Abstract

 

This review was conducted on behalf of the HAARP, with the goal of better understanding the vulnerabilities, risk behaviors, service uptake and needs of female drug users (DUs), the partners of injection drug users (IDUs), men who engage in sexual activities with other men (MSM), and the transgender population (TG) in South-East Asia.

 

Female, MSM and TG populations are hard-to-reach groups for harm reduction programs. This may be partially attributed to the higher levels of discrimination to those being both an IDU and a woman or a MSM/TG. In SE Asian societies, where there are very clear views on the roles and responsibilities of men and women, these expectations lead to behaviors that can increase the risk of acquiring HIV. This report highlights and explores a range of risks, behaviors and vulnerabilities that are more likely to be heightened due to gender issues.

 

According to the literature and information gathered during consultations with female injection and non-injection drug users, service providers captured some of the unique factors that can play a role in limiting or deterring female DUs. These factors include those which hinder injectors from accessing harm reduction and other services. They also include male-dominated services, fear of disclosure, and personal safety concerns in some circumstances. There can also be a reluctance to be associated with a drug-related service and difficulties associated with the rigid hours of service operation. 

 

This report also describes the key components of effective programming for female injection and non-injection DUs, and the sexual partners of male IDUs, to improve access to services to all genders. It reflects on some HAARP sites where good practices in improving the utilization of harm reduction services by women have been noted. This includes not only accessing clean injecting equipment and advice, but also on-site sexual and reproductive health (SRH) information, HIV testing and services, or referral to SRH services. The success of harm reduction programs in reaching female injection and non-injection DUs can be attributed, in part, to the following:

 

? building trust and relationships over time with female clients

? employing/ recruiting female outreach workers (ORWs)/peer educators and staff

? providing a women-only space, or time, for female clients

? offering child-care support/facilities

 

? offering community outreach education to establish contact with female DUs in communities

? building partnerships and collaborative relationships with other service providers, such as having referral processes in place and systems for follow up

?offering on-site health services, including testing and treatment for sexually transmitted infections (STI)

? offering flexible hours of service delivery.

 

With the growing number of female DUs and HIV carriers, both within SE Asia and globally, the lessons and experiences shared in this report present a strong case for further developing gender-responsive harm reduction programs. At the same time, in both the published literature and in discussions with national partners, it is evident that the appreciation of gender issues relating to MSM and TG in relation to harm reduction is poor. More advocacy and research is needed to better address these issues in such populations.