HIV/HCV testing within low-threshold services for women who use drugs – barriers and recommendations. Alexandra Gurinova, Deutsche AIDS-Hilfe, Germany

WP4. Testing and linkage to care Objective: Improved early diagnosis of HIV, viral hepatitis and TB, as well as improved linkage to care for PWID 1. Trainings for personnel working with PWID in Hungary and Latvia. 2. An interactive training manual and e-learning package on HIV and HCV testing. 3. Linkage to care after positive test result. 4. Gender-specific approach in testing services focused on women who use drugs.

Content Why should harm reduction services be focused at women who use drugs? Most common problems of WUD and deficits of low threshold settings. Examples from HA-REACT project in Latvia and Hungary. Proposals to improve existing services

Why should harm reduction services be focused at women who use drugs? Women and men have different experience in drug use. Higher risk of HIV/HCV/STI Violence Sex work Created stigma ("second on needle") Limited services Women who use drugs are one of the most vulnurable to HIV and HCV groups. They are also very hard to reach as they are more stigmatized as male drug users. Most of the women sell sex to finace their own and partner’s drug use. Often they have minor childrean and afraid to lose them or simply can not leave them with anyone while reciving services. Women who use drugs all over the world face violence and police harrasement. In some countries there are still co called „subbotnic“ when policemen force women who use drugs to have sex with them.

Why should harm reduction services be focused at women who use drugs? The overall epidemiological picture of drug use shows gender disparities, with approximately 75-80% of drug users being males, and 20-25% being females. This fact remain poorly explained and understood and needs further researches.

Why should harm reduction services be focused at women who use drugs? Hungary: Drug use in young adults (18-34 years) (EMCDDA, 2018) The overall epidemiological picture of drug use shows gender disparities, with approximately 75-80% of drug users being males, and 20-25% being females. This fact remain poorly explained and understood and needs further researches.

Why should harm reduction services be focused at women who use drugs? Latvia: Drug use in young adults (18-34 years) (EMCDDA, 2018) The overall epidemiological picture of drug use shows gender disparities, with approximately 75-80% of drug users being males, and 20-25% being females. This fact remain poorly explained and understood and needs further researches.

Women who use drugs benefit less from treatment options and harm reduction services

Most common problems of WUD and deficits of LTC in Latvia LTCs do not have enough resources (lubricants, pregnancy tests); Women do not have possibility to leave their children with someone, while receiving social support; High level of stigmatization and discrimination of WUD in Latvia; Health care providers lack knowledge about WUD (pregnancy and drug use, for example); Violence. Women who use drugs benefit less from treatment options and harm reduction services

Most common problems of WUD and deficits of LTC in Hungary LTCs do not have enough resources. It’s a stigmatized group of people, and funders are not likely to donate for this group. Pregnant women, who use drugs, are strongly pressured to have an abortion. There is only one low-threshold service focused on pregnant WUD, and it is located in Budapest. Health care system and LTC are not familiar with special needs of WUD. WUD are often hiding and don’t come to the services because of shame or the fear of losing their children, or violence. Gender issues are not highly famous or supported in Hungary

In order to improve access of WHUD to harm reduction services it is essential to adapt those services for their needs.

Proposals to improve existing services Most drug services are designed with male drug users in mind — as they are the predominant client group. But it is also widely accepted that drug policy and programme effectiveness is enhanced when sex differences are acknowledged and the different needs of women and men are addressed.

Advocacy work (national level) Better working conditions for social workers (bigger space, higher salary, more specialists). Opening of rehabilitation centers for women with children. Supplying LTCs working with women with contraceptives for WUD, syringes, naloxone kits. Harm reduction programs should be the states responsibility.

Improving existing services “Kids corner” and changing table for babies Self-help groups for women Child rearing consultations Consultations on sexuality Motivate GPs to work with HR services Involve peers Work out referral strategies for women

WP 4 Training Manual