Drug use and (non-)use of addiction treatment by women in French Guyana: gender and migration effects

Background

French Guiana is a single French territorial collectivity (CTU) located on the north-east coast of South America. The territory was colonised by French royalty in the 17th century and was granted the status of overseas department in 1946. Although general population surveys show that drug use in French Guyana is lower than in mainland France, the territory has specific social and health problems, such as the high visibility of crack cocaine and an HIV seropositivity rate 10 times higher than the national average (Obradovic, 2020). The medico-social offer, made up of harm reduction centres and addiction treatment centres, is present almost exclusively on the Atlantic coast. Most of the facilities cater for male alcohol and crack users. Women's drug use and the experiences of female drug users in French Guiana are not well known. However, according to the literature and professionals, the lack of access to care for this population is a major issue. In this paper, I will highlight the links between (non-)use of addiction treatment and the effects of gender and migration.

Methods

Firstly, I will draw on the quantitative analysis of the ANRS-Coquelicot survey, an sociological study into the seroprevalence of HIV and viral hepatitis, and the profiles of users in mainland France and French Guyana. Secondly, I will draw on the qualitative data collected during my fieldwork, consisting of interviews with female users and observations within medico-social structures.

Results

Crack cocaine, alone or in combination with alcohol, tobacco and cannabis, is the substance most used daily by the most vulnerable fringe of female users. The standard of living of the women we meet in the medico-social facilities is extremely low, and few of them work, have accommodation or have their administrative situation regularised. The various waves of migration (mainly from Brazil, Haiti and the Dominican Republic) to French Guiana have made the population very heterogeneous in terms of language. This is an important factor to take into account when analysing the use of healthcare. On this subject, I was able to observe that the women I met have regular relations with harm reduction centres and their professionals, but access to care is much less common. On the one hand, this is due to administrative obstacles and the fact that migrant women have to go back and forth to their country of origin, which makes treatment and follow-up inaccessible; on the other hand, it is due to the way addiction and medicine are represented. The allopathic medicine on offer does not necessarily coincide with the needs of the users, some of whom turn to alternative treatments based on magico-religious beliefs.

Conclusions

While harm reduction measures seem to meet the expectations of women users, there are limits to the use of addiction treatment. In order to understand the needs of women in this context, it is necessary to take into account gender, migration history and Guyanese norms.