Healthy Options Project Skopje How to integrate gender perspective in Harm Reduction Programs Vlatko Dekov Contents 1. Context 2. Gender roles 3. Problems associated with gender roles 4. Recommendations for gender sensitive HRP - On policy level - On services level Context • Although drug use often has been treated as non gender specific issue, data and experiences show that prevalence of drug use, problematic drug use and related health and social consequences differ greatly between the genders. Men and women characteristically have different histories of drug use from initiation to exit. The reasons for those differences are complex and are related to mixture of social, physiological and personal factors. Gender roles One of the reasons are gender roles and women position in society • Men are those who hold key position - have decision making positions; • Women are more visible in private than in public sphere; Gender roles • Most frequent roles for woman connected with private sphere are - to be a mother, to take responsibility for raising of children, to care for house work - cleaning, cooking etc.. • The patriarchal system which is pushing women into private sphere creates a lot of problems including problems connecting with drug use and approaching the services for drug users. What kind of problems? 1. Invisibility of WUD Although presumed percentage of WUD in the Balkan countries is 25% to 40 % we can not see them in the programs. • Harm reduction programs: Percentage of WUD in HRP in Balkans countries - 14 % Montenegro , 18% Macedonia-, 19 % Serbia, 25% in Bulgaria, • Treatment programs: Percentage of WUD in treatment programs in Balkans countries is even lower. Table TDI-4. Demographic characteristics of clients entering treatment, 2011 or most recent year available, EMCDDA , 2011 Gender Country Year % Male % Female Gender Ratio Gender Number Unknown 84.3 15.7 5.4 478 39 Bulgaria 2011 Greece 2011 86.7 13.3 6.5 2570 2 2011 87.7 12.3 7.1 3199 23 2011 76.4 23.6 3.2 1136 10 2011 81.4 18.6 4.4 1151 0 88.4 13.6 7.6 422 0 Hungary Romania Croatia Macedonia 2011 (Capital city) 2. In Macedonia WUD are more visible only in life threatening situation, such as overdose; • Number of non fatal overdose cases in Skopje, Clinics of toxicology, 2001-2005 Year Total per year M N 2001 2002 2003 2004 2005 274 327 319 263 253 Total 1436 W % N % 200 250 241 201 198 72.9 76.4 75.5 76.4 78.2 74 77 78 62 55 27.1 23.3 24.5 23.6 21.8 1090 75,7% 346 24.3% What kind of the problems? 4. Initiation of injecting drugs by men. • In Macedonia, 7 out of 8 WUD start injecting on men’s initiative (boyfriends , friends..); • Most inexperienced women users are injected by someone else in the beginning. It is paradoxical that women who had independently initiated their use of heroin, would subsequently become dependent on a man to inject the drug… this pattern has symbolic import; the dependency of woman’s addiction makes it somewhat less an addiction than if she were “shooting up” herself ( Rosenbaum, M. 1981); • This power of men to “shoot up women” is reflection of the metaphoric warfare which man continue to lead; while the willingness of women to accept yet another area in which they become dependent on men recreates the idea of female vulnerability and gender hierarchy, and another domain in which women accept as socially normal a situation in which they lack control over their own lives and bodies. • Another aspect connected with gender roles and private sphere is public use of drugs. Are you often seeing scenes of woman injecting in public place? What measures should we take to make HRP gender sensitive? • On political level - involve women in decision making processes: - Strengthen the WUD movement; - Equally include women and men using drugs in the creation of an HRP. Their expertise and contribution to the design, implementation, monitoring and evaluation of services contributes to the improvement of service effectiveness and efficacy; On service level 1.Support WUD to become more independent Women self-help groups, specialized counseling sessions and women-outreach workers may help female drug users to a large extend, and decrease the factors contributing to risky behavior. It is especially significant to introduce activities for education completion, job seeking training and assistance in finding employment, which would make them financially independent. 2. Inclusion in HRP The inclusion of WUD as staff and volunteers in Harm Reduction Programs will contribute for WUD to feel more comfortable and less stigmatized. This will contribute to the increase in the percentage of women using the program’s services. 3. Provisioning specific intimate and comfortable space and specific time in which women can use the services. 4. Develop integral harm reduction programs for drug users who are also sex workers. Drug users engaged in sex work need services related both to their work and to their use of drugs and those services should be provided by one team in one space. Having in mind that acknowledging sex workers as drug users may be a problem in their negotiation /finding clients, it is better that services related to drug use should be discretely integrated in the sex worker targeting program. 5. Provide free of charge legal aid The free of charge legal aid for WUD shall enable access to legal remedies in case of abuse, exploitation, unjust imprisonment or losing custody over their children. This is of special importance for the respect of their rights, but also as a preventive measure, because it sends a message to women-drug users that they cannot be abused, without the perpetrator being punished. 6. Connection with services for GB violence Having in mind that gender-based violence is an obstacle for service accessibility, which correlates with the risk from HIV exposure, harm reduction programs should be connected to programs providing protection from gender-based violence 7. Counseling for intimate partnerships Harm reduction programs should provide counseling for intimate communities (intimate partnerships), in order to empower women and to create safer drug use and sexual behavior in partnerships in order to decrease the HIV transmission risk. 8.Develop mother targeted programs The obligation for caring and upbringing of their children is one of the major obstacles for the accessibility of not only addiction treatments for WUD, but also HRP. Enabling child care will increase the willingness and possibility to contact HRP and start an addiction treatment. If possible, treatment and harm reduction programs should create a safe, clean and age-appropriate space where children will be able to stay while their mothers are using the programs. 9. Gender education The personnel and employees in services should acquire knowledge about genders , gender roles and skills in recognizing social and health needs of women and men, in order to accommodate and prevent the factors causing risky behavior. Thank you for your attention ! Blagodaram na vnimanieto ! [email protected] Thanks to NGOs – Prevent, Serbia Initiative for Health, Bulgaria Juventas , Montenegro Romanian Harm Reduction Network
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