gender aspects of health and social risk of female partners of injecting drug users
TRANSCRIPT
Belgrade, 2012
Gender aspects of health and
social risk of female partners of
Injection Drug Users
Main goals of the study
• To provide an empirical basis for formulating gendersensitive recommendations that should be includedin the Action Plan for the National Strategy on HIV inSerbia.
• To develop recommendations for gender sensitiveservices for governmental and non-governmentalactors for people infected by and at risk of HIV.
• To get insight into gender aspects of HIV risk amongfemale partners of IDUs within the broader contextof their living conditions and exposure to social andhealth risks.
Specific goals of the study
• To identify specific patterns of social and health riskthat female partners of IDUs are exposed to.
• To deepen the understanding of various aspects ofpartner relationships and the impact IDUs have onrisky behavior - sexual work, initiation into druginjecting practices, use of sterile equipment etc.,
• To identify and assess accessibility and the role ofgovernmental and non-governmental servicesavailable for women who are at risk of HIV.
Implementing organization - SeConS in
brief
• Independent think-tank, founded in 2005 in Belgrade by a group of sociologists and social researchers.
• SeConS’ mission is to contribute to integrated and sustainable development of Serbia and the Region.
• Organization’s good practices have spread in neighboring countries, Montenegro and BiH.
• Areas of SeConS’ support are: social inclusion of vulnerable groups, such as women, Roma, refugees and IDPs, people experiencing poverty; regional and local sustainable development; institutional and organizational reform and development of the public sector; HR development; evaluation of development programs and projects and assessment of public policies at the national, regional and local levels.
SeConS in brief (cont.)
Expertise of SeConS:• Designing methodologies and conducting empirical research from
different fields in Serbia and the region• Drafting comparative studies, analyzing policies, legislation and
providing recommendations for further improvement in Serbia and the region
• Designing and conducting training and education programs for individuals, institutions and organizations, to support their work in social inclusion
• Empowering marginalized groups and individuals through trainings, to improve information sharing and help them to become more proactively involved in decision-making processes
• Advocating for social development, through representation of interests of vulnerable groups and networking with relevant stakeholders.
METHODOLOGY
Method of data collection:
Qualitative research method - in-depth semi-structured interviews with focuson:• Personal characteristics and features of the respondents family context
during childhood and in the present - history of gender relations and riskbehaviors,
• initiation into into the world of drug use,• characteristics of current and former relationships with partners who are
IDUs,• personal history of vulnerabilities - patterns of health and social risks,• experience with health and social service providers,• coping strategies and/or exit strategies,• and, subjective perceptions of risk and the need for social protection.
Quantitative research method: short survey focusing on the socio-demographic profile of respondents
Sensitive topics research - challenges
The research could have negative effects onrespondents:
(1) questions can intrude into the most intimate sphereof their lives and problems, issues that can provokepain, stress or shame and therefore can causesecondary victimization of respondents;
(2) questions can be related to activities that are illegal;
(3) respondents can be afraid that revealinginformation can put them in danger, lead topunishment or revenge of other persons in theirsurrounding that might be in power positions.
Sample
• 99 in-depth interviews in Belgrade and Nis
• Snowball sampling in two Drop-In centers where IDUs can obtain sterile equipment
• Respondents selected according to following criteria’s: a) women that are in a relationship with an
IDU (regardless of whether they are IDUthemselves or not),
b) or, women that are themselves IDUs whohave previously been in a relationshipswith IDUs.
Analysis and fieldwork
• Duration of fieldwork: 22nd of November - 9th ofDecember.
• 23 interviews completed in Nis and 76 interviews inBelgrade – all interviews were audio-taped andtranscribed ‘word to word’
• Qualitative content analysis conducted
• Quantitative data processed in SPSS andsubsequently analyzed
RESEARCH FINDINGS
SOCIO-DEMOGRAPHIC
CHARACTERISTICS
Socio-demographic characteristics
Respondents’ socio-economic position is extremelyunfavorable and they belong to the most vulnerable socialgroups.
• Education levels are low – 37% without qualifications
• Household conditions are unfavorable – 28.1% ofhouseholds do not meet minimum standards in housing,5% are homeless or live in e.g. containers, barrack etc.
• Material deprivation is high – 60% struggle to make endsmeet, 30% can barely cover basic costs.
• A vast majority unemployed - only 15.5% are employed
GENESIS OF RISK
Genesis of risk – social and family context
Research shows a few key factors (push factors) that impactlater drug use and life of risk among respondents:
• lack of parental care and supervision;
• experience with/exposure to different forms of violence(psychological, physical, and sexual);
• substance abuse problems within the family;
• life on the streets and exposure to sexual work,delinquency, and peer pressure;
• curiosity or submissiveness in relation to the impact ofpeople from family and peer networks;
• and, lack of awareness about the risks and consequencesof drug use.
Genesis of risk – social and family context
Genesis of risk – social and family context
• Identified risk factors during childhood and adolescentyears are interlinked and contextually bound – theycontinually reinforce one another.
• All risk factors are saturated with powerful genderspecific roles:– Respondents are often subordinate in relation to a male figure
from early childhood.
– Internalization of gender roles (in which women are in asubmissive position, with less or no power) influences thereproduction of gender inequality in the future life of therespondents - it leads to greater exposure of women to the riskof initiation into drug use, relationships with partners who areIDU, and social and health risks.
PARTNER RELATIONSHIPS
Partner relationships and life with drugs
Several key gender patterns (gender inequalities) put women inrelationships with IDUs in a specifically risky position:
1. Partners play an important role in initiating drug use of theirpartners: IDUs often conceal their addiction at the start ofthe relationship and they are often actively trying to forcetheir partners to start using drugs (directly through mentaland physical coercion, pressure, and persuasion), as well asby different forms of allurement.
2. Household priorities are dependent and centered aroundthe need for drugs - all other needs in the household aresubordinated to the priority of procuring drugs and meansfor drugs. When the partner is not IDU herself, her and herchildren's needs are subordinated to that of the partner andthey often live in constant deprivation of basic needs.
Partner relationships and life with drugs
3. Strategies for providing funds for drug use:
– Women often internalize and accept the responsibility of providing for thelivelihood of the household – they are most often the main household providers.
– Sexual work is a very common strategy whereby respondents use their 'women'sresources‘ as means to obtain drugs. This is not simply the choice of respondents,rather, in many cases this is a direct result of coercion and pressure from theirpartners. Furthermore, women often practice sexual work in order to protect theirpartners from risks related to other criminal acts, which can result in strongersentences than sexual work. This type of responsibility whereby women aresacrificing their own resources and putting themselves in a vulnerable positions inorder to protect their partners, has deep roots in patriarchal patterns of genderroles that are largely present in the social environment of women.
– Women who are not users themselves are also often the main providers offinancial means for their partners drug use: borrowing money from friends andrelatives, using their welfare checks, and stealing. This is often due to fear ofpossible outbreaks and aggressiveness of their partners.
Partner relationships and life with drugs
4. Gender inequalities of household lifethat expose women to numerous healthand social risks:
– respondents are almost exclusivelyresponsible for care of the household andchildren
– women are systematically exposed todomestic violence and violence againstwomen - physical, sexual, economic andpsychological violence are dominatingpartner relationship
Partner relationships and life with drugs
– male domination in the drug market puts women who areIDUs themselves in a position where they are dependenton their partners for the procurement of drugs
– practices of injection drug use produces a range ofadditional risks:• women who are not IDUs help with preparation of equipment and
injection itself due to fear of ‘crisis’
• when both partners are users, these risks are closely related topractices of sharing equipment whereby partner authority shouldnot be questioned
Partner relationships and life with drugs
5. Exit strategies from a life with drugs and a life withIDUs are very difficult to follow through. There aretwo main strategies, both mostly unsuccessful:
– Treatment of addiction: failure of treatment
– Ending the relationship: physical and psychologicalviolence and socio-economic dependency
Inability to exit an abusive relationships or a relationshipwhere the woman is continuously exposed to health andsocial risks, leads to the acceptance of and adaptation toadverse circumstances.
PATTERNS OF HEALTH RISK AND
ACCESS TO HEATH SERVICES
Patterns of health risk
1. Infectious and sexually transmittable disease (especially, HIV, HCV and HBV).
Prevalence of HIV among respondents and their partners
Prevalence of HCV among respondents and their partners
Respondents Partners of respondentstotal % total %
HIV postive 5 5,1 4 4,1HIV negative 79 79,8 71 71,7Unknown 13 13,1 13 13,1Missing 2 2,0 11 11,1Total 99 100 99 100
Respondents Partners of respondentstotal % total %
HCV positive 40 40,4 40 40,4HCV negative 36 36,3 36 36,3Unknown 17 17,2 17 17,2Missing 6 6,1 6 6,1Total 99 100 99 100
Patterns of health risk
Main cause of infection:– unprotected sexual relations,
– sharing of drug injecting equipment (in cases whererespondents are IDU),
– and injury related to drug injection practices (in cases whenwomen are not IDU).
Mechanisms that increase exposure include:– limited knowledge of infectious and sexually transmitted
diseases,
– exposure to violence,
– accidental injuries,
– and lastly, conscious exposure to disease as a ‘pathological’desire to share experiences and problems of partners.
Patterns of health risk
Patterns of health risk
2. Reproductive health is often at risk as a result of:– high-risk pregnancies,– unwanted pregnancies,– and frequent abortions and miscarriages.
These problems are closely associated with:– addiction problems,– lack of information of risks and disregard of risk,– trust in partners,– no use of protection - because they find it less satisfactory, and
because the partner rejects use of such forms of prevention.
3. Physical injuries as a result of violence (in their relationshipsor by other male figures in the family or environment) andinjuries related to long-term injection drug use.
4. Psychological problems associated with addiction problemsand/or adverse living conditions.
Health care services
Access to health services is limited due to:– lack of proper documentation (id cards, health insurance),
– lack of trust in health services providers and medical personnel(unpleasant and antagonistic communication with healthpersonnel),
– discrimination and refusal of health care professionals duringprovision of services (inadequate provision of health services isrooted in the dismissal and stigma related to the lifestyles of therespondents and prejudices of possible attaining an infectiousdisease) manifested through a lack of attention, superficial andinaccurate diagnosis, and inadequate therapy,
– lack of psycho-social support,
– and finally, fear that the police and/or the Center for SocialWork might be contacted.
PATTERNS OF SOCIAL RISKS AND
SOCIAL SERVICES
Patterns of social risks
Main social risks female partners of IDUs are exposed to:
1. poverty and material deprivation,
2. exclusion from the labor market and therefore highprevalence of engagement in informal sectors of thelabor market,
3. delinquency and problems with the law enforcement,
4. family dysfunction and instability,
5. exposure to domestic violence and violence in theenvironment,
6. and social discrimination, social exclusion and isolation.
Social services
Social service
Access to social services limited due to:
• Lack of information about different types of supportand procedures necessary to be able to access theseforms of social protection,
• discrimination and stigmatization when trying toaccess such services,
• avoidance of contact with governmental institutionsdue to the fear of loosing custody over children,
• and, experiences of violence or threat of violence,especially in regard to law enforcement personnel.
RECOMMENDATIONS
Prevention of health and social risk
1. Enable and adapt various forms of protection againstdomestic abuse and neglect:– Identify dysfunctional families and different types of problems
in family relations
– Support to parents who experience communication or otherforms of problems with their children
– Provide adequate protection from and systematic monitoring ofchildren in families with substance abuse problems
– Systematic support against domestic violence
2. Encourage integration of girls from vulnerablegroups/socially excluded groups (Roma, poor, homelessgirls, and so on) to be educated and involved in extra-curricular activities.
Prevention of health and social risk
3. Strengthen channels of information on health andsocial risks that are a result in risky behavior:
– Inform boys and girls about risks and preventive measuresrelated to infectious and sexually transmitted diseases and thereproductive health of women.
– Inform young people about different forms of violence andsupport systems for victims of gender-based violence.
– Empower girls through normative education on genderequality in school.
– Educate teachers in this field and how they can recognize riskybehavior and family problems.
– Educate health care providers to recognize violence againstchildren, as well as other forms of risky behavior.
– Educate parents about the effects their risk-behavior has onchildren and how identify risky behavior in children.
Support measures
1. Sensitize the social care system on the specificneeds of women who are at risk.– Improve availability of information on the right to financial
social support, child support, one-time municipal aid, RedCross assistance, soup kitchens etc.
– Ensure rights to material assistance for women andchildren victims of violence throughout Serbia
– Provide material assistance to IDUs that have finishedtreatment against addiction
– Educate social care professionals on the specific needs ofwomen with IDU partners, women who are IDUs, sexworkers etc.
Support measures
Support measures
2. Improve measures for women victims of violence(especially for female partners of IDUs and women thathave more children).– Inform about support systems in the event of violence in an
accessible way through 'close‘ institutions (especially non-governmental org.)
– Provide shelters for women who are victims of violence and IDU– Improve support systems in cases of psychological, sexual and
economic violence– Sensitize employees in the judiciary and police against
discrimination of female IDUs and sex workers.
3. Improve provision of legal aid to female partners ofIDUs and female IDUs:– Provide free legal aid throughout Serbia– Provide free representation in court when it comes to lawsuits
Support measures
4. Improve health provision to women who are exposed to many health problemsbecause they are IDUs, female partners of IDUs and sex workers:
– Educate health personnel at health centers (and other health care facilities) aboutworking with IDUs and other vulnerable groups in order to reduce discrimination andimprove health services for people with and at risk of HIV.
– Systematize trainings of health workers on infectious diseases (HIV, HCV, HBV),substance abuse problems, and pregnant women in this vulnerable group.
– Inform vulnerable groups on infectious and sexually transmittable diseases,– Increase availability of psychological help,– Develop gender sensitive programs for treatment of addiction,– Increase access to and information about free testing for HIV , HCV, and HBV,– Provide free sterile injection equipment ,– Complement sterile equipment services with psychological support, work with the
NSP, work with children from IDU partnerships, etc,– Link sexual and reproductive health with measures related to HIV / AIDS strategies and
programs,– Provide free contraception and information about various types of protection,– Improve the accessibility of health insurance to women who do not have id
documents or support for attainment of personal documents.
