Gender specific approach - recommendations

Taking into account specificity of issues as well as importance of early diagnostic and treatment of women who use drugs, it is strongly recommended to review existing harm reduction services for gender sensitivity and involve WUD on every stage of this work – from identifying the gaps, to designing new offers. Harm Reduction International developed lists which draw on examples of existing gender-specific HR services and provide a ‘menu’ of options to improve and expand care for WUD. Since HR strategies and programs are implemented very differently (and sometimes not at all implemented) in the different countries, ideally services should be tailored to the needs of women in a given context. In order to be cost effective and achieve maximum result, it is important to provide all recommended HR core interventions as a comprehensive package – rapid HIV/HCV testing must be offered together with other harm reduction services, including needle and syringe provision, OST, linkage to treatment, information and consultation. The following improvements have been suggested for those organizations that can only afford to bring adjustments or small additions to their existing services/programs:

• Addition of women-specific items to basic HR kits (women’s hygiene materials and female condoms along with syringes, male condoms, wipes, lubricant)
• Additional basic services/material assistance for women at HR sites (pregnancy tests; diapers and other supplies for children; short-term babysitting while women get counselling; informational gender-specific materials; help in learning to inject oneself to eliminate dependence on partners)
• Staff training on gender issues (counselling techniques for women, needs of WUD etc.)
• Gender balance in HR staff, including active involvement of WUD in service provision and design
• Special time for women only (‘Ladies Night/Day’)
• Women-only support groups, women-specific counselling programs (including injection trainings)
• Relationships with trusted gynecologists, obstetricians and other specialists for client referrals
• Trainings for OST providers and obstetricians-gynecologists on drug use and drug treatment in pregnancy
• Basic training on drug use for primary care and women’s healthcare providers to enable effective and prompt referrals to HR and related services when needed
• Links between services for people who use drugs and for sex workers, including discreet provision of HR for sex workers unable to openly visit a HR site in opening hours

A «children play corner», including table, chairs and some toys was put in some NGOs in Hungary and Lithuania during the HA-REACT project. The cost of the intervention was 0 Euro, but it definitely improved impression of WUD towards the services. For those organizations, which can invest some funds for improving their services, it is recommended to add the following:

• Specialist to work with women’s children and give counselling on parenting skills
• Counselling services to respond to sexual violence, IPV, other trauma, and to address the links between trauma and risky behaviors
• Women-only drop-in center or space in the HR center devoted especially to women
• Appointments with a gynecologist and other medical specialists at the HR site
• Multidisciplinary case management for women and their children, including pregnant women
• Mobile HR, OST, basic medical services for women unable to visit service sites
• Legal aid to help women resolve problems with documents, access to social support, legal problems, etc.
• Free, low-threshold sexual and reproductive healthcare, including PMTCT
• Job training, job placement assistance and economic empowerment programs to increase women’s economic independence
• Social support for women released from prison, including support related to parenting

Finally, it is important to keep in mind that the components of an enabling environment that need to be addressed across the individual, relationship, community and societal levels to support SRHR for WUD should always include the following:

• Psychosocial support
• Healthy sexuality throughout the lifetime
• Economic empowerment and resource access
• Integration of SRHR and HIV services
• Protection from violence and creating safety
• Social inclusion and acceptance
• Community empowerment
• Supportive laws and policies and access to justice
• Interventions at the relationship level to ensure that health workers at health-care facilities respect and support WUD instead of judging or stigmatizing them
• Interventions at the community level to shift social norms relating to violence and stigma; this would result in a healthier sexual life for WUD, who would not experience violence, but rather an increased acceptance of their sexual identity
• Interventions at the societal level to enact law and policy reforms. WUD will more likely exercise their agency if they can benefit from health system policies providing them a wide range of contraceptive options or fertility support services.

Low threshold settings, offering rapid HIV and HCV testing for WUD must ensure qualitative pre- and post-test counseling and linkage to care, including accompanying of women for the confirmatory tests and treatment.