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Women might represent 20-30% of injecting drug users in Eastern Europe and Central Asia, [2] and the proportions of women using are rising. [7] The European Union reports increasing proportion of females among young people who use drugs with differences depending on type of drugs. [1] Increasing numbers of female IDUs are in need of harm reduction services, and programs need to adjust to the needs of their female populations served.
Historically, the HIV epidemic in Eastern Europe and Central Asia started among injecting drug users (IDUs), the vast majority of whom were male. Most of harm reduction services for IDUs were designed for the male majority with little consideration of gender sensitivity. In recent years, however, the number of women using drugs, seeking drug treatment, and being diagnosed with HIV in Eastern Europe and Central Asia has increased. UNAIDS estimates that 85% of HIV-positive women in the region were infected through injecting drug use or sex with an IDU partner. [5]
Vulnerabilities, risks and needs
The vulnerabilities, risks and needs of women drug users often differ from those of men, and vary depending on cultural and social context. [1] Drug use, especially injection, among women is often more stigmatized than it is among men, inhibiting a woman’s ability to access health services, reduce risk behaviors, and defend her rights. There is a substantial overlap between drug use and formal and informal (transactional) sex work, and this overlap is associated with lower levels of condom use and higher frequency of HIV and sexually transmitted infections (STIs). Women drug users are more likely to have regular sexual partners who are IDUs, to inject with their partners, and to rely on their partners for injections, drugs, and supplies. These factors further increase their vulnerability, and reduce their ability to control whether sterile injecting equipment and condoms are used. Violence and the threat of violence in relationships also add to the vulnerability of many female IDUs. Services for women who are victims of violence are rarely adapted to the needs of IDUs, and sometimes specifically exclude drug users. Counseling related to condom negotiation skills and other reproductive health issues and services are often neglected in harm reduction services, and gender-specific harm reduction outreach and support groups for women are rare. [3]
Female problem drug users face many specific challenges related to pregnancy and childcare. They often do not have adequate information on drug use and drug treatment during pregnancy, and there are few programs offering outreach and support to pregnant drug users. Some IDUs are encouraged to terminate their pregnancies, told that they cannot have healthy babies, and denied appropriate care. Many women opiate users, particularly those in Russia, do not have access to opioid substitution therapy, which is a vital part of care for pregnant opiate users. Some rehabilitation and detoxification facilities reject pregnant clients, and some do not accept women, while others make no provision for childcare and therefore exclude women with young children. Women who leave their children to enter rehabilitation sometimes lose custody—another disincentive to entering treatment. [6]
Services
Improving services and access to services for women who inject drugs requires an assessment of women’s needs and vulnerabilities, and adaptation to respond more effectively to these needs. Examples of gender-specific harm reduction services include:
• Work with female outreach workers and female peer counselors
• Special spaces and groups for women, and “ladies’ nights” when only women come the service center
• Childcare options for women who want to attend groups or other service activities
• Information materials addressing the special needs of women
• Distribution of special hygienic kits for women
• Provision of food, clothing, and supplies for children
• Drug dependency treatment programs designed to meet the psychological needs of women
• Domestic violence programs
• Couples counseling, and training in condom negotiation and other communication skills
• Harm reduction counseling and supplies offered confidentially at women’s health sites, or through services for sex workers, to provide access for women afraid to disclose their drug use
• Links to other services for women (such as gynecological care, prenatal care, shelters etc.)
It is vital that harm reduction services are able to refer their clients to other services (such as gynecological care, prenatal care, shelters etc.) that are friendly to IDU women and knowledgeable about their needs. This may require advocacy for better education of the staff of these facilities about the nature of drug dependence and problem drug use, and may require that harm reduction services establish links with these services and work to increase their knowledge and skills.
[1] EMCDDA (2006) A gender perspective on drug use and responding to drug problems. EMCDDA, Lisbon, November 2006
[in English]
[2] Malyuta, R. and Thorne, C., (2008) “Eastern Europe and Central Asia: IDU, HIV and PMTCT in the context of drug use.” Presentation at the International AIDS Conference, Mexico City, 2008.
[3] OSI (2007) Pinkham, S. and Malinowska-Sempruch, K. Women, Harm Reduction, and HIV, International Harm Reduction Development Program of the Open Society Institute. New York. 2007
[in English]
[4] OSI PHP (2007) Public Health Factsheet: Women’s Health and Harm Reduction: Communities Working Together to Save Lives, Open Society Institute Public Health Program, 2007
[in Russian] [in English]
[5] UNAIDS (2008) UNAIDS, Report on the global AIDS epidemic, 2008.
[in English]
[6] UNODC (2004) Substance abuse treatment and care for women: Case studies and lessons learned. Vienna, 2004. |
