Gender shapes the experience of drug use and its consequences. In a society where policies are mainly designed by men, directed towards men’s needs and where women are often excluded, discriminated against or abused, it is more important than ever to consider female drug use in terms of gender equality.
Although more research is needed, there is enough evidence showing that many existing harm reduction services exclude women and that existing policies have a discriminatory stance which leads to human rights abuses of drug using women. It is now a fact that gender-related factors can enhance women drug users’ vulnerability and victimization and decrease their access to drug treatment and sexual and reproductive services.
Gender inequality has many negative outcomes for women’s drug use. Low socioeconomic and political status, unequal access to education and employment, fear of male violence, intimate partner violence and sexual abuse increase female problematic drug use and add to the biological vulnerability of women and girls being infected with HIV. The consequences of gender inequalities in terms of low socioeconomic and political status, unequal access to education, and fear of violence, add to the greater biological vulnerability of women and girls being infected with HIV. Violence is catastrophic for a woman’s capacity to have safe sex and safer drug use and a history of trauma encourages risky behaviour and reduces possibilities of female empowerment.
A testimony from a woman who has been an injecting drug user for thirty years in Australia and the UK is indicative: ‘HIV services were almost exclusively male domains throughout the 80’s and 90’s despite the welcoming rhetoric and HIV positive women were forced to create services for themselves because it became clear that services not created by women didn’t cater for women. … We must address this unrealistic view we have of women who use drugs–vulnerable or deviant, or kicked to the curb or needing saving from themselves, the lives they can’t control, or the children they shouldn’t have had. HIV does not happen in isolation. It is strongly linked to violence against women, lack of knowledge and/or harm reduction, poverty, social and economic exclusion.’ ( quote taken The Global Coalition on Women and AIDS paper on women drug users)
There are still many societies where female drug use is considered as a sin or a taboo or a high level crime. The stigma of injection drug use is added to gendered discrimination and is reflected in the treatment of women and the inadequacy of harm reduction services. Women lose self-esteem, get panicked, threatened in many instances by the social rules of conservative societies and resort to catastrophic solutions such as unwanted abortions and higher dependence on substances instead of seeking help and treatment.
Moreover, power imbalances and drug economy hierarchies put women in an inferior position, making them vulnerable and easy targets to arrests, detention and incarceration. According to research findings, women are mostly confined to the lower levels of the drug trade which facilitates their arrest in comparison with the high level traffickers, who are almost always men. The majority of drug using women suffer from poverty and lack of resources, which results in them being without the appropriate legal defence. This power imbalance and general gender inequality in the drug economy, combined with rigid and punitive drug policies that often criminalise drug possession, along with a discriminatory attitude from police officers and health providers, has devastating consequences for the lives of women, who very easily become subject to long, unjust prison sentences and degrading treatment.
Women have specific needs that need to be addressed and met. Women’s specific characteristics, including reproductive health, family bonds, pregnancy and many more have to be taken into account so that they have equal and full access to harm reduction services and treatment. As it is stated in the 2010 UNAIDS chapter on women: ‘ Efforts to promote universal access to HIV prevention, treatment, care and support services require a sharper focus on women and girls. Fewer than half of countries report having a specific budget for HIV-related programmes addressing women and girls’.
All women who use drugs need to have full right to health, full access to HIV and sexual and reproductive health services, the right to denounce violence and to bring their persecutors to justice as well as the right to maternity and reproductive freedom. The UNAIDS 2010 Global Report recommends the following:
• A gender centred AIDS response including a full budget addressing women’s needs.
• Given the widespread violence and the clear association between gendered violence and HIV, national HIV responses must include specific interventions to address violence.
• All countries need to ensure that women have access to integrated quality HIV and sexual and reproductive health services that enable women to fully exercise their rights.
Female drug users have specific needs that have to be met through careful policy design that addresses them. Punitive approaches towards drug injecting women only aggravate their condition and cause worse problems. A gender-sensitive approach to harm reduction programs around the world coupled with a decriminalisation approach to drug policy will certainly improve not only women’s lives but those of the people who live around them.
* this article was published at talkingdrugs.org