National Consultation to develop a harm reduction strategic plan for women who use drugs in India

Kapurthala, May 29,2019: India HIV/AIDS Alliance is the Principal Recipient (PR) for the Global Fund regional Harm Reduction Advocacy in Asia project (2017-2019) that involves 7 countries in Asia (India, Vietnam, Indonesia, Cambodia, Thailand, Nepal and the Philippines). The project aims to maximize the impact of investments that help break the cycle of transmission of HIV among PWID in concentrated epidemics by addressing legal, policy and health system barriers that hinder necessary outreach, coverage and access to core services through the community system strengthening.

Asia the region is home to the greatest numbers of women who inject drugs and use amphetamines globally – 1.5 million and 2.4 million, respectively – but programmatic and policy attention to their needs remains inadequate. Despite shouldering worse health outcomes and higher risk practices compared to their male counterparts, women who use and inject drugs face limited access to HIV-related health and support services. Punitive drug policies and elevated stigma and discrimination further prevent women from benefiting from existing interventions. Though relatively smaller in number compared to people who use drugs (PUDs), the situation of WUDs could be more serious than that of PUDs for several reasons. Firstly, WUDs are known to trade sex for money or drugs. Secondly, female drug users who exchange sex for drugs or cash may not identify themselves at risk of HIV infection because they do not consider themselves as sex workers. Thirdly, condom use can be infrequent among them because drug dependency and financial problems may impair power to negotiate for condom use with their sex partners. Additionally, WUDs depend in many cases on their male partners for drugs and injections, leading them to an elevated risk of equipment sharing practice. Further, WUDs are socially more stigmatized, hidden and vulnerable compared to their male counterparts, making it more difficult for them to access harm reduction services. For these reasons, WUDs expose themselves to the exceptional risk of HIV infection and play a critical role in the local HIV epidemic by bridging infection to the broader population through their drug injection network as well as sexual network.

A study published in 2019, estimated about 2.1% of the country’s population (2.26 crore individuals) use opioids, and nationally, it is estimated that there are about 8.5 lakh people who inject drugs with high numbers in states of Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana, Haryana, Karnataka, Maharashtra, Manipur and Nagaland[1]. According to the NACO expert group on size estimation, women who inject drugs as reported in 2012, was between 10,055 to 33,392 approximately in India[2]. Association drug abuse has with domestic violence, blood-borne viruses, and emotional anguish impacts households every day in India[3]. Drug abuse among Indian women was not recognized until recently, and still has not been given proper merit and the number of women who actually are able to access to HIV and Harm Reduction services is very low. There remains a general lack of understanding of the specific needs of women and a lack of appropriate drug treatment services that take into account the diverse needs of WUDs. This situation is more worrisome in resource-constrained countries like India, where there is limited availability of data on WUDs and scientific evidence-based treatment services in general