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.
Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
Drug Alcohol Depend. 2019 Jan 1;194:495-499. doi: 10.1016/j.drugalcdep.2018.10.019. Epub 2018 Nov 13.
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.
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.
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.
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.
在全球范围内，吸毒女性通常从事性工作，并经历多种健康和社会危害，这使得她们的药物治疗需求变得复杂。在东非，了解女性中出现海洛因使用的情况对于制定有效的药物治疗计划至关重要，包括正在扩大的药物辅助治疗（MAT）。我们探讨了肯尼亚从事性工作的女性中出现的海洛因使用情况，以了解服务需求。
在肯尼亚基苏木对 45 名报告有物质使用史的女性性工作者进行的定性研究中，有 32 名报告有终身海洛因使用史，是本次分析的重点。半结构式访谈探讨了物质使用和性工作的历史以及健康规划需求。主题分析侧重于海洛因使用的背景和意义。
在 32 名女性中，中位年龄为 28 岁（范围：18-37 岁）。女性在从事性工作之前，通常会吸食含有海洛因的鸡尾酒，同时还会饮酒和使用其他毒品。大多数女性认为海洛因能带来“士气”和“勇气”，使她们能够从事性工作，并“对抗”可能虐待她们的客户。性工作以既能管理又能制造新风险的方式强化了药物使用。
借鉴“矛盾自主性”的概念，我们认为海洛因使用带来了新形式的自主性，使女性能够在不确定的情况下支持自己，但并不能使她们完全克服自己的脆弱性。性工作者的药物治疗计划应解决性风险背景下物质使用的具体逻辑，包括可能使某些使用海洛因的女性不适合接受 MAT 的多物质使用模式。
