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Positive Action for Women Who Use Drugs

This week sees the start of a new NACOSA project to support and empower Women Who Use Drugs (WWUD), thanks to a ViiV Healthcare Positive Action grant. The Amaqhawekazi Harm Reduction project aims to remove structural barriers and promote psychosocial wellness through peer educators in Gauteng.

Amaqhawekazi means female warriors in isiZulu and isiXhosa and represents the courage and strength of women who use drugs fighting to survive in the harsh environment and situations in which they find themselves.

There are an estimated 15.6 million people who inject drugs (PWID) globally and 20,5% of these are women. In South Africa, it is estimated that there are 400,000 people using heroin, with 82,500 injecting drugs (Scheibe, A. 2021). South African women account for roughly 27% of all people who inject drugs and 19,4% of women who inject drugs are living with HIV (Lefoka MH, Netangaheni TR 2021). Women who use drugs are more vulnerable to HIV and other blood borne infections due to patriarchal drug culture, intersectionality with sex work and gender-based stigma. They also experience higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress.

Hidden population

Although NACOSA recognises that all people who use drugs are vulnerable, this project is specifically geared towards Women Who Use and Inject Drugs who remain a hidden population that face multiple barriers to accessing harm reduction services. These include stigma, both in society in general and from healthcare workers; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement and incarceration; and a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare.

NACOSA will give momentum to its existing harm reduction interventions with expanded clinical and social support services, as well as improved supportive and enabling environments at local level in West Rand, Sedibeng and Ekurhuleni in Gauteng over three years. Female peer educators will be appointed and trained in strategies and targeted interventions for women who use drugs. These ‘warriors’ will identify women who use and inject drugs and support them to access available services.

Three of NACOSA’s trusted implementing partner organisations – Tshepo Ya Bana, Indibano and Tintswalo – who are already embedded in the communities will appoint peer educators, conduct group sessions with the women and undertake sensitization workshops with service providers and in the community.

Amaqhawekasi project interventions

Breaking down barriers

The project will raise awareness of harm reduction services, link women who use drugs to these services and provide additional support such as parenting programs and contemplation groups. Key to any harm reduction service is sensitizing communities and facilities to break down barriers to access. Amaqhawekazi will work with communities and facilities to help them understand the distinct issues and needs of women who use drugs.

Advocacy and awareness raising around harm reduction for women is also a key component of the project and NACOSA was delighted to receive additional support from ViiV Healthcare through its Amplify Impact initiative for this, enabling the project to collaborate, communicate and share learnings from the Amaqhawekazi project.

Giving back

This project will seek out and support women like Berenice who overcame trauma, abuse and homelessness to get back on her feet, be reunited with her children and become a peer educator giving back to her community:

“I’m happy today. I’m clean, I’m young, giving back to the people who are struggling with addiction and the homeless community. It’s amazing, man, and I just want to tell the peers out there who are struggling, ‘you know when it’s enough.’”