28 May 2025
Nombulelo Mkhuma, from Tintswalo Home Based Care in South Africa, reflects on her time at the Harm Reduction International Conference in Bogotá, Colombia, and the women-led conversations that struck the deepest chord.
“It has been beautifully crazy,” said Nombulelo, who spoke at a session focused on the complex intersections of gender, drug use, and motherhood.
Titled “Mamma Mia! Empowering Women Who Use Drugs and Protecting Family Rights,” the session was chaired by Joelle Puccio and featured a powerhouse panel. Nombulelo shared insights on parenting and the law. Jeanne Flavin presented research on pregnancy and drug use. Anna Millington explored injecting equipment and women who use drugs. Lynn Paltrow spoke on sex, drugs, and pregnancy.
“Although everyone’s backgrounds are different, there are so many similarities in our experiences,” Nombulelo said. “These are all things that women go through, and there’s a lot of overlap in the work we’re doing on the ground.”
The room stayed packed throughout, showing a growing passion for conversations centred on women who use drugs and the narcofeminist movement. Attendees listened, engaged, and shared their own stories and advocacy work afterwards.
“The support was heartwarming,” she said. “We just wished we had more time. We kept saying we should have been given the whole day to talk about women and the issues we go through.”
Should Men Be Involved in the Conversation?
One audience question stuck with her: Should men be included in conversations led by and about women? Reactions were mixed and intense.
“It was so interesting hearing so many different views,” she said. “Some were saying yes, we need to. Others were saying, no, what the f*ck?”
The next day, Nombulelo attended “Unseen but Unstoppable: Innovating Harm Reduction for Sex Workers.” It struck a chord — not just because of the content, but because of how much is missing back in South Africa.
As provincial lead for people who use drugs in Gauteng, Nombulelo works across a movement made up of people who use drugs, civil society, and advocates. They fight for visibility, funding, and representation in policymaking spaces like central drug authorities and national strategic plans. The goal is for people who use drugs to be recognised as their own standalone group, something that’s already underway.
After HR25, she’s now calling for the same recognition and support for sex workers.
“In South Africa, we always miss the data linking sex work and people who use drugs,” she said. “And it was amazing to see different countries present data on that.”
But what stood out most was how other countries are already building services around this crossover.
“Women are hustling, selling sex because they want to feed their families, take care of themselves, pay bills,” said Nombulelo. “And it’s really interesting how other countries aren’t struggling to link it all together. I hope South Africa can get there too.”
She was also struck by the role drug consumption rooms can play in creating safe, dignified spaces.
“If our country could adopt that model, it would reduce stigma, violence, and police brutality,” she said. “It would save lives, prevent overdoses, and offer constant medical support for people who are often forced to migrate or live without basic health care.”
Towards a One-Stop Shop for Women Who Use Drugs
What does harm reduction mean? For Nombulelo, it means power. Liberty. Health. Success. Leadership. Dignity. Empowerment. Resilience. And service. That’s why, as she looks to the future, she’d like to see a one-stop shop for women who use drugs — a single space where services meet the realities of women who use drug’s lives.
“Maybe I need a harm reduction pack that day. Maybe I need methadone. Or a day care for my child, for the days when I’m dealing with gender-based violence or depression, so that people don’t take my child away,” said Nombulelo. “There should be a rape crisis centre onsite or nearby. It’s about creating a space that understands what women go through and supports them without judgement, and with all the services they need.”
Women Who Use Drugs at INHSU 2025
From 11–14 October 2025, INHSU’s annual conference heads to Cape Town, South Africa, with several sessions dedicated to the experiences of women who use drugs. Topics will include:
- Understanding Intersections Between Gender and Health: A qualitative presentation on the gendered risks faced by cis and trans women, including stigma, discrimination, criminalisation, intimate partner violence, and sexual and reproductive health
- Designing HIV, HCV, and Harm Reduction Services for Women: Including trauma-informed approaches and real-world models of care
- HIV and HCV Care for Women Who Use Drugs: Exploring the burden of disease, treatment during pregnancy, and integrating HIV and HCV services into antenatal care and perinatal testing pathways
Join us in Cape Town from 11 to 14 October 2025.
