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‘Women injecting drug users are one of the most stigmatised
groups in Russia
,’ Peter Meylakhs of the Center for Independent
Social Research in St Petersburg told delegates at Tuesday
morning’s
Women, harm reduction and HIV: obstacles and
opportunities
. ‘Services specifically designed for them are scarce
and not easy to access.’
He had carried out research to identify barriers that hinder women
taking advantage of the services. ‘The main barriers are any kind of
costs – whether financial, time or emotional,’ he said. ‘Everybody
understands financial costs. But what if a woman is sick, needs
treatment but doesn’t want to go to the doctor and be stigmatised?’
Barriers could be subjective, he said, and what is a barrier in one
country might not be in another. They could be institutional or
individual – such as a person’s values, norms, beliefs, and social
circumstances. The barriers for women injecting drug users
accessing treatment included a hostile social environment, active
drug use, emotional dependence on partners, childcare and the fear
of looking like a bad mother and the fear of their HIV positive status
being revealed.
Women could often see their drug use as their main and only
problem and other health problems could be ignored, said Mr
Meylakhs. There were also the analgesic properties of the drugs to be
considered: ‘Because they’re on opiates, nothing hurts. So they only
go to the doctor when things are really bad. They think “drug use is my
main problem – I’ll get off drugs first and then I’ll go to the doctor”.’
Another problem was the ‘hierarchisation’ of patients, he said,
with rehab patients often treated better than detox patients. ‘But
women do overcome these barriers,’ he said. ‘Otherwise we
wouldn’t know about them.
Lowering institutional barriers would require changes in legislation
and structural reform, he said. ‘There’s no point blaming individual
doctors – they’re often overwhelmed, overworked and burnt out.’
Lowering individual barriers, meanwhile, would involve addressing
women IDUs’ attitudes to their health and norms. It was also
essential to develop multidisciplinary teams to work with women
IDUs, more innovative research, and changes in the law regarding
parents and drug use.
'The experience of getting healthcare
for women who use drugs is not a very
comfortable one,’
said project officer at
the open Society Initiatives' public health
programme, Sophie Pinkham, reporting on
research carried out in Ukraine and Georgia.
The research was based on focus groups
with users and providers, mapping services
and semi-structured interviews. ‘The
purpose was to listen to what drug users
thought about their lives and the services
available, as well as what providers
thought.’
Ukraine was now facing a ‘feminisation’
of its HIV epidemic, with women accounting
for 40 per cent of cases. ‘It’s not clear how
much of this is down to drug use because
data collection is very flawed,’ she said. ‘But
STI rates are through the roof and unsafe
abortions – involving significant risk of death
and infertility – are commonplace.’
Ukraine’s National Reproductive Health
Programme was often inaccessible and
unfriendly towards drug users, she said.
‘They don’t consider drug users and sex
workers to be target groups and the stigma
towards them is intense. Women also
reported extremely low levels of condom
use, for the same reasons as all over the
world – expressions of trust and the risk of
violence from partners and clients.’
There were several layers of stigma that
kept women from accessing services –
stigma from health workers, self-stigma in
terms of the way they expect to be treated
and tangible barriers, such as the fact that
STI diagnosis and treatment was not free.
‘Community health centres do not do STI
diagnosis,’ she said. ‘It has to be sent away
to a lab, and there is a fee attached. You
have to pay for everything – even con-
fidentiality costs extra.’ Most people found
out they were HIV positive when in hospital
for something else and were often treated in
an uncompassionate way.
Women often had very little control over
how they took drugs, she said. ‘The men
usually obtain and inject the drugs – after
they have injected themselves – and there is
lots of transitional sex.’ The fact that women
usually stayed at home and were dependent
on men made them an especially hard to
reach group, and there were significant
issues of low self esteem and low
educational levels along with physical and
sexual abuse. ‘Because of the intense
stigma of women IDUs, they often have a
very limited social circle and lose social
contexts much quicker than men,’ she said.
‘There’s no one for them to depend on
except men.’
Barriers to access included the attitudes
of male partners, children, geography, time
and the fear of public exposure. In Georgia,
meanwhile, only preliminary results were
available because women were so
stigmatised that they refused to participate
in focus groups, even with trained female
outreach workers.
Integrated and gender-sensitive services
were needed, alongside improved provider
training, according to Ms Pinkham.
‘Providers are a huge part of the problem
and they could be a big part of the solution,’
she said.
6 –
Daily Update
– DAY FOUR – Wednesday 14 May 2008
Reaching Russia’s drug-using women
Women hidden from services by ‘layers of stigma’
‘Because they’re on opiates,
nothing hurts... They think “drug
use is my main problem – I’ll get
off drugs first and then I’ll go to
the doctor”.’