Gender-specific approach - introduction
There are many sound public health and human rights recommendations that indicate the need for Harm Reduction (HR) and other HIV related services to specifically address the needs and preferences of women who use drugs.
There are marked differences between the genders in almost all aspects of the drug phenomenon, and there are many sound public health and human rights recommendations that indicate the need for Harm Reduction (HR) and other HIV related services to specifically address the needs and preferences women who use drugs. Such reasons are evidence-based and are supported by relevant international agencies and institutions. Nevertheless, HR services are generally primarily target men and women who use drugs often feel that their specific needs are unacknowledged and that the sites they need to access to are not “women-friendly.” HR programs and projects often do not succeed in guaranteeing women’s personal safety and confidentiality; in providing sexual and reproductive health (SRH) services; prevention of mother-to-child transmission (PMTCT) services; and providing child care. In many cases, staff are not trained to offer gender-specific services, support for sex workers or for the victims of gender-based violence (GBV).
The failure to address the needs of women who use drugs (WUD) contributes to the spread of blood borne infections and other infections. In fact, first of all, WUD are actually at higher risk of acquiring HIV, viral hepatitis and other sexually transmitted infections (STIs) than their male counterparts. Specific risk factors include the fact that women are more likely than men to be “second on the needle”—i.e., they inject after, and often are injected by, a male partner. Data by gender shows that women who inject drugs (WID) are more vulnerable to HIV infections and STIs than are males who inject drugs. The likely reasons for such a gender difference include both social factors, e.g. WID are much more likely to be involved in sex work than males are, and biological factors, such as women’s higher
risk of contracting genital infections. WUD are likely to be more often in a vulnerable position when attempting to protect themselves from infection within partnerships and networks.
Those of them engaged in sex work increase their vulnerability to HIV and other blood-borne infections. When involved in sex work, they often experience physical and sexual violence from clients and other intimate partners, as well as from the police; abuses can also occur while they are detained in prison.
Gender-based violence prevents WUD from accessing services and the criminalization of sex work heavily affects their willingness and possibility to access HIV-related services and to negotiate condom use.
Other factors which prevent WUD from accessing health services include policies or laws suggesting that drug use can be a reason for loss of child custody, coerced sterilization and abortion. Such practices are examples of gender-related stigma and discrimination that is still widespread in some countries.