BMC Public Health | |
Meeting the needs of women who use drugs and alcohol in North-east India – a challenge for HIV prevention services | |
Alex Devine2  Temjen Nungsang Jamir1  Collins Z Sono1  Chinzaning Hangzo Songput1  Michelle Kermode2  | |
[1] Project ORCHID, CBCNEI Mission Compound, Panbazar, Guwahati, Assam, 781001, India;Nossal Institute for Global Health, University of Melbourne, 161 Barry St Carlton, Melbourne, Victoria, 3010, Australia | |
关键词: Health service needs; India; Women; Injecting drug use; Alcohol; | |
Others : 1163038 DOI : 10.1186/1471-2458-12-825 |
|
received in 2012-06-01, accepted in 2012-09-24, 发布年份 2012 | |
【 摘 要 】
Background
The North-east Indian states of Manipur and Nagaland consistently report relatively high HIV prevalence. The targeted HIV prevention interventions in these two states are mostly delivered by non-government organizations (NGOs), and prevention of HIV transmission by injecting drug use is their main focus. Most injecting drug users (IDUs) are male, and the services are primarily tailored to meet their needs, which are not necessarily the same as those for women. This qualitative study describes the health service needs of women who use drugs and alcohol in Manipur and Nagaland, with the goal of identifying strategies and activities that can be implemented by NGOs wanting to improve their reach among vulnerable women.
Methods
In 2009-10, semi-structured in-depth interviews were conducted with 27 key informants and nine focus group discussions (FGDs) with women who use drugs and alcohol, and two FGDs with male IDUs. The thematic areas covered included: the context of female drug and alcohol use; drug and alcohol use patterns; HIV risk behaviours; barriers and facilitators of service use; perceived health needs; and expressed health service needs. The data were recorded, transcribed, translated and thematically analysed.
Results
The most problematic substance for women from Nagaland was alcohol, and for women from Manipur it was heroin. The most commonly identified health problems were primarily related to the women’s drug and alcohol use, reproductive health and mental health. Other problems of major concern included social exclusion, violence, children’s welfare, and financial difficulties. The expressed service needs of these women were women-only integrated health services, women-only detoxification and rehabilitation services, mental health services, desensitization of mainstream health workers, free access to medicines, assistance to meet basic needs, and a safe place for engaging in sex work.
Conclusion
The expressed health and other service needs of women who use drugs and alcohol in Manipur and Nagaland do not match the services currently provided by HIV prevention NGOs, and this may, in part, account for the relatively poor uptake of these services by women. Strategies and activities that can be implemented by NGOs to strengthen their reach to vulnerable women are identified. However, many of these women’s needs are beyond the scope of services typically offered by HIV prevention NGOs, and require a coordinated multi-sectoral response.
【 授权许可】
2012 Kermode et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150413090018465.pdf | 237KB | download |
【 参考文献 】
- [1]United Nations Office on Drugs and Crime: Substance abuse treatment and care for women: case studies and lessons learned. New York: United Nations; 2004.
- [2]Pinkham S, Malinowska-Semprunch K: Women, Harm Reduction, and HIV. New York: International Harm Reduction Development Program of the Open Society Institute; 2007.
- [3]Pinkham S, Malinowska-Sempruch K: Women, Harm Reduction and HIV. Reprod Health Matters 2008, 16(31):168-181.
- [4]Saggurti N, Jain AK, Sebastian MP, Singh R, Modugu HR, Halli SS, Verma RK: Indicators of mobility, socio-economic vulnerabilities and HIV risk behaviors among mobile female sex workers in India. AIDS Behav 2012, 16(4):952-959.
- [5]Verma RK, Saggurti N, Singh AK, Swain SN: Alcohol and sexual risk behavior among migrant female sex workers and male workers in districts with high in-migration from four high HIV prevalence states of India. AIDS Behav 2010, 14(Suppl 1):S31-S39.
- [6]Go VF, Srikrishnan AK, Parker CB, Salter M, Green AM, Sivaram S, et al.: High prevalence of forced sex among non-brothel based, wine shop centered sex workers in Chennai. AIDS Behav 2011, 15:163-171.
- [7]Roberts A, Mathers B, Degenhardt L: Women who inject drugs: A review of their risks, experiences and needs. Sydney: Secretariat of the Reference Group to United Nations on HIV and Injecting Drug Use; 2010.
- [8]Murthy P: Women and Drug Use in India: Substance, Women and High-Risk Assessment Study. New Delhi: UNODC ROSA; 2008.
- [9]Panda S, Bijaya L, Sadhana Devi N, Foley E, Chatterjee A, Banerjee D, Nail TN, Saha MK, Bhattacharya SK: Interface between drug use and sex work in Manipur. The Natl Med J India 2001, 14(4):209-211.
- [10]Azim T, Chowhury EI, Reza M, Ahmed M, Uddin MT, Khan R, Ahmed G, Rahman M, Khandakar I, Khan SI, Sack DA, Strathdee SA: Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study. Harm Reduct Jl 2006, 3:33. BioMed Central Full Text
- [11]Oinam A: Exploring the links of drug use and sexual risk practices among young female injecting drug users (FIDUs) in the state of Manipur, India. New Delhi: Population Council; 2006.
- [12]Devine A, Bowen K, Dzuvichu B, Rungsung R, Kermode M: Pathways to sex-work in Nagaland, India: implications for HIV prevention and community mobilisation. AIDS Care 2010, 22(4):228-237.
- [13]Cook R, Clark DB: Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis 2005, 32(3):156-164.
- [14]Kumar MS, Sharma M: Women and Substance Use in India and Bangladesh. Subst Use Misuse 2008, 43:1062-1077.
- [15]Kerr-Corrêa F, Igami TZ, Hiroce V, Tucci AM: Patterns of alcohol use between genders: A cross-cultural evaluation. J Affect Disord 2007, 102:265-275.
- [16]Sherman S, Kamarulzaman A, Spittal O: Women and drugs across the globe: A call to action. Int J Drug Policy 2008, 19:97-98.
- [17]Murthy P: Women and Drug Abuse: The Problem in India. New Delhi: United Nations International Drug Control Programme and Ministry of Social Justice and Empowerment, Government of India; 2003.
- [18]Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK, Lincoln M, Hien D, Miele GM: Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Depend 2007, 86:1-21.
- [19]National AIDS Control Organization: HIV declining in India; new infections reduced by 50% from 2000-2009; sustained focus on prevention required. Press Release December 2010 [ http://www.nacoonline.org webcite]
- [20]Kermode M, Deutschmann P, Arunkumar MC, Manning G: Injecting drug use and HIV in Manipur and Nagaland: negotiating a public health response in a complex environment. South Asian History and Culture 2010, 1(2):239-249.
- [21]Chandrasekaran P, Dallabetta G, Loo V, Rao S, Gayle H, Alexander A: Containing HIV/AIDS in India: the unfinished agenda. Lancet Infect Dis 2006, 6:508-521.
- [22]Avahan: From Hills to Valleys: Avahan’s HIV Prevention Program among Injecting Drug Users in Northeast India. New Delhi: Bill & Melinda Gates Foundation; 2009.
- [23]Patton MQ: Qualitative Research & Evaluation Methods. 3rd edition. New Delhi: Sage Publications, Thousand Oaks, London; 2002.
- [24]Reed E, Gupta J, Biradavolu M, Devireddy V, Blankenship K: The context of economic insecurity and its relation to violence and risk factors for HIV among female sex workers in Andhra Pradesh, India. Public Health Reports 2010, 125(Suppl 4):81-89.
- [25]Swain SN, Saggurti N, Battala M, Verma RK, Jain AK: Experience of violence and adverse reproductive health outcomes, HIV risks among mobile female sex workers in India. BMC Publ Health 2011, 11:357. BioMed Central Full Text
- [26]Biradavolu MR, Burris S, George A, Jena A, Blankenship KM: Can sex workers regulate police? Learning from an HIV prevention project for sex workers in southern India. Social Science & Medicine 2009, 68:1541-1547.
- [27]Jana S, Basu I, Rotheram-Borus MJ, Newman PA: The Sonagachi Project: A sustainable community intervention program. AIDS Educ Prev 2004, 16(5):405-414.
- [28]Venezuelan Children in Need. Ambar Project. http://www.veninos.org/ambar.php webcite
- [29]Kermode M, Devine A, Chandra P, Dzuvichu B, Gilbert T, Herrman H: Some peace of mind: assessing a pilot intervention to promote mental health among widows of injecting drug users in north-east India. BMC Publ Health 2008, 8:294. BioMed Central Full Text