Bill & Melinda Gates Foundation

Q&A: Women at the Frontlines of HIV Prevention in India

September 19, 2012

There are thousands of women in India who are injecting drug users. These women contend with serious health risks, including the danger of contracting HIV and transmitting the hepatitis C virus via shared needles; and the dangers that surround unsafe sex work. Female drug users live at especially high risk of HIV infection because they inject themselves more frequently than males, and they tend to have more clients than other sex workers so that they can support their drug habit.

To help these women protect themselves from HIV and stop using drugs, the HIV/AIDS prevention initiative, Avahan, works with local organizations  (through Project ORCHID, a program of Avahan) to provide female drug users with safe places where they can access needle exchange and HIV testing programs, practice safer sex, gain access to primary health care, and receive referrals to oral substitution therapy – a method that has helped thousands of women stop using heroin. An essential element of success for programs for female injection drug users has been the creation of networks of peer counselors led by women who are recovering drug users.  

On a recent visit to Manipur State in India, I met Pui and Ramzavi, two amazing women who are making a difference in the lives of women who are injecting drug users. Pui manages SHALOM, a local AIDS service organization, and Ramzavi is a SHALOM peer counselor and president of the Network of Women at Risk, an organization that represents women who use injection drugs.

I asked Pui and Ramzavi to tell me about what they have learned from their work, the challenges they face, and their hopes for Indian women.

Sema: How did you start working with women who use injection drugs?

Pui:  I had no intention to work in HIV or with this group of women. I was doing research on women’s rights and my father was working on HIV and the drug epidemic in our home district.

My father asked me to help him out. He said, “Not all of us can run away from the problem that we have in our community. We all have to contribute.” His words convinced me. Once I started working in SHALOM, I couldn’t turn back. The issue was close to my heart because it related to my original research on women.

Ramzavi:  I started injecting drugs in 1994. I learned about SHALOM in 1996, when I was in need of clean syringes to inject heroine. At that time, I could not afford them, and I did not want to share.  The program told me that I had to register with them, and I did. I went through rehab several times, but I relapsed. Then, in 2009, SHALOM provided me with oral substitution therapy, and I stopped using drugs. Ever since, my life changed. I restarted my relationship with my family and started helping them with their farming and livestock raising.  I became a peer educator for the program in 2010 and am now a peer counselor.

Sema: What are the challenges that you face?

Pui:  Managing people, that’s the most difficult thing. Working with communities that are marginalized and that have a lot of issues is very difficult.

Ramzavi:  I manage four peer educators who work with 160 women who are injection drug users to provide them with HIV prevention services. Distributing syringes and condoms and getting the women to come to the clinic on a regular basis is a real challenge. The women are busy trying to earn money, through sex work or other activities, to support themselves and pay for their next dose. Getting their time and attention is hard.  My role is to help the peer educators solve the problems they face and make sure that the women are accessing the services.

Sema: What are your dreams for the future?

Pui:  I had different dreams before I worked with SHALOM. I wanted to teach college. Now, my dream is related to my work with women who are injection drug users. I want to see a time when HIV and hepatitis C are no longer a problem for them. I want to see a time when they are no longer marginalized and more treatment options are available. I would like to grow in the work that I do and take up more challenges.

Ramzavi: My dream is for this community of women to come together and move forward. If we are united, we can solve a lot of our problems. Right now, many women are still focused on funding their drug habit. Oral substitution therapy can solve a lot of our problems.

 
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