What proportion of people who inject drugs in Myanmar are women? How many women who inject are being reached by this AHRN effort?
Jamie
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Women who inject drugs: a hidden population
Three MDG Fund
17 January, 2018
In Myanmar, women are less likely than men to use and inject drugs. However, stigma, gender stereotypes and challenges in accessing services mean that they are often hidden from society and healthcare providers. Reaching women with Harm Reduction services requires special efforts to meet their specific needs.
Drug use is a significant issue in Myanmar. In some hard-to-reach parts of Kachin State, nearly one out of two people who inject drugs is living with HIV. They can also face a higher risk of other diseases, as well as discrimination and criminalization.
To reduce these harmful consequences, 3MDG’s implementing partners offer a package of health services in high risk areas.This is known as ‘Harm Reduction’, and is part of a broader right to health agenda. By focusing on prevention, education, treatment and support, these services are a departure from ‘zero-tolerance’ programmes that criminalize people who use drugs. Instead, they are seen as people in need of healthcare and support.
Services are offered at clinics, drop-in centres or through mobile outreach programmes, and include counselling, HIV-testing and treatment, condom distribution, needle exchange programmes and overdose prevention. In 2016 and 2017, one in every two people reached by a Harm Reduction intervention was supported by 3MDG.
However, women who use drugs often still remain hidden and hard-to-reach. They may face extra health risks related to sexual and reproductive health and their rights. In the first half of 2017, only five percent of the people reached by 3MDG were women. There are a number of reasons for this, including stigma, discrimination and gender stereotypes. Stigma affects both men and women, but women can face more severe consequences because their drug use may also severely transgress gender roles and social norms.
Significant numbers of female sex workers use drugs and have limited access to existing services because of cultural, legislative and political barriers. Women who are not sex workers may also be reluctant to access services for fear of being stigmatized as a female sex worker. Women may also remain hidden from health services because of their traditional role within the home; or be unable to afford transport costs. Drop-in centres are dominated by men, which can create an unwelcoming environment for women.
Ma Lu Lu Aung is a mother of two children from Seng Taung village. She started using drugs when she was 19.
“When I was addicted to drugs, my life was meaningless,” she said. “The stigma towards the women like us is too strong, so it was hard for me to get to the services that I needed.”
To ensure there are services available for women like Ma Lu Lu Aung, the Asian Harm Reduction Network Myanmar (AHRN) launched the Seng Taung Female Project. The project includes a ‘women-friendly drop-in centre’ which offers access to Harm Reduction services, including prevention of mother-to-child transmission (PMTCT), testing and treatment for sexually transmitted infections, reproductive health, antiretroviral therapy (ART), Methadone Maintenance Therapy (MMT) family planning, counselling and health education and medical intervention if required after sexual violence. Services are provided by female health staff and outreach workers who have been specifically recruited and trained.
A holistic approach to care is crucial to the usefulness of the centre. This is because individuals may fear stigma from other members of the community or health providers. “I had regular medical check-ups, counselling and all the other necessary services there. The clinic became my second home,” said Ma Lu Lu Aung.
AHRN also knows that building trust is critical amongst a marginalized group like people who inject drugs. Ma Lu Lu Aung said, “I felt hesitant when AHRN approached me to talk about their project and available services. But their continuous support helped me to overcome my addiction.”
Recreational activities led by female peer educators are important for support, community and encouraging return visits. Now, many of the visitors to the women-only centre have become regular clients or volunteers. Ma Lu Lu Aung, for example, is now stable so she is working as a peer support volunteer. She provides health education and support sessions to other women who inject drugs.
“My life is meaningful again,” she says. “I earn regular money for my family. By taking MMT, I can work to support them.”
There are also income-generating activities at the drop-in centres as part of the Harm Reduction package. This includes daily wage jobs where women can earn money to support their families. AHRN is currently discussing how to expand these efforts.
Nevertheless, there is the opportunity to increase the number of women clients, in 2018 AHRN will increase their promotion efforts to make sure that women are aware of the ‘female-friendly’ centre and available reproductive health services. At larger, mixed centres, AHRN will further expand safe and women-only spaces. More staff will receive training to ensure they are sensitive to the needs of women clients.
Alongside this, AHRN will also support more outreach services which specifically target women. These reach women in the places where they are, with their communities, helping to overcome barriers of cost, travel, and stigma.
The Ministry of Health and Sports has scaled up its commitment to holistic Harm Reduction services, and Methadone Maintenance Therapy in recognition of its effectiveness. 3MDG will continue to support Harm Reduction services throughout 2018.
https://www.3mdg.org/en/newsroom/item/907-women-who-inject-drugs-a-hidden-population
