Twice Stigmatized: Provider's Perspectives on Drug-Using Women in the Republic of Georgia

Addiction Research Center, Alternative Georgia, Tbilisi, Georgia.
Journal of psychoactive drugs (Impact Factor: 1.1). 05/2013; 45(1):1-9. DOI: 10.1080/02791072.2013.763554
Source: PubMed


This study examined attitudes and perspectives of 34 health service providers through in-depth interviews in the Republic of Georgia who encountered an injection drug-using woman at least once in the past two months. Most participants' concept of drug dependence treatment was detoxification, as medication-assisted therapy was considered part of harm reduction, although it was thought to have relatively better treatment outcomes compared to detoxification. Respondents reported that drug dependence in women is much more severe than in men. They also expresSed less tolerance towards drug-using women, as most providers view such women as failuresas a good mother, wife, or child. Georgian women are twice stigmatized, once by a society that views them as fulfilling only a limited purposeful role and again by their male drug-using counterparts. Further, the vast majority of respondents were unaware of the availability of specific types of drug-treatment services in their city, and even more did not seek connections with other service providers, indicating a lack of linkages between drug-related and other services. The need for women-specific services and a comprehensive network of service linkages for all patients in drug treatment is critical. These public health issues require immediate consideration by policy makers, and swift action to address them.

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Available from: David Otiashvili, Jan 13, 2015
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    • "Discussion This study provides evidence that injecting drug use is a highly stigmatized activity for women within Javanese culture. This is consistent with international literature on the stigma associated with injecting drug use (Ahern et al., 2007; Simmonds & Coomber, 2009) and the double stigma of being a woman who injects drugs (Kirtadze et al., 2013). The degree of stigma was reported to have been greater for the women in this study than for their male counterparts. "
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    ABSTRACT: People who inject drugs have experienced stigma around the world. Stigma has been found to have negative consequences for individuals in relation to health-service use, psychological wellbeing and physical health; and for populations in terms of health inequalities. Indonesia has experienced a rapid growth in injecting drug use and HIV and little is known about drivers of HIV risk among Indonesian women who inject drugs. The purpose of this paper is to describe and consider the multiple impacts of stigmatization of injecting drug use on injecting behaviors among women who inject drugs in Java. In-depth interviews were conducted with 19 women who inject drugs in Java. Mean age was 25 years, all but one was employed or at college. The interviewers were Indonesian women. Significant stigma around women's drug use was reported from multiple sources in Java including family, friends and health services, resulting in feelings of shame. To avoid this stigma, most of the study participants hid their drug use. They lived away from family and had few friends outside their drug-injecting circle, resulting in isolation from mainstream society and harm-reduction services. Sharing of injecting equipment was restricted to a small, closed circle of trusted friends, thus limiting possible HIV transmission to a small number of injectors. The stigmatization of drug use, particularly of drug use by women, in Indonesia appears to have contributed to significant shame, isolation from mainstream society and high rates of sharing injecting equipment with a small group of trusted friends (particularly the partner). Copyright © 2015 Elsevier B.V. All rights reserved.
    The International journal on drug policy 07/2015; DOI:10.1016/j.drugpo.2015.07.011 · 2.54 Impact Factor
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    • "This is not an unprecedented situation elsewhere and in post-communist countries with strong family control cultures in particular (see, e.g. Jones, Chisolm, Jansson, & Terplan, 2013; Kirtadze et al., 2013) and it suggests an urgent need for specialised treatment and harm reduction and other services for female drug users in both countries and, most probably, in the whole of Central Asia. "
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    ABSTRACT: Background Within the fifth phase of the Central Asia Drug Action Programme (CADAP) covering five post-Soviet Central Asian countries, an analysis of the mortality of drug users was performed. The results for Kazakhstan and Uzbekistan are presented in detail in this paper since results from Kyrgyzstan and Tajikistan are not considered valid and Turkmenistan did not provide data at all. Methods: A system of registration of all users of illegal drugs known to the health and/or law enforcement authorities (“narcological registers”) exists in Central Asian countries inherited from the system of Soviet “narcology”. According to the legal norms, the death of a registered person should be recorded. We conducted indirect standardisation of crude mortality rates and computed the standardised mortality ratio (SMR) comparing observed number of deaths with expected number of deaths according to age and gender specific mortality rates in the general population of the same country. Results: The results show excess mortality in registered drug users, particularly in registered females, in Uzbekistan (the latest available SMR for all those registered is 7.4; the SMR in females is 16.3) and Kazakhstan (4.0 and 12.9). The excess mortality is highest among young adults (18-34) in all the studies. Conclusions: Taking into account the limited quality and reliability of the data–first of all, the likely under-reporting of deaths in the narcological registers,–the crude mortality rate among registered drug users is quite high when compared to EU countries. The SMR in total is comparably lower as a result of the high background mortality in the general population. This excess mortality is preventable and should be targeted by the national drug policies. Specifically, the programmes should target registered and unregistered female drug users.
    The International journal on drug policy 11/2014; 25(6). DOI:10.1016/j.drugpo.2014.03.007 · 2.54 Impact Factor
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    • "For example, while there was consensus on the need for developing women-specific services, respondents fell short of suggesting what these services should look like. In our previous publication we pointed to the absence of national treatment guidelines and a lack of agreement among clinicians on how to measure effectiveness of treatment for substance use disorders (Kirtadze, et al., 2013). This lack of effort continues and can be viewed as an additional sign of the generally passive and static position of treatment institutions towards developing and introducing novel approaches for substance use treatment. "
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    ABSTRACT: Background: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services. Methods: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services. Results: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance. Conclusion: Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.
    The International journal on drug policy 06/2013; DOI:10.1016/j.drugpo.2013.05.004 · 2.54 Impact Factor
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