Irina was 21 when she first started using drugs. More than 30 years later, having lost her husband, her home and her business to drugs, she is still battling her addiction.

But, like almost all female drug addicts in this former Soviet state, she has faced a desperate struggle not only with her drug problem, but with accessing help in the face of institutionalised and systematic discrimination because of her gender.

“Georgia’s society is very male-dominated,” she told IPS. “And this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there.”

Women make up 10 per cent of the estimated 40,000 drug users in Georgia, according to research by local NGOs working with drug users.“Georgia’s society is very male-dominated and this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there” – Irina, now in her 50s, who has been taking drugs for 30 years

However, because of very strong gender stereotyping, women users have very low access to harm reduction services – only 4 percent of needle exchange programme clients are women and the figure is even less for methadone treatment.

Local activists say this startling discrepancy is down to the massive social stigma faced by women drug users.

Dasha Ocheret, Deputy Director for Advocacy at the Eurasian Harm Reduction Network (EHRN) told IPS: “In traditional societies, like Georgia’s, there is a much stronger negative attitude to women who use drugs than to men who use drugs. Women are supposed to be wives and mothers, not drug users.”

Many female addicts are scared to access needle exchanges or other harm reduction services because they fear their addiction will become known to their families or the police. Many have found themselves the victims of violence as their own families try to exert control over them once their drug use has been revealed. Others fear their drug use will be reported to the authorities by health workers.

Registered women drug users can have their children taken away while they routinely face violence – over 80 percent of women who use drugs in Georgia experience violence, according to the Georgian Harm Reduction Network– and extortion at the hands of police helping to enforce some of the world’s harshest drug laws. Possession of cannabis, for example, can result in an 11-year jail sentence.

Irina, who admits that she arranges anonymous attendance at an opioid substitution therapy (OST) programme so that as few people as possible can see her there, told IPS that she had herself been assaulted by a police officer and that police automatically viewed all female drug users as “criminals”.

But those who do want to access such services face further barriers because of their gender.

Free methadone substitution programmes in the country are extremely limited and because levels of financial autonomy among women in Georgia are low, other similar programmes are too expensive for many female addicts.

Discrimination is not uncommon among health service workers. Although some say that they have been treated by very sympathetic doctors, other female drug users have complained of abuse and denigration by medical staff and in some cases being denied health care because of their drug use.

Pregnant women are discouraged from accessing OST, despite it being shown to be safe in pregnancy and resulting in better health outcomes for both mother and child.

Eka Iakobishvili, EHRN’s Human Rights Programme Manager, told IPS: “Pregnant women don’t have access to certain services – they are strongly advised by doctors and health care workers to abort a baby rather than get methadone substitution treatment because they are told the treatment will harm the baby.”

While some may then undergo abortions, others will not, instead continuing dangerous drug use and the potential risk of contracting HIV/AIDS which could then be passed on to their child.

Meanwhile, those harm reduction services accessible by women are not gender-sensitive, according to campaigners, who say that female drug users need access to centres and programmes run and attended only by women.

Irina told IPS: “On some [harm reduction] programmes, the male drug users there will abuse the women drug users for taking drugs. This puts a lot of women off attending these programmes.”

She said that she had asked for a women-only service to be set up at the OST centre she attends but that it had been rejected on the grounds that only a few women were enrolled in it.

Together, these factors mean that many women are unable to access health services and continue dangerous drug-taking behaviour, sharing needles and injecting home-made drug cocktails made up of anything, including disinfectants and petrol mixed with over the counter medicines.

But there is hope that the situation may be about to change, at least to some degree, as local and international groups press to have the problem addressed.

At the end of July, CEDAW (UN Commission on Elimination of Discrimination against Women) released a set of recommendations for the Georgian government to ensure that women obtain proper access to harm reduction services after local NGOs submitted reports on the levels of discrimination they face.

These include, among others, specific calls for the government to carry out nationwide studies to establish the exact number of women who use drugs, including while pregnant, to help draw up a strategic plan to tackle the problem, and to provide gender-sensitive and evidence-based harm reduction services for women who use drugs.

The government has yet to react publicly to the recommendations but local campaigners have said they are speaking to government departments about them and are preparing to follow up with them on the recommendations.

Tea Kordzadze, Project Manager at the Georgian Harm Reduction Network in Tibilisi, told IPS: “We are hoping that at least some of the recommendations will be implemented.”

The Georgian government has been keen to show the country is ready to embrace Western values and bring its legislation and standards into line with European nations in recent years as it looks to create closer ties to the European Union. Rights activists say that this could come into play when the government considers the recommendations.

Iakobishvili said: “These are of course just recommendations and the government is not obliged at all to accept or implement any of them. But, having said that, Georgia does care what other countries and big international rights organisations like Amnesty International and so on say about the country.”

Irina told IPS that only outside pressure would bring any real change. “The European Union, the Council of Europe and other international bodies need to put pressure on the Georgian government to make sure that the recommendations don’t remain on paper only.”

But, she added, “in any case, the recommendations alone won’t be enough. The whole attitude in society to women drug users is very negative. It has to be changed.”

(Edited by Phil Harris)

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

As a hepatitis C pandemic rages among drug users and threatens the lives of millions around the world, a group of high-level leaders called today on governments to reform their drug policies and raise awareness about the public health threat of hepatitis C.

Sharing needles among injecting drug users is the main driver of the spread of hepatitis C in Eastern Europe and Central Asia. Credit: Lauri Rantala/CC by 2.0

In a major new report, the Global Commission on Drug Policy, which includes former presidents, high-ranking United Nations (U.N.) officials and human rights activists, says that punitive drugs laws and repressive policies are helping spread what the World Health Organisation has described as a “viral time-bomb”.

Michel Kazatchkine, the U.N. secretary-general’s special envoy on HIV/AIDS in Eastern Europe and Central Asia, told IPS, “We need to see drug policies changed, funding moved away from the war on drugs and into public health approaches that maximise hepatitis C prevention and care.” He added that raising awareness of the issue was just as important.

The WHO estimates that at least 350,000 people die annually from diseases related to hepatitis C, which causes chronic liver damage.

According to the report, of the estimated 16 million people who inject drugs around the world, about 10 million are living with hepatitis C. In some of the countries with the harshest drug policies, over 90 percent of people who inject drugs have hepatitis C."[Hepatitis C] needs to be taken as seriously as the HIV/AIDS epidemic among drug users."
-- Michel Kazatchkine

The highest numbers are reported in China (1.6 million people), the Russian Federation (1.3 million) and the United States (1.5 million).

“The urgency of the situation cannot be overemphasised,” Kazatchkine stressed. “This needs to be taken as seriously as the HIV/AIDS epidemic among drug users.”

A failed war on drugs

The Global Commission and other advocates for drug law reform have long campaigned to end to the decades-long “war on drugs”, claiming that not only has it wasted vast sums of money and countless human lives, but it has also destroyed communities and utterly failed to halt the multibillion dollar illicit drug trade. The group has also highlighted its catastrophic public health implications.

In a report last year, the commission showed how repressive anti-drug legislation and policies, including long-term jail sentences for minor drug offences and the failure to introduce or properly support harm reduction programmes, marginalised and criminalised drug users, ultimately helping to fuel an HIV/AIDS epidemic.

This phenomenon has been seen most clearly in Eastern Europe and Central Asia – the only region in the world where new HIV infection rates continue to rise – where the sharing of needles among injecting drug users is the main driver of the disease’s spread.

The commission also said that harm reduction programmes, such as needle-exchanges, opioid substitution therapy and support networks for drug users could essentially reverse the HIV/AIDS epidemic in regions such as Eastern Europe.

Hepatitis, like HIV, can be spread by blood-to-blood contact and, globally, most HIV-infected people who inject drugs are also infected with hepatitis C.

Ignoring numbers

While the HIV/AIDS public health threat has received significant attention, the spread of hepatitis C, which is three times more prevalent than HIV among drug users, has been dangerously ignored.

“I hate to compare HIV/AIDS and hepatitis C and say one is worse than the other, but when you look at the overall absolute numbers, such as infections and so on among the drug-using community, they are even higher,” Kazatchkine told IPS.

He pointed to “an overall lack of awareness of the hepatitis C problem at all levels – from governments…to parts of the medical community and among drug users themselves”.

“There has been great awareness of HIV/AIDS over the years because of public campaigns, celebrity support and so on but that has been lacking where hepatitis C is concerned. The silence on this issue needs to be broken,” Kazatchkine added.

The report stressed that while harm reduction services can effectively prevent hepatitis C transmission among people who inject drugs, prevention can only be achieved if such services are accessible and delivered early and at the required scale.

In many places with severe hepatitis problems, access to these resources is severely limited, and where people do have access, quality is often poor.

The report highlighted how harm reduction programmes aimed at fighting the spread of the disease had been successful in Scotland. But it also showed that similar schemes in Lithuania – which has an 80 percent infection rate among drug users – were being accessed by only a tiny fraction of those who needed them.

People working to promote harm reduction and who are in daily contact with drug users at drop-in centres around Eastern Europe – which has one of the highest hepatitis C infection rates among drug users in the world – are pessimistic about the outlook for control of the disease in the region.

“It will definitely get worse before it gets any better,” said Dasha Ocheret of the Eurasian Harm Reduction Network.

She told IPS, “Given the high prevalence of up to 95 percent [among drug users] in the region, the more than 10-year history of the epidemic and almost no access to treatment, it is going to get worse.”

“There will be more deaths and higher infection rates among young injection drug users,” Ocheret believed.