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NINI PAKMA
MEGHALAYA
INDIA
IAC 2014
Melbourne, Australia
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.
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.
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
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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.

Women are a minority of the IDU population, they are
not always included in relevant health programs.
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Many harm reduction programs do not respond to the
specific needs of women such as reproductive health
care
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It provides only a basic package of injecting supplies
and condoms.
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.
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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.
Sexual Risk :
 Women who use drugs are often unlikely or unable to
negotiate safe sex practices with their primary partner,
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Sexual risk taking may be related to feelings of trust in
relation,
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Or may be culturally embedded in the gender
distribution of power,
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Attempts to negotiate condom use with a primary
partner can thus result in violence, isolation and
exclusion within the relationship

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.
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.
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Women exchange sex for drugs use or other resources
and exert little influence over their partner’s condom
use.
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Women who use drugs reports a lack of knowledge on
accessing sexual and reproductive health services and
commodities.
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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.
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Sexual coercion is one of the forms of intimate
partner violence most associated with the risk of HIV
transmission.
Sexual and Reproductive Health and Pregnant:
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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.

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.
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Reduced access to prenatal care can lead to reduced
levels of PMTCT among women IDU living with HIV.
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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.
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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.
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When a woman is suspected to have an STI, they often selftreat rather then suffer the embarrassment of seeking
diagnosis and treatment from a health professional.
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Long periods of amenorrhea were identified among women
using heroine in particular, and irregular menstruation
contributed to late detection of pregnancy.
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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.
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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.
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Drug overdose is also one health risk among the female
drug users.
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Associated with all these depression, stress and tension are
found among the women using drugs.
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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.
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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.
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Women IDU faces a heightened risk of HIV as well as other
harms and special barriers in accessing health care.
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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.
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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.
“Harm Reduction Programmes can be
scaled up but must be tailored to the
needs of Women”.
Thanks