Every Woman Deserves Care  

By Indibano Victim Empowerment Project 

Puleng (not her real name) is a 32-year-old woman from Bequarel who uses drugs and does sex work. She faced double stigma at public clinics, where she was shouted at, made to wait last, and judged. She is living with HIV but defaulted on her antiretroviral treatment and had never had a Pap smear or breast examination. She believed these services were not for women like her. She also shared needles at times and could not always insist on condom use. 

A peer educator from Indibano approached her without judgment during outreach and told her about the Amaqhawekazi (“heriones”) Programme funded by NACOSA through a ViiV Healthcare Positive Action Grant.  Puleng was offered integrated services: HIV care, STI screening, Pap smears, breast examination, family planning, harm reduction, support with experience of gender-based violence and weekly empowerment sessions. She was re-initiated on HIV treatment, given her first Pap smear (which was negative) and breast examination, and taught breast self-examination. Peer educators follow up on her adherence, and she collects her medication at the community safe space instead of queuing at the clinic. 

The most significant change for Puleng has been a shift in her sense of self-worth. She moved from believing she did not deserve healthcare to seeing herself as an iqhawekazi – a hero. “I am a woman first before I am a drug user. I deserve Pap smear, I deserve to check my breasts, I deserve ARVs,” she says.  

Puleng is now back on ARVs and adherent, with fewer opportunistic infections and more energy. She has been screened for cervical and breast cancer and no longer shares needles. She is working towards viral suppression and is hopeful, though still using drugs, that she can be healthy even while she does. She is better at negotiating condom use, knows her rights and knows where to report violence. She has moved from being a beneficiary to an informal peer champion. She brings other women to Indibano and teaches them breast self-examination. 

Women-only safe spaces make sensitive services such as Pap smears and breast examination accessible and integrating HIV, sexual and reproductive health, and harm reduction removes barriers to care. However continued outreach, especially at night, and screening camps are needed because many women remain unscreened. 

Puleng’s journey from a fearful defaulter to an empowered, treatment-adherent peer champion shows that when key populations are treated with dignity in a safe, integrated and peer-led setting, they can take charge of their own health. 

WATCH: Treat Us as People – the lives and experiences of women who use drugs