To mark International Women’s Day 2019, we look at innovative approaches to reaching hidden female drug users and female intimate partners of men who inject drugs in Kachin State, Myanmar, with health care and harm reduction services.
While drug use is less common among women than men in Myanmar, female drug users often remain hidden from society and health care providers due to social and cultural stigma and gender stereotypes. As a result, they are less likely to seek and receive help.
The lack of awareness and understanding of female drug users in Myanmar means that health care services related to drug use tend to be oriented primarily or exclusively to male clients. There are few female-friendly services available, and few outreach activities specifically oriented to reaching female drug users.
In Kachin State, injecting drug use is a significant and fast-growing issue driven by several factors. The region has experienced decades of conflict. A lack of livelihoods and employment opportunities has pushed many families and communities into deep poverty. Widespread opium cultivation means that opium and heroin are widely and relatively cheaply available. The rapid expansion in mining, driven by rich deposits of jade, amber, gold, copper and other natural resources, has attracted large numbers of migrants from across Myanmar who come to pick through the mine waste to make a living. Drug use among mine workers is known to be extensive.
Injecting drug use is deeply intertwined with HIV prevalence in Myanmar. According to Global Aids Monitoring and UNAIDS data for Myanmar in 2018, HIV prevalence among people who inject drugs is 34.9%, almost 50 times higher than the 0.7% HIV prevalence in the general population. In Kachin State, the situation is even more serious. Data from the the 2019 Myanmar Integrated Biological and Behavioral Surveillance Survey shows mean HIV prevalence of 50.2% among people who inject drugs in the five townships surveyed (Bamaw, Hpakant, Mohnyin, Myitkyina and Waimaw).
Unsafe practices such as needle and syringe sharing are a significant driver of high HIV prevalence rates among people who inject drugs in Kachin State, and are directly linked to limited access to harm reduction services. Harm reduction aims to “to reduce the harm to individuals, communities and society related to drugs, including HIV infection,” and is “the key in the prevention of HIV infection among people who inject drugs and their sexual partners.” (1) Harm reduction encompasses a comprehensive package of services including needle and syringe exchange programs, opioid substitution treatment, HIV testing, counselling, treatment and care, and sexual and reproductive health interventions.
Community Partners International (CPI) is implementing the the USAID HIV/AIDS Flagship (UHF) Project with technical guidance from UNAIDS to support national efforts to achieve an AIDS-free future in Myanmar. The UHF Project is scaling up HIV testing and treatment services for key populations – people who inject drugs, female sex workers, and men who have sex with men including transgender people - in Kachin State, Shan State, Sagaing Region, Yangon Region and Mandalay Region in Myanmar. The project focuses extensively on Kachin State due to high and rising HIV prevalence among people who inject drugs, with emphasis on increasing their access to harm reduction.
Under the UHF Project, CPI is working with Médecins du Monde (MdM) in Kachin State to develop female-friendly services for female drug users and female intimate partners of men who inject drugs. MdM has introduced special female-friendly days once per week at local Drop-In Centers. Women who visit on these days can access a range of harm reduction services tailored to their needs, including medical consultations, HIV Testing, screening and treatment for sexually transmitted infections, family planning, sexual and reproductive health and health education. Between October and December 2018, 209 female clients visited the Drop-In Centers, including 100 female drug users (of whom six were injecting drugs users) and 109 female intimate partners of men who inject drugs.
On these days, female Drop-In Center staff lead entertainment sessions to engage female clients and provide opportunities for discussion around health and harm reduction. For example, In September 2018, MdM’s Myitkyina Drop-In Center screened the film ‘Pad Man’ about an Indian innovator and inventor who tried to revolutionize the manufacturing of sanitary napkins in his village. The screening was attended by 12 female participants including female drug users and female intimate partners of male drug users. After watching the film, the participants engaged in an interactive discussion about the film and broader health topics. Following the event, participants were given hygiene kits, condoms and health education pamphlets. Through such initiatives, the Drop-In Centers create “safe spaces” where women can openly share experiences and enjoy themselves, while also having access to harm reduction services and health information.
MdM is also recruiting women who inject drugs and female intimate partners of men who inject drugs to act as peer outreach workers in their communities, promoting awareness of and access to female-friendly services at the Drop-In Centers. With their knowledge of the local situation and unique access to hidden populations of female drug users, these outreach workers play a crucial role in linking women to health information and harm reduction.
To reach female drug users and female intimate partners of men who inject drugs in remote rural locations, MdM is setting up periodic short-term clinics exclusively for women in these hard-to-reach areas. These clinics offer a range of services including needle and syringe exchange, condom distribution, medical consultations, STI diagnosis and treatment, health education, and HIV testing.
A second UHF Project partner, Population Services International (PSI), is adding family planning and reproductive health services at their TOP/Sun Hybrid Clinics in Kachin State in order to attract more female drug users and female intimate partners of men who inject drugs. These private sector clinics provide the full range of HIV prevention, care and support services to key populations through trained general practitioners.
While it is early days, these female-friendly initiatives have already shown that they can play an important role in encouraging female drug users and female intimate partners of men who inject drugs to access harm reduction services without fear of stigma or discrimination. There is a clear need to build on these foundations and intensify female-friendly services through these service networks in Kachin State, with particular focus on women who inject drugs. Community Partners International (CPI) will continue to support the expansion of female-friendly harm reduction services through the UHF Project.
(1) "Harm reduction" World Health Organization. Accessed March 4, 2019. http://www.euro.who.int/en/health-topics/communicable-diseases/hivaids/policy/policy-guidance-for-areas-of-intervention/harm-reduction
The USAID HIV/AIDS Flagship (UHF) Project is funded by USAID under PEPFAR through UNAIDS Myanmar. Community Partners International (CPI) is providing project implementation support and management to five partner organizations: Asian Harm Reduction Network (AHRN), Medical Action Myanmar (MAM), Médecins du Monde (MDM), Metta Development Foundation (Metta) and Population Services International (PSI).