Janna Ataiants, Nino Janashia, Ketevan Bidzinashvili, Dali Usharidze, Tea Akhobadze, Olga Rychkova

1. Tailored Harm Reduction Approaches:Bringing health care and social support to women drug users in Georgia Janna Ataiants, Nino Janashia, Ketevan Bidzinashvili, Dali Usharidze, Tea Akhobadze, Olga Rychkova International Harm Reduction Development Program, OSI, New York

2. Making harm reduction work for women: • Barriers to access harm reduction services • Attracting and retaining women clients • Outcomes of the gender-sensitive programs • Challenges and recommendations

3. 1 The Global State of Harm Reduction 2010, IHRA While drug use remains to be the main driver of HIV epidemic in Eurasia, Georgia has one of highest adult population prevalence rates of injecting drug use in the world at 4,19%1

4. 2 Expert Estimate, data provided by NGO New Way, Tbilisi Estimated20% of all drug users in Georgia are women2

5. 3Women, Harm Reduction and HIV: Key findings from Azerbaijan, Georgia, Kyrgyzstan, Russia, and Ukraine, IHRD, 2009 In Georgia, despite the high percentage of women drug users whose sexual partners were themselves using drugs, more than four in five womenhad not been tested for HIV3.

6. Stigma: “It is always more difficult for a woman, she cannot trust anyone, especially if she has a husband – it is a small town, and then you get problems in the family if they find out”. - Anna, client of a harm reduction program, Zugdidi, 2010

7. Male partners “What kind of treatment can you offer to a woman who uses drugs? She does not deserve to live”. - Male client of a harm reduction program, Gori, 2007

8. Access to health “It is true, normally we do not go to a doctor voluntarily, we are brought to a doctor at the very last moment. I was sure the doctor will tell me something terrible, so I thought better avoid going all together. But the project made an appointment for me and it was not that bad. It was not too late yet. First time that I ever went to see a women’s doctor”. - Interview with a women’s project client, 2010

9. Building trust: Establishing relationship first, harm reduction second “Drugs – this is my biggest problem and my biggest complex. And this is the only place where I can openly talk about it”. - Interview with a women’s project client, 2010

10. Safe space “First time when I came here, I was really so much afraid, I was afraid even to walk in. But they [the staff] were so warm and understanding. I walked out a different person”. - Interview with a women’s project client, 2010

11. Naloxone and secondary exchange “I personally never used Narcan, but I always take it for them [her partner and his friends]. I have 100% certain information that Narcan has really helped someone” - Interview with a women’s project client, 2010

12. Outcomes • Tenfold increase in the number of women clients • Greater awareness of risky practices and prevention strategies • Access to HIV and HCV testing: 2% women tested positive for HIV and 25% - for HCV • Access to health care, including SRH 10 pregnant women referred to PMTCT and antenatal care • Outreach to the community

13. Recommendations • Strengthen connections between harm reduction and women’s shelters • Reaching out to other women’s rights groups • Advocate for gender-sensitive drug treatment and OST options