Women and Harm Reduction: Interview with Sue Purchase

When considering the social stigma surrounding people who use drugs--as a moral failing--the harshest judgments are often directed towards women, particularly those pregnant or with children. Women who use drugs grapple with unique challenges: power dynamics in their relationships with intimate partners who also use drugs; fear of losing their children to social services if they were to seek medical help or substance use treatment; the criminalization of sex work which is often used to earn money for drugs, including the inherent risk of harassment, assault, and rape; and much more.

Sue Purchase, Operations Manager with the North Carolina Harm Reduction Coalition, has been working with women drug users for over two decades. She has created programs that address these unique circumstances and needs. During the mid 1990s she co-founded Women with a Point, a harm reduction organization in Minneapolis, Minnesota, dedicated to engaging and empowering female drug users. I spoke with her recently about how her personal journey led her to work with women and asked her thoughts on what needs to be done to ensure the health, well-being, and empowerment of women who use drugs.

TC: How did you get into harm reduction?

SP: In the mid 1980s I was introduced to intravenous drug use by my husband who was a chaotic drug user. In 1986, when I finally realized that my domestic situation was a threat to my children’s future, I moved out. My children and I moved to Minneapolis, Minnesota, my home state. Once there, as a single parent in subsidized housing, receiving food stamps and welfare, I learned about harm reduction as it applied to alcohol use via an NPR broadcast. It was a huge wakeup call for me because I had only known about abstinence-based programs, which weren’t a good fit for me. Furthermore, I was reluctant to get into a traditional treatment program for fear of the exposure for my children and I didn’t want a program that was religious-based. I hadn’t realized there were other options. Harm reduction as a concept made sense to me because it was practical and I had been taking steps to mitigate my drug use already. For example, before moving to Minneapolis, I had quit injecting drugs.

TC: What motivated you to start your own harm reduction program for women?

SP: While in Minneapolis, I returned to school and earned my degree in human services and was introduced to the concept of needle exchange. From there, I was determined to create positive change in my life and in the lives of other women. At the time there weren’t any services available that specifically met the needs of women drug users but there was a grassroots needle exchange. I volunteered to help as an outreach worker and there I met another volunteer, Toni St. Pierre. Toni had lost custody of her two children as a result of her own drug use. Shortly thereafter, realizing the need for a program that served the needs of women who use drugs, she and I created Women With a Point.

TC: What are some ways in which WWAP was able to meet the specific needs of women?

SP: Back then there were no conversations about women and drug use, particularly injection drug use. Just talking about the risks for HIV transmission, for example, in men versus women, was new since other HIV prevention efforts were based on a male model. At Women With a Point we talked about power differentials and how disease is transmitted. Many women didn’t know that viruses like HIV and other STDs transmit more easily from a man to a woman than vice versa. Women often rely on a male partner to supply the drugs, syringes, and to inject them with the drug as well. This situation is further complicated with issues of domestic violence. We provided education about safer injecting, including learning how to do your own injections. We talked about barriers to using condoms and about negotiating condom use instead of just letting men decide. We trained women on how to put on condoms. We offered groups about how to manage your habit on a budget. The expectation for women is that they shouldn’t do drugs at all, but the reality is that drug use may happen, so we had open and honest conversations about that reality.

Another way Women With a Point was different is we did home delivery of syringes and services, which is huge for women, especially pregnant women who endure so much shame and stigma if they go out in public to a program for drug users. Home delivery also helps women with children who can’t bring kids to an exchange. Traditional service programs expected women to show up at an appointed time for a meeting and if they can’t make it they are viewed as noncompliant. There is no taking into account difficult life circumstances.

TC: How can just talking about different issues be empowering for women?

SP: There is such freedom in being able to have open and honest conversations about difficult topics such as raising children as a drug user, intimate partner violence, and condom negotiations. Just talking about these things helps women feel less alone and they can empower each other to take more control over their lives. The needle exchange program did so much more than swap needles. It was about building a bridge, creating community, and recognizing the intrinsic value of human life. It was about transformation, no longer being passive about a woman’s own health and well-being.

TC: What other programs currently exist for women?

SP: There is still a big gap in programs from women, at least programs that are tailored to women specifically. I think nowadays there are greater numbers of women in positions of power within harm reduction, but specific women’s programs are few and far between.

TC: What would you like to see happen in terms of harm reduction programming for women?

SP: I think we need to look at programs that cater to women who have been incarcerated. Two thirds of incarcerated women are mothers. Programs need to thoughtfully address the needs of women who are using drugs, ask questions such as why are they using, and figure out how to best support women who are parenting as they try to access treatment.

We need trauma-informed care in harm reduction. In my experience working with different programs across the U.S., women talk about trauma and violence in their lives. The majority of women in treatment or incarceration report experiencing sexual assault or trauma in their lives.

We need harm reduction programs that talk about women who are pregnant and parenting, violence towards women, the need for transactional sex, and single parent households. There should be needle exchange hours for women only. Women should know about the dangers of arrest and incarceration when they are using and also when they have a partner who is using. With the current opiate crisis and the continuing criminalization, I don’t think the needs of women are being fully addressed, especially for women of color. We have to confront the issues of power that keep women oppressed and also recognize that women are diverse and come from all walks of life.

TC: What are your plans to address women’s issues at NCHRC?

SP: I want to establish a platform where women could craft their stories and help empower them through written and spoken word. It’s proven to be a powerful and personal experience for me. But, sharing can be re-traumatizing: you risk judgment by other people; who has access to your story; what happens after you share; and how does it impact you on a personal basis? Hopefully, this platform could potentially mitigate those usual problems associated with revealing one’s personal and private struggles.

Authors note: A workshop to help women drug users share their stories will be available at the upcoming Southern Harm Reduction Conference this spring in Waynesville, North Carolina. Details TBD.

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