Women who use drugs represent 20% to 30% of those who visit harm reduction structures in Europe. Socially included people are also a minority in these services. Socially included women who use drugs are therefore doubly invisible in harm reduction structures. This communication Aims to explain the lower attendance by socially included women of harm reduction structures, in France and in Quebec. The results presented are based on 97 interviews carried out with socially included women and men who use drug, with harm reduction professionals and actors in drug-related public policies, in Bordeaux and Montreal. Harm reduction structures are, in both cities, more designed to meet the needs of a precarious men who use drugs. In Bordeaux as in Montreal, non-mixed spaces dedicated to women are rare, whereas non-mixed spaces have been shown to encourage the arrival of women in the services. The services and schedelus proposed by the structures also correspond more to the needs of precarious drug users. However, structures exist which could better meet the needs of women and socially included people, but the drug users interviewed do not seek them either. This non-use can be explained by four main reasons: first, the participants believe that they do not need help. Secondly, some have already spoken about their drug use to professionals who are not specialized in the management of drug consumption, and they have felt judged or misunderstood, which subsequently constitutes an obstacle to health care. Third, most participants are unaware of the existing services. Fourth, the interviewees refuse to be assimilated to the marginalized public targeted by most of the harm reduction structures, in a strategy of avoiding stigma. Several recommendations can be considered to improve harm reduction among a female and socially included population, their non-use of the services constituting a public health problem.