Sexual And Reproductive Health and Rights

1. Sexual And Reproductive Health and Rights NINI PAKMA MEGHALAYA INDIA IAC 2014 Melbourne, Australia

2. SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS OF FEMALE INJECTING DRUG USERS The North Eastern Indian states especially Manipur, Meghalaya, Mizoram and Nagaland report relatively high HIV prevalence. The targeted intervention programmes are supported by the Department of AIDS Control,Ministry of Health and Family Welfare,Govt of India are mostly delivered by non-government organizations (NGOs), and prevention of HIV transmission by injecting drug use is their main focus. Most injecting drug users (IDUs) are male and the services are primarily tailored to meet their needs, which are not necessarily the same as those for women. Some strategies and activities have still to be identified and implemented by NGOs wanting to improve their reach among vulnerable women who use drugs and alcohol.

3. Condts…. The most problematic substance for women in my country is alcohol and heroin/ brown sugar, spasmoproxyvon (SP) and cannabis. The most commonly identified health problems were primarily related to the women’s drug and alcohol use, reproductive health and mental health. Other problems of major concern includes social exclusion, violence, children’s welfare, and financial difficulties. The expressed service needs of these women are women-only integrated health services, women-only detoxification and rehabilitation services, mental health services, sensitization of mainstream health workers, free access of medicines, assistance to meet basic needs, and a safe place to engage in sex work.

4. Differences in the Health Status and Risk Practices amongst WUD There are significant differences in the health status and risk practices of female injecting drug users as compared to male IDU. Women who inject drugs experience significantly • higher morality rates, • Increased likelihood of injection- related problems, Faster progression from first drug use to dependency, • Higher levels of risky injections, • Sexual risk behaviors and • Higher rates of HIV

5. Limited Access to Health Services • Gender specific stigma decreases Women’s access to Harm Reduction services or any other Health care services which they need. • The majority of the clientele is male, and the services they provide are geared to meet the need of men. • Fear of stigma makes them avoid DIC and dislike buying injecting equipments. • Male partner may discourage the female from seeking prevention and treatment services.

6. Contd… • Women are a minority of the IDU population, they are not always included in relevant health programs. • Many harm reduction programs do not respond to the specific needs of women such as reproductive health care • It provides only a basic package of injecting supplies and condoms.

7. WHY ARE FEMALE INJECTING DRUG USERS SO VULNERABLE? Stigma and Discrimination • Women who use drugs experience disproportionate levels of stigma and discrimination during pregnancy and also as a mothers. • Some health care providers have been deny access to treatment and services to women who use drugs. • Women also suffers breaches of confidentiality relating to their drug use and their status which can lead to violence, harassment and family disconnection.

8. Contd….. • The stigmatized nature of women’s drug use forcible removed from their homes, ostracized by family, friends and community and having removed their children from their custody.

9. Sexual Risk : • Women who use drugs are often unlikely or unable to negotiate safe sex practices with their primary partner, • Sexual risk taking may be related to feelings of trust in relation, • Or may be culturally embedded in the gender distribution of power, • Attempts to negotiate condom use with a primary partner can thus result in violence, isolation and exclusion within the relationship

10. Contds……. • Infrequent use of condoms by women who use drugs with long term and casual partners and a correlation between inconsistent condom use and the sharing of injection equipment. • High risk sex is more significant of HIV infection than risky injecting practices in women who use drugs.

11. Injection Behaviours and Intimate Partner Violence: • Women who inject drugs are more likely to have partners, clients and friends who also inject contributing to their elevated vulnerability. • Women exchange sex for drugs use or other resources and exert little influence over their partner’s condom use. • Women who use drugs reports a lack of knowledge on accessing sexual and reproductive health services and commodities.

12. Contds….. • Women when injecting with men are more likely to be ‘last on needle’ concerning the risk of HIV and other BBVs from the use of contaminated equipments. • Sexual coercion is one of the forms of intimate partner violence most associated with the risk of HIV transmission.

13. Sexual and Reproductive Health and Pregnant: • Pregnant drug users also face major barriers to access harm reduction and HIV related services. • Stigma and discrimination associated with drug use during pregnancy results in many women keeping their drug use concealed preventing them from accessing HIV prevention and treatment programs as well as preventing vertical transmission of HIV. • Health care provider in some regions are inadequately not aware about the effects of drug use in pregnancy.

14. Contds….. • Some women do not realize they are pregnant until relatively late making it more difficult for them to access appropriate prenatal care, drug treatment and other support or to terminate their pregnancies safely if they choose so. • Reduced access to prenatal care can lead to reduced levels of PMTCT among women IDU living with HIV.

15. HEALTH PROBLEMS AMONG FIDU • The most pressing health problems among FIDU were explicitly and implicitly associated with their dependence on drug and alcohol use. They also complain of symptoms of withdrawal from drugs and alcohol and consequently also associate that use of the drugs or alcohol makes them feel better. • A number of reproductive health problems have been reported including unwanted pregnancy leading to both abortion and birth of children, white vaginal discharge, irregular or absent menstruation, and STIs- syphilis and gonorrhoea.

16. Contd….. • When a woman is suspected to have an STI, they often self-treat rather then suffer the embarrassment of seeking diagnosis and treatment from a health professional. • Long periods of amenorrhea were identified among women using heroine in particular, and irregular menstruation contributed to late detection of pregnancy. • In some cases of pregnancy , the identity of the father was difficult to ascertain, or the father refused to acknowledge paternity, with the result that some women were single parents to their children.

17. Contd…. • A range of gastro-intestinal complaints has been identified as problematic for female alcohol users in particular, especially gastritis, stomach problems, liver problems, hepatitis, lack of appetite, weight loss due to poor food intake, diarrhea, constipation, nausea and vomiting. • Drug overdose is also one health risk among the female drug users. • Associated with all these depression, stress and tension are found among the women using drugs.

18. Conclusion • Harm reduction package for the prevention, treatment and care of HIV among people who use drugs does not include contraceptive methods (other than condoms), pregnancy tests, pre and post natal care and prevention of vertical transmission of HIV. • Adding these to the package could help women who inject drugs to better manage their sexual and reproductive health, thus preventing unplanned pregnancies and improving pregnancy outcomes, including through improved access to prevention of vertical transmission of HIV.

19. Contds…… • Women IDU faces a heightened risk of HIV as well as other harms and special barriers in accessing health care. • Sexual and reproductive health services, as well as special needs of women with small children or with a history of trauma should be incorporated into the harm reduction and drug treatment services. • Interventions should be developed to better respond to the specific needs of women who inject drugs and governments should take these needs into account and formulate policy accordingly.

20. “Harm Reduction Programmes can be scaled up but must be tailored to the needs of Women”. Thanks