2. Project description (background and justification)
Political and socio-economic situation:
In India, there is a marked gender imbalance in literacy rates, access and availability of health related services for adolescent girls and women. This is coupled with an early age of marriage, low rates of employment and general lack of awareness of risks and vulnerabilities.
Extent of drug abuse in India:
According to the document entitled
The Extent, Pattern and Trends of Drug Abuse in India, it is estimated that there are 62.5 million alcohol users, 8.7 million cannabis users and over 2 million opiate users. Close to 60% of these drug users are married. Many drug users - particularly Injecting Drug Users (IDUs) - also reported sex with sex workers, highlighting the vulnerability of their spouses to various sexually transmitted infections including HIV. Adequate knowledge about HIV transmission was lacking and the risk perception was found to be low.
Drug abuse and women in India:
In the Rapid Assessment Survey (RAS), 7.9 % of the total sample was female drug users.
The burden on women by drug abusing family members:
Women, who typically feature significantly less than men in terms of prevalence for all substance abuse, are now recognized to suffer substantially in terms of shouldering the burden of physical and psychological abuse by close male relatives (usually spouses, partners and sons) and are increasingly having to take on the responsibility of family breadwinner following the illness and death of HIV/AIDS-infected drug using partners. This aspect of the burden of drug use on women and related HIV vulnerabilities in India has, to date, received scant attention. In a focused thematic study undertaken as part of the national survey on drug abuse in India entitled,
The Burden on Women Due to Drug Abuse by Family Members, data was obtained from 179 women having drug using family members and 143 key informants. A majority of women (55.3 percent) reported husbands as drug using family members. These women reported several health, economic, occupational and psychosocial problems on self and the family due to drug use by their family members. Key informants recommended several measures to reduce the burden among women: fostering women's empowerment and economic independence; establishing help lines and legal aid cells for women; promoting community action and encouraging formation of self help groups (SHGs).
HIV/AIDS in India
India has an estimated 5.1 million people infected with HIV/AIDS.
(IMPORTANT: footnote on revision of estimates in July 2007) The sero-positivity rate is currently 0.9 %. This means that, after South Africa, it has the largest absolute number of people living with HIV, accounting for approximately 10% of the world's affected population. The major transmission route is through unprotected heterosexual intercourse. However, it is reported that approximately 2% of AIDS cases in India can be attributed (directly or indirectly) to the IDU route of transmission. The trajectory of HIV/AIDS is clearly demonstrating that gender inequality fuels 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/AIDS. In addition, there is the large unrecognized burden of care that women shoulder in providing support to family members, at high cost to themselves. Recent data on the spread of HIV/AIDS is clearly evident of transcendence beyond high-risk groups to affecting younger women and adolescent girls within the households. The proportion of women living with HIV/AIDS has risen steadily in recent years. Today in India, approximately 36.8% of the 5.1 million adults living with HIV/AIDS are women.
Drugs and the feminization of the HIV epidemic
According to the household survey on extent, pattern and trends of drug abuse in India, there is a serious risk of transmission of HIV and other blood borne viruses to partners of infected drug/substance users, and of contracting sexually transmitted diseases. While the HIV epidemic originated and then spread rapidly among IDUs, it is now established among the general population. The spread of HIV to the general population in Manipur is evident from the HIV prevalence rate (1.3% among women attending antenatal clinics, STD clinics 13.0%, IDUs 24.4% as reported in NACO's sentinel surveillance in the year 2003). In some districts of Manipur like Churachandpur and Ukhrul, antenatal clinic prevalence of HIV has reached over 3%. The prevalence level of HIV among STD clinics attended was estimated to be 2.4% in 2003. The antenatal clinic prevalence of HIV was 1.3% and prevalence of HIV among IDU's was 10.2% in 2003. The vulnerability of women drug users to HIV risks is high as some of them also get involved in sex work to sustain their drug habits.
Stigma and discrimination - the double burden
Drug-using women are likely to be more stigmatised than their male counterparts because their activities are regarded as 'double deviance' by society: taking drugs is seen as both deviance from accepted social codes of behaviour and deviance from the traditional expectations of the female as wife, mother and family nurturer.
3. Objectives, Outputs and Activities
The project will reduce the vulnerability of female drug users and female partners of drug users and in this way contribute to reversing the overall feminization of the HIV epidemic in India.
To strengthen the technical capacities of women's groups and NGOs working on drug demand reduction to reduce HIV-related vulnerabilities among women partners of male drug users.
Outputs and Activities
situation assessment (desk study) on substance use related HIV vulnerabilities among women users and female partners of male drug users in place.
- Prepare a situation assessment desk study on substance use related HIV vulnerabilities among women users and female partners of male drug users.
- Publish, launch and disseminate the desk study as a joint publication of UNODC, UNAIDS, UNIFEM, Ministry of Social Justice and Empowerment and Department of Women and Child Development.
- UNODC, UNAIDS and UNIFEM jointly organize a round table for Directors of State AIDS Control Societies, Directors of Social Welfare, NACO, Ministry of Social Justice and Empowerment and Department of Women and Child Development, women's groups and networks of positive men and women and experts in the country on addressing gender concerns related to substance and related HIV prevention, especially for preventing feminization of the HIV epidemic.
Service providers strengthened (female peer educators) - Technical capacities of civil society organizations, women's groups and positive women's representatives will be strengthened towards addressing substance use related HIV vulnerabilities among women partners of male substance users.
- UNIFEM and UNODC develop an information tool kit and package jointly on gender, substance use and HIV.
- The RRTCs and NCDAP train a cadre of 50 trainers from NGOs working in drug demand reduction and HIV prevention through two training of trainers workshops using the available training tool including Drug Abuse and HIV/AIDS Concerns of Family Members; Training of Trainers' module on participatory training methodology in drug abuse and HIV/AIDS prevention; legal literacy; negotiating safe sex and reducing RTI/STI among partners of drug users.
- These trainers will select and train women peer volunteers from 450 NGOs engaged in drug demand reduction work especially those supported by the Ministry of Social Justice and Empowerment, Government of India, on improving their negotiating especially for safe sex, preventing STIs, HIV, referral on domestic violence, grief, trauma, VCTC, mother to child transmission and increase awareness for women's human rights and empowerment strategies.
- To act as information nodes and knowledge networks to respond effectively to the burden of substance use and substance use related HIV vulnerabilities among women.
Technical capacities of the National Institute of Public Cooperation and Child Development National Institute of Public Cooperation, Department of Women and Child Development are strengthened to incorporate substance use and HIV related concerns in their ongoing training programmes.
- UNIFEM and UNODC support the training of a cadre of 30 trainers at the National Institute of Public Cooperation and Child Development to incorporate the issues in their ongoing training programmes for women empowerment programmes.
- UNODC and UNIFEM in consultation with the Department of Women and Child Development will identify key entry points for implementing programmes to mainstream substance abuse related HIV concerns in ongoing schemes/programmes of Self Help Groups (SHGs) /micro credit.
- Will support the establishment of referral linkages of the SHGs/micro credit groups with the RRTCs and other NGOs and network of positive women to train them on STIs address the reproductive health issues of partners of drug users in high prevalence states.
Demonstration sites - for field-based learning on developing gender sensitive responses for prevention of HIV among female partners of drug users and women drug users in place for replication and scale up in the country.
- Identify, in consultation with the Ministry of Social Justice and Empowerment and Department of Women and Child Development, networks of women's groups and NGOs.
- Provide support to 20 NGOs to launch pilot initiatives on reducing vulnerability of partners. The NGOs will be using manuals on Drug Abuse and HIV/AIDS Concerns of Family Members as a base guideline for interventions. They will also adopt peer based self-help approach. The protocol on low cost community based care and support at some sites will also be implemented at select sites. The eight RRTCs will monitor the progress and the NGOs will report on a monthly basis to the project coordinator.
- Establish Help lines, electronic networks, telephones and other relevant communication channels for women partners of drug users and its consequences especially HIV/AIDS, STIs, with formation of links to relevant information sources and services. Each of the demonstration sites and the RRTCs will serve as hubs for above mentioned.
- Document good practices as a joint publication and disseminate among concerned stakeholders.
4. Counterpart, institutional setting and implementation arrangements
UNODC ROSA, will be the executing agency for this project. The associate agency will be UNIFEM, to bring in the expertise for deepening the dynamic linkages between gender, human rights and women's empowerment. UNODC will bring in its technical expertise and experience on drugs and HIV.