Why I Gave Condoms, Lube and Conversation to a Drug-Addicted Sex Worker

Why taking a harm-reduction approach is sometimes all you can do to change a life.

Thick shining copper hair. That’s what I picture when I think of April. I try to block out the rest of the memory: the hair splayed on a dirty linoleum floor, the purple slip barely covering a body ravaged by hard living, the heroin needle stuck in her arm.

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 “April,” I said, shaking her gently. “April, come eat your cake.” She came groggily awake, lashes fluttering through swollen eyes, and the slip strap slid down a saggy, freckled arm.  

“You haven’t eaten the cake we brought you,” I said. “It’s your favorite.”

She mumbled something I couldn’t make out, perhaps an apology. Two co-workers and I helped her up and lead her to the living room, where we cut her a generous slice of tres leches cake and handed it to her on a paper plate.

“Thank you,” she murmured, but instead of eating, she slumped forward, tilting the plate dangerously. Someone intervened before the milky, spongy layers splattered onto the floor.

“Happy birthday,” we said. She’d just turned twenty-nine.


The first time I met April on the warped porch of her home in Durham, North Carolina, she wouldn’t look at me. Eyes darting to and fro, she scratched an abscess on her arm and asked repeatedly if I was a cop.

I handed her my peace offering, a box of condoms, flavored lubricant, band-aids and triple antibiotic ointment.

“Would a cop give you this?”

“Who sent you?” she asked in a thick Southern accent.

“I told you. I work for the North Carolina Harm Reduction Coalition. I’m Molly’s replacement.”

April squinted. “Molly?” Then she added, “Oh, yeah.”

We sat down and she shuffled through the box. Glancing at her arm, I winced at the abscess protruding from a grid of collapsed veins and scabs.

“You should have that arm looked at,” I said. “Do you want me to drive you to a clinic?”

She frowned. “I ain’t goin’ to no hospital. They treat me like shit. Always think I’m there for drugs, even when I’m sick.”

I was silent as April continued her appraisal of the supplies. Presently, a van pulled around the back of the house and a man emerged in a greasy mechanic’s uniform.

April sighed. “A client.” She picked up a condom. “Good thing you brought these.”

I nodded and took my leave.

In the coming months I continued to visit April at her home where she lived in a sunken ruin wallpapered in nicotine stain. Each time I delivered a box of supplies: condoms, clothing, hygienic items to prevent infection from drug use, even food, as during one visit I’d glanced in her refrigerator and found nothing but a half-empty bottle of Sunny Delight orange juice. As an employee of a harm reduction agency, I visit many people like April, those at high risk for HIV, hepatitis C and drug overdose. We offer educational resources, supplies to reduce the risks of death and disease, and if the person requests, referrals to drug treatment, vocational training programs or social services.  

During my three years at the agency, I’ve often been asked why I don’t tell people like April that they should “get a real job” or stop using drugs. As someone with a middle class background, I was taught to divide people into those who “deserved” help and those who didn’t, assured that a little tough love was necessary lest the undeserving become complacent, or worse, dependent. It is difficult to watch April sink deeper into addiction and not to judge her choices, but I’ve never told her to stop for the same reason I don’t harass every overweight person I meet about exercise. I don’t know if a person’s situation resulted from poor choices, genetics, stress, or something deeper. But I do know that the sting of judgment, the silent accusation that their plight is self-inflicted, the constant refrain from society, family, friends and even strangers, “if you would just fix yourself…” does not often motivate change. If anything, piling stigma and shame onto an already fragile self-esteem leads to resignation, self-hatred, depression and hopelessness. Cocooned in my privileged home, it was easy to avoid drugs and sex work. But if life had handed me April’s shoddy decks of cards, what makes me so certain I wouldn’t make the same choices she has? April might well be following the most rational path, given her options. So as a harm reductionist, I try to offer my services in a spirit of non-judgment. I don’t always succeed, but the more time I spend with April, and the more I learn about her background, the easier it becomes.

Though suspicious of me at first, April warmed as our visits became more frequent, and piece by piece she recounted the story of her life. By five years old, she’d taught herself to cook cheese and grits before catching the bus to school, tiptoeing past her mother, unconscious on the floor from a bottle of pain pills and past her father whose liquored snore rumbled through the house.

Raised with no boundaries or parental guidance, April wound up pregnant at fifteen. She struggled to raise her newborn son and keep up with school, maintain a job at a cleaning company, and care for her parents, who often stole her earnings to buy pills and alcohol. She planned to finish high school and move away to a better life with her son, but just before graduation, two-year-old Jamie was diagnosed with autism.

“I didn’t know how to handle it,” she confided to me one day, slumped on a worn sofa on her porch. “I was stressed and cryin’ all the time, pissed off at life, at God. I wanted to be a good Mom, but didn’t know how anymore.” She paused and picked at the lint on the couch. “A co-worker introduced me to dope to help with the stress. When I shot up for the first time, I thought, ‘Shit, I’ve been looking for this my whole life.’”

April’s mother and grandmother were both hooked on painkillers, so she was likely predisposed towards opiate addiction. From that first taste of heroin, her life swerved completely off course. Two consecutive DUIs and no money to pay for a good lawyer landed her an 18-month prison sentence. Jamie was taken away by the state and placed in a foster home. While in prison, April gave birth to a second son, Gabriel. Per prison regulations, she was shackled all through the birth, and she screamed and struggled against the cold metal chafing her wrists and ankles. Once Gabriel was born, she was permitted to hold him for only 15 minutes before he too was whisked away to a foster home.

When April left prison she was drug-free and determined to win back her sons. She dove into the fight against a powerful system stacked against her, enduring condescension, mind-numbing bureaucracy, accusations of unworthiness, and the weight of a criminal record and history of drug use that threatened to nullify her efforts. But stress, grief and dead ends became too much and she again turned to heroin to cope. In time, her tolerance increased, as did the price of her addiction.

“I started sellin’ my body,” says April. She was twenty-five.

The link between sex work and drug use is well documented. Though not all drug users are sex workers and not all sex workers use drugs, the two often compliment and complicate each other. Some people start sex work for the money and later turn to drugs as a coping mechanism or to gain entrance to a particular lifestyle. Others, like April, start with drugs and later use sex work to finance their habit (See the journal The Lancet). A criminal record and the absence of resources can also lead one to sex work as a means of sustenance.

Regardless of which came first, when coupled, sex work and drugs can lead to numerous complications. Sex workers who use drugs are more likely to experience violence and less likely to practice safe sex, which puts them at greater risk for disease transmission (Lancet). Many, like April, have been stabbed, raped, beaten and infected by clients.

During our visits April and I talked about tips to avoid violence and disease transmission, such as having a buddy system, never going alone to a client’s house, and not sharing drug equipment. I often wished there was more I could do to help - a box of strawberry-kiwi lube starts to look pretty pitiful when compared to not only addiction and violence, but also periodic homelessness, trauma, poverty, lack of resources, a criminal record and a host of other problems that weave a strong net to hold her in her current position. But I have to remind myself that I am a resource, not a rescuer. Just being present, someone to call in a time of need, may be the best I can offer.

Two weeks ago, April did call unexpectedly. I hadn’t heard from her in months, though I’d left multiple messages and visited her house. Her voice sounded brighter than usual.

“I’ve decided to change my life,” she announced, and proceeded to ask for referrals to drug treatment, a homeless shelter, and a vocational training center to learn new job skills. I happily obliged.

“I gotta get outta here,” she said. “Gotta get a new life.”

“That’s great,” I said. “And I’m glad to hear you’re okay. I was worried about you.”

“Who, me? I’m a survivor, remember?” She laughed. It was the first time I’d ever heard her laugh.

We chatted a few more minutes before she excused herself to call the treatment center.

“Good luck,” I said. “And keep in touch this time. Let me know how it goes.”

“Sure will.”

After she hung up, I stood for a few minutes with the phone in my hand, thinking. I wanted to believe she’d find a better life, though experience has taught me not to expect too much. Still, it’s remarkable that in the face of overwhelming odds, she’s still trying. I’m still trying too—to be present when I am needed, to step aside when I am not. And to make a small difference, even when all I can give is a sympathetic ear and some strawberry-kiwi lube. 

Tessie Castillo is the advocacy and communications coordinator at the North Carolina Harm Reduction Coalition. She writes a regular column for the Huffington Post.