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Tailoring programs to women who use drugs

In this video, Ruth Birgin from WHRIN talks about a gender perspective to harm reduction and practical solutions to adapt to women who use drugs
In contexts where harm reduction services implementation is new or of limited scale, it’s really important to first focus on scaling up and reaching people who use drugs with essential services. But once these services are established, it’s then really important to ensure that all people who use drugs can benefit from those services and are given unfettered access.
In the case of clients who identify as women, including trans women, this means ensuring relevance, safety and meaningful involvement of women who use drugs. People who use drugs face many barriers tied to stigma and criminalization when accessing the usually too few existing harm reduction services. Women face additional gender related obstacles that can vary from country to country and by location. They include a lack of consideration among harm reduction providers of how to ensure that relevance and access to women, including trans women, sex workers and other intersecting communities. While women may be the minority of the population of people who use drugs, their numbers are clearly substantive enough for their access limitations to be carefully considered and corrected.
Incomplete sex related data when it is collected tends to underestimate the numbers of women who use drugs when based on harm reduction service use alone, particularly where the service lacks gender sensitive programming. Furthermore, when women women who inject drugs have higher HIV and hepatitis C prevalence which has been demonstrated where data is available so women who use drugs are also less enabled to access and to adhere to antiretroviral therapy than their male counterparts.
The provision of women friendly services is vital for all harm reduction providers, the approach to service, adaptation or addition cannot be standardised as it varies depending on the priority needs and experience of women service users in each location. So it’s imperative to meaningfully involve women and also for services to be led by women who use drugs from the outset. However, there are a number of common implementation considerations that generally should be taken into account. Women who use drugs experience high rates of violence from the state as well as from intimate partners and others. And they have often few or no options for recourse.
This means that many affected women will not feel comfortable in male dominated service settings and may avoid services where they anticipate meeting particular men or spaces that they associate with police monitoring. In some societies, women are also restricted in their movements due to other commitments in their family or because permission or a compliment from their husband or a male member of their family is expected. Service hours can also be a barrier for many women, particularly those who are a principal carer for children.
So in addition to the conventional nine elements of harm reduction ,as listed by the UN system, it is increasingly recognized that harm reduction services must begin to more uniformly provide a range of sexual and reproductive health services tailored to the needs of women who use drugs. They include tailored outreach and programs to prevent gender based violence and to support survivors of violence, contraception, maternal and newborn health, safe abortion and post abortion services. In addition to the conventional STI services and treatment and condom programs already included among the nine elements. Employing women who use drugs peers for outreach and on staff creating violence prevention and support services.
Women only support spaces or times, provision of child care, parenting supports and women Peer outreach have also become priorities in various ways across different contexts in order to meet the needs of women who use drugs.
As an example, in Kachin State in the north of Myanmar, 12 member women’s advisory group has been established to improve harm reduction services. This group meets quarterly and consults with other women who use drugs on how to improve women’s sensitive services and to represent their community in various other forums. Members of the group identified low service attendance among their peers being caused by male dominance in service use numbers, as well as a strong preference for receiving services more anonymously and from women staff. As a result of feedback from the group The Medicine du Monde Kachin drop in center now has one day a week reserved for women users only and provides gender based violence awareness sessions and referrals.
Sexual and reproductive health services such as prevention of mother to child transmission and family planning alongside other harm reduction services and commodities. When harm reduction services were introduced in Dar es Salaam in Tanzania, there was a noticeable lack of women service users at both the drop in centre and the Mobile Outreach Service, which was a colorful bus with slogans promoting harm reduction. Focus group discussions with women who use drugs found that women were intimidated by the lack of other women attending the drop in centre and did not want to be seen in public with the colourful bus.
As a result of this consultation, smaller, unmarked vehicle was used to visit women at agreed meeting points at their homes and designated women only periods were also established at the drop in centre, which is now popular with women service users.
While harm reduction services tailored for women are still uncommon, harm reduction providers now have numerous working examples to draw from to improve relevance for women who use drugs, where one stop shop service provision is not immediately or comprehensively available, harm reduction workers can build women friendly referral networks. In these cases, it may be necessary to provide training to other services on gender, on drugs and on tolerance to reduce stigma and discrimination and to ensure optimal access. In all good practice examples, the key has been consultation with and meaningful involvement from women who use drugs.
Harm reduction practitioners can encourage the formation of women who use drugs groups and link women service users to local, national, regional and international networks of people who use drugs, many of which now include women’s advocacy groups.

At the beginning of this week’s topic, Naomi mentioned that women who use drugs are particularly vulnerable in terms of their health and are at a greater risk of HIV viral hepatitis infection then men who use drugs. In this video Ruth Birgin, from the Women and Harm Reduction International Network (WHRIN) expands on the particular vulnerabilities of women who use drugs and breaks down some of the mechanisms causing enhanced risks.

We hope you notice some familiarities with the intersectionality sessions from Week 1, or perhaps from other sessions touching on vulnerability factors or protective environments.

Ruth will not only guide us through the status quo, but will provide practical recommendations, such as:

  • offering sexual and reproductive health services tailored to the needs of women who use drugs
  • including tailored outreach
  • providing programs to prevent gender based violence
  • supporting survivors of violence
  • contraception
  • maternal and new-born health
  • safe abortion
  • post abortion services
  • etc,

There is a growing recognition of the great lack of progress on addressing the issue around women who use drugs. Ruth helps us understand that sometimes, something as simple as adapting the opening hours of a Harm Reduction centre, adapted to the needs of women who use drugs, can make a huge difference.

In the next topic of this week we will further explore how including female peer-workers in a harm reduction team is a fundamental component of a community based project.


You will find some documents attached in the ‘see also’ section below. This is just a selection, there are many more available online. You can find a useful virtual library here on the website of WHRIN. Feel free to share some of your suggested documentation with your fellow students in the comments section.

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Drug Use and Harm Reduction

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