Drug use and its impact on women

A number of speakers noted the particular problems associated with injecting drug use among women and the increased vulnerability to HIV/AIDS that comes with it

"This is the time to seize the opportunity, this is the time to scale up services", emphasised Pakistan's federal minister for health, Muhammad Nasir Khan, demonstrating strong political commitment during the First Asia-Pacific Women, Girls and HIV/AIDS Best Practices conference.

He was referring to the issue of drug use and its impact on women, which were discussed by delegates from India, Pakistan and Bangladesh during a conference working group session specifically on the subject. The session examined how the behaviour of drug users (IDU) increases women's vulnerability to HIV/AIDS and other health issues, and looked at best practices in harm reduction and prevention.

IDUs are one of the highest risk groups for HIV/AIDS transmission due to needle sharing and unprotected sex. The opportunity to confront the drug epidemic in Asia-Pacific is gone according to Tariq Zafar of Nai Zindagi, Pakistan. In Asia, 65% of injection drug users share needles. Unfortunately, drug-related harm reduction and health services only reach a small percentage of those who need them.

Women are often forced into the sex trade to finance their own (or their spouse's) drug addiction, which further increases their chance of HIV infection. The psycho-social effects of this on women drug users and their families can be devastating, undermining the fabric of the family. The healthcare difficulties posed by a lack of HIV prevention information and education, and the stark social inequalities and prejudices related to gender, sexuality and criminality, are further compounded when women are taking drugs.

The complex problems associated with drug use by women need to be highlighted and understood, and special measures adopted to counter them and reduce related harm. Many women who use drugs are forced to sell sex to sustain their habit. Where opiate drugs, such as heroin, are involved there is a further complication of the desperation of withdrawal that affects both brothel-based and 'informal' sex workers.

Such circumstances make condom negotiation difficult, and greatly increase HIV/AIDS vulnerability. Women in sex work who also have HIV are doubly stigmatised, made even worse if they are also drug users. Such women are by and large not in control of their own circumstances. To help them requires cross-cutting services that address these multiple issues holistically.

Key are harm reduction strategies, which are policies and programmes that attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances to individuals, drug users, their families and their communities.
Appropriate drug treatment and rehabilitation not only help to reduce drug use, but also diminishes associated HIV risk. Harm reduction, care and prevention programmes are more successful when laws and government agencies facilitate outreach and service provision aimed at drug users and which actively involve the community.

A basic ethical principle of effective intervention should be that drug control policies must reduce and not augment the HIV risk faced by drug users. A special strategy aimed at reducing drug-related harm among women should be incorporated into all existing or new harm reduction programmes.

Ishdeep Kohli-CNS

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