Addressing Women’s Needs in Harm Reduction Services. Member Meeting 2018
AIDS Action Europe Member and Partner Meeting took place on Saturday, October 20, in Berlin. This year the AAE Steering Committee decided to focus on 2 topics of concern for civil society organisations working in the field: good practices and gaps in addressing women in harm reduction and the role of international networks in response to HIV/AIDS, TB and viral hepatitis.
Sasha Gurinova, Deutsche AIDS-Hilfe, Germany, opened the first topic with her keynote speech focusing on women’s needs in harm reduction services. Sasha has been working in the harm reduction field for over 15 years and is leading the work package on testing and linkage to care in the HA-REACT Joint Action. In her presentation she highlighted why it is important to consider gender in harm reduction approaches. Women and men have different experiences in drug use. Women who inject drugs remain more vulnerable and at higher risk than their male counterparts. Compared to males who inject drugs, they experience higher mortality rates, faster progression to drug dependence, increased likelihood of injecting related problems, increased level of risky injecting and/or sexual behaviors, and increased rates of HIV. Traditionally, harm reduction services are tailored to the needs of men who use drugs and do not meet the special needs of women or other non-binary people, which prevents them to use those services.
During the meeting AAE member organisations presented the challenges they face and good practices on meeting the needs of women who use drugs in their work. Country examples were presented by members from Tajikistan, Georgia, Greece and Czech Republic.
Parvina Giyosova from NGO Apeyron presented the situation in Tajikistan and the conditions and setting they need to work in. The Republic of Tajikistan shares a border with Afghanistan, and as a result of this a big amount of drugs pass through and, consequently, settle in the country. Even though the government provides support to people who use drugs, due to the more traditional view on women’s role in the society, women who use drugs face higher stigma and are more likely to be discriminated by governmental structures. This is one of the main reasons why women who use drugs do not use harm reduction services.
The situation in Georgia was presented by Ia Verulashvili from NGO Women Centre and there are similarities to the situation in Tajikistan. At the same time, Georgian drug legislation is one of the strictest in the countries of former USSR. Women who use drugs face double stigma as a person who uses drugs and as a woman. It keeps them away from accessing harm reduction and HIV prevention services. Only a tiny proportion access harm reduction services. Those who manage to access services face discrimination and abuse from male clients of HR services, many women leave harm reduction programmes because there are insulted for their drug use.
Already during the preparation of the meeting, it became clear that quite often harm reduction services address women when they are part of services provided to sex workers. That was reflected in the work presented by our two member organisations from Greece and Czech Republic.
Hana Malinova, from the NGO Bliss without Risk, presented their work with sex workers, which they have carried out since 1992. Bliss without risk runs drop-in centres in 9 regions of the Czech Republic as well as a mobile clinic. The positive experience of mobile clinic was replicated and is now available in Ukraine and in Zimbabwe. It offers a space for almost a full range of services and not only health services but above all it is a place for undisturbed confidential interviews that provides valuable data on the situation of women who are involved in sex work and/or drug use.
The situation in Greece is characterised by the availability of governmental services for OST care, distribution of safer injection kits happening in Athens mostly, and access to testing and treatment of HIV/HBV/HCV. At the same time there is no available naloxone or opioid overdose prevention interventions, no shelters for homeless PWUD, there are very few community-based interventions/ peers empowerment, very few outreach interventions in Athens & Thessaloniki, no drug consumption rooms, no LGBTQI+ friendly services, no sex work friendly services and high level of stigma and discrimination. Maria Xanthaki, from the NGO Positive Voice in Greece talked about her experience with the Red Umbrella Athens drop-in centre and outreach work where they provide counselling and referrals for sexual & reproductive health, harm reduction of sex work and drug use, psychosocial support, testing and linkage to care, legal advice etc.
Sasha Gurinova presented the following recommendations on what can be done in order to improve the situation.
On national advocacy level we should work in the following direction:
- Direct contact and involvement of women, fight stigma towards WUD,
- Focus on improvement of access of women to healthcare and harm reduction services and those services should fit to the need of WUD.
Another direction of work is how we can improve already existing services:
- By introducing “Kids corner” and changing tables for babies
- Setting up self-help groups for women and safe injection skills training since women are quite often second on the needle and are injected by their partners.
- Introduction of child rearing consultations as well as consultations on sexuality and sexual health.
- Motivate GPs to work with harm reduction services
- Involve peers/women
- Work out referral strategies for women
Furthermore, she presented the training manual on HIV and HCV rapid testing in low-threshold settings for PWUD developed within the Joint Action HA-REACT, which includes a chapter on gender sensitive approaches, in English and Russian.