Download Women`s Health Victoria

Submission to the National Drug Strategy beyond 2009
Women’s Health Victoria
GPO Box 1160, Melbourne, 3001
Telephone: (03) 9662 3755
24/02/10
National Drug Strategy Consultation
MDP 27
GPO Box 9848
Canberra ACT 2601
Introduction
Women's Health Victoria is a statewide women’s health promotion, information and
advocacy service. We are a non government organisation with most of our funding
coming from various parts of the Victorian Department of Human Services. We work
with health professionals and policy makers to influence and inform health policy and
service delivery for women.
Our work at Women’s Health Victoria is underpinned by a social model of health. We
are committed to reducing inequities in health which arise from the social, economic
and environmental determinants of health. These determinants are experienced
differently by women and men. By incorporating a gendered approach to health
promotion work that focuses on women, interventions to reduce inequality and improve
health outcomes will be more effective and equitable.
Women’s Health Victoria’s vision is for a society that takes a proactive approach to
health and wellbeing, is empowering and respectful of women and girls and takes into
account the diversity of their life circumstances.
Women’s Health Victoria’s ways of working are guided by four principles:
 We work from a feminist framework that incorporates a rights based approach.
 We acknowledge the critical importance of an understanding of all of the
determinants of health and of illness to achieving better health outcomes.
 We understand that the complexities involved in achieving better health
outcomes for women require well-considered, forward thinking, multi-faceted
and sustainable solutions.
 We commit to ‘doing our work well’; we understand that trust and credibility
result from transparent and accountable behaviours.
Women's Health Victoria - National Drug Strategy Beyond 2009
General Comments
Women’s Health Victoria welcomes the opportunity to respond to the consultation
paper for the National Drug Strategy (NDS) Beyond 2009. Drug use among women
appears to be on the rise both in Australia and around the world1. The number of
women in Victoria that misuse drugs is small with 10.35% of women using illicit drugs
in the past 12 months2 but the health implications for these women and their families
are serious and wide ranging. Women misuse both prescription and illicit drugs for
various reasons. These include dealing with past trauma, relieving stress3, and self
medicating mental illness.
Women’s particular needs regarding drug use and abuse are not being
comprehensively addressed.
Many of the current and past policies do not
acknowledge the ways that gender impacts on substance use and treatment services.
Differences exist for women and men around drug taking behaviours. Women and
men’s drug use differs with men more likely to use drugs for recreational purposes and
women more likely to use them to improve mood, reduce tension and cope with
problems4.
There are many health and social implications associated with women’s misuse of
drugs. Exposure to violence and significant illness including hepatitis C and human
immunodeficiency virus (HIV) can dramatically reduce quality of life. Falls and other
injuries sustained while under the influence of prescription drugs used for illicit
purposes is a concern for women, many of who are also abusing alcohol3. Maintaining
employment can be difficult for women using drugs further exacerbating the lack of
financial security women experience compared to men. Women are more likely to be
incarcerated for non-violent drug offences than men which can result in separation from
dependent children5.
These examples show that the impact of gender on drug use is significant. Both the
principles and the emerging issues of the NDS have the capacity to incorporate issues
of gender and tackle the causes and determinants of drug use in Australia.
What you think the top priorities for action should be during the next five years?
During the next five years a gendered approach to drug policy is necessary to
successfully increase the reach of drug prevention messages to disadvantaged groups
of women. This approach would recognise differences in women’s and men’s
experiences of drug use, their related support seeking behaviours, healthcare needs,
employment, educational requirements, and disparities in their social and economic
currency. A targeted approach that incorporates gender makes policies, programs and
service delivery more effective.
Gendered strategies are needed to reduce drug use and its impact on Australian
women. Effective and coordinated strategies are required to ensure that the number of
women abusing drugs is reduced and the treatment options are appropriate and
accessible.
A social determinants model of health should underpin the strategy. This model will
consider how different sectors impact on the health of individuals, families and
communities through environmental, economic, biological and gender factors.
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Women's Health Victoria - National Drug Strategy Beyond 2009
Key consultation questions:
 Cross Sectoral Approaches
How can structures and processes under the National Drug Strategy more
effectively engage with sectors outside health, law enforcement and education?
The involvement of other sectors is crucial in a social inclusion approach to drug
prevention. However, this requires greater awareness and understanding in the
community of the causes and impacts of drug use, particularly on women. A socially
inclusive approach must incorporate strategies to understand and address the
determinants of drug use.
WHV advocates for a holistic approach to drug prevention that considers the impact of
gender on the causes, experiences and outcomes of drug use for women. In addition to
involving other sectors it is essential that the health, law enforcement and education
sectors are taking a gendered approach to drug prevention. The Victorian Department
of Human Services Gender and Diversity Lens is one example of ensuring gender is
consistently taken into account.
Which sectors will be particularly important for the National Drug Strategy to
engage with?
WHV welcomes the potential engagement with the population health sector, as inferred
to in the consultation paper through the linkage of the NDS with the National
Preventative Health Strategy (NPHS). The NPHS represents a comprehensive
framework for improving health through prevention. The social determinants of health
are referred to, however many of the actions that are recommended in the report do not
always reflect this (for example, a focus on policing and enforcement re: alcohol, or
raising costs of cigarettes). The theme of making healthy choices easy choices is
evident throughout, however it is important that individuals who do not change their
behaviour are not demonised. Understanding and incorporating the social determinants
of health in the NDS would address this.
Connecting with the women’s sector by incorporating recommendations from the
National Women’s Health Policy (to be released in March 2010) will strengthen the
NDS beyond 2009. This linkage will provide the NDS with tools such as a gender
responsiveness framework which when adopted, will maintain a gender equity
approach to drug prevention in Australia.
Broadly engaging the non-government sector will increase the reach of drug prevention
messages to highly disadvantaged groups. Utilising these organisations will work
towards addressing the social determinants leading to drug use and harm, further
supporting the NDS beyond 2009.
 Capacity Building
Where should efforts be focussed over the coming five years to increase the
capacity of the generalist health workforce to identify and respond to substance
use problems?
Education and training is needed for any mainstream service providers that are
required to address drug use in Australia. Development of the drug and alcohol
workforce should be focussed on building their capacity to prevent drug use by
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Women's Health Victoria - National Drug Strategy Beyond 2009
addressing the social determinants of health. The workforce should be gender sensitive
in its approach and have a thorough understanding of the different ways drug use is
experienced by men and women.
A diversity rather than a lifecourse approach to drug policy should be adopted by the
workforce. A diversity approach recognises the diversity and complexity of women’s
lives and health needs, including lifecourse. This should be aligned with a social
determinants approach to health inclusive of factors such as Aboriginality, culture,
religious and linguistic diversity, disability, sexual identity, age, geographic location and
socioeconomic status.
A gender-based analysis of the health outcomes is needed to enable the workforce to
develop effective inventions, and evaluate the interventions. Any mechanisms that are
developed to measure the reduction of drug use in Australia must be disaggregated by
sex in order to provide an accurate picture of how drugs affect women and men
differently.
 Increased vulnerability
How can efforts under the National Drug Strategy better complement the social
inclusion agenda such as addressing unemployment, homelessness, mental
illness and social disadvantage?
Efforts under NDS must complement the social inclusion agenda by considering
women and the determinants that lead to women’s being unemployment,
homelessness and experience of mental illness and social disadvantage. Structural
issues such as housing, income assistance, transportation, and access to health care
are integrally related to women’s stress and substance use, and fragmented health and
social services are a common barrier to women’s efforts to access treatment, obtain
stable accommodation and reliable income6. This needs to be specifically
acknowledged in the NDS, with the intersection with the social inclusion agenda spelt
out.
Where should effort be focussed in reducing substance use and associated
harms among vulnerable populations?
Women who are socially isolated are at higher risk of depression and excessive alcohol
consumption7 self-harm and suicide contemplation8. To reduce substance abuse in
vulnerable populations, effort should be focussed on collecting and interpreting
gendered data to be used to develop a solid evidence base. This evidence base will lay
the foundation to reduce substance use and associated harms in Australia by working
towards achieving gender equity in health and health equality between women.
The issues facing vulnerable sub-populations of women are listed are below. Policies,
programs and services must be holistic to address the needs of all women.
Women with Mental Illness
The use of illegal drugs by women has been associated with experiences of trauma,
including physical, sexual and psychological traumas9,10. For some women, drug use is
a way to cope with mental illness11. These mental health issues impact on their ability
to attend and participate in drug treatment. Service providers need to identify women
in this situation to give them a better opportunity to address their drug problem and
improve their situation.
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Women's Health Victoria - National Drug Strategy Beyond 2009
Women experiencing intimate partner violence
Power imbalances relating to gender are compounded for women misusing drugs.
Researchers report high rates of intimate partner violence among women who use
substances6. Many women identify substance use as a way to cope with genderbased abuse and trauma4. It is estimated that around half of women undergoing drug
treatment are victims of childhood sexual abuse5. Linking services for domestic
violence and substance abuse would result in better health outcomes for women;
however these links are not commonly made by service providers and policy makers.
Same sex attracted women
In Australia same sex attracted women use illicit drugs more often than heterosexual
women12. Same sex attracted women aged 22 – 27 years are significantly more likely
to report risky alcohol use (7% compared to 3.9%), marijuana use (58.2% compared to
21.5%), other illicit drugs (40.7% compared to 10.2%) and injecting drug use (10.8%
compared to 1.2%) than their heterosexual counterparts13. Higher levels of drug use
by same-sex attracted women have been attributed to self medication to cope with the
stress caused by homophobic discrimination14. The illicit drug use patterns of same
sex attracted women are at least as common as young men and are not currently
considered in Australian drug policy. The inclusion of sexual orientation within the NDS
would push for the higher rates of drug use among same sex attracted women to be
recognised and reflected in health policy.
Women in prison
Drug policy resulting in better outcomes for women in prison is especially important
when at least 80% of women inmates are serving a sentence for drug related
offences9. There are unique treatment opportunities to assist women who misuse drugs
while they are in correctional facilities. Corrections Victoria established the Victorian
Prison Drug Strategy in 2002 which recognizes the use of alcohol and other drugs by
offenders is one of the biggest issues facing Victoria’s criminal justice system. The
Bridging the Gap Initiative includes women as a target group to receive assistance in
transitioning back into the community. While a positive step, this misses the
opportunity to connect women with treatment services while in prison.
In the 2003 Victorian Prisoner Health Survey, 40 percent of prisoner participants
reported having hepatitis, and 93 percent of those had hepatitis C (HCV)15. This is
consistent with other research that reports greater prevalence of HCV in women than
men in prison.16 17Researchers have linked this to the greater proportion of women
imprisoned for illicit drug related offences than men16. A multifaceted, gender sensitive
approach which recognises and addresses the needs of female offenders will result in
improved health and wellbeing for this vulnerable population.
 Performance Measures
Are publicly available performance measures against the National Drug Strategy
desirable? If so, what measures would give a high level indication of progress
under the National Drug Strategy?
Overall, there are limited studies that provide in-depth gender analyses of drug use.
Sex-disaggregated data often stands alone without analysis of the gender and social
context. Publicly available performance measures against the NDS are desirable to
demonstrate the differences in women’s and men’s drug patterns and behaviours, and
what is being done to address this.
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Women's Health Victoria - National Drug Strategy Beyond 2009
Sex disaggregated performance measures will show the progress under the NDS and
will draw attention to the relationships not only between women and the social
determinants of drug use but also violence against women, mental health, social
inclusion, unemployment and homelessness.
Conclusion
The ways in which gender intersects with drug use has important implications for policy
and service delivery. Much of the research into drug use does not take a gendered
approach and therefore less is known about the characteristics, needs and treatment
outcomes of women with drug problems than men with similar issues. It is therefore
necessary to tailor policies, programs and services to meet the needs of women which
differ to those of men. Links with other services need to be able to consider the
determinants, what is contributing to drug use. Clearly, there is a need for gender
analysis to be included in evaluations of drug usage, harm reduction and treatment
options.
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Women's Health Victoria - National Drug Strategy Beyond 2009
References
1
Pinkham S, Malinowska-Sempruch K (2007) Women, Harm Reduction and HIV, New
York: International Harm Reduction Development Program of the Open Society Institute.
Available at:
http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/publications/women_2
0070920/women_20070920.pdf Accessed on 1 August 2008
2
Australian Institute of Health and Welfare (2008) 2007 National Drug Strategy Household
Survey: State and territory supplement. Drug statistics series no.21 Cat. No. PHE 102.
Canberra: AIHW. Available at: http://www.aihw.gov.au/publications/phe/ndshs07sats/ndshs07-sats.pdfn Accessed on 29 August 2008
3
Haseltine, FP (2000) Gender differences in addiction and recovery, Journal of Women's
Health and Gender-Based Medicine 9 (6) 579-583
4
Poole, N & Dell, CA (2005) Girls, Women and Substance Abuse. Canadian Centre on
Substance Abusen Available at: http://www.ccsa.ca/NR/rdonlyres/628CF348-1B92-45D5A84F-303D1B799C8F/0/ccsa0111422005.pdf Accessed on 5 September 2008
Willis, K, Rushforth, C, (2003) The female criminal: an overview of women’s drug use and
offending behaviour. Canberra: Australian Institute of Criminology. Available at:
http://www.aic.gov.au/publications/tandi2/tandi264.pdf Accessed on 7 August 2008
5
6
Poole, Nancy; Greaves, Lorraine; Jategaonkar, Natasha; et al., (2006) Connecting
Systems, Supporting Change: transition houses, women experiencing partner violence and
substance use Available at: http://www.cewh-cesf.ca/en/publications/RB/v5n1/page8.shtml
Accessed on 8 August 2008.
7
VicHealth (2005) A plan for action 2005-2007: promoting mental health and wellbeing.
VicHealth. Melbourne.
8
King M., Semlyen J., Tai, S., Killaspy, H., Osborn, D., Popelyuk, D. & Nazareth, I. (2008)
A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay
and bisexual people. BMC Psychiatry. 18(8): 70.
9
Corrections Victoria (2003) Substance use treatment is Victorian Corrections: service mix
and standard. Prepared by the Forensic Psychology Research Group, the Centre for
Applied Psychological Research and the University of South Australia.
10
Johnson, Holly (2004) Drugs and Crime: a study of incarcerated female offenders
Australian Institute of Criminology, Research and Public Policy Series, Available at:
http://www.aic.gov.au/publications/rpp/63/RPP63.pdf Accessed 22 August 2008
11
Roberts, A (2007) Common questions about trauma and substance use among women,
Cross Currents, Spring, v.10 n.3 p 18
12
Hillier, Lynne; De Visser, Richard; Kavanagh, Anne M; et al. (2003) The association
between licit and illicit drug use and sexuality in young Australian women Medical Journal of
Australia Available at:
http://www.mja.com.au/public/issues/179_06_150903/letters_150903_fm-4.html Accessed
18 August 2008.
13
Pitts, M, Smith, A, Mitchell A and Patel, S (2006) Private Lives: A report on the health and
wellbeing of GLBTI Australians, Australian Research Centre in Sex, Health and Society, La
Trobe University Available at:
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Women's Health Victoria - National Drug Strategy Beyond 2009
http://www.latrobe.edu.au/arcshs/assets/downloads/reports/private_lives_report.pdf
Accessed on 2 September 2008
14
Hillier, L., Turner, A. & Mitchell, A. (2005). Writing themselves in again - six years on: the
second national report on the sexuality, health and well-being of same sex attracted young
people, Australian Research Centre in Sex Health and Society, La Trobe University,
Melbourne.
15
Department of Justice (2003) Victorian Prisoner Health Survey: Part 1. Government of
Victoria. Available from:
http://www.justice.vic.gov.au/wps/wcm/connect/DOJ+Internet/Home/Prisons/Research+and
+Statistics/JUSTICE+-+Victorian+Prisoner+Health+Study+(PDF) Accessed 26 May 2009.
16
Miller, E. & Ryan, P. (2006) The prevalence of HCV antibody in South Australian
prisoners. Journal of Infection, 53: 125-130.
17
Hellard, M. Crofts, N & Hocking, J. (2002) Hepatitis C among inmates in Victorian
correctional facilities: A report of the prevalence of hepatitis C virus and the risk behaviours
associated with the transmission of hepatitis C virus in Victorian correctional facilities.
Burnet Institute and the Blood Borne Viruses Consortium, Melbourne, Vic. Available from:
http://www.justice.vic.gov.au/wps/wcm/connect/DOJ+Internet/Home/Prisons/Research+and
+Statistics/JUSTICE++Hepatitis+C+Virus+Among+Inmates+in+Victorian+Correctional+Facilities+(PDF)
Accessed 26 May 2009.
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