Substance use and abuse is a significant public health problem for women. Challenges of addiction are exacerbated for women living in poverty. Through our discussions with women in HPTN 064, we revealed that substance use (both drugs and alcohol) was consistently identified as a pervasive problem in their lives. Women described how drugs were ubiquitous in most aspects of their lives—from the environmental/neighborhood level to their social, sexual, and family networks. Other common themes regarding substance use and abuse were related to violence surrounding both the drug trade and addiction, the financial implications of drug and alcohol abuse, as well as resilience and strength in response to the addiction or sustaining recovery from their personal drug use. Policy implications include developing programs to improve women’s financial situations, decriminalize drugs, and focus on resiliency and self-efficacy.