The systematic abuse of India’s female opiate users

Women who use drugs are at increased risk from HIV and violence, but as they don’t explicitly feature in official national data, their needs largely go unmet.

<p>WINGS harm reduction programme</p>India has the largest number of heroin users in Asia. ©Gemma Taylor

Despite India having the largest number of heroin users in Asia according to the UN, the number of women that make up these figures is unknown. The lack of a gender breakdown, along with India’s prevailing gender stereotypes, allows for a presumption that smoking or injecting chitta, brown sugar, or number four, is largely a male pursuit.

Women who use drugs are more likely to experience violence than those who do not - two to three times more likely. HIV prevalence among people who inject drugs is 6.3% according to HIV sentinel surveillance data of National AIDS Control organisation 2016-2017, compared to the overall national rate of 0.2% for adults, and the risk of HIV increases further for women when both drug use and violence are present. In the country assessed to be the most dangerous place to be a woman, and where 63 million women and girls are ‘missing’, drug use is compounding the normative risks.

Benefits of a harm reduction approach (versus unrealistically trying to stamp out drugs) are globally recognised, including by the Government of India which does invest in services and centres. However, while these aren’t deliberately male-only sites, women struggle to get through the door.

“If she can get away from the house without being questioned or accompanied, and she can get across to the building without neighbours seeing, and she can pass through the crowd of guys in the doorway, she then has to sit in an intimidating male environment until she is seen,” says Pemu Bhutia, Senior Technical Officer at Alliance India.

We’ve had colleagues who work at these places asking, have you really found the women who use drugs? Really?”

No-one could realistically deny that women who are addicted to opiates do exist, and they’re not absent from all data. The UN and NGOs have carried out studies, but try advocating for female-friendly services and you hit a vicious cycle: You need official national data to prove to the government that this is an area that needs funding, but you need funding to find the data.

That’s why WINGS, a currently small scale female-focused harm reduction programme, is addressing this ‘catch 22’ to prove that there are women using drugs, along with demonstrating the impact that tailored services can have. WINGS stands for Women Initiating New Goals for Safety and its mission is to reduce violence and HIV among women who use drugs in India.

Pemu, who oversees the programme in the three states it operates (Delhi, Manipur and Pune), says that as well as being uniquely directed at women WINGS is also the first harm reduction programme in India to address gender-based violence.

Many of the women enrolled had been seeing violence as part of their day to day life, something at best to accept, or worse that they 'deserve it’ because of their addiction. WINGS helps women to identify risk, realise their rights, and, through counselling, find strategies to deal with and reduce harm.”

Pemu WINGsPemu Bhutia, Senior Technical Officer at Alliance India, who oversees the WINGS harm-reduction programme.  ©Gemma Taylor

Pemu acknowledges that they don’t have a “magic wand” and many situations can seem hopeless, for example when dealing with women who are homeless. The WINGS staff know the programme is not going to celebrate huge figures or necessarily witness dramatic life transformations at the end of its first year this coming April. It’s about making small yet significant changes for individuals, as well as proving that the need exists. “If you just give up because it feels insurmountable nothing will change - and these women have been ignored for long enough,” says Pemu.

WINGS has reached 185 of its modest 200 target. 75 have received HIV testing and counselling, 8 were positive, and 6 are on treatment as a result. Other services include providing clean injecting equipment; condoms; sexual and reproductive health and rights advice and referrals; other health referrals including Hep C, STI and TB testing and treatment; counselling; 24 hour support for emergencies including overdose; and referrals for opioid substitution therapy (OST) if a client voluntarily wants to enrol. WINGS provides these services through drop-in centres, outreach sites, home visits and by phone.

The status of women

Common reasons that the women have cited for taking drugs include recreational experimentation, being influenced or pressured by a husband’s drug use, or dealing with one of the following: trauma from early or forced marriage; being subjected to abuse from husbands and in-laws; kidnap of a child; and/or ex-husbands denying access to children. It’s a stark reflection of how women’s low status in India can play out.

The data that WINGS collects will shape the next phase of the programme if funding is secured. If the programme expands after April working with male partners would become a fundamental component. “You need to deal with the perpetrators of violence, not just the victims,” states Pemu. This would partly come in the form of couple-counselling, and the team also plans to ramp up police training and ‘community sensitisation’. This is because once a woman’s drug use is discovered, often she is also subject to violence outside of the home.

For example, in Imphal, Manipur, women are routinely arrested. “One time, during a holiday, they arrested a group of women and lined them up on public display,” says Shobana Sorokhaibam who manages the WINGS programme at Imphal, “Officers were overheard saying ‘we’re going to have some fun later’. Our staff went down before nightfall and pleaded with the superintendent for their release.”

As was thankfully the case that night, women are usually released when the WINGS staff go down to the station to negotiate. The arrests are often illegitimate to start with. According to Shobana, typically neither the officers or the women are aware of what is and isn’t an offence under India’s drug law.

It’s not just the police dishing out ‘justice’. The community, seeing drug use as a moral issue, sometimes takes the matter into their own hands, especially in rural areas. “I had my hair shaved off by community members,” says Kashvi*, 27, a mother of three. The Manipur WINGS staff confirm that 'head shaving’ has become a unique brand of punishment and humiliation specifically reserved for drug users. “It was in front of so so many people - and police officers were in the crowd,” says Kashvi.

“What are you going to do after that?” proffers her friend, Mia*. “You’re going to go and find the peddler.”

While WINGS continues with its mission of reducing harm, its interventions will also need to be unique and specific. It hopes that Kashvi and Mia’s experiences, along with the other 183 women, will be enough to show that while they may be missing from national statistics they are very much alive and their lives matter.

If WINGS 2.0 gets off the ground it hopes to increase the number of women it supports. The programme will continue to employ proven, recognised harm reduction methods and the team believes that for women to have more control over their lives, addressing gender-based violence will also remain pivotal. This means slowly raising the status of women who use drugs, woman by woman, household by household, community by community. It’s a tall order in a country with up to five million opiate users, but it has to start somewhere.

After-all, lack of status and a presumption of a woman’s role and behaviour is a factor as to why women are not in the data to start with, and it's really hard to help someone when they don’t exist.

WINGS is a pilot project working with women who use drugs and alcohol in India. It is implemented by Alliance India, an Alliance Linking Organisation.

*Names changed.