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Articles published by IANS :
The Hidden Population -
Need for Services
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Background
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology." U.N. Platform for Action, Beijing, 1995.
All available evidence points to an increase in problems associated with drug abuse for women in South Asia. Women feel the impact of drug abuse in two main ways. First, if they are themselves users. Second, when a member of their family abuses drugs. In certain instances, women also engage in trafficking drugs.
Yet, paradoxically, the extent of the evidence for all of this is patchy. There are several reasons for this. Women have traditionally not been associated with drug use in the minds of the general public. (There are certainly fewer female than male drug users, but anecdotal reports and work underway are destroying the myth that drug use is an exclusively male phenomenon). In addition, drug abuse by women is much more stigmatized by the community. This forces female drug users to hide their problems. This itself is a problem because 'hidden' drug use means that female drug users will not access the services that they need. The flip side of this is that service providers find it hard to identify, reach out and engage with this vulnerable population.
Seen in the larger context, the problem of drug use and addiction cannot be separated from other aspects of women's social conditioning. The social and economic status of women directly impinges upon their freedom. The problem is expounded when women suffer the consequences of such abuse by members of their family.
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Challenges Facing Women
A list of the challenges facing women in South Asia would include: violence, poverty, a lack of education and access to health services, restricted opportunities for employment, unequal status and limited visibility in the political arena, especially decision making positions. In South Asia, it has been said that women are sometimes just invisible.
Women drug users in particular face challenges related to blame, stigma and discrimination to a much larger degree than their male counterparts. As a result, the burden that women carry is manifold and in addition to the above includes emotional and interpersonal difficulties, neglect of children, loss of security, compromised dignity, and health risks including HIV. A list of the main problems associated with drug use is:
Financial implications of drug use, including expending sometimes limited family resources towards supporting a drug abuse habit. Indebtedness often leads to the female becoming involved in commercial sexual exchanges.
Chronic health conditions and poor health Along with poor physical health, many women drug users/partners of male drug users experience trauma and emotional and mental health problems, including poor self esteem, feelings of worthlessness, anxiety, insomnia, depression and suicidal ideation which often go undiagnosed and untreated.
Burden of household and child care related responsibilities. The impact of drugs on women as caregivers carrying the burden of the drug use of their male family members is sizeable and cannot be underestimated. As well, child care responsibilities lie primarily with women, and women are often unable to access services due to the relative scarcity of services offering/inclusive of a child care component.
Lack of effective and gender responsive services. Services that are gender sensitive, non threatening and include trained female service providers with appropriate skills are limited in number. Another challenge that women face is lack of information and access to health services, including HIV/AIDS prevention & care programmes.
Women, Drug Use & HIV/AIDS Drug use, and especially injecting drug use (IDU) are major risk factors in an individual contracting HIV. On top of this, women face an increased vulnerability to HIV, not only due to biological, but also social reasons, thereby leading to an increased number of infected women, a phenomenon that is now being termed as the 'feminization of the epidemic'.
The trajectory of HIV infections in South Asia clearly demonstrates that gender inequality is powerfully linked to the epidemic. Feminized poverty and discrimination against women and girls intersect with issues of forced migration and trafficking, thereby contributing to increased risks to HIV. Power imbalances in their relationships with men often make women unable to negotiate safer sex or protect themselves from unsafe sex. Particularly tragic when women contract HIV through violence committed against them.
Further, to add to their misfortune there is the dual scourge of stigma and prejudice attached to those who have contracted the virus. Many times, instead of receiving the special attention and services women and girls deserve because of their unique needs, they are discriminated against and isolated. This highlights the urgent need to address issues related to women's disempowerment and the spread of HIV.
Service Needs In most countries of the world, the circumstances of women's lives are very different from those of men. This is also reflected in their experience of substance use problems. Women's substance use problems are more stigmatized and less likely to be acknowledged than men's. As a result, much less is known about the prevalence and patterns of women's substance use, and their treatment needs.
Women with substance use problems experience significant barriers to accessing treatment. This is related to the social and cultural norms that exist, which include the role that a woman has and what type of behavior is considered appropriate as well as societal and community norms and attitudes about women who have substance use problems.
At the same time, because more men than women use illicit and other substances of abuse, most treatment programmes have been designed with men in mind and do not take into account gender differences.
Among the areas that still need to be examined are: the gender issue and how it relates to substance abuse and HIV; developing strategies that discourage substance abuse; promoting rehabilitation and recovery; and supporting appropriate, affordable and quality health-care and related services for women in all stages of life.
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Women and girls have special needs, and these are often lacking under existing programmes. Due to an inadequate number of programmes designed to meet the unique needs of women and girls impacted by drug abuse, they are often not able to receive adequate prevention and treatment.
Recommendations In order to reach women and provide them with effective services to combat the ill effects of drug abuse, it is crucial that the needs of women are considered at every level of programme, from policy making to intervention design and implementation. Some key effective strategies in reaching out to women involve, recruiting women (often peers) as service providers and low cost, low threshold services situated in local communities which promote inclusiveness and engagement.
At the same time, no single paradigm or strategy can effectively address the ever changing drug scenario in a once-and-for-all fashion. This is especially so given the regional variations and the pluralistic and cultural diversity of South Asia. Different elements of intervention and prevention may be drawn upon to develop an eclectic model, suitable and appropriate to local and regional situations.
Some specific service strategies which could form a part of a comprehensive package of service addressing the needs of women impacted by drugs could include:
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Information and education about drug use consequences
HIV/STD Counselling and Testing facilities
Gender sensitive training for counsellors
Night shelters/hostels for the homeless
Peer driven outreach services through training of ex-users, or other affected women
Vocational skills training and economic programmes like micro-credit co-operative schemes
Auxiliary services for children of affected women
Services for pregnant women in the community with adequately trained and sensitive staff to recognise additional drug problems
Legal Aid Cell and Advocacy groups
Suicide prevention and crisis intervention help-lines
Self-help groups and co-operatives
Utilisation of government schemes for loan for small businesses
Risk reduction programmes
Life - skills based approach, with focus on current gender issues in society
1: MSJE and UNODC 2002 (Murthy.P) Women and Drug Abuse: The Problem in India
2: UNODC 2004, Substance abuse treatment and care for women: Case studies and lessons learned
3: 2002 MSJE and UNODC 2002 (Murthy.P) Women and Drug Abuse: The Problem in India
