Hidden women

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.