Gender - Situation Analysis

A situation analysis conducted in 2007 identified the key risks and harm reduction needs among different sexes and populations. This section contains a breakdown of these risk and needs.

HIV vulnerabilities are frequently different for men, women, boys and girls:

• Men who inject drugs are a potential bridge to the general population via sexual transmission to regular partners (male, female, transgender);
• HIV positive male injecting drug users in detention can transmit HIV via unprotected sex;
• Injecting drug use among sex workers (female and male) appears to be growing;
• Sex workers (especially street-based) who inject drugs are more likely to share equipment and not use condoms;
• Gatekeepers and stigma towards "deviant" female injecting drug users make them harder to reach; 
• Asian cultural concepts of trust and fate may be obstacles for adoption of safer sex/injecting;
• Widows of injecting drug users/AIDS are more likely to become destitute due to illness costs, and lack of property rights, possibly leading to sex work for survival.

Important evidence gaps exist, including:

• Drug use patterns among women and men (initiation, dependence, sharing behaviours, treatment opportunities and outcomes);
• Nexus between injecting drug use and commercial sex: where, why and how;
• Women's special harm reduction needs related to reproduction and stigma;
• Masculine norms and risk-taking;
• Risks for transgender individuals.

Current Harm reduction programs lack gender sensitivity, for example:

• Most focus on risks of injecting drug use, ignoring sexual risks;
• Few address risks associated with masculinity;
• Insufficient peer outreach and drop-in services, especially for women;
• Generic 'male' model less likely to be used by women;
• Few models address gatekeepers who inhibit women's access;
• Regional and national programs often overlook gender dimensions;
• Male and female injecting drug users/sex workers are rarely consulted or involved in programming;
• Skills in gender analysis are limited and often not utilised in program design and implementation.