Side event: Voices from the left behind: Protecting the human rights of women who use drugs

Side event organised at the Reconvened 61st Session of the Commission on Narcotic Drugs, by the International Drug Policy Consortium, the International Network of People Who Use Drugs, the Women and Harm Reduction International Network, Canada, Mexico, Norway and Uruguay.

Ambassador Alicia Buenrostro Massieu, Mexico (Moderator): Welcome to this side event. A couple of years ago, Brazil initiated CND resolution 59/5 on mainstreaming gender perspectives in drug policy. This work breakfast is jointly organised by the International Drug Policy Consortium, International Network of People who Use Drugs (INPUD), Women and Harm Reduction International Network and the governments of Canada, Uruguay and Norway. This embodies the engagement of my government on this issue. Member states have committed to ensuring that women have access to services, as well as to address the factors that make women vulnerable including in relation to drug policy. I welcome the Ambassador for Norway to share their work on this issue. I also have Ms. Louise Beale-Vincent from INPUD who will share about the impacts of criminalisation on women, and Ms. Putri Tanjung of the Asian Network of People who use Drugs who will share about experiences in Indonesia as well as examples of best practice. On my right I also have Ms. Marie Nougier from IDPC – she will focus on key recommendations from IDPC post-2019 in line with the SDGs. I look forward to discussions and am sure we will be able to enrich the work of the Commission on Narcotic Drugs.

Ambassador Kjersti Andersen, Norway: in September 2016, our government launched a new action plan on community, rights and gender and lasts from 2016 to 2020. It sets 5 objectives including the elimination of violence and harmful practices against women and girls. Norway seeks to protect human rights in all our operations, as well as sexual reproductive health rights. Such commitments include the resolutions adopted by consensus at CND covering HIV prevention specifically prevention of mother to child transmission tabled by Sweden and Norway. There is consensus that a comprehensive approach covering human rights is needed to eliminate transmission between mother and child. A normative battle is being waged against these commitments, and the agenda has come under threat due to lack of funding. Norway has committed to provide USD700 million to support this work. There is a need to understand the specificities of each gender in designing relevant programmes, and the links between gender and violence. Measures undertaken include gender-specific programmes in Algeria. We welcome the focus of the UNODC World Drug Report on women, including women who use drugs and are pregnant. It highlights the importance of gender and age-sensitive policies. For the Norwegian government, gender equality is a human right.

Louise Beale-Vincent, INPUD: I am a woman who uses drugs and represent people who use drugs in the US. Women who use drugs in the US are disconnected from their families and friends and as a result we are more likely than experience violence, living in underground economies which expose us to further violence. There are so many ways that women experience harm in the US. I have experienced a lot of suffering and I am a woman of privilege. Many of us can only obtain medication underground, we isolate people and then they cannot seek help. When women are on methadone, that is a reason for taking their children away. We stigmatise people so much that people cannot receive the medication that they need which prevents them from reconnect. There are so many polices that cause disconnect. If there are policies that help us reconnect, it would help, but we don’t have that. Harm reduction allows for that – it has allowed me to come back in. If you want to see someone’s life fall apart, I usually say give them a court date. Policies that criminalise women who use drugs and take away their children makes it so difficult for them to get help. If you cannot call the police when you are experiencing violence, it makes everything so much harder. I work a lot with women who use drugs, and we need so much a harm reduction approach, and loving kindness.

Ambassador Alicia Buenrostro Massieu, Mexico: Louise, I know it is not easy sharing your story but I’m really glad that you are sharing this with us. Thank you. We are all concerned with this issue and that’s why we are here.

Putri Tanjung, ANPUD: There is a silent epidemic afflicting people who use drugs, despite the incredible efforts to establish and expand harm reduction programmes, providing treatment and supporting the movement of drug users in Indonesia and  across the world. It is the suffering of the women who use drugs, having to endure compounded burdens of being drug users and being of the second sex, facing a higher level of shame and stigma associated with gendered social roles. Throughout my work with women who use drugs in Indonesia, I have had to provide comfort and support to my sisters that:       

  1. Continue to be labeled immoral, because of their drug use and failing to adhere to social’s feminine image; pushing them further away from their families and friends, for any psychological support
  1. remain vulnerable to violence by intimate partners. The Perempuan Bersuara (Women Speak Out) study by Oxford University and the Indonesian Network of PWUD found that 9 out of 10 women injecting drugs, faced violence by their intimate partners in the last one year, whether physical, psychological or sexual.

As a field worker, I had to comfort a woman using drugs that not only had to endure such violence, but also was experiencing financial extorsion by her partner. The violence suffered pushed her further to feelings of isolation and desperation. Instead of breaking herself from this chain of violence, she couldn’t help it but to return to that relation.

  1. The same study also indicated that 87% of them that had to face law enforcement were confronted with financial extortion. There were also others that had to endure verbal degrading insults, physical and sexual violence.

I had to assist a client being tortured and rape by a law enforcement officer who refused to report her case. “It would be suicide if I did”, she would say. The repercussion of  threats towards her family and close friends are too severe to endure.

  1. An earlier study Perempuan di Lingkar Napza or Women Caught in the Circle of Drugs already talked how Women Who Use Drugs were coerced to have sex with dealers for drugs which continues to this day even by my current clients.
  1. The Women Speak Out Study noted that 32% of respondents experienced overdoses at least once in their lifetime and 34% saw a friend experiencing fatal overdoses. At least 73% had witnessed overdoses by friends or acquaintances.
  1. And lastly, more than 60% have reported indication of clinical depression and Post Trauma Stress disorder. Personally, I am a survivor of a clinical mental breakdown. If you saw me earlier this year, you would see me in a vegetated state unable to use eating a fork and spoon for eating and had lost most of my short term memory. I continue to struggle to remain composed so that I may continue my work.

Over a decade ago, harm reduction programmes took place in Indonesia, with services of sterile syringes and Oral Substitution made available. Already there have been talks of decreasing rate of HIV among People Who Inject Drugs in the country by 29% by 2014. Unfortunately, most workers are male – this, in a situation where most are getting their needles from field workers – out of reluctance to face judgements from female health providers or other patients. Even good practices such as the  out-patient social rehabilitation with the MI-CBT (Perpanjangannya apa) method showing good results with ATS users especially those working or at school, remains limited, because of the lack of female counselors.

My clients feel that it is useless to even try rehab, as most are designed by males for males, denying female issues and specific needs such as those related to reproductive health, their roles as caregivers as many are with children.

Nowadays, the current repressive approach that is intensifying the war on drugs in Indonesia is detrimental to access to these services for all users. The Government’s refusal to look at scientific evidence for policy decision was the push to continue with the death penalty. Even at this stage, a women drug user is denied access to our specific needs.

There the case of Merry Utami, a detained woman drug user, on the death row currently detained at the Cilacap Prison, which is not a Women Prison. Local NGOs have been demanding that at least she could be moved to the more appropriate prison of Tangerang which has a Women section. Her current place of detention is so close to where executions take place that it’s causing her trauma and trembling fear.

For too long, programme design have forgotten that people who use drugs are coming from a spectrum of gender. I would like to acknowledge my trans sisters, who many have shown support to our movement and as us, are also affected by the problem of invisibility. And so, while I am here, talking for all women who are using drugs; I am also including my trans sisters with their needs and vulnerabilities.

For too long we have been silenced and let male leaders design drug policies and programmes, now is the time that some changes take place:

  1. Disaggregate all development data based on gender to ensure appropriate follow up;
  2. All policy affecting women who use drugs, should explicitly mention women on equal terms as men;
  3. Gender sensitivity should be mandatory to all public and non-government services affecting women who use drugs with evidence-based evaluation;
  4. Human Rights Institutions to acknowledge the violence against women who use drugs in the studies and annual reports; this acknowledgement should not only apply at country level but globally too.
  5. Social services for victims of violence should also cater to the needs of women who use drugs including harm reduction services.

Few months ago, facilitated by ANPUD, I have had the privilege of sharing stories with my sisters from across Asia and hearing their plights and struggles – many are experiencing similar problems and denied rights because of the gendered social perspectives. I am here, hoping to also do justice to their voices.

As the #MeToo movement is soaring across the world and in all aspects of lives, we too, believe that we have remained invisible for too long, vulnerable to unspeakable violence and susceptible to infections of HIV and Hepatitis C. #WeAreHere and invisible no more.

Ambassador Alicia Buenrostro Massieu, Mexico: Thank you Putri for sharing. We are here today because we understand the invisibility and that we need to do something about it. We will keep striving in this work. Both of you have portrayed the situation and the vulnerabilities in particular the invisibility of women. We remain sensitive to this. I now give the floor to Marie from IDPC who will share about the recommendations from IDPC.

Marie Nougier, IDPC: Good morning to you all. First of all, I would like to thank Putri and Louise for coming all the way to Vienna to provide us with a critical insight into the lived experiences of women who use drugs in contexts as different as Indonesia and the United States. These are a stark reminder that women who use drugs continue to be left behind in drug policy. I therefore also want to take this opportunity to thank Mexico and Norway, as well as Canada, Uruguay and Germany, for their support in organising this side event today.

We are at a critical juncture in international drug policy, with the end of the 2009 Political Declaration drawing near, and ongoing discussions around what the post-2019 global drug policy will look like – discussions which will culminate with the Ministerial Segment in March 2019.

In this presentation, I therefore want to offer some recommendations for the next decade of UN drug policy as it relates to women who use drugs, drawing from two high-level policy frameworks – the UNGASS Outcome Document, and the Sustainable Development Goals.

SDG 5 aims specifically to achieve gender equality and empower women and girls – and provides a number of targets and indicators through which to evaluate progress made against this goal. This includes, for example, ending all forms of discrimination and all forms of violence against women and girls. It also includes ensuring ‘women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life’.

In the area of drug policy, the UNGASS Outcome Document has given more visibility than ever before of the specific vulnerabilities and needs of women who use drugs. And unsurprisingly, in relation to women who use drugs, the Outcome Document echoes some of the key targets including SDG 5.

Paragraph 4.b of the UNGASS Outcome Document, for instance, calls on member states to ‘ensure non-discriminatory access to health, care and social services’, both in the community and in prison and ‘ensure that women, including detained women, have access to adequate health services and counselling, including those particularly needed during pregnancy’.

Paragraph 4.g also seeks to ‘ensure the involvement of women in all stages of the development, implementation, monitoring and evaluation of drug policies and programmes’.

CND Resolutions 59/5 on mainstreaming a gender perspective in drug policy, and Resolution 61/4 on preventing HIV infections from mother to child also offer useful recommendations on how to tackle the specific needs of women who use drugs in a non-discriminatory, and non-stigmatising manner. The urgent need to address stigma against people who use drugs is also recognised in Resolution 61/11.

However, more needs to be done for these agreed commitments to be fully implemented on the ground, and to ensure that women are no longer left behind in the drug response.

Today, it is estimated that a third of people who use drugs are women, but only one in five people in drug dependence treatment is a woman. Access to drug services in prison is more severely limited for women – even more so than for incarcerated men. And women who use drugs continue to face significant stigma and discrimination due to their drug use – as Putri and Louise have reminded us. This is often because women are seen as breaking with their traditional role within the family sphere, especially when they are mothers. The criminalisation and stigmatisation of drug use can have particularly negative consequences for pregnant women who use drugs, as they will be less likely to access the pre-natal care, harm reduction and drug dependence services they may need.

Recommendations:

Based on these conclusions, I will finish with four key recommendations for your consideration as you are discussing the direction of global drug policy post-2019:

  • Firstly, we recommend ending the criminalisation of people for drug use – we know from the 26 countries that have already taken this step that this will not increase levels of drug use, but it will reduce prison overcrowding, reduce stigma, and facilitate access to health and social services. This will be a critical step to end the stigma, discrimination and demonization of women who use drugs, and help them access the life-saving services they may need.
  • Secondly, ensure better access to harm reduction and treatment services that are tailored to the specific needs of women – including childcare services, adequate opening hours, sexual and reproductive health advice, support to tackle gender violence, among others. These services should also be made more widely available in prisons and other closed settings.
  • Thirdly, facilitate the participation of women who use drugs in policy making processes that affect them to ensure that policies and programmes are adapted to their needs, and that they do not involuntarily exacerbate risks and harms for women who use drugs.
  • And finally, there is an urgent need to collect more, and better, data on women who use drugs, using the SDGs as a basis, but also some of the key operational recommendations from the UNGASS outcome document. This should be an essential point in the review of the Annual Report Questionnaire in 2019. Possible new indicators could include:
    • The number/proportion of women accessing harm reduction services and drug dependent treatment services
    • New HIV and hepatitis infections among women who use drugs
    • Number of overdose deaths among women who use drugs
    • The number/proportion of women who use drugs in prison
    • The number/proportion of women who use drugs who benefit from alternatives to punishment or incarceration

I will end here, thank you very much for your attention and look forward to your comments and questions.


Ambassador Heidi Hulan, Canada: thank you for the presentations. The word we think a lot about is ‘effectiveness’ and it is clear to us that to develop effective strategies governments need to consider a wide range of factors in addition to gender, including religion and other indicators of wellness. In Canada we have developed a gender-based anlaysis plus with the goal of improving those policies and have done that with our strategy covering substance use and we have discovered similar issues to those reported by the panelists. For example, women are afraid of reporting their substance use because they are afraid their children will be taken away from them, and this is a real problem particularly amongst First Nations communities – we are working to address that now. Also, women who inject drugs can experience more violence and we are ensuring the provision of safe injection facilities and covering issues such as peer injection. We are very conscious of the need to be work more on this issue, and we are very glad to be included today. Thank you for your comments. It will really help us to shape our thinking as we develop policies on this.

Annie King, FAAT: I have a simple observation. Monday and Tuesday I was at the synthetic opioids meeting. Estonia presented on their approach and spoke a lot about their law enforcement approaches. Estonia has no domestic violence laws and was accused of abuse – why are we giving them the floor when they have not shown efforts to work towards gender equality?

Ambassador Alicia Buenrostro Massieu, Mexico: thank you. The only thing I can say is that it is very important you are here and participating in this debate. This just highlights for us what a challenge this is when there are so many realities on the ground. It shows that we need to keep working on international cooperation to harmonise our policies and sharing best practices, to let everyone knows what is going on. Then we know how different the experiences are on the ground. We have seen how different the situation is in US and Indonesia, as well as the commonalities. We need better policies and those which protect human rights. We are here to keep on working and to try to evolve it in a direction that protects human rights and takes women out of this isolation.

Ambassador Kjersti Andersen, Norway: I can add that there are different perspectives amongst member states. Our approach is to listen to member states even when they have a different approach.

Marie: thank you for the intervention. We need to hear from affected communities and civil society, so maybe this is a plea for their voices to be heard in the CND so that they can be taken into account in developing drug policies.

Nina Frey, Embassy of Switzerland in Austria: this is important for the delegations to hear. Thank you to IDPC. Louise and Putri, if you have 3 wishes, what do you think would be the most helpful policy changes that would help you specifically women who use drugs?

Louise: I’m so glad you asked. In relation to what the representative from Canada was sharing, we really need pioneering policies such as decriminalization and the end to prohibition would really make a difference, and moving away from this abstinence approach where you are either really sick or really well and there is no common ground. Harm reduction recognizes all the different stages people go through. Pioneering policies like those are needed to help people wherever they are.

Marie: hearing Putri, I can see that we really don’t need policies that are top down, we need to understand what is happening on the ground and to make that link more clear between policies and what is happening on the ground.

Ambassador Alicia Buenrostro Massieu, Mexico: we need to do more events like these so that we can hear what is really happening and adjust our policies accordingly. Thank you for sharing with us and ensuring the human rights of women who use drugs.

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