Nepal: 'In Conversation' with Jayanti Sunuwar, Member of the Asian Network of People Who Use Drugs (ANPUD)

The Regional UNODC Office for South Asia recently interviewed Jayanti Sunuwar, Member, Asian Network of people who use drugs (ANPUD) on the vulnerability of female drug users in Nepal and strengthening integrated gender responsive services for female drug users. As a woman who has quit drugs and an outreach worker, she understands the importance in reaching out to female drug users who often lack personal power and skills, experience a lack of community support and access to health care and social services. Too often services for female drug users either do not exist or are too under developed to have an impact on their lives. Jayanti shares why effective responses and interventions for female drug users need urgent attention.

UNODC: How did your journey with drugs began?

Jayanti:My association with alcohol addiction subsequently to drug addiction began during my school days. To ensure that I had a proper education I was sent to a boarding school. Being away from the family was always emotionally trying and I had to constantly adjust to the changing environment. Although today I understand well their intention, at that time I felt neglected and was full of resentment. To cope with emotional insecurity and my low academic grades, I instinctively drifted towards the male group of friends who introduced me to alcohol. I was only 15 years of age. I started seeking instant refuge in illegal activities to deal with the daily pressures of survival. After marriage, I was unable to join my husband who was working in a different country, due to complications during my second pregnancy. The feeling of being neglected and insecure grew even stronger. I drowned my sorrow by drinking with old school mates and frequenting night clubs and bars. Gradually I began taking pharmaceutical sedatives and heroin. Things became worse when one day my husband discovered my dependence on drugs. With no regular source of income, I started experimenting with injecting pharmaceuticals intravenous drugs such as tidigesic, norphine which were very easily available. I was regularly arrested by the police officials. I was admitted for detoxification at treatment centers several times and was unable to quit drugs and had episodes of frequent relapses. I wish I was more aware about drugs and their effects.

UNODC: You have a vast experience working with women drug users in Nepal. Can you throw some light regarding how vulnerable are the female injecting drug users in Nepal? Could you also talk about some programmes and interventions that reach out to them?

Jayanti: Female injecting drug users are more likely to be stigmatized by society than male injecting drug users because it carries with it the dual burden of being a woman and than someone who also uses drugs. The situation is worse when women inject as it's a fairly new phenomenon and is associated with vulnerabilities to HIV and AIDS and Hepatitis. The overall risk of females using contaminated injecting equipment is likely to be greater as compared to males, as in many cases in Nepal a female drug injector is likely to share contaminated needles used by their male partners who may be infected with blood borne viruses. In Nepal currently there are few programmes catering to the specific needs of female drug users. HIV and AIDS prevention and care programmes in particular are not yet reaching out to this vulnerable group, because services are largely designed for men. Attempts to reach and work with female injecting drug users are limited and, in fact, gender sensitive services addressing the specific needs of female injecting drug users hardly exist. The lack of trained female service providers with appropriate skills and a proper attitude often stops female injecting drug users from accessing services, since they feel uncomfortable speaking openly about their problems with men. Also several HIV and AIDS prevention and care services, including for drug dependence treatment, do not admit women clients, particularly if they are pregnant, HIV-positive, or have children. The reasons for this, range from a lack of women friendly services, child-care facilities to a fear of transmission of HIV. I am aware of only a few good drop-in-centers for women in Nepal who also provide after care, treatment and counseling for drug users and injecting drug users. One such non governmental organization is Aavash Samuha where I work as an outreach worker and finance officer. Supported by UNODC, Aavash Samuha recently opened a female drop-in-centers at Lalitpur, Nepal.

UNODC: What kind of treatment programs does Aavash Samuha provide for male and female injecting drug users?

Jayanti: Since our initial phase we have been providing care and support for People Living with HIV (PLHIV). Aavash Samuha has a capacity of 12 beds at the detoxification center managed by HIV positive IDUs. The aim of the organization is to reach out to drug users infected with HIV, rehabilitate them for a successful re-integration into the society where they can advocate against the spread of HIV. The treatment programs include detoxification. After this, the clients are encouraged to visit the drop-in-centers where information on drug use and HIV and AIDS are disseminated. To encourage drug users for regular visits, we provide them with amenities like food and beverages, access to reading material and rest rooms. A separate female drop-in-center was set up by Aavash Samuha managed by women with a comprehensive approach to gender responsive services.

UNODC: We understand that there are interventions to support women who have quit drugs. What in your opinion needs to be done to help those female injecting drug users who are not yet prepared to stop using drugs?

Jayanti: This is a very important issue that is often ignored. This is becoming a growing concern as most treatment centers and drop-in-centers are not factoring this problem into their programs. I think a comprehensive package approach for women friendly services is immediately needed for female injecting drug users. This approach would include: community outreach particularly by female peer educators; women friendly HIV and AIDS prevention and care materials; specialized women friendly drug dependence treatment, including substitution treatment, for female drug users with and without children; access to essential prevention commodities such as male and female condoms, and sterile needles and syringes; voluntary HIV testing, integrated counseling; diagnosis and treatment of sexually transmitted infections; antiretroviral treatment for positive female drug users and prevention of HIV transmission from mother to child.

UNODC: What are some of the challenges faced at the female drop-in-centers and what steps need to be taken in addressing them?

Jayanti: Trained female health practitioners and female counselors are few therefore reducing the quality of services at the drop in centers. There is a need for integrated training programs and good trainers who can educate women like us not only on how to effectively reach out to FIDUs but also on prevention of HIV and AIDS. Additional strategies should include advocacy to create an enabling policy and legal environment. It is important to include female injecting drug users and civil society organizations representing them in every stage of the policy and programme development process to make them realistic and responsive to the needs of the community. Measures could include vocational training, employment, micro-finance programmes, legal support, safe housing and childcare services. Such services would empower females to have options and to take voluntary and informed decisions regarding adoption of safer practices to prevent the transmission of HIV among FIDUs.

Jayanti is an outreach worker at the female drop-in-centers and the financial officer at Aavash Samuha, an organization working towards the treatment, rehabilitation and social re-integration of those infected and affected by drug use and HIV and AIDS

UNODC is committed to support the Government of Nepal for developing and implementing strategies to prevent the problem of drug use and HIV especially amongst vulnerable groups. In doing so UNODC is currently implementing the comprehensive package of services for Injecting Drug Users and their sex partners with the help of civil society partners.

UNODC work in Nepal is possible trough the contribution of the Australian Agency for International Development (AusAid), The Department for International Development (DFID) UK and The Norwegian Agency for Development Co-operation (NORAD)