“Women are the most vulnerable among the vulnerable”

A few minutes before 10 am, the Integrated Support Service (SAI) run by Ares do Pinhal, in the former Casal Ventoso area, opens its doors. There is always a queue when it opens, and throughout the day there is a constant flow of people: they come in, go out, stay for a while and then return. For many – those in need of support – this is one of the few places where they can feel safe and have their basic needs met. 

“When we open at 10 am, there are already about 20 to 30 people waiting. Many come for a light meal, to watch television or just to rest for a while,” explains Cláudia Pereira, psychologist and Research and Development Coordinator at Ares do Pinhal. 

Inside, the flow is constant but orderly. To the left, reception organises entry: each user gives their number and is directed to the different areas. On the right, a communal area where they can sit down, have a coffee, charge their mobile phones, watch television, use one of the computers or have a light meal. Further on, the changing rooms provide the essentials – every day, around 20 people have a shower and are given clothes and personal hygiene products. 

A solution off the streets

On the other side of the building, separated from the communal area by corridors, are the supervised consumption rooms, the heart of this initiative. There are three separate spaces: two for smoking and a third room for injecting. 

Before entering, users are given the necessary equipment – except for the substances themselves – which is disposed of at the end of each session. The rooms are enclosed and have a glass wall, allowing the support staff to monitor what is happening inside and intervene if necessary. 

The environment aims to move away from a clinical feel: there are tables, chairs, lamps, extractor fans and even a mock window. The intention is clear: “if they are going to use drugs, let them do so safely, comfortably, hygienically and, above all, without infecting themselves or others,” emphasises the manager. 

Risk Reduction and Harm Minimisation (RRMD) 
 

The SAI receives around 700 people a month (around 300 a day). Around 25% are homeless; the rest live in precarious conditions, often “on the edge” between having a roof over their heads and not, as Cláudia Pereira describes it. Throughout the day, services from various areas come together: social support, medical care and access to basic resources. “There is always a social worker on hand to help them with whatever they need.” 

Here, the aim is not to impose change. “We don’t expect everyone to go into treatment. We want them to live a good quality of life. People choose their own path; we accompany them,” she emphasises. This is the logic behind Harm Reduction and Harm Minimisation. 

The results reflect this ongoing work. In the last month alone (April 2026), over 100 screenings for HIV, hepatitis C and syphilis were carried out, with no new cases among regular users.  

The most vulnerable among the vulnerable 
 

Within this already vulnerable group, there is a group that is even more at risk: women. They account for around 15% of SAI service users, yet face disproportionate risks. “They are subjected to physical and sexual assaults that men are generally able to avoid,” explains Cláudia Pereira. Many turn to sex work to survive, increasing their exposure to violence and infections. Some arrive after years on the streets, without documents, without a support network, completely cut off from the system. 

“They are the most vulnerable among the vulnerable,” she sums up. Added to this are invisible difficulties: menstruating on the streets, years without gynaecological care, going through the menopause without support, or living with untreated illnesses.