Side Event: Achieving gender equality in HIV interventions among people who use drugs

Guimaraes, Brazil: Without evidence based responses, we will not achieve anything.

Gilberto Guerra (UNODC): Applying the same tools across genders is wring. The female population is often left on the streets in dependence. Conversations about interventions should take into account their contexts, peer-to-peer or mother-to-mother solutions are needed in these communities in the management of children and sexual productive services. Most people affected by use disorders are females but they are invisible with the multiple stigma. Stigma is a strong barrier. Statistics are tilted because of this too; women only really appear when they reach a critical point. Lack of psychological services, shaming attitudes, dependence of criminal organizations. The sole responsibility for the management of children has to be taken into account too.

Monica Ciupagea (UNODC): We are working on this topic for a long time – the idea was generated in our civil society group. Thank you, Brazil and Norway, for bringing this to the policy level. We have produced a technical brief and trained oved 1500 HIV service providers in Afghanistan, Belarus, Egypt, Indonesia, Iran, Kazakhstan, Kyrgyzstan, Moldova, Morocco, Myanmar, Nepal, Tajikistan, Thailand, Uzbekistan, Vietnam, Dominica, South Africa. On the resolution of prevention mother to child we worked with INPUD, INWUD, WHO, UNAIDS, UNFPA, UNICEF, UN Women. Our guidance proposes 4 components: preventing new HIV infections among girls and women who use drugs (harm reduction), preventing unintended pregnancies, preventing transmission to their infant, providing treatment, care and support incl children to families.

Ehab Salah (UNODC): Our target group is 30 million people per year – women in prison are only 7% but women have less access to healthcare services in general and are more vulnerable to infections. Sexual reproductive services and post-natal care are the most behind areas in prison settings. The prison system was designed with men in mind, we are late to addressing this. CCPJ came out with an important resolution in 2017 26/2: Ensuring access to measures for prevention of mother-to-child transmission of HIV in prisons. We held an expert group meeting with 40+ technical experts in July 2018, the technical guide was developed with the help of UN entities. We rolled-out in selected countries in 2019. We are planning two more events this year. We are training trainers. We have a long way to go, we are only beginning to sensitize stakeholders. As we go, we discover further gaps and challenges. Our ultimate goal is to contribute to the goal of ending HIV by 2030 and making sure there are no more babies born in prison with HIV.

Judy Chang (INPUD): The role of community in scaling up gender-responsive services. I have been a woman who uses drugs for 20 years and have been engaged in harm reduction services for 10 years in four countries. The access of women who use drugs to har reduction is alarmingly low. What drives our visibility on the agenda? The topic gets brought up by civil society but the ongoing criminalization is putting us at further risks. The war on drugs is a war on women who use drugs. Discrimination in health care settings is one of the main challenges, but women also face more violence and lack of access to abortions. This leads to a fear in access to health care systems. We published testimonies among our members last year. Addressing stigma is key. Women lack proper care because they fear disclosing their use and status, there is a doubling down of stigma for women in connection with gender norms. Stereotypes among PWUD and women – unstable, overly emotional, passive, irresponsible. 2014 policy brief in women who inject drugs by UNODC, WHO, UN Women, INPUD includes guidance to genders specific responses. Two landmark CND resolutions as well.
The role of community is critical in design and delivery. Programs this was can be more attractive and relevant for the target. It is not only about availability but also working to remove barriers and getting people in the door – the packages must vary among settings and specific needs. How do we create demand? Community advocacy, engagement is critical. INPUD will launch it’s community led monitoring tool supported by UNODC HIV section.

Ministry of Health, Brazil (video message): Thanks do civil society’s suggestions, Brazil recognized that certain groups face specific challenges. Our policy offers HIV prevention and care for all with specific strategies to specific groups. All services have specifities for women including care for infants. Evidence based HIV response – the use of crack cocaine is strongly related to the prevalence of HIV. Women who use drugs are an extremely vulnerable population, they are routinely confronted with violence and gender-based discrimination. Addressing a concentrated epidemic – 20% of PrEP users are women. Coordination with NGOs and local groups and services. Testing is offered peer-to-peer, we had many women tested for the first time. We must constantly innovate and keep HIV at the core of the global health agenda.

Dr. Wan, Myanmar: Access to treatment services for women who use drugs in Myanmar. The gap between men and women has narrowed down. HIV prevalence among key population: 35% PWUD, men who have sex with men 12%, prisoners 6%, female sex workers 15%. Methadone maintenance therapy active daily clients steadily increasing. There are significantly less women in treatment, about 1% of the whole population. Reasons: stigma, discrimination, motherly roles, less social and peer support, co-occurring mental health disorders. Challenges for WWUD: lack of information, no specific services, knowledge gaps re reproductive health and rights, pregnancy, lack of anti-stigma programs.
Audience question: I’ve been doing consultation in South Africa with drug users – one consistent universal issue was police violence against women who use drugs. The key intersection here is the criminalization of women who use drugs. How can we move forward?

Chang (INPUD): Decriminalization.

Guerra (UNODC): I totally agree. Prison is not a good place. It has been mentioned during this CND.

Ciupagea (UNODC): raising awareness among law enforcement forces, training, alternatives to imprisonment. It takes time but we sustain our efforts.

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