4 June 2026
The INHSU Fellowship Program is a nine-month initiative supporting early- and mid-career professionals working to improve health outcomes for women who use drugs. Through mentorship, training and global collaboration, it aims to strengthen leadership and support more gender-responsive approaches to care.
As part of the inaugural cohort, Alex White brings a community-led harm reduction perspective shaped by lived experience and on-the-ground practice in Austin, Texas.
Working at the Texas Harm Reduction Alliance, Alex delivers harm reduction in a highly restrictive policy environment, all while creating safer, more inclusive spaces for women and LGBTQ people who use drugs.
Can you tell me a bit about yourself, your work, and how it connects with women who use drugs?
I work at the Texas Harm Reduction Alliance in Austin, Texas, doing harm reduction in a state that criminalises the distribution of life-saving and safer use supplies. It’s a really interesting place to work because while there are so many restrictions, it has also given us flexibility to stay true to our values and do what we want to do.
We only hire people with lived experience of drug use, sex work, homelessness and/or incarceration — including people who actively use drugs.
One day a week, our drop-in space is open only to women and LGBTQ people who use drugs. It’s a really sweet, tender space for women and queer people to take care of each other and spend time together.
What drove the decision to create a dedicated day for women and LGBTQ people?
About 75% of the 3,000 people we reach in Austin are men, and our drop-in space is very high volume.
We noticed that it could feel intimidating and even hostile for a woman or a queer person to walk into. So we wanted to create a space that was just for them — somewhere they could feel comfortable.
What led you into harm reduction work?
I was doing full-service sex work as a teenager and was part of a community where a lot of people were using heroin.
At the same time, two of my brothers ended up using heroin, including my youngest brother, who was overdosing repeatedly. We weren’t able to get naloxone where we lived at the time, so I went to a needle exchange in another state to get it. That’s what we used to reverse his overdoses over and over again.
The paramedics were like, “How did you get this? How did you even know what this was?” You know?
From there, I just kept seeing people die. At one point it felt like every week I knew someone who had died from an overdose.
That experience is what led me to dedicate my life to harm reduction.
What are the most pressing issues you’re seeing for women who use drugs?
A big one is that many women don’t know how to inject themselves and are relying on men to do it for them. That can create really controlling dynamics, so helping people understand their own bodies and have autonomy is really important.
A lot of the women we work with are also experiencing homelessness and a huge amount of violence – both sexual and physical. And there just aren’t services that are designed specifically for women who use drugs.
Another major issue in Texas is child removal. Women are having their children taken away, sometimes permanently, and the impact of that is devastating.
What’s working well in your setting?
We’re seeing overdose deaths decrease in our city while, at the same time, overdose reversals reported by our participants are increasing.
To me, that shows that people who use drugs are keeping people alive.
Hiring people with lived experience – especially people who actively use drugs – is also incredibly effective. It builds trust, strengthens services, and gives us real-time understanding of what’s happening in the community.
What does good gender-responsive care look like to you?
For me, it comes back to bodily autonomy.
That includes reproductive care, harm reduction, gender-affirming care, anything that puts power back into people’s hands.
Women’s bodies are often a site of struggle, so any way we can give people more control over their own bodies feels really powerful.
What does being selected for this fellowship mean to you?
I was really shocked and excited to receive it.
Being part of this program, and getting exposure to people doing this work internationally, especially focused on women, really broadens my world. It gives me new ideas and new ways of thinking about what’s possible.
What change would you most like to see in the next few years?
I want to see women who use drugs organising.
What do you wish more people understood about the women you work with?
Women who use drugs are resilient, resourceful and scrappy. And I think it’s worth saying that there are so many reasons people use drugs – it’s not always about trauma or coping. Sometimes it’s about pleasure, and in a world where our bodily autonomy is criminalised, even allowing yourself pleasure can be a really subversive thing for a woman to do.
The Fellowship program is supported by a grant from AbbVie, we thank them for their support of this program. Supporters have no control over content, tone, emphasis, allocation of funds, or selection of recipients.
