UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
Plenary Session, 31 January 2008
Women and Substance Use in India: Dimensions and Ramifications
Presenter: Dr. Pratima Murthy, Professor, NIMHANS, Bangalore, India
Dr. Pratima Murthy Dr Pratima Murthy is Professor of Psychiatry at the National Institute of Mental Health and Neuro Sciences, Bangalore, India. She is a graduate of the Bangalore Medical College. She completed her Diploma and MD in Psychiatry from NIMHANS, Bangalore, and a Diploma from the University of Manchester, UK. She presently heads the De-Addiction Centre at NIMHANS. Her work in the area of substance use spans two decades, and she has extensive clinical and community experience in this area. At the local level, she has been involved with NGO networking, and workplace interventions. At the international level, she has been a consultant to the International Labor Organization, The United Nations Office on Drugs and Crime, and undertaken several projects of the World Health Organization. She is presently PI for a WHO initiative of expanding tobacco cessation services in India. She has several research projects in the area of substance misuse, and has a special interest in course and outcome. She is the principal author of the ILO monograph on Community Based Drug Rehabilitation and the UNDCP monograph on Women and Drug Use in India. She was an international consultant for the Rapid Situation of Drug Use in the Maldives. She is a contributor to the ILO Geneva module on Minimizing Stress, a management and leadership development programme. She has served as an international trainer for the ILO and UNODC in the South Asian Region. Apart from her interest in addictions, she is actively interested in training professionals.
This paper reviews available information in India on the causes, consequences and intervention needs of women affected by substance use. It provides a window view into two contemporary UNODC initiatives, the H 13 study which focuses on the prevention of transmission of HIV among drug users in SAARC countries and the I 49 study on reducing substance use related HIV vulnerabilities in female drug users and female partners of male drug users.
Earlier studies highlight the need to shift from a simple linear model of understanding substance use issues among women to a multi-factorial interactive model that understands substance use from a gender perspective. In the Rapid Situation and Response study of current drug users and their regular sex partners, 5742 male drug users and 3221 regular sex partners across 23 sites in India were interviewed. Most respondents were in their early adulthood, and among those sexually active, sex with multiple partners was common. In nine sites, more than 20% of the female partners themselves used drugs, a sizeable number of them after marriage or relationship with a drug using partner. Over half the female sex partners who used drugs reported injecting drug use. The I 49 study, completed recently, interviewed 4401 women partners of male substance users and 1865 women substance users across 110 non-governmental organizations in India. Women substance users differ from non substance using women in terms of socio-demographic backgrounds, living arrangements and sources of income. Substance use among women is associated with greater childhood adversity, early initiation into sexual activity, greater likelihood of sexual abuse and multiple sexual relationships. Women partners of male substance users and women substance users (most of whom have substance using partners) report high levels of violence, particularly partner violence. While women partners primarily rely on primary sources of support, women substance users tend to rely on secondary sources of support in the community. Tertiary supports are few and poorly accessed. The two groups differ in family planning practices. They also differ in their sexual expectancies and perception of HIV risk. Their knowledge of HIV, its transmission and prevention, is at best, superficial. Among those with knowledge of HIV risk, there is a gap between knowledge and safe sex practices. Unsafe injecting practices are common among injecting women drug users. The two groups also differ in terms of concerns about their children and consequences of substance use upon them. There are significant mental health problems among both groups.
The findings of recent studies underscore the need to understand substance use and related vulnerabilities in a holistic and gender sensitive manner. Services need to be developed and networked in different sectors and at different levels, and much greater inter-sectoral co-operation and alliance is needed for prevention as well as to provide comprehensive interventions.