Jennifer L Syvertsen1, Kawango Agot2, Spala Ohaga3, Angela Robertson Bazzi4. 1. Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA; Department of Anthropology, University of California, Riverside, 1320B Watkins Hall, Riverside, CA 92521, USA. Electronic address: jennifer.syvertsen@ucr.edu. 2. Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya. Electronic address: mamagifto@yahoo.com. 3. Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya. Electronic address: spaoha@yahoo.com. 4. Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, USA. Electronic address: abazzi@bu.edu.
Abstract
AIMS: Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. METHODS: In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. RESULTS: Among 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. CONCLUSIONS: Drawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.
AIMS: Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. METHODS: In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. RESULTS: Among 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. CONCLUSIONS: Drawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.
Authors: Sheryl A McCurdy; Michael W Ross; Mark L Williams; Gad P Kilonzo; Melkizedek T Leshabari Journal: Addiction Date: 2010-03-12 Impact factor: 6.526
Authors: Angela R Bazzi; Jennifer L Syvertsen; María Luisa Rolón; Gustavo Martinez; Gudelia Rangel; Alicia Vera; Hortensia Amaro; Monica D Ulibarri; Daniel O Hernandez; Steffanie A Strathdee Journal: J Subst Abuse Treat Date: 2015-09-21
Authors: Anna M Leddy; Carol Underwood; Michele R Decker; Jessie Mbwambo; Samuel Likindikoki; Noya Galai; Deanna Kerrigan Journal: AIDS Behav Date: 2018-10
Authors: Kathryn E Lancaster; Sarah A MacLean; Thandie Lungu; Pearson Mmodzi; Mina C Hosseinipour; Rebecca B Hershow; Kimberly A Powers; Brian W Pence; Irving F Hoffman; William C Miller; Vivian F Go Journal: Subst Use Misuse Date: 2017-10-11 Impact factor: 2.164
Authors: Alicja Beksinska; Emily Nyariki; Rhoda Kabuti; Mary Kungu; Hellen Babu; Pooja Shah; Chrispo Nyabuto; Monica Okumu; Anne Mahero; Pauline Ngurukiri; Zaina Jama; Erastus Irungu; Wendy Adhiambo; Peter Muthoga; Rupert Kaul; Janet Seeley; Helen A Weiss; Joshua Kimani; Tara S Beattie Journal: Int J Environ Res Public Health Date: 2022-06-14 Impact factor: 4.614
Authors: Jason J Ong; Mingzhou Xiong; Joseph D Tucker; Yajie Wang; M Kumi Smith; Weiming Tang; Hongyun Fu; Heping Zheng; Bin Yang; Cheng Wang Journal: Arch Sex Behav Date: 2021-11-16