Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance

Hidden women

4
APR
2011

(c) Malaysian AIDS Council

Outside of sub-Saharan Africa, approximately 50% of HIV positive women are infected through sex with a male partner who is an injecting drug user (IDU) while between 30-35% are infected through sharing contaminated injecting equipment.

The stigma and discrimination women who use drugs face is intense and poses serious obstacles for them in terms of access to health and education services. This is compounded by gender norms that lead to a range of inequalities – such as being dependent on male partners who have access to drugs - which often place them at greater risk of HIV transmission.

Where harm reduction services are available, too few specifically meet the needs of women.

THE MALAYSIAN EXPERIENCE

HIV and AIDS statistics from Malaysia show that an estimated 0.5 percent of the population are living with HIV.  Although most people infected with HIV in the country are male, there has been a steep increase in the number of new cases among women.

In 2008, UNAIDS estimated that 10% of injecting drug users in Malaysia were women. Many more women who are the wives and/or sexual partners of men who use drugs are also very vulnerable to HIV.

Being so stigmatised it’s hard to reach women who use drugs, or the partners of men who use drugs,  but the Malaysian AIDS Council (MAC) and partners are reaching out to these hidden women to understand more about their needs and provide services.

REASONS WOMEN ARE VULNERABLE

Women who inject drugs have lower access to services than men who inject drugs.  This is because drug use services are rarely “women-friendly”, with women made to feel like outsiders and their needs not being met.  For example, many drugs services do not offer pregnancy or maternal health services or programmes for women with children.   

Many women engage in commercial sex or transactional sex to deal with drug dependency, poverty and homelessness. Women who use drugs are more likely to take risks in sex work because of their drug habits or those of their partners, and are less likely to work in brothels.  They are also less likely to have access to or use condoms.

Women who use drugs and are pregnant are often marginalised by health care workers, families, partners who tend to assume that their drugs will be causing substantial harm to their unborn babies.  In fact, they are more likely to experience other problems, for example relating to malnutrition and lack of appropriate medical care, than from the drug use itself.

For pregnant women who use drugs who are also HIV positive the need for supportive medical care intensifies. However, access to prevention of mother-to-child transmission programmes is often limited for women who use drugs and maternity wards rarely have access to OST (opioid substitution therapy) programmes.

Women who use drugs may fear losing custody of their children.  This means they become reluctant to use HIV and drug dependency services for fear that their children will be taken away by the authorities.

WHAT IS BEING DONE?

MAC supports specific services for  women who use drugs. One of these is run by MAC partner, Drug Intervention Community Pahang (DiC Pahang) in Pahang State, funded by the Ministry of Health.

DiC Pahang provides a safe space at Projek Persona Grata Wanita, a drop-in centre that provides information, counselling, basic nursing care, provision of condoms and referral to medical services for women using drugs. Last year the project reached 178 female injecting drug users with services.

Two such women are Saira Banu, and Tuan Noraliza.

SAIRA

Saira injects drugs but became seriously depressed when she knew she’d contracted HIV. Ostracised and alienated by her local community she found herself on the streets, barely surviving. Whilst wandering the streets she came across the Projek Persona Grata Wanita drop-in centre.

She became a frequent visitor where she used the facilities to eat, rest and freshen up. Slowly Saira felt better, understanding that despite being HIV positive and using drugs she wasn’t judged by the workers and through counselling sessions and support group activities her self esteem improved.

Saira is now a dedicated and committed permanent member of the Persona Grata Wanita, happy to help out with the tasks given to her. She has stopped using drugs and is working at a nearby restaurant and rents a room not far from her workplace.

“DIC Pahang should operate more drop in centres like this so more female IDU or partners of IDUs can come forward and get help…they have helped me to become a better person,” she says.

TUAN

Tuan Noraliza, known as Jar, also uses drugs and is with a partner who injects drugs. They live in a traditional Malay village just outside Kuantan. At the same time as managing her own drug use she is also looking after her family and her partner.

She met an outreach worker from Persona Grata Wanita and the services available appealed to Jar. She agreed to try Methadone Maintenance Therapy (MMT) and is now a full time volunteer at the drop-in centre.

“I am indebted to DiC Pahang for the good life that I am living now. I will do whatever it takes and give my best to help my female IDU friends.”

For guidance on working with women who use drugs, download the Alliance Good Practice Guide on HIV and drug use.

The Alliance Community Action on Harm Reduction Project aims to reach 180,000 drug users, their partners and children in China, India, Indonesia, Kenya, and Malaysia.