Organised by the UNODC HIV/AIDS Section with the support of South Africa, the Group of Friends of HIV Prevention Among People who Use Drugs and People Living in Prison Settings, the World Health Organization, UN-Women, the Joint United Nations Programme on HIV/AIDS, the UNODC Prevention, Treatment and Rehabilitation Section and the Women Harm Reduction International Network

Fariba Soltani, UNODC. I am the chief of the HIV/AIDS section and coordinator for HIV/AIDS for UNODC. I thank all participants and speakers for joining us on addressing gender-based violence against WWUD. This topic is of great importance because of the 10 10 10 targets of the Global AIDS Strategy: that less than 10% of key populations experience gender inequality and gender-based violence. We need to increase our efforts to ensure that WWUD are not left behind.

Draurio Barreira Cravo Neto, Brazil. It’s an honour to stand with you today from within the department on HIV and STIs to address this critical and urgent issue. A warm welcome to Fariba for her leadership role and efforts in fighting against HIV at UNODC. I also note the crucial role of Fariba as the UNAIDS Programme Coordinating Board in which Brazil serves as vice chair, we will assume chairmanship in 2025. I extend greetings to Justice Tettey at UNODC. We recognise and thank your contribution to our shared goals. Special acknowledgement at the Brazilian Secretariat on Drug Policy. We are proud of our leadership role in GRULAC since last year. Globally, women are a significant portion of WWUD (around 25-27% of 3 million PWUD). This is a reflection of many challenges faced by many women because of discriminatory policies and laws. In Brazil, we are deeply aware of the challenges faced by WWUD and are committed to addressing them, including links between GBV and HIV due to punitive policies, gender-based stereotypes. Recognising these facts, last month we launched the programme Health Brazil to eliminate social determinants of HIV, adopting an inter-ministerial approach and showcasing our commitment. It brings together 14 ministries, international cooperation agencies and CSOs. We launched the programme with the presence of the WHO Executive Secretary Tedros. Brazil also produced guidelines on HIV and BBV for women in situations of vulnerability. This includes cis and trans gender women. It emphasises the need for comprehensive healthcare from the perspective of human rights and offers pathways to address GBV. We need to integrate drug policies in universal and equitable care. We are working to prevent HIV infections and ensuring integrated care for WWUD. This event is an opportunity to share strategies and practices to address the dual crisis of GBV and HIV. We are eager to learn from our counterparts. We emphasize the need for our joint commitments. 

Justice Tettey, UNODC. Thank you for joining this side event. I thank the Vienna Group of Friends for HIV prevention, and our newest member of the group: South Africa. I also thank INPUD and WHRIN and colleagues at UNAIDS, WHO and UN Women who are cosponsoring the event. The Ministerial Declaration identified HIV, hepatitis C and other BBVs as a challenge in our progress in addressing and countering the world drug problem. We’ve heard many times at the CND session that PWUD are disproportionately impacted, with hep C being the number 1 cause of death globally. Structural factors impact women’s access in engaging with HIV and hep C services: unequal power dynamics, violence, poverty, stigma and discrimination. GBV is a major driver of HIV transmission with long term consequences for PWUD, families and communities. We have laws against against sexual and GBV but institutions responsible for preventing and addressing it have limited resource sand capacity to truly doing something. We developed guidance and capacity building programmes to support governments address GBV. I am proud to support the work done by the HIV section and expand collaboration with other parts of UNODC, other UN agencies, governments and civil society to increase the impacts of our work. Today you will learn more about Brazil and South Africa, both are priority countries for UNODC regarding HIV. Today, I am pleased to launch our technical brief on GBV against women and gender-diverse people who use drugs. This was produced in collaboration with various UN entities, INPUD and WHRIN. We are also developing another technical brief focusing on prison settings. Political and financial commitments to scale up interventions, address inequalities and structural and gender-based violence is essential. We need to work together, connect the dots and be bold to leave no one behind. 

Nara de Araujo, Brazilian Secretariat on Drug Policies. GBV is a high priority for Brazil. I will be brief. Among the different forms of violence women face in the application of drug policy, I want to raise two important issues: 1- contact that women have with the criminal justice system. When we talk about the application of drug laws, we should stress that we have a smaller number of women in prison if we compare it with men, but there is an increase in the numbers in the last decade. Among women, we have more women in prison for drug offences than men (more than 50% compared to 30%). In the broader region, it’s even more concerning, it can rise to up to 80% for women in prison. Besides that, it’s important to highlight that women are being disproportionately affected by the criminal justice system. If we have a closer look at the amount seized among women it’s twice the amount seized among men. We also have an intersectional gender/race issue as most women in prison are black women. There is also a link with HIV. We have pregnant women and women with children in prison, even though they are entitled to protections within Brazilian laws. Women have therefore been disproportionately affected, and this has impacted on HIV transmissions. 2- women, drug use and social exclusion: there are resolutions stating that being a woman living in the streets and using drugs is not a reason for removing child custody. But this is a usual practice in our country. The impact on the lives of these women who have been removed custody of their children is huge. There are recurring recommendations associated with judicial bodies to immediately notify the judiciary of the birth of children born to women who use crack and other drugs, as well as pregnant women who refuse to undergo prenatal care. But that is a sign of social exclusion and puts them at risk of avoiding the healthcare system, and we cannot avoid the transmission of HIV from mother to child. They cannot even know their HIV status, or access prenatal care if there is a risk of losing their baby. IN terms of strategy, we have an important inter-ministerial committee with 7 ministries involved in the committee, which is developing a programme on STIs. We discuss the social determinants of health for these women, and social vulnerability markers. We also have a strategy with Ministry of Health and civil society with a focus on harm reduction, including for people living in the streets. We have been working on institutional strengthening of people who use drugs. We fund 20 CSOs focusing on women and drug use. We also have a partnership established with the public defender’s office to provide training for public defenders on drug policies and women’s rights. We hope that, especially in border regions, we can provide support for women in contact with the criminal justice system so that we can better protect their human rights.

Siza Magangoe, South Africa. We are painting a picture of what is happening in South Africa. The intersectionality of drug use, GBV and HIV means you can’t address one without addressing the others. Local research shows that intimate partner violence is 5 times higher where one or both partners use drugs. This issue of drug abuse and GBV and HIV is a power relation issue, it’s a gender inequality and insecurity issue. Drug use is a critical catalyst for violence. The is a medical research council that ensures the interventions are evidence based. They have painted a picture for us and showed us how alcohol and drug use are drivers of GBV and HIV transmission. Women exposed to GBV experience trauma, and need services on trauma. We recognise that females injecting drug experience unmet needs due to barriers and stigma from the community at large. Our president has declared GBV as an issue that should be addressed nationally. Our integrated framework aims to address the triple challenge of GBV, substance abuse and HIV. Our pillars include accountability, coordination and leadership; prevention and rebuilding social cohesion; justice, safety and protection (we are reviewing all our legislation to make this happen); response, care, support and healing for our women; economic power to break out of toxic relationships with their male counterparts; and research and information management. We need to go back to our communities for dialogue, irrespective of what communities engage on. We need to provide tools to include them. We need an explicit gender lens focusing on men’s drug use and harm experienced by women, and we must strengthen interventions aimed at reducing intimate partner violence. We must invest in capacity building that will address prevention, treatment and aftercare services for women addicted to substances.

Emily Rowe, Women and Harm Reduction International Network. This presentation will highlight practical responses to violence. It reflects the work done by WHRIN partners on drug use. WHRIN recognises the way in which punitive drug policy has gendered impacts. We disseminate evidence and guidance on GBV against WWUD. Firstly, we need to highlight decriminalisation. Punitive drug policies exacerbate violence and perpetuate impunity. Without decrim, all other responses remain limited. Decrim is the elephant in the room. It might not be immediately achievable, but it is increasingly accepted and implemented. WWUD have been disproportionately incarcerated in several jurisdictions, and it’s been ineffective and has worsened health and social issues for women, their families and communities. Alternatives such as case dismissals, decrim, restorative justice, etc. should be urgently applied. PWUD may avoid available support services if risking losing child custody. The 2018 Lancet submission highlighted the need to addressing violence and human rights, and integrating GBV and sexual and reproductive rights. This includes violence prevention and support services (health, legal and social), while creating alliances with allied services. Trainings and other support can help services increase their capacity to respond to the needs of PWUD. To ensure optimal outcomes, a regular community led evaluation should be applied. Zero tolerance to drug use in shelters hampers efforts to address violence. We developed a workshop tool to support harm reduction and shelter services to open their doors to PWUD. Examples of shelters that welcome women, trans and gender-diverse PWUD have been documented by WHRIN. Governments should consult with WWUD to conceive response plans that are adapted. Client autonomy and leadership is key to addressing GBV and developing adequate services. Harm reductions services can offer meeting services, request technical support, etc. Building networks with women who use drugs can facilitate peer support. We also work closely with sex workers, feminist networks, and others.

Emily Christie, UNAIDS. The drivers of GBV are many: gender inequality, poverty, criminalisation, stigma and discrimination. This is part of the Global AIDS Strategy. One of our global targets relates to the need to remove criminal sanctions against drug use, as well as on gender-based violence and harmful gender norms. It’s the first time we have specific targets on GBV specifically and for women who use drugs. We work closely with our cosponsors, UNODC is one, on addressing GBV and HIV and WWUD. One of the things we’re doing is to try and improve data collection. The prevalence of HIV among WWUD is twice as high as that of MWUD in 8 countries. We are trying to collect data on harm reduction provision and access, as well as on GBV. We support community-led data collection through the stigma index on PLHIV. We also have data collection on attitudes of law enforcement against PLHIV. We also collect data on barriers that prevent people from reporting on violence. Those assessments have led to the development of programmes, a train the trainers module on PLHIV. The technical guide on GBV on WWUD is an important one to highlight all of the evidence from this work, including the need to address criminalisation and ensure access to a whole range of services including those on sexual and reproductive rights.

Giovanna Campello, UNODC. Here I will only present concrete tools aiming at addressing GBV among WWUD, especially in the context of overdoses. This comes from our observations that there is a connection between GBV including intimate partner violence and increased rates of use and possible increases in risks of overdose. This is striking because this is about people already in treatment, so they are in principle more protected. But violence puts them at risk of overdose. Overdose is increasing faster among women than among men. This is why we are happy about this initiative called SOS – Stop Overdose Safely. This does not appear as a response to GBV, it was about overdoses. In 4 countries, we trained 14,000 people likely to witness overdoses (police, families, peers, etc.). 90% of those trained used naloxone successfully and saved lives. So we can make a difference. The most touching for me was the link between giving the community of PWUD the sense that people around them can help take care of them. I look forward to connecting this initiative with the other positive initiatives that were presented today.

Monica Ciupagea, UNODC. I had the pleasure to coordinate this technical guide and collaborate with WHRIN and other partners. What Justice said is: it’s the time we are launching the brief. It was pre-launched before, but this is now widely available. It’s part of a larger initiative, the 2025 targets in particular. The publication is meant to help countries reach the target of less than 10% of women who experience GBV. It doesn’t come in isolation. It’s part of a bigger initiative on HIV with support and advice from CSOs to address the needs of WWUD. Over the years, we’ve published various publications on WWUD, including on prevention of mother to child transmission. We work in collaboration with other UN agencies for this work. For the sake of time, I will not take you through all the recommendations, but please take a look at the 10 recommendations included in the guide to reduce GBV among WWUD: support networks of WWUD, removing criminal sanctions, addressing stigma, addressing social determinants of health, harm reduction, eliminate harassment and other forms of violence including from police and healthcare providers, provide resources for data collection on the issue to make sure we use the real resources we have to have an impact. Next steps: we will invest in high priority countries to scale up gender based violence services. Over 155 countries have legislation on GBV and have signed legislation to eliminate GBV. The commitments are there, but there needs to be support for these to be implemented.

Fariba Soltani, UNODC. Thanks to all of you for coming and for supporting us. We hope this document can help us achieve the 10 10 10 targets.