port Elisabeth, and Pretoria – including, when possible, previous studies from other locations. The assessment also contains the perspectives of staff from services - such as food provision, shelter, gender-based violence support, and projects to generate skills and income - which were perceived by women as fundamentally needed, but oftentimes very difficult to access.
Building upon prior studies, in-depth interviews, and focus group discussions, the present assessment provides a detailed representation of the current needs of and challenges faced by women who use drugs in South Africa. It taps into the web of existing services directed towards and accessed by women, to focus on what has been hindering their access to basic human needs and specialized care. This rich information serves as a basis for recommendations on strategies and interventions to help closing the gender gap in services needed by women who use drugs.