1. health and fitness
2. sexuality

Healthy Options Project Skopje
How to integrate gender perspective in
Harm Reduction Programs
Vlatko Dekov
Contents
1. Context
2. Gender roles
3. Problems associated with gender roles
4. Recommendations for gender sensitive HRP
- On policy level
- On services level
Context
• Although drug use often has been treated as non
gender specific issue, data and experiences show
that prevalence of drug use, problematic drug use
and related health and social consequences differ
greatly between the genders. Men and women
characteristically have different histories of drug use
from initiation to exit. The reasons for those
differences are complex and are related to mixture of
social, physiological and personal factors.
Gender roles
One of the reasons are gender roles and women
position in society
• Men are those who hold key position - have decision
making positions;
• Women are more visible in private than in public
sphere;
Gender roles
• Most frequent roles for woman connected with
private sphere are - to be a mother, to take
responsibility for raising of children, to care for
house work - cleaning, cooking etc..
• The patriarchal system which is pushing women into
private sphere creates a lot of problems including
problems connecting with drug use and approaching
the services for drug users.
What kind of problems?
1. Invisibility of WUD
Although presumed percentage of WUD in the Balkan countries
is 25% to 40 % we can not see them in the programs.
• Harm reduction programs:
Percentage of WUD in HRP in Balkans countries - 14 %
Montenegro , 18% Macedonia-, 19 % Serbia, 25% in Bulgaria,
• Treatment programs:
Percentage of WUD in treatment programs in Balkans countries
is even lower.
Table TDI-4. Demographic characteristics of clients entering treatment, 2011
or most recent year available, EMCDDA , 2011
Gender
Country
Year
%
Male
%
Female
Gender
Ratio
Gender
Number
Unknown
84.3
15.7
5.4
478
39
Bulgaria
2011
Greece
2011
86.7
13.3
6.5
2570
2
2011
87.7
12.3
7.1
3199
23
2011
76.4
23.6
3.2
1136
10
2011
81.4
18.6
4.4
1151
0
88.4
13.6
7.6
422
0
Hungary
Romania
Croatia
Macedonia 2011
(Capital
city)
2. In Macedonia WUD are more visible only in life
threatening situation, such as overdose;
• Number of non fatal overdose cases in Skopje, Clinics of
toxicology, 2001-2005
Year
Total per
year
M
N
2001
2002
2003
2004
2005
274
327
319
263
253
Total
1436
W
%
N
%
200
250
241
201
198
72.9
76.4
75.5
76.4
78.2
74
77
78
62
55
27.1
23.3
24.5
23.6
21.8
1090
75,7%
346
24.3%
What kind of the problems?
4. Initiation of injecting drugs by men.
• In Macedonia, 7 out of 8 WUD start injecting on
men’s initiative (boyfriends , friends..);
• Most inexperienced women users are injected by
someone else in the beginning. It is paradoxical that
women who had independently initiated their use of
heroin, would subsequently become dependent on a
man to inject the drug… this pattern has symbolic
import; the dependency of woman’s addiction makes
it somewhat less an addiction than if she were
“shooting up” herself ( Rosenbaum, M. 1981);
• This power of men to “shoot up women” is reflection
of the metaphoric warfare which man continue to
lead; while the willingness of women to accept yet
another area in which they become dependent on
men recreates the idea of female vulnerability and
gender hierarchy, and another domain in which
women accept as socially normal a situation in which
they lack control over their own lives and bodies.
• Another aspect connected with gender roles
and private sphere is public use of drugs. Are
you often seeing scenes of woman injecting in
public place?
What measures should we take to make
HRP gender sensitive?
• On political level - involve women in decision making
processes:
- Strengthen the WUD movement;
- Equally include women and men using drugs in the
creation of an HRP. Their expertise and contribution
to the design, implementation, monitoring and
evaluation of services contributes to the
improvement of service effectiveness and efficacy;
On service level
1.Support WUD to become more independent
Women self-help groups, specialized counseling sessions and
women-outreach workers may help female drug users to a large
extend, and decrease the factors contributing to risky behavior. It is
especially significant to introduce activities for education
completion, job seeking training and assistance in finding
employment, which would make them financially independent.
2. Inclusion in HRP
The inclusion of WUD as staff and volunteers in Harm Reduction
Programs will contribute for WUD to feel more comfortable
and less stigmatized. This will contribute to the increase in
the percentage of women using the program’s services.
3. Provisioning specific intimate and comfortable
space and specific time in which women can use
the services.
4. Develop integral harm reduction programs for
drug users who are also sex workers.
Drug users engaged in sex work need services related both
to their work and to their use of drugs and those services
should be provided by one team in one space. Having in
mind that acknowledging sex workers as drug users may be
a problem in their negotiation /finding clients, it is better
that services related to drug use should be discretely
integrated in the sex worker targeting program.
5. Provide free of charge legal aid
The free of charge legal aid for WUD shall enable access to
legal remedies in case of abuse, exploitation, unjust
imprisonment or losing custody over their children.
This is of special importance for the respect of their rights,
but also as a preventive measure, because it sends a
message to women-drug users that they cannot be abused,
without the perpetrator being punished.
6. Connection with services for GB violence
Having in mind that gender-based violence is an obstacle for
service accessibility, which correlates with the risk from HIV
exposure, harm reduction programs should be connected to
programs providing protection from gender-based violence
7. Counseling for intimate partnerships
Harm reduction programs should provide counseling for
intimate communities (intimate partnerships), in order to
empower women and to create safer drug use and sexual
behavior in partnerships in order to decrease the HIV
transmission risk.
8.Develop mother targeted programs
The obligation for caring and upbringing of their children is one
of the major obstacles for the accessibility of not only addiction
treatments for WUD, but also HRP.
Enabling child care will increase the willingness and possibility
to contact HRP and start an addiction treatment. If possible,
treatment and harm reduction programs should create a safe,
clean and age-appropriate space where children will be able to
stay while their mothers are using the programs.
9. Gender education
The personnel and employees in services should acquire
knowledge about genders , gender roles and skills in
recognizing social and health needs of women and men, in
order to accommodate and prevent the factors causing risky
behavior.
Thank you for your attention !
Blagodaram na vnimanieto !
vlatkod@hops.org.mk
Thanks to NGOs –
Prevent, Serbia
Initiative for Health, Bulgaria
Juventas , Montenegro
Romanian Harm Reduction Network