Download Communicating

Communication challenges & opportunities
to address alcohol and drug abuse among
adolescent girls and women
Sanjanthi Velu
Johns Hopkins Bloomberg School of Public Health
Center for Communication Programs
Roadmap of the presentation
• Vulnerabilities that are unique to women and girls that
contribute to risk of drug and alcohol abuse
• Challenges of working with women and girls – dearth of
services, barriers to accessing existing services, stigma,
lack of support, economic dependency
• Gaps, Needs identified for strategic communication
• Audience segmentation and opportunities for
communicating with different primary, secondary and
tertiary audiences and service providers
• Some useful communication strategies
• Successes and lessons learned in communication
programs – case studies
Vulnerabilities of women and girls
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Gender gap in substance abuse is
closing
Data indicates more young women are
abusing alcohol and drugs worldwide
Adolescents are influenced by their
peers
Women drug users differ from male
users in background, reasons for using
drugs, and psycho-social needs
•Girls are more vulnerable than boys to the effects of alcohol and drugs
due to differences in male–female body weight, water content
•Girls more likely to suffer consequences of its use –violence, injuries and
vulnerability to sexual coercion
(Binge drinking spot)
Vulnerabilities and Challenges
•
Women sexually abused during childhood are at increased risk for drug
abuse as adults
 According to NIDA-supported study conducted by the Medical College of
Virginia Commonwealth Univ, women who experienced sexual abuse in
childhood were roughly three times more likely than unabused girls to report
drug dependence as adults
•
Women and girls disproportionately experience more violence and
victimization including sexual, physical abuse, neglect, loss, domestic
violence, or the witnessing of violence
• Unequal power relations and gender dynamics in intimate relationships
• Wives and daughters of drug users are especially vulnerable to social, health
and economic disadvantages including domestic violence
 National Violence Against Women Survey - 8,000 women and 8,000 men
about their experiences with interpersonal violence (rape, physical assault,
and stalking) found women are more likely to be victims of interpersonal
violence than men
Gaps and Needs
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Economically vulnerable women are more likely to abuse drugs, engage in sex work
Women in sex work often abuse alcohol and drugs to numb their senses and tide
over the anxiety, depression and hopelessness
Interventions must address the relational, cultural, social, psychological and
economic context of their lives
Women substance users are highly stigmatized and stereotyped which poses a
barrier to accessing services
Services must include establishing recovery supports, social networks, stigma free
treatment services
Services must be based on the values of self-determination, hope and empowerment
Resources are mainly focused on male drug users
Women and girl’s drug use is more hidden
Mental health issues, depression and suicide is largely neglected
Few appropriate program designs that specifically looks at adolescents and drug
abuse
Agenda is often in the shadow as other issues are discussed (HIV/AIDS, sex work,
trafficking)
Audience
• Important to segment audience and sustain communication
with different audiences to create awareness, facilitate stigma
free services and to support an enabling environment
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Segmentation
Primary Audience: adolescent girls and women currently
using drugs and adolescent girls in general
Secondary Audience: partners, parents, family members
Tertiary Audience: local law enforcement authorities, jail
administration, police, pushers, religious leaders, community
leaders, chemists, policy makers, media
Fieldworkers: Peer educators, outreach workers, health
service providers, counsellors, educators
Some useful strategies
 Design innovative community based approaches to create awareness, to
promote safe behaviours and increase access to support and recovery services
 Strengthen the existing positive peer networks
 Build stronger links with health services
 Sensitize service providers and augment their skills in interpersonal
communication and counselling through meetings, outreach, workshops and
interactive materials
 Promote safe, drug free communities and neighbourhoods though religious
and community leaders
 Design new and innovative approaches to promote safe behaviours
including safe injection practices, condom use and access to support and
recovery services
 Convergence with other communication where relevant (from the context of
HIV/AIDS and STIs).
(
Youth ICTC spot)
Communication - primary audience
• Ensure understanding of substance abuse and addiction as a health
issue
• Care should be taken not to reinforce low self-esteem and
powerlessness
• Not further stigmatize women by insinuating that addiction is a moral
failure
• A balanced message that does not blame women for their addiction
• Recognize the need for personal responsibility
• Communicate understanding of the stress that women face in their
daily lives
• Inform that there are ways to reduce and cope with stress and factors
that are beyond their control
Communication - primary audience cont..
• Women and girls are often coerced into using or selling drugs by
their partners. Interventions must include life skills and
confidence building
• Materials should describe the program’s services in culturally
sensitive, easy to read language that is relevant to the target
audience
• Materials should be published in multiple languages used by the
target audience
• Use of illustrations, real life testimonials, role model stories, and
powerful audio visual tools
Communicating - secondary audience
• Engaging parents so they:
– spend more time with their children
– communicate in an open and friendly manner
– identify early warning signs of drug abuse,
depression or stress or failed personal relationships
– guide and protect their children and that they can
be reached out to at any time
• The message must also reach support groups
(other family members, significant others,
friends, coworkers)
Communicating -tertiary audience
• Advocate with policy makers to facilitate real
changes
• Engage at least one parliamentarian or legislative
council member to advocate for drug demand
reduction
• Remind donors and stakeholders that drug abuse,
besides HIV/AIDS and STIs, should be a top priority
• Garner support of local officials to achieve success
of drug demand reduction projects
• Sensitize police to support work with groups like sex
workers and active drug users
Communicating with tertiary
audience cont..
• Sensitize government service agencies, social
services, the criminal justice system, law enforcement
officers, probation and corrections officers
• Special efforts to educate community groups and start
community-based programs
• Rope in support from charitable organizations, sports
organizations, places of worship (spiritual leaders,
shelter personnel)
• Strengthen referrals to and establish linkages with
home health care workers, detoxification clinics,
physicians, pharmacists, and teachers
(Drug free world spot)
Case Study - Kenya
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Kenya Girl Guides Association (KGGA) under a USAID-funded
AIDS, Population, and Health Integrated Assistance Programme
(APHIA II)
32 Girl Guides, whose average age is 13, helped to develop an
interactive life skills curriculum and a peer education handbook
The first was used for adult-led training for guiding units
The second is for peer education delivered in schools by Girl
Guides for classmates ages 10–14 years
Session topics covered included; values and school performance,
self esteem, common illnesses, understanding feelings of
attraction, communication skills, helpful adults, decision-making
skills, responding to negative peer pressure; understanding HIV
transmission and prevention; reducing stigma and discrimination;
preventing rape; and refusing drugs and alcohol
Case study continued
• UNICEF’s Sara Communication
Initiative’s comic books and
stories about a spirited, selfreliant adolescent girl named
Sara provided empowering
messages help to overcome reallife challenges and promote
decision-making
• The highlight of this initiative is
that it integrates the enduring
values of the Girl Guide
movement with the life skill
education rather than treating
HIV/ AIDS and life skills
education as a stand-alone item
Outcome
 Some parents of PEs recognized their daughters' great
potential and noticed that they became more responsible
 One parent testified that she herself had benefited from
what her daughters had shared about decision-making,
self-esteem, HIV and AIDS, and other topics
 Peer educators attest to improved grades and changed
lives
 Maureen Anita, 14, said that session participants "no
longer use drugs and others have stopped engaging
in sex. They continue to tell us to teach them more."
Case Study – Youth & Community
Voices - CHP
• Gary Alan Fine: a social movement is a “bundle of narratives”
• In the early nineteenth century former slaves “told their stories”
in published slave narratives and in public speeches (Young,
2006).
• Health reformers, most of whom overcame debilitating illnesses
through the use of alternative cures, spoke and wrote about their
experiences often telling remarkable stories of their resurrection
and path to healing and recovery (Whorton, 2002)
• In the early days of the AIDS epidemic, telling of personal
stories and illness narratives was an important strategy used by
people living with AIDS as a way to cope with the uncertainty
and the trauma of being young people with an incurable and
initially baffling illness.
“We need
more effort to
overcome
stigma
associated
with former
IDU. We are
not able to get
back to living
within healthy
family and
social
settings. What
happens to us
after we are
clean?”
“The
importance of
addressing
issues of wives
of IDU needs to
be recognised.
We have rights
as well, but a
lack of
recognition of
women’s rights
and limited
livelihood
options leave us
helpless.
Collectively,
these drive
young women
like us to drug
and alcohol
abuse.”
"Sharing our stories
about being young
positive widows who
were forced into sex
work because of our
circumstances and
lack of income earning
options was
empowering. Rights
violations and police
harassment also
pushed us into drug
and alcohol abuse.
This project has
helped us connect with
each other and find
solutions to common
issues and
challenges.”
Youth & Community Voices
“Many issues are common across communities (e.g., stigma and
harassment). Before this I did not know that communities other
than my own faced stigma and harassment”
“Using creative forms of expression is a powerful means of sharing
our stories and showcasing our talent”
“We have learnt about the importance of advocating for our own
issues”
“We have found a new strength by sharing with one another”
Case study in Goa
Hunting Brownies – IDU Photo Novel
Given their high literacy levels and expressed need
for good reading materials, a photo novella called
Hunting Brownies was developed for drug users in Goa
A Participatory Process
• Participatory method of developing communication strategies, and
activities with community members enabled the development of a
socially relevant and culturally appropriate, user-friendly, needbased and effective communication material – the photo novel
• Workshops and discussions conducted with the community to
identify key themes and messages.
• In-depth brainstorming sessions, and formative research with
community members helped finalize the content; after pre-testing for
comprehension, size, image, color, and impact on target audience
• Conceived as a graphic novel initially, Hunting Brownies became a
photo novella after pretesting
• Shooting was supervised by drug users themselves to ensure every
action appeared true to life
• The plot and the situations reflect the experiences of community
members
Hunting Brownies
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Message: The story deals with how young people become vulnerable to
drug use, their struggles, relapses, lack of support, stigma, relationships,
health complications and finally hope.
It depicts:
the consequences of not being able to let go of the drug habit
the impact of continued drug use
the lapses of judgment that make young people vulnerable to HIV/AIDS
the risk of using contaminated needles
and how it is possible to make a change and revive one’s life and regain
self confidence
Dissemination: Copies provided to drop-in-centers, targeted intervention
NGOs, rehabilitation and counseling centers as discussion starters
Outcome - Voices from the field
Many of our clients have given up drugs for OST
• “Many of our clients have given up drugs and gone for Oral Substitution
Therapy (OST) because it was featured so positively in ‘Hunting
Brownies.’ The novella has been very useful with college boys as it
arouses their curiosity and they learn about effects of drugs on them
and how doing drugs can break up families and friendships. We are
using it for our prevention program, but it is also quite popular with
people who have just started on drugs. It is motivating them to leave
drugs. At the DIC, the photo novella is read out during group sessions.
We also find it a useful tool in sessions with girls who have multiple
partners. “
Preethi Pereira, Project Manager, ‘Positive People’, IDU TI Project, Goa
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“The photo novella has also been in use for the past three years in the
field. It’s helped our communication with IDUs become more effective.”
Ramesh Rathod, AD, TI, Goa SACS
Case study - multimedia campaign
in North East of India
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Mizoram, Manipur and Nagaland share an international border with
Bangladesh and Burma; see high incidence of sex trade, smuggling of
goods, trafficking in women and drugs
Intravenous drug use common in the north East, an important source
for HIV transmission among youth
Love for football and music define the life of the youth in North East.
The states have elaborate networks of youth football federations.
Common to see young people playing the guitar and enjoying music
JHU.CCP with SACS of Mizoram, Manipur and Nagaland, created a
platform in the form of music and football competitions to bring the
youth together at the village, block and the district levels
Choosing music and football to spearhead the prevention campaign
served to demonstrate to youth how exciting these activities were and
more satisfying and uplifting than drugs and unprotected or unsafe sex
Summary and Conclusion
Some ‘must haves and dos’ in communication:
• Typically programs that understand the neurological, biological,
psychological, and social context of women and girls’ drug and alcohol
abuse have better outcomes
• Programs focusing only on knowledge, affective issues, recreation, or
interactive program delivery produce modest prevention outcomes for
girls
• Those that emphasized life-skills programming had significantly
stronger effects (CSAP National Cross-Site Evaluation of High-Risk Youth Programs)
• Focus on the positive aspirations, attributes and ambitions of young
people and harness that potential in communication
• Community led interventions and amplification of voices – with young
people, for young people and led by young people
• Engage local partners, parents, policy makers, service providers, media
• Collaborate with all relevant sectors, organizations, Ministries,
departments – we cannot do it alone!