4StatusIn many states, women do not have any autonomy in decision making in their personal livesIn Madhya Pradesh and Rajasthan, less than 50% of women had access to money in household (IIPS 2000)In some states between 62.7 and 85.5% of married women suffer from anaemia (IIPS 2000)The average Indian woman bears her first child before she is 22 and has little control over her own fertility and reproductive health
5Transition Especially in urban area Greater participation in the economic workforceGreater exposure to mass mediaMultiple roles, multiple stressors
6Sexual behaviours, vulnerabilities CHARCA Baseline Survey 2004:Baseline survey of knowledge, attitude, behaviour in 5 selected districts through a systematic, multistage sampling design450 eligible females from each district between years
7Sexual initiation/condom use Age of sexual exposure years35-47% of women in 3 sites: first sex before age 15Use of condoms for family planning: under 1% in Bellary, 7% in Guntur, 19% in Aizawl, 26% in Kishanganj, 41% in Kanpur.For dual protection (family planning and protection against HIV/AIDS) the figures were even lower (CHARCA)26% of sex workers in the city of Mysore were HIV-positive. While 14% of women used condoms consistently with clients, 91 % of them never used condoms during sex with their regular partners Reza-Paul (2005).
8Determinants of RTI/STI Poverty-driven sexPoor economic backgroundAlcoholic husbandsDomestic and sexual violencePre-marital sexRepeated abortionsLow age at first birth, short birth intervalsUnhygenic practices during menstruationPoor ability to deny sexLack of early diagnosis and treatment by trained medical practitioners
9Socio-Economic and Gender Impact of HIV/AIDS Survey covered 2068 HIV households and 6224 non-HIV households spread over the rural and urban areas of six HIV high-prevalence states(UNDP 2006)More than 40% of PLWHA were housewives. More than one-third of the sample female PLWHA were widows.Heavy burden of care in terms of cost, domestic work, economic responsibilitiesGender differences in health seeking behaviourSchool dropouts higher among female children
10Condom UseThe Charca Study (IIPS 2004) reveals some startling facts regarding the use of condoms. For family planning, was under 1% in Bellary, 7% in Guntur, 19% in Aizawl, 26% in Kishanganj, 41% in Kanpur. For dual protection (family planning and protection against HIV/AIDS) the figures were even lower.Reza-Paul (2005) found that 26% of sex workers in the city of Mysore were HIV-positive. While 14% of women used condoms consistently with clients, 91 % of them never used condoms during sex with their regular partners.
11Decision MakingWhile 41% of respondents in Bellary think that utilisation of health facility decision should be jointly made in practice, only 3% are actually involved in deciding health services (IIPS 2004). However, a majority of women seek their husbands’ permission to seek health care services, and to use the contraceptive method of her choice
12Knowledge/StigmaUNIFEM-SARO (2000) undertook community based research on Gender and HIV/AIDS in four regions of India representing both high and low prevalence regions.Most women respondents lacked elementary knowledge of reproduction, health issues and safe sex practices.Major discriminationPartners of infected men and women themselves infected did not get the same kind of support and care that positive men got
13Enter drugs…. Women as partners of drug users Women using drugs Women involved in selling drugWomen have traditionally not been part of the statistics when it comes to drugs…
14Women’s vulnerability to HIV through male drug abuse: the Indirect evidence Across studies:Multiple partners commonLow rates of condom useConcomitant use of intoxicants prior to sexUnsafe injecting practicesInjecting in groups not uncommonBorrowing/lending needles/syringes common
15Emerging evidence about women Women and substance Use in India (UNDCP 2002) collated the impact on women family members of male drug users and impact on them (179 women and 143 key informants)RSA (UNDCP 2002) 361 of the 4648 drug users interviewed across 14 sites throughout the country were women
16Burden of Drug Abuse Health problems Psychosocial problems Economic problemsViolence
17Financial Difficulties faced by family members of drug users
18ReactionsI feel like committing suicide when I come home and find that the little money I have saved and hidden for my daughters has been stolen by my husband. He doesn’t care even a bit for them. What will happen when both of us die soon?’
19Drug Use- Preliminary Experiences Difficult to capture in conventional studies1-3% of treatment seekers femaleAmong 4648 respondents in earlier RSA (7.9%) were women substance usersTrends: Increasing inSingle, educated, urban womenHigh rates of family substance useEarly onset substance useEarly initiation into sexual activity
20Common Substances Abused by Women - RSA HeroinPropoxypheneAlcoholMinor tranquilisers
21Interacting factors leading to drug use among women Social Disadvantage and Social isolationPredisposition, ModellingRole Transition and lifestyle changesPhysical and emotional problems and ignorance about treatmentDrug AvailabilityStigma, lack of supportLack of knowledge of harmDrug Use
22RSA women drug abuse 40% were IDUs. Mostly single, educated and employedEarly onset of substance use.Early initiation into sex and sharing injecting equipment.Almost half the women had engaged in sex work to support the habitNearly a third sold drugs
23IDUA study from Manipur showed that 20% of commercial sex workers were also injecting drugs (BSS 2001).Drug injectors report higher levels of regular and casual partnerships and as a rule, condom use in these partnerships is even lower than in commercial sex (MAP 2005, UNDCP 2002a).
24SharingWomen are also likely to share injecting equipment with more people in their social network compared with men (Sherman et al 2001)Women often the last to use, increaing health risks (European Monitoring Centre 2003)Being female is one of the risks for sero conversion (Estanbez et al 2000)
25Study of female IDUs-Bangladesh 82 were sex workers and 48 were non-sex workers.More sex workers reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively)More sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively)More sex workers reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively).Lifetime sexual violence and being jailed in the last year was more common in sex workers (Azim et al 2006).
26Women in treatmentThere is little data on the characteristics and needs of women drug users in treatment.A retrospective characterization of 35 women seeking help at a de-addiction centre in North India (Grover et al 2005) revealed that the typical subject was urban, married, with opiods being the commonest drug of abuse. Common reasons cited for use were medical. Comorbidity was common, as well as impairment in functioning, especially social.
27Reticence to Treatment Overwhelming family responsibilities often make their own needs a lesser priority and consequently their drug dependence remains untreated. Societal disapproval, fear of exposure, lack of support
28Issues in follow-up with women Lower cessation ratesPoor follow-upLack of supportEmotional difficulties
30Comprehensive client based approaches Client-centred treatment plan, flexibleFocus on issues concerning partners and family relationships and responsibilitiesPregnancyHigh risk behavioursTrauma history and mental health problems.Address possible obstacles involved in participating in treatmentSome women require residential services,Community –based outpatients or day services neededAftercare and social integration components, particularly skill developmentEmployment trainingHelp with stay especially for women on the streets
31Other areas Child care Relapse prevention Extra-treatment support Attention to training and capacity building in order to reduce drug useProgrammes that address HIV risk prevention for partners of substance users as also for women substance users engaged in high risk sexual behaviourIncrease in the participation of women in demand reduction programmes.