Ruth Birgin, INPUD: Women’s rights rarely feature in discussions of the world drug problem, and are not sufficiently recognized by UN drug control agencies. Both UNODC and INCB do not demonstrate due regard to women’s rights obligations. Negative consequences of the world drug problem are the result of, and are being exasperated by, the policy response. Current prohibitionist approach results in violence, threats to public health, and undermines gender equality. UNGASS outcome document barely mentions any reference to women, and thus fails to meet the needs of women due to problems created by drug policy. Single most powerful threat to health and wellbeing of women who use drugs is the criminalization of drug use. Suspends access to health and social services, undermines human rights, and leads to substantial barriers in accessing harm reduction services where they exist. Most are worried about being identified as a drug user. Physical and sexual violence. Children removed from mothers who are good parents. Women who inject drugs are at increased risk of blood borne disease transmission. Criminalized during pregnancy. Do not report domestic abuse. Tough approach has specific effects on women, such as increased stigma from health professionals, law enforcement, and wider community. 18 states in USA consider drug use during pregnancy as child abuse. Tennessee allows prosecution of women who use drugs while pregnant. Babies born without prenatal care has risen substantially. No health care access. Women are more represented in prisons than ever before, mostly for minor offences and from socially marginalized backgrounds. UN system noted that women could be dealt with more effectively with alternatives to imprisonment. Bangkok Rules aren’t mentioned in the outcome document. Violence against women is a devastating consequence of the response to the drug problem. Strong body of examples, though too few, where women who use drugs are contributing to policymaking and gender specific models. Humane approach to drug control efforts must include gender responses. Unintended consequences can’t possibly be unintended when they have continued for this long. Growing and promising focus on women and drugs in recent years, but much work remains to be done.

Olga Ponomarova, Club Svitanok: Speaking about how punitive drug policies have a negative impact on sexual health of women and speaking from personal perspective. I have been using drugs for six years and at one time I had an unwanted pregnancy. After nine weeks, I obtained a referral for an abortion. When the doctor who was supposed to give me an abortion saw the track marks on my arm, she had a very negative approach towards me. When she asked me if I had HIV, I said I didn’t know, but I did have HIV and I was afraid to admit it. She started screaming and calling me names, and promised to put me in prison if she found out I had HIV. After I woke up from the abortion, no doctors or nurses approached me. I went home, but felt very sick in the courtyard and couldn’t even walk. A nurse who was passing by saw me and brought me back to the hospital. The doctor was angry that I was brought back. She said that drug users don’t have the right to live at all. She said that god punishes people like me and that is why I felt sick. I still ask, was it god who punished me or was it the doctor that performed the surgery so poorly? Even though eight years passed by, I felt ashamed about this story and I haven’t told it before. Barriers impede women from obtaining the highest standard of health care. One barrier is when menstrual cycle is disrupted, resulting in unwanted pregnancies. Women who use drugs are vulnerable to violence by sexual partners and family members. Forced to become sex workers by their male partners. Worst situation is when medical and social staff also perform violence towards women who use drugs. Force women to have an abortion or be sterilized. Women often face lack of access to contraceptives, including female condoms. Often women have faced cervical cancer because of lack of access to medical treatment. No systematic training and coordination for cross-cutting issues such as sexual and reproductive health, HIV, and violence. No access to harm reduction services for women, such as substitution therapy. Violence towards women becoming structural. Stigma towards women who use drugs impedes their health and their right to have a family. Often if a woman is a drug user, her parental rights are terminated. Women with HIV face no access to in vitro fertilization and cannot adopt a child. Drug policy also marginalizes women who use drugs and doesn’t include perspective of drug use a social disease, with main reason being lack of equality. War on drugs is a war on people, especially women.

Nathalie Rose, PILS – Data on Mauritius. 7 out of 10 people who live with HIV are currently injecting drugs. 97%, so nearly 100%, of people who inject drugs are diagnosed with HIV. 8 of 10 have been incarcerated. 1 prison inmate out of 5 living with HIV. HIV is 48% higher among women. Syphilis 100% higher among women. 15% not even sure if a mother can transmit HIV to her kids. Methadone launched in 2006. 2010 launched in prisons. For women, not available until 2008 in community and not at all available in prisons. Needle and syringe programs available since 2006 for both men and women, but never in prison. Peak of incidence rate of HIV among people who inject drugs in 2005. After started harm reduction services, figure went down. HIV in general population also went down. Decrease of more than 60% after introducing harm reduction programs. Fixed community based places to access needles were not accessible to women. Female workers, including peers, went into the community with backpacks or mobile units. Could reach twice as many women who inject drugs. Have a new government in December 2014. Needle and syringe program demand has increased by 70% in 2015, but government started to limit the number of syringes. Methadone distributed in front of police stations, so less people accessing methadone. Methadone induction stopped by new government, meaning that no one new could enroll in methadone. Waited for more than six months until there was any way to access substitution therapy. New treatment available since 2016. Combination of naltrexone and suboxone. Current ministry of health convinced this treatment will heal people on opioids after six months, so limited treatment access to six months. Not a lot of information yet since this started. Everything done in a non-transparent process. Peer networks and drug users not involved. Access hindered for pregnant women. Women requested to get clearance from gynaecologist to enroll in substitution programs. Of course gynaecologist has no drug background, so doesn’t want to issue a clearance. With these changes and restrictions, last year the incidence rate of HIV among people who inject drugs increased by 13%. First time it increased in 10 years. Recommendations are to support harm reduction services. Harm reduction works, as my country is clear evidence. Has positive impact on HIV and general health and social wellbeing. Include civil society organizations in planning and implementation of services, including user networks. Include gender sensitive interventions. UNODC guidelines for addressing specific issues about women who inject drugs. Drug policy reform should be included in debates around the UNGASS. Harm reduction more effective when incorporated in an enabling environment.

Judy Chang, WHRIN: WHRIN is about supporting the development and expansion of gender sensitive harm reduction services. UNGASS shaping up to be a lost opportunity for reform. Focus on drug control at the expense of human rights, fundamental freedoms, and peace and development. Pursuit of a drug free world is expensive, ineffective, and immoral. Takes away from fundamental rights, freedoms, security, and development for all. Women mentioned in very short operational recommendations in pre-CND draft of outcome document. Latest draft has expanded mention to women. Do not explicitly acknowledge multiple harms caused and brought about by prohibition. Women who use drugs experience vulnerabilities compounded by being women and being drug users. Criminalization directly places us at risk of abuse, violence, and exploitation. Apply a gender lens to analyze how current policies impact the rights of women. Public health response focuses on disease transmission related to drug use, but violence reduction, discrimination, and access to justice are also important. Right to live free from violence. Gender-based violence includes intimate partner violence, non-partner sexual violence, trafficking, and structural violence from police, prison guards, etc. Women who use drugs experience intimate partner violence at 2-5 times a greater rate than the general population of women. Yet, not given equal protection under the law. Punitive policies create a world where police have greater incentive to pursue a drug charge than violence. Women fear reaching out. Stigma and discrimination lead to limited employment opportunities, reduced standards of social welfare, and restricted access to health care. Programs that address violence should be scaled up, as should specialist domestic and sexual violence resources. Need to end the continued criminalization of drug users. Goal 5 of SDGs is relevant. Drug policies need to benefit rather than harm, and increase rather than limit opportunities.

Erika Matuzaite, EHRN: 90% of women who use drugs have experienced physical, sexual, or economic violence at the hands of their partner, family, and especially police. Women who use drugs are not reporting cases of police violence to the police. Almost all women we are working with have experienced this at least once. Regional advocacy campaign, “Women Against Violence,” has a goal to stop police violence. First year was about breaking the silence and documenting cases of police violence using an online platform. Collected almost 1000 cases of police violence. Police violence is a negative consequence of punitive drug policies. Law enforcement representatives think that if a person is a criminal, they can violate their human rights. Women who use drugs don’t have access to existing justice mechanisms. Don’t approach police for fear of being detained. Other barriers are a lack of knowledge, legal literacy, lack of funds for legal representation, stigma and discrimination. Police need to reach their performance indicators related to detaining a certain number of people. Recommendations include promoting partnerships between law enforcement and civil society. Organize trainings for police. Have law enforcement representatives aware of existing harm reduction services, and refer people who use drugs to those services during their encounters. Employ alternatives to incarceration, including treatment programs. Punishment of people who use drugs doesn’t work. Need to use alternatives, like treatment.