Zanzibar, Tanzania – Jackie held her one month old child to her chest. If for no other reason, the new life pressed against her had to be why she stopped using. After eight years of heroin addiction, she‘d been clean for three weeks.
“Let me be clear, this isn‘t my first time in a sober house,” she said from a treatment centre in Zanzibar, an island off the coast of Tanzania where, according to the Revolutionary Government of Zanzibar, an estimated 7 percent of the one million residents are drug addicts.
This is one of the highest rates in the world.
Jackie‘s determined that this will be her last time.
“The first fix is not the solution, I‘m staying clean for myself and for my baby. I don‘t want to lose her, I can‘t stay sane if I know she‘s being raised by another person.”
Jackie, whose surname has not been published to protect her privacy, has been in and out of treatment centres seven times.
Zanzibar has launched an aggressive campaign to deal with its drug problem but everyone is confounded by how to help female addicts such as Jackie, whose treatment always seems to end the same way – back on the streets using.
In the 1990s, international drug smuggling routes began moving heroin from Afghanistan through East Africa‘s poorly regulated ports on the way to the US and Europe.
It wasn’t long before dirt-cheap narcotics leaked into the population – affordable even for the more than 40 percent of the population living below the poverty line.
The help available to addicts in Zanzibar is rare in the rest of Africa, where only one in 18 drug users have access to help services, as compared to one in three in North America.
This has drawn addicts from across East Africa and as far as Oman to seek help.
Zanzibar has a network of 11 sober houses that have treated more than 3,000 people, harm-reduction programmes for those still using, daily 12-step meetings around the island, and for the past two months, a methadone clinic.
But women are slipping through the cracks of these services. Only one of the methadone clinic‘s 30 or so patients is a woman, and while the men‘s sober houses range from 20 to 30 who recover, the two women‘s clinics have only three or four who kick the habit.
“Everywhere you go you see this phenomenon of women not getting to treatment, or they drop out of treatment, and if you ask them why they say they are uncomfortable, they say, ‘we‘re stigmatised and we have no services that address our needs,'” said Nabila el-Bassel a professor at Columbia University who studies female drug use.
Globally, limited research exists on female drug addicts.
“There is a huge, huge gap in knowledge about women who use drugs everywhere,” Bassel said. “We need to stop using women as variables.”
Women constitute a minority of drug users, but they are likely under-reported and they also experience devastating consequences of addiction: female injection drug users face higher mortality rates, higher risks of HIV infection, and faster progression to dependency.
Female drug users are stigmatised around the world but particularly in conservative Zanzibar, where 99 percent of the population is Muslim.
“Women feel embarrassed, ashamed, they‘re dealing with religion, culture, tradition, prostitution, rape.”
Female drug users are likely to have been sexually assaulted in the past and sexually assaulted when they‘re using. Women often exchange sex for drugs, pairing two sins that make them irredeemable in the eyes of many of the island‘s residents.
“When I was using I‘d go to Maskani, I wouldn‘t have anything, no money,” Jackie said, referring to the place where she bought drugs. “‘Don‘t worry Jackie,’ they‘d say, ‘I have money,’ they‘d buy me drugs,” she said recounting her conversation with male drug users.
“Are you going to sleep with me?” Jackie recounted saying as she balanced her baby on her lap, bottle-feeding her.
Women are typically introduced to injection drugs by a male partner with whom they often share needles.
Injection drug user rates have ballooned to 16 percent, and among sex workers to 12.8 percent in the last decade.
“Anybody can find themselves into drug addiction [but it’s more likely] with traumatic effects of domestic violence, sexual assault, physical abuse, single parents,” said Abdullah.
“You try to cover your feelings, you try to escape.”
Hadija and Sandra sat outside Malaika Sober House, one of the island’s two clinics for women. They had just finished a 12-step meeting and the women traded stories while smoking cigarettes.
Stretched across the door step was a woman who periodically groaned as the pain of withdrawal rustled her consciousness.
This is Hadija’s second time at Malaika, she relapsed a few months ago after staying sober for more than two years.
“We started to establish the women‘s programme in 2011 and very few have sustained recovery, more have collapsed along the way,” Abdullah said of the women‘s sober houses.
“Its been a good programme with very few clients.”
Sandra misses her two children. It is illegal for children to be in sober houses in Zanzibar, a barrier for many women.
“For now, they‘re better off without me, especially the youngest one,” Sandra said.
“Oh god, I used to take her with me to places where people smoked dope. I need to focus on my recovery, a year isn‘t a long time if I know it means I can have the rest of my life with them,” she said.
Because of her baby and because in the past Jackie was caught with heroin at the sober house, she’s left and is looking for an apartment of her own.
“My sister calls me every morning, ‘Jackie please don‘t use today,'” Jackie said. “Sometimes I talk to myself when I‘m thinking about using: ‘Don‘t do this Jackie, don‘t do it.’“