Elevating Women of Color in Public Health and Harm Reduction

The battle cry for women to step into roles and responsibilities in politics, technology, and marketing has steadily gained momentum in circles across the United States. For the past decade, academic institutions have spouted the importance of programming to encourage women pursuing a career in Science, Technology, Engineering, and Math (STEM). Organizations like EMILY’s List create a pipeline to encourage and fund women entering politics.

In 2013, Facebook COO Sheryl Sandberg’s TED Talk and subsequent book, Lean In, sparked an energetic global conversation surrounding gender inequality in the workplace and the dearth of female leaders in the highest levels of industry.

In a similar vein, the field of public health has suffered a paucity not only women leaders, but women of color in top leadership positions. This lack of representation promotes a narrative that fails to acknowledge health disparities communities of color, particularly women of color, face.

My background in public health and harm reduction began in Seattle, where people experiencing homelessness face a dire housing crisis compounded by the opioid and heroin epidemic. The disparities among racial lines provide a stark contrast. A recent Frontline investigation revealed that between 2010 and 2014, heroin overdose deaths tripled among African Americans.

Homelessness, often a consequence of chaotic drug use, also spotlights a racial divide: in 2010, nearly 25% of Black families lived in poverty, three times the rate of White families. Black families also occupy homeless shelters at a rate 7 times higher than White families.

The acute need of communities of color ravaged by these joint epidemics clearly exists. However, due to institutional racism, generational trauma, and gender-based stigma, women of color remain at increased risk for disease and complications of drug use compared to men.

For example, the HIV epidemic has a disproportionate impact on Black women. In 2010, African American women comprised the fourth largest number of all new HIV infections, making them 20x more likely to contract HIV than their White counterparts. Among transgender women of color, the disparities are even greater. Yet when the pre-exposure prophylaxis (PrEP) pill—which is 90% effective when taken daily­­––was introduced as a preventative HIV measure, prevention efforts shifted to target men who have sex with men (MSM).

While I worked in hepatitis C in Seattle, many conversations about infectious diseases with providers and case management clients included PrEP education. With African American clients in particular, the knowledge of an HIV prevention pill was explosive and often triggered anger and a slew of questions.

“How come I don’t know about this already? Why aren’t they telling people about it? I need to be talking to my children about this!”

Given the disproportionate impact of the HIV epidemic on Black women, this lack of awareness of PrEP is troubling. However, this disregard for women of color extends to prevention initiatives for substance use, viral hepatitis, HIV, reproductive health, and more.

Women of color have suffered immense health disparities under the opioid epidemic and the subsequent rates of infectious diseases, they remain unrepresented in the highest tiers of in mission-driven organizations and government sectors.

However, September of 2016 promised to shift that sentiment when Monique Tula was appointed the new Executive Director of the Harm Reduction Coalition, a pioneering New York organization dedicated to advocating for policy and public health reform for people who use drugs and people living with HIV and hepatitis C.

Tula’s appointment represents a significant paradigm shift in the harm reduction movement, which has been led by white men for the past twenty-five years. The Harm Reduction Coalition recently held its 11th annual conference in San Diego. When Tula was presented to the 1200 advocates gathered in the room, the crowd roared its approval. Many women stood and spoke about the effect Tula’s appointment would have on their work and the joy of seeing her represented at the highest professional level in the movement.

Tula is disarmingly modest about the organization’s decision to appoint her. “There may be some people who have a more credentialed pedigree who would be suitable for this role, people who are smarter, who are more politically savvy. [But] I think the board of directors made a very clear statement, unspoken or spoken, that now is the time for a black leader, and a black woman leader at that. If not now, when?” Tula’s ascension to this role symbolizes not only a professional impact on other women, but an emotional and psychological impact as well. It marks a long overdue reorientation to women of color in public health circles, particularly as statistics regarding the opioid epidemic, overdose rates, and viral hepatitis cases continue to rise.

I believe Tula’s presence as a pioneer and leader will help strengthen the scaffolding for other women of color to step into leadership roles in the harm reduction movement. Similar to the call for to create trajectories encouraging young women to enter STEM and politics, I am hopeful that this avant-garde woman will inspire women of color to take their rightful place in this movement.



About the author

Emily Stets is a young public health professional and harm reductionist with an interest in women's health, reproductive justice, youth development, and drug user health. A Minnesota transplant, she currently works to integrate preventative public health and positive youth development at the Forum for Youth Investment. Connect with her via LinkedIn.