The Global Village at the AIDS 2012 conference includes representatives from women’s groups from around the world. Many are focused exclusively on HIV and gender. More power to them! But one of the absences at the conference is sustained discussion about the relationship between gender, HIV and drug policy. Several groups representing sex workers, composed mainly of women, are doing their best to remind conference attendees about the need for gender-based harm reduction services. As these groups note, the violence, marginalization and stigma faced by sex workers force women away from services. And violence against sex workers is often gender-based violence.
It’s apparent, however, that more discussion is needed about how harm reduction programs can make their services more gender-sensitive. Best practices do exist, have been tried and have been shown to work. Harm reduction services need to guarantee the personal safety and confidentiality of their women clients; women-only drop in services can help gain the trust of women. Harm reduction services that utilize peers have also been successful including programs that provide clients with harm reduction supplies that can then be distributed among friends and colleagues who use drugs. Recruiting women as staff and outreach workers can also help gain the trust of those who would not ordinarily use a harm reduction service.
Due to childcare responsibilities and partner resistance, some women may be unable to access fixed site services. Mobile services can bring a range of services to women including harm reduction supplies, STI and pregnancy testing. Programs that integrate harm reduction services with reproductive and sexual health services can also improve have been shown to be particularly successful. Most importantly, integrated non-judgmental harm reduction services for pregnant women who use drugs including counseling, OST, and “friendly” doctors is an important part of gender-sensitive programming. Again and again programs that offer these services have shown that when pregnant women and mothers who use drugs are provided with comprehensive care that is supportive, sympathetic, woman-centred, and non-judgmental, maternal outcomes improve and mothers have more positive birth experiences (Boyd, 1997).
Sheway in Vancouver, BC is one such excellent example. This program provides comprehensive health and social services to women who are either pregnant or parenting children who have experience with drug use. They offer prenatal, postnatal and infant health care, education and counseling for nutrition, child development, addictions, HIV and Hepatitis C, housing and parenting. Sheway also helps to fulfill basic needs, such as providing daily nutritious lunches, food coupons, food bags, nutritional supplements, formula, and clothing.
So what’s stopping us from scaling up these great harm reduction initiatives in Canada? Women who use drugs face a doubled stigma; add pregnancy and mothering to that mix and policy-makers are often afraid to touch the subject. It’s time to speak up in favour of these important services for women who use drugs.