Education + Advocacy = Change

Click a topic below for an index of articles:

New Material

Home

Donate

Alternative Treatments

Financial or Socio-Economic Issues

Forum

Health Insurance

Hepatitis

HIV/AIDS

Institutional Issues

International Reports

Legal Concerns

Math Models or Methods to Predict Trends

Medical Issues

Our Sponsors

Occupational Concerns

Our Board

Projects

Religion and infectious diseases

State Governments

Stigma or Discrimination Issues

 

IIf you would like to submit an article to this website, email us at info@heart-intl.net for a review of this paper
info@heart-intl.net

any words all words
Results per page:

“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



 


The Asteria Foundation 

The Spread of HIV among Female IDUs in Southern Kyrgyzstan:

Social and Psychological Factors

And Limited Services

A Report on Research Results

 

A study conducted with support from the Soros Foundation-Kyrgyzstan

And the International Harm Reduction Development Program,

Open Society Institute, New York

Bishkek 2009

Authors:

I.D. Dzhalbieva – sociologist, author of questionnaires and analytical report.

I.V. Yermolaeva – study director, director of the Asteria Foundation

M.M. Tokombaeva – expert on preventing and fighting HIV/AIDS, drug addiction, and on working with convicts. President of the Harm Reduction Network in Kyrgyzstan.

Editor:

M.A. Smelyanskaya – Coordinator, International Harm Reduction Development Program, Open Society Institute, New York.

1. Introduction

1.1. Study Description

1.1.1. The Purpose and Goals of the Study

This study was conducted during December 2007 and January 2008 in the cities of Osh and Jalal-Abad, and in Osh Oblast. The purpose of the study was to fill an information vacuum regarding female drug users in Kyrgyzstan. Despite frequent references to the use of Kyrgyz women in narcotrafficking and reports by international organizations about growth in the number of women drug users in neighboring Kazakhstan, this vulnerable group has received remarkably little attention from international donors and human rights and nongovernmental organizations on the one hand, and from government bodies that provide medical and social services on the other. According to reports by the Republic Center for Narcology (RCN), as of August 2008, 488 women were registered as drug users in the republic. This would constitute 9 percent of total drug users in Kyrgyzstan (5356). The RCN also reported that the number of female drug users is growing beyond what it had been in past years: the official figure for registered women in 2008 (488) is twice what it was in 2005 (236). Considering that statistics on registered drug users do not paint a complete epidemiological picture and that female IDUs in Kyrgyzstan are a rather closed group, it can be assumed that the real number of women using narcotics and the percentage they represent of drug users overall is much greater than official figures would indicate.

The primary goal of the study, which was conducted by investigating the social, psychological, medical, and legal needs of women drug users, was to produce specific recommendations on how to improve the conditions under which women live and create and/or modify prevention, treatment and care programs specific to the target group.

In order to achieve this goal, the study group assigned itself the following tasks:

1. To identify the demographic and socioeconomic profile of the female drug user.

2. To determine the behavioral risks associated with drug use, including those associated with sex work.

3. To determine the state of health of female drug users; to study childrearing practices and assess access to prevention and treatment programs for female IDUs.

4. To identify stigmas affecting female drug users in their interactions with law enforcement, health workers, and society.

1.1.2. Study Methodology

Study results and recommendations are based on data collected using qualitative information gathering methods (semi-structured in-depth interviews using a questionnaire). The financial, human, and time resources available to the research group, as well as the closed nature of the group being studied, limited the number of respondents we were able to survey. Therefore we do not claim that study results permit us to extrapolate totals (all female drug users; all female drug users with children; all female sex workers). Instead they reveal trends helpful in determining the needs and requirements of the studied target group. The methodology is appropriate to the goals and tasks of the study.

Respondents were reached using a "snow ball" method and members of the target group were sent out into the field to work with their peers. Collaboration with the Oblast Narcological Dispensary, the NGOs Parents Against Drugs, Podruga, and Tais Plius Dva also brought us into contact with respondents.

Information was collected using questionnaires adapted to each group and subgroup:[1]

1. Questionnaire for semi-structured in-depth interviews with female drug users;

2. Questionnaire for semi-structured in-depth interviews with female drug users with children;

3. Questionnaire for semi-structured in depth interviews with female drug-using sex workers.

1.1.3. Confidentiality and Safety

Respondents were guaranteed complete confidentiality. Information identifying respondents, either directly or indirectly, cannot be disclosed to anyone except the team of researchers, who need these records to verify interviews, analyze data, etc. All respondents were given clear assurances of this before the interview. The interview did not begin without the consent of the respondent. Some respondents agreed to take part in more detailed telephone and in-person interviews, the records of which are filed with the research group. Quotations from these interviews are included in this report. All names have been changed to ensure confidentiality.

2. Study Overview and Primary Recommendations

Over the course of the study 73 female injecting drug users were surveyed. All the women (98%) used heroin as their primary drug; 44% had been users for more than 8 years, and 73% of those surveyed were between 19 and 35. Almost half of those surveyed had been involved in the criminal justice system and of them, 65% had been charged with drug possession and use. The primary means of employment among the women surveyed was sex work – 62%.

According to study results, 67% of those surveyed did not always use condoms and the majority, including those engaged in sex work, did not clearly understand the importance of using condoms as a means of protecting against disease. Additionally, the group exhibited a lack of awareness of harm reduction services and substitution therapy, and access to these services was extremely limited due to stigma, lack of awareness, and the low level of self-esteem among those surveyed. Over the course of the study it was also determined that in the southern region there are no support groups, 12-step programs, or narcotics anonymous groups for women.

The survey group had a disproportionately high rate of HIV infection – 23% of women surveyed identified themselves as HIV positive. A comparison of this figure with data from sentinel surveillance conducted by the Kyrgyz Ministry of Health in 2006 shows that the level of HIV infection in the survey group is almost twice as high as the average rate of HIV among drug users in the city of Osh. Only 6% of those surveyed had been tested for HIV in the past year. One quarter of those who had ever been tested for HIV stated that they did not receive pre- or post-test counseling. Among survey subjects, 66% tested positive for hepatitis C. They also reported frequent instances of violence and violations of their rights by law enforcement.

The findings make it clear that in order to reduce the risk of infectious diseases, it is essential that female IDUs be provided better access to preventive services and drug treatment and that more precise situational analysis of this group is needed throughout the country. It must also be noted that widespread stigma and discrimination toward female drug users on the part of government workers, those close to them, and the public at large, has served to close off this exceptionally vulnerable group. Consequently, what is needed first and foremost is work with the public at large and the nongovernmental sector to reduce the stigmatization of these women and discrimination against them. Other major recommendations are summarized below and spelled out in greater detail in the concluding chapter of the report.

The main recommendations presume collaborative work between NGOs and government bodies both with the target group and the public at large.

NGOs engaged in harm reduction and providing medical and social services to sex workers already have access to the target group and are uniquely positioned to attract large numbers of female IDUs into prevention programs and develop self-help groups among them. Additionally, in cooperation with leaders of local communities, NGOs are able to launch educational programs aimed at preventing violence against women and reducing stigmas and discrimination affecting vulnerable groups of women. NGOs must cooperate with government bodies, such as: drug treatment centers, AIDS centers, and gynecology clinics to create a system of referrals and client management for female IDUs. It is evident that both NGOs and health workers need to be educated in the specific services needed by female IDUs, and it is therefore recommended that they be acquainted both with this report and with literature that gives more extensive examples about providing medical and social services to female drug users.

Drug treatment services, in collaboration with NGOs, are capable of improving the conditions under which women undergo short-term detoxification treatment and of informing women about the methadone substitution therapy program and recruiting greater numbers of women into this program. For example, pregnant IDUs and HIV-infected female IDUs should be accepted into drug substitution programs on a priority basis. Health workers specializing in gynecology can become better qualified in the area of drug dependency and study existing treatment models, and inform patients about them and methods for preventing HIV and STIs.

3. Main Section

3.1. Demographic and Socioeconomic Profile of Respondents

3.1.1. Basic Information

A total of 73 women were surveyed:

All 73 were injecting drug users

32 had children (44%)

45 were engaged in sex work (62%)

17 were HIV positive (23%)

They had been using drugs for:

from 1 to 3 years – 17 (23%)

from 3 to 5 years – 4 (5%)

from 5 to 8 years – 20 (28%)

from 8 to 12 years – 9 (13%)

12 years or longer – 23 (31%)

The children of the 32 who were mothers ranged in age from 1 to 25. Of those respondents, who stated that they engage in sex work, more than half had children.

Table 1 presents basic socio-demographic information about the respondents. A large percentage of the women surveyed (48%) were in their prime years in terms of employment and reproduction – between 26 and 35.

A plurality of the respondents had a secondary school education. About one-tenth of respondents had only a primary school education, and it should be mentioned that among them were those who could neither read nor write. The study sample also included a few college-educated women.

 

Table 1: Socio-Demographic Data

 

   

%

Age 19-25 

        25  

  26-35

        48  

   36-45

        27   

Education Primary school

          5  

  Some secondary school

        14  

  Secondary school

        48  

  Technical secondary education

        21  

  Some college

          5  

  College

          9  

Ethnicity Kyrgyz

          7  

  Russian

        52  

  Uzbek

        27  

  Other (Tatar, Korean)

        14  

 

Half of the respondents lived with their parents or at least in their parents' home. The other half, rented housing.

3.1.2. Income Sources.

The vast majority of those surveyed had some source of income (80%). While a high rate of employment might appear to be something positive, the incomes of most respondents do not place them within any economically stable segment of the population.

Of the 18% that have regular employment, 3% had their own business and engages in commerce. Seven (7) percent worked as outreach workers for NGOs and earned 2500 som/month. Eleven (11) percent worked in the service sector and most often performed menial labor (dishwasher, housekeeper, laundress, scrub women, etc.). Salaries for such jobs ranged from 1000 to 2500 som per month.[2]

A very large percentage of respondents performed sexual services along trucking routes, for which they reported payment ranging from 100 to 200 som. In more "elite" establishments, payment can reach 600-700 som.[3] The behavioral risks associated with drug use, sex work in particular, is described in section 3.2. A certain percentage of respondents – 4.11% - admitted to engaging in crime.

Among sources of income, 5.48% of respondents received child support (from 500 to 830 som/month) and 1% received compensation for the loss of a breadwinner (170 som/month).[4]

Table 2: Employment

 

   

Employed

Unemployed

Age

 

 

19-25 

        83  

        17  

26-35

        77  

        24  

 36-45

        83  

        17  

Education

 

 

 

 

Some secondary

        50  

        50  

Secondary school

        77  

        24  

Technical secondary education

       100  

    

Some College

       100  

    

College

        75  

        25  

Ethnicity

 

 

 

Kyrgyz

        67  

        33  

Russian

        87  

        13  

Uzbek

        67  

        33  

Other

        67  

        33  

 3.1.3. Incarceration Experience

Forty (45) percent of those surveyed reported that they had been charged with crimes and incarcerated. In most cases they were charged with possession and use of narcotics (65%). The percentage of those detained by law enforcement for petty theft was also rather high.

Table 3: Crimes with Which Respondents Were Charged

Crimes with Which Respondents Were Charged

%

Drug possession

65

Тheft

30

Engaging in prostitution (in OAE), infliction of bodily harm, grand larceny.

20

Total

115*

*Here and elsewhere, when the total percentage is more than 100, this indicates that respondents were able to give multiple answers.

Despite the fact that the Kyrgyz Ministry of Justice has collaborated with the nongovernmental sector in recent years and has made qualitative improvements in the area of HIV prevention in male prison settlements by introducing syringe exchange programs, social work, and, in August 2008, through a methadone pilot project, the HIV prophylaxis situation in incarcerated female populations is much worse, since none of the above-mentioned programs have been implemented there.

Most of the respondents spent from 3 to 5 years incarcerated. Changes introduced into Kyrgyz law and reductions in the penalties for possession of small amounts of drugs, making this an administrative offense, will have a positive effect on the fate of female IDUs in the future. Currently, amnesties and retroactive application of the updated law is leading to the release of a large number of women (according to a source in the Ministry of Justice, in women's colony No. 2 the number of prisoners was cut in half over the course of a year, from more than 500 inmates in 2007 to 265 in 2008).

Table 4: Incarceration Terms

Incarceration Terms

%

3-5 years

        44  

1-3 years

        28  

7 or more

        17  

5-7 years

        11  

Having been incarcerated has serious consequences not only for women's status in society, but also for their psychological state and health, and it determines the conditions under which children are raised. The situation is further exacerbated by the fact that the social support system for those freed from colonies is not working well. As a rule, this leads to a situation where female ex-convicts are essentially deprived of all rights in the eyes of civil law. Additionally, even those governmental and nongovernmental organizations that provide support to former inmates – shelters, drop-in, and rehabilitation centers – often are not equipped to work with female drug users, since their main contingent is male or women with a more "acceptable" lifestyle.

Here is what Ryskul, a psychologist in the Social Bureau of Women's Colony No. 2 (village of Stepnoe), had to say about this.

The task of our Social Bureau is to prepare convicts to be released from incarceration. We discuss a joint plan of action and how they will solve their problems when they are released and provide information about NGOs and various governmental offices where women can receive some help. But as soon as they are released, women confront a number of problems much more serious than those confronting men. The housing that NGOs provide is for a maximum of one month, maybe just a bit more, and beyond that it's unknown what will happen. At best it takes half a year to receive new [identification] documents, and without documents you can't get a job. And in order to get a passport you need a residence permit, and who will give you one? So restoring documents might take more than a year. If a woman has a child or several children, then there are even more problems. And many women's centers won't take the women we help…they deal with different categories of women. It would be wonderful if all government offices actively supported the initiatives of the ex-convicts who turn to them for help. If this were the case it would be easier to monitor the fates of women who are released. Now there are some efforts by government bodies, but the problem remains unsolved.

The problem of identity documents was common among respondents. For a variety of reasons, one quarter of them had no such documents (23.29%).

Diagram 1: Reasons for Lack of Documents

 

Although having recently been released from incarceration is not the primary reason respondents did not have documents, this problem still demands attention, especially since the lack of documents has consequences not just for the women, but for their children.

A woman named Irina had the following to say about her situation:

In general, I'm a Russian citizen, and the first time I was imprisoned I still was. By the time I was released I didn't have documents anymore and the certificate of release listed me as a Kyrgyz citizen. So the second time I was imprisoned it was as a citizen of the KR. Now it's not clear what country I'm a citizen of, and I have no documents. And I have no idea what to do to get them, where to start.

In Tanya's case, the inability to obtain documents in time may have an impact on her parental rights:

I was released from prison with a baby. I'm from Kochkor-Aty (Jalal-Abad Oblast) – that's where I lived with my husband. While I was in prison he sold the house and left for some unknown destination. I don't have any parents either, so I have nowhere to go. I wanted to give the baby to an orphanage until I could find work, housing, and obtain documents. But I heard that it would be hard to get my child back. Now I'm afraid to give up my child, but I have no idea where to go.

3.2. Behavioral Risks Associated with Drug Use, Including Those Associated with Sexual Services

3.2.1. Duration and Context of Drug Use and Associated Risks

For the most part, the drugs of choice used by respondents were heroin and hanka. In addition, some respondents also smoked cannabis.

Table 5: Drugs of Choice

Type

%

Heroin

        98  

Hanka

        39  

Practically all respondents use heroin as their main narcotic. If heroin was not available, they used hanka (39%), and also substituted alcohol (98%) or psychotropic pills (34%) for heroin. To complement heroin they used dimedrol, a sedative.

As Diagram 2 shows, most respondents had been using drugs for a rather long time. Approximately one-third of those surveyed indicated that they had used drugs for 12 years or more.

 

Diagram 2: Duration of Drug Use

 If we consider that most respondents were between 26 and 35 years of age (48%) and that they had been using drugs for 8 years or more (44%), it becomes apparent that most of those surveyed were first given drugs when they were adolescents or were aged 20 to 25, or when they married. This is consistent with the findings of international research indicating that women often first use drugs within the context of a sexual relationship.[5]

Below are some of the most commonly repeated responses in answer to a question about the first experience using drugs.

It was interesting, all my friends were using…

Curiosity, then I got used to it…

It was popular…

I wanted to be like everyone else…

To fit in with a group…

Interest, I thought it was cool…

I saw other people doing it and I wanted to try, I got drawn in…

Everyone in my crowd was using…

My boyfriend said that I would like it, it became interesting…

When my joints were hurting, my husband injected me, said it would help…

He talked me into it and I liked it…

My husband and his friends are addicts…

Under pressure from my husband…

It seemed interesting, then I didn't notice how much I craved getting high…

With my husband and his friends…

My older sister was shooting up and she got me into it…

My husband got me into it…

My husband pressured me…

Most responses involve three repeating themes – interest associated with imitating friends and peers; the search for an escape from a difficult situation or a means of dealing with difficult circumstances; and the influence or a husband or loved one.

It should be noted that using drugs with a partner or in a group of friends entails a heightened risk of HIV/AIDS infection for female IDUs. Twenty (20) percent of those surveyed were married or had a stable partner. As they expressed it, they had no need to hide their drug use from their husband or partner since he also was a user. The trust that women tend to place in their intimate partners often leads to the joint usage of injection equipment. For example, research in three regions of Russia revealed that 25% of female IDUs shared injection equipment with their partners.[6] Similar research conducted by the nongovernmental organization Clean World that studied female drug users in five cities of Azerbaijan showed that 76% of them used shared syringes and only one-third of them injected themselves first, while the remaining two-thirds used injection equipment that their partner or friends had used. Additionally, a 2006 study conducted in Kyrgyzstan, Tajikistan, and Uzbekistan by the UN Office on Drugs and Crime (UNODC) found that of the three countries, drug users in Kyrgyzstan cleaned their injection equipment less often than in the other countries. Furthermore, 90% of female drug users surveyed stated that they never clean injection equipment before using it.[7]

Women (female IDUs in particular) are often unable to persuade their husbands or partners to use condoms during sexual activity. Despite the fact that essentially all those surveyed (96%) know about contraceptives, 67% do not always use a condom. More than half of women who reported not using a condom were not involved in sex work and, consequently, relied entirely on the faithfulness of their partners. In a region where informal polygamy is still practiced, such trust can have very unpredictable results. It was evident from comments by those surveyed that even those women who have a steady partner are inclined to random sexual encounters, which further exacerbates the risk of HIV and STI.

3.2.2. Sex Work

Sixty-two (62) percent of respondents were sex workers. This statistic is consistent with figures from neighboring Tajikistan, where sentinel surveillance conducted in 2005 showed that 58% of women drug users were drawn into sex work.[8] When asked what had compelled them to earn money this way, the main factor cited by respondents was lack of money, including money to buy drugs.

Not enough money for a dose and for food…

Ran out of money for drugs…

Because they pay…

Needed money…

Earn a bit extra this way, but don't do it regularly…

Got onto "otrava" [heroin or opium], didn't have enough money, had to go out on the trassa [streets, i.e., enter prostitution]…

At first I wound up in a group where everything was nice, expensive, beautiful things, seemed really cool, then drugs, lack of money…

Didn't have anything to live on…

Came from Talas, my sister didn't have money for an operation…

Because of money, had to pay for housing, food, drugs…

Didn't have a job, needed money for a dose and to pay for housing…

Need money for my dose, for my son, to live on…

The stories of two respondents are given in greater detail below. It should be noted that these are the stories of individuals, but they are not unique among the survey group and point to the limited options and other social factors that impact the women's lives.

Here is how 22-year-old Zukhra from Jalal-Abad tells her story.

I have been working in the sauna since I was 16, as a prostitute in other words. My husband stole me when I was 14, I gave birth to a son, and ran away. I don't want to see my husband or the child I had with him. I came here, met a guy who was an addict, and he got me into drugs and, after 2 months he sold me to the sauna so I could earn money for him. Then he died of an overdose.

And here is the story of 18-year-old Adina from the city of Osh:

I've been shooting up for three years and my younger sister has been for one year. She started with me. There are six of us sisters, living together renting a little house. We had a brother who helped, but he died of an overdose recently and we needed some way of living and getting food. So we went out onto the trassa [streets]; I'm too old to sell my body, but my little sisters are in demand.

International experience confirms that the economic situation and the need for the means to support a family or a child, as well as for drugs for themselves and their partners often compels female drug users to get involved in sex work. Female drug users do not always get opportunities to work in more prestigious establishments and the main source of income for them becomes street sex work, with all the risks to life and health that this entails, such as frequent episodes of violence and persecution by law enforcement. Furthermore, when riskier sexual services are provided, clients usually demand that no condom be used. Female drug users also sometimes engage in so-called "barter" sex, offering themselves in exchange for drugs, shelter, or food.

The results of this survey showed that among sex workers there is no clear understanding of the need to use a condom as a means of protecting against disease. The reason for not using a condom is often the client's desire to have sex without one. Below are some responses explaining why those surveyed have unprotected sex.

When the client doesn't have one…

With a partner I trust…

He asks or demands…

The client will pay more if…

Sometimes the client doesn't want to…

When I don't have one…

Sometimes I don't have one, sometimes I just want to save money…

A drunk client didn't want to…

Many respondents who, one way or another, did use condoms, often got them for free. As the women indicated, there is access to free condoms, in other words cost should not be an issue, but lack of awareness may be, along with such factors as work schedules, location of distribution points, and the inability to convince partners to use condoms or formulate a refusal to have sex without one.

3.2.3. Violence

The experience of violence is both a psychological motive behind self-destructive actions and a consequence of the lifestyle of female IDUs. A rather high percentage of respondents – 38% - have been victims of violence, both physical and sexual. The circumstances, locations, and times vary. Violence experienced at any age, but especially in adolescence, has been linked in the foreign and Russian literature with a subsequent propensity to use psychoactive substances and engage in risky sexual behavior. The responses listed below indicate that in general, within the survey sample, violence was experienced either in the form of rape or physical violence associated with sex work, or as rape or physical violence by a partner or acquaintances. It might be assumed that many of those surveyed were victims of violence before they became sex workers and before they began to use drugs.

At work, in other words on the trassa [streets], you'd run into people who want a lot and want it for free…

They hit me over the head with a bottle on the street, made fun of me, and raped me…

My husband beat me and demeaned me…

They raped me and beat me on the street…

From men, they beat me and raped me…

My husband beats me…

Rape…

On the trassa, as a sex worker…

Emotionally, by acquaintances…

I was in Kazakhstan illegally, as a sex slave…

My husband demeaned me…

Most often when I was working as a sex worker, clients would beat me, make fun of me, trick me…

At work drunk clients beat and demean me…

Drunk, insolent clients…

In the sauna: clients would make fun of me, I was subjected to rape…

My acquaintance raped me, my live-in boyfriend beat me…

My live-in boyfriend beat me…

When I was "bumming around" in the park, several times teenagers beat me and raped me…

Clients sometimes beat me…

I was beaten by my live-in boyfriend, raped by an acquaintance…

I was beaten by my live-in boyfriend, other IDUs..

I was gang raped…

I was beaten in the bazaar by homeless people, merchants…

Drunk clients beat me, demeaned me…

My guy beat me…

3.3. Determining the Health of Female Drug Users: Studying Childrearing Practices and Assessing Prevention and Treatment Opportunities


 


3.3.1. Overall Health

A high percentage of respondents (59%) report that their health is "not good." This is reflected in the rather high instance of medical visits – 80% had sought medical treatment within the past year. Table 6 shows how recently respondents had sought such treatment.

Table 6: Time Elapsed since Last Seeking Medical Care

Time since Last Visit to Health Care Provider

%

1-6 months

        39  

1 month

        25  

Had not sought health care

        21  

 1.5-3 years

          9  

3 years or more

          5  

1-1.5 years

          2  

Special attention should also be focused on those who had not sought health care at all during the past year – 20% of respondents. Among the 20% that had not sought health care during the past year, 18% said there was no need, but the majority (82%) had given a lack of funds as the reason. This last category, which totals 16% of the survey group, while having a heightened risk of HIV infection, had no access to health care.

The reasons for seeking health care were varied, but common among them, in addition to getting general tests, were reasons associated with gynecological diseases. Only a small percentage of those surveyed noted that they had sought medical care to be tested for HIV during the past year. This indicates a glaring lack of awareness and points to the fact that women in the survey group either do not seek or, due to stigmatization, actively avoid undergoing regular testing for HIV and STIs.

Table 7: Reasons for Seeking Health Care

Reasons

%

General tests

        17  

Gynecological diseases (discharges, pelvic pain)

        14  

abscess

          9  

injury

          9  

HIV testing

          6  

Hepatitis C

          6  

Detoxification

          6  

Dental problems

          6  

Other (appendicitis, lung inflammation, flu, surgery, liver, kidneys, childbirth, heart, tuberculosis)

          24

Refused to answer

          3  

3.3.2. Infectious Diseases

According to a 2006 assessment of the HIV rate among injecting drug users compiled by the Ministry of Health, in the city of Osh this figure was 14% and in Bishkek it was 0.8%. The overall HIV rate among injecting drug users throughout the country is cited as 7.4% by the Ministry of Health. This same assessment gives the HIV rate among sex workers in two major cities of Kyrgyzstan as 1-1.5%.[9]

In contrast, the survey group exhibited a very high rate of infection – 23% of respondents indicated that they were HIV positive. Considering that the majority of the 17 women who admitted being HIV positive did so during personal interviews, perhaps an even greater number of women in the sample are HIV positive but did not want to admit their status. The group selected for study is not sufficiently representative to draw any solid epidemiological conclusions. Nevertheless, this high percentage of HIV positives in the survey group points to the need to conduct more precise assessments of the HIV rate in the country, as well as the even more urgent task of winning the confidence of female IDUs and conducting purposeful prevention intervention.

One quarter of the surveyed population that did test for HIV, did not receive counseling either before or after testing. Pre- and post-test counseling is an integral part of the successful prevention and treatment of HIV infection. The absence of this service, in addition to increasing psychological trauma, also often leads to a low rate of patients returning to get their test results and to an overall lack of trust among clients toward health care workers. This can lead to the development of HIV and associated diseases.

The survey group also displayed a high rate of hepatitis C infection – 66% of respondents said they had tested positive.

Diagram 3: HIV Rate in Survey Population Group

 

3.3.2. Reproductive Health and Childrearing Practices

Forty (40) percent of those surveyed had had abortions (between 1 and 5 times). The only resource we have for comparison is a study conducted by the Kyrgyz Ministry of Health in the late 1990s, which noted that 30% of Kyrgyz women of reproductive age had had at least one abortion.[10] Since the late 1990s, the number of abortions per 1000 women continues to decline – from 26.0 in 1997 to 14.0 in 2004,[11] from which it can be presumed that the figure for respondents, which exceeds the old figure by 10%, exceeds the current figure even more dramatically.

Historically, Kyrgyzstan has had high rates of abortion and of using abortion as a primary form of family planning. So this is a problem affecting all Kyrgyz women, not only female IDUs. In their case, however, this problem is exacerbated by the fact that doctors often force them to have abortions or do not pay sufficient attention to "problem" patients, which can led to a higher rate of abortions and a general worsening of female IDUs' reproductive health. Many doctors also tend to view pregnancy in a female IDU as something negative, basing this attitude in the belief that a women who uses drugs is not capable of giving birth to and raising a healthy child.

It should be noted that methadone substitution therapy (MST), which can be prescribed during pregnancy and is not dangerous either for the mother or the fetus, is also the most effective method for treating heroin dependency. MST allows patients to stop the risky injection of narcotics and thus decreases the probability of HIV infection. Methadone also helps adherence to antiretroviral therapy, which in turn reduces to a minimum the likelihood that HIV will be passed from mother to child. As of January 2007, there were two instances of pregnant women being admitted to MST programs in Osh Oblast. Both pregnancies were successful and both mothers are still on methadone.[12] The level of knowledge among women surveyed about drug treatment services, including MST, is examined in detail in the following section.

Of all those surveyed, 32 women had children, ranging in number from one to three.

Table 7: Number of Children

Number of Children

Absolute Value

1 child

23

2 children

7

3 children

2

A small percentage of respondents (14%) are raising their children themselves. Most leave their children either with their parents or their husband's relatives, their own relatives, or resort to the services of state institutions. The reasons given for this include a lack of trust by relatives, being confined as an inmate, or insufficiently available time:

Because my child is in Russia…

I work, but I don't have housing…

I was in prison, and when I was shooting up, I wasn't attentive enough…

At first we all lived together, and when I started to shoot up, my parents took them in…

I have to work to make money to live on…

I cannot give my child a normal upbringing…

I'm working, I often disappear, my mother-in-law doesn't trust me…

Because I shoot up…

No time…

Exactly half of the respondents had children who attend school. Many respondents were not informed about how often their children are ill, evidently because they are not raising them themselves.

Among respondents with children, 9% of them had school-aged children who did not attend school. The reasons for this failure to attend school is: no funds (11.12%) and they are ill (6.67%). In 13.34% of cases respondents encountered discrimination (they were not accepted into school or kindergarten, or they were not admitted to a hospital for treatment) because their mother was a drug user.

Half of respondents replied that their children observe their mothers using drugs. A quarter of the overall total with children sent their children to buy drugs in cases when:

When I'm in withdrawal…

When I was sick…

I was afraid of the cops I called the pusher and she gave it to my son…

It was right next door…

When I was being tailed by the police…

Half of the respondents replied that their children had enough food, clothing, school supplies, and toys. Almost all respondents stated that they had trusting relationships with their children. With the exception of one respondent who "abandoned" her child in the care of her parents, nobody in the group had been deprived of parental rights.

The following were among the problems that came up in association with raising children:

I'm not around…

My mother doesn't give me access to them…

I would like to pay more attention to them; I think I will after all give up drugs and everything will be fine, but for now I'm up to my ears in this swamp…

Generally don't have enough money to support them…

I don't always have enough time to take care of them better…

I don't have an opportunity to continue my education…

I would like to send them to kindergarten; I don't have any opportunity to bring up my younger daughter, since if I look after her, then there's nobody to earn money to live on…

I would like to raise my daughter myself, but until I get off drugs that's impossible…

My child has cerebral palsy, so I have a lot of problems…

I don't have my own housing…

Not enough money…

While mothers who are drug users do confront negative attitudes, having children can be the main impetus to changing behavior among female IDUs. Caring for a child is an important responsibility that can motivate a woman to find employment, a place to live, and can cause her to limit or completely cease the use of psychoactive substances. Since female IDUs often are the only guardians for their child, such traditional methods as long-term rehabilitation are hard to manage for mothers, and therefore more progressive methods are needed, such as MST, short-term rehabilitation, and support groups.

3.3.3. Drug Treatment Services

Half the respondents stated that they had been treated with drugs (detoxification) in a drug treatment center or a psychiatric clinic. Some respondents had been through treatment four times, but most had only been treated once or twice. It should also be noted that a study conducted by UNODC in 2005 indicated that women in Kyrgyzstan were much less likely to undergo a course rehabilitation than men: at the time the study was conducted, 97% of the patients who had gone through a course of treatment in Osh were men, with the percentage being 92% in Bishkek.[13] Those surveyed were not aware that there is a long-term course of rehabilitation available in the Republic Narcological Dispensary in Bishkek that includes psychological support and social adaptation. As the respondents mistakenly understood it, "rehabilitation" is a 10-day course of treatment that consists of short-term detoxification. As they put it, when a person is registered as a drug user, they can go through a course of detoxification if they pay 1900 som, while anonymous treatment (without registering with the narcological dispensary) costs 5000 som.[14] A course of detoxification, in addition to having practically no effect from the perspective of long-term remission, is expensive. It was also learned that there are no support groups or narcotics anonymous groups whatsoever for women, which truly limits opportunities for women in terms of behavioral change, rehabilitation, and socialization.

Essentially all respondents had attempted to give up drugs several times. Remission had extended for from several months to three or more years. Ninety-three (93) percent had attempted to give up drugs on their own. Among those who were not incarcerated, the average length of remission was 2-3 months. Among those who had been in the penal system, remission lasted between one and three years. During remission, 38% of respondents substituted drugs with alcohol, cannabis, pills, or methadone, and 7% took only methadone.

Almost all those we surveyed knew about the existence of MST. But most of them had catastrophic misconceptions about methadone. Rather than understanding methadone as a medication that could help overcome the obstacle of heroin dependence, they viewed methadone as a free heroin substitute. Many described methadone as a medicine against withdrawal.

A medical substitute for heroin…

A free substitute for heroin…

If you don't abuse it, it helps against heroin dependency…

It helps against withdrawal…

Heroin substitute…

A synthetic drug substitute…

It's a synthetic product…

I don't know anything – just that it's free…

There is such a drug, it's legal, and it's at the narcological dispensary…

There is such a program…

It's synthetic heroin, you take tablets regularly, there's such a program at the narcological dispensary…

You take it in pill form instead of heroin…it's at the drug treatment center…

People take it so they won't shoot up heroin, you have to go to the drug treatment center…

People take methadone so they won't spread HIV/AIDS…

It's a medical narcotic, safe and better than heroin, you don't have to worry about the cops…

The fact that female drug users are unaware of how widespread and accessible MST is can be seen in the official statistics showing who takes part in the program. Since 2002, 518 patients have managed to undergo treatment with methadone therapy in Osh and only 35 of them (6.8%) have been female. As of August 2008 there were 150 participants in the Osh program and only 10 (6.7%) of them were women.

Ten respondents had participated in MST programs in the past. The reason they are no longer participants in MST is that they were incarcerated or they moved. This testifies to the need to introduce programs within the penitentiary system and expand it in the civilian sector, and to bring treatment up to international standards, which allows patients to undergo a course of treatment for some time in their own homes.

3.3.4. Harm Reduction Programs

Among respondents, 86.37% knew what services the AIDS Center and the syringe exchange program (SEP) offer. They had received information about SEP from volunteers, friends, acquaintances, and outreach workers. The overwhelming majority of women we surveyed had received some kind of services offered by the syringe exchange program 

Most respondents saw the work of harm reduction programs as something needed. Assessments of how well these programs were working ranged from average to high praise, but there were cases where some flaws were pointed out.

It's necessary work, it helps us…

They didn't want to give me syringes…

I don't like it, they don't offer medicines…

It's okay…

Very good…

They are doing much needed work…

We need more such programs…

Useful, something IDUs need…

It's good when its free and anonymous…

We need more SEP…

Not very – they don't often bring the syringes…

Average…

I don't like it…

3.4. Identifying Problems Associated with Stigmas Affecting Female Drug Users in Their Interactions with Law Enforcement, Health Workers, and Society

3.4.1. Discrimination by Those Close to IDUs

A rather higher percentage of respondents – 18% – hide their drug use from relatives; 23% hide it from acquaintances and neighbors; and 16% from their children.

The attitude of those closest to drug users toward their drug usage ranged from attempts to talk them out of it and demonstrations of compassion and pity on the one hand, and aggression and threats on the other. There were some respondents who were not able to formulate or explain the attitude of those close to them.

Horrible…

I don't know…

They feel sorry for me, don't trust me…

It varies – some feel sorry, others are angry…

Bad…

My mother cried, tried to persuade me, swore at me…

Mama is fighting it, lectures me, cries, makes scenes, pays for treatment…

They don't trust me, they know that I might steal something from the house…

My mother took my daughter from me…

They're sick of it…

Negative…

They kicked me out of the house before…

They kicked me out…

They're trying to help…

The attitude of acquaintances and neighbors is somewhat different from the attitude of those closest to the respondents. Here, one often encounters an indifferent or neutral attitude. Of course, here there is also benevolence, pity, attempts to help, advice, but there is also avoidance, mistrust, and even condemnation, insults, and aggression.

It varies – some feel pity, others are afraid, curse, don't trust me…

Okay…

Bad…

They curse and insult me…

Some curse, some feel pity…

They were afraid…

Didn't matter…

Indifferent…

They feel pity, are angry, they worry…

They keep their distance, are afraid, don't trust me…

I didn't notice any particular changes…

Worse, they don't trust me…

They don't trust me, they don't talk to me, don't borrow money…

They scorn me…

It got worse…

They try not to talk to me…

They don't trust me and don't talk to me as much…

They don't talk to me…

Same as before…

3.4.2 Stigma Impacting Health Care

In the case of half of all respondents, health care providers had determined that they use drugs. In response to a question about whether or not there had been cases where health care had been withheld due to drug use, 6 respondents said it had: "they didn't come when I had a drug overdose…", "they wouldn't give me a certificate from the drug treatment center…", "they sent me to one doctor after another…", "my doctor was a neighbor, and when I lived at home she didn't want to see me…"

Seventy (70) percent of those surveyed had noticed a change in the attitude of health care providers toward them when they determined that the patient was a drug user. Most often this took the form of demonstrating "disgust."

Table 9: Health Care Provider Attitudes Associated with Drug Use

Attitudes Demonstrated by Health Care Providers Associated with Drug Use

%

Demonstrated disgust

        62  

Attitude worsened

        31  

Rudeness

        23  

Refused to provide care

          8  

Total

       123  

3.4.3. Stigmas Impacting Employment

In half of cases, employers had refused to hire respondents because of drug use. Thirty-four (34) percent of respondents replied that their drug use was the reason they lost their jobs, but half acknowledged that they were fired for objective reasons associated with their drug use – that they had not been fit to work when they used.

They were turned down for jobs from 1 to 10 times, but in many cases there were only 1 or 2 such instances. Reasons given for a refusal to hire amounted to a reluctance to work with drug users or simply that they had found someone more suitable for the job.

At first they were going to hire me, but then they said they found someone else…

Because I was an addict…

That they'd already found someone…

Because they didn't want problems with the cops because of me…

They spoke openly about the fact that I'm an addict…

They said they couldn't trust me…

Lack of trust toward an addict…

They didn't explain, they just refused…

No vacancies…

They hired someone more suitable…

They didn't say, they just refused…

They knew I was an IDU and came up with various excuses…

They fired me because I missed work because of drug use…

An addict can't perform normally, will steal…

Respondents who had been turned down for jobs often did not do anything to change the situation; there were a few cases where they attempted to explain and convince the employers that they would perform their jobs as needed, but this initiative did not yield any positive results. Many simply swallowed their feelings and tried to keep their failures "on the inside."

3.4.4. Rights Violations by Law Enforcement

The majority of respondents – 66% - had at one time or another been detained by the police. These detentions occurred rather regularly, and some respondents had been detained 50 or more times over the course of their drug use. The circumstances were almost always the same: drug possession, most often at a yama [place where drugs are sold].

They grabbed me, searched me, took me to a gynecologist, found drugs, jailed me…

I was coming from the bazaar and they stopped me, searched me, and detained me…

At yamas…

At my pusher's place, at yamas…

When I was leaving my pusher…

1 – I was set up; 2 times when I was leaving my pusher's place…

Near the yama, near my house…

They stopped me and searched me…

Arrest, frisk, I was set up, they caught me by yamas…

They kept watch, caught me, searched me, and jailed me…

They stopped me, searched me, detained me…by the yama…

When I was leaving my pusher; when I had picked up a packet from another person; when I had the packet…

They broke into the apartment when we were shooting up; they found a dose when they searched the apartment; when I was leaving my pusher's place; when another addict set me up…

They found it at home during a search…

Other IDUs set me up; they brought me a dose and then Drug Control Bureau agents came bursting in…

We were drinking near the yama, other IDUs set us up…

We came out of the yama, we had a syringe with solution with us…

We were drinking at the yama; they set us up; I was leaving my pusher with a dose…

They detained me when I had a dose with me…

Coming from my pusher; they took me from the drug treatment center…

Respondents most often solved the problem of being detained by the police in the following manner:

Money, sex…

Trickery or money…

Pay or jail…

Sometimes I paid, sometimes I provided sexual services…

Sometimes I paid what they wanted and sometimes I negotiated the price…

My mother paid…

My live-in boyfriend took it on himself…

Paid whatever they asked…

With money, but if I didn't have it, I'd stay in jail…

My relatives paid (daughter and son-in-law, sister, mother)…

I paid, provided information…

Money, sex, information…

From this list of responses it is evident that the most common means of getting out of detention for drugs is bribery, providing sexual services, or providing information.

Thirty-two (32) percent of all respondents experienced violence at the hands of the police. Reasons included:

Resistance…

Did not want to admit the crime…

Because of drugs…

To get information out of me…

They just wanted to…

Because of prostitution…

Drug addict, sex worker…

During detention…

Police attitudes due to drug use:

Negative, mocking…

Emotional and physical humiliation…

They tried to catch me with drugs…

Bad…

Vile…

They tried to use my services for free…

Hatred, revulsion…

Took money, insulted me…

Tried to manipulate, extort money…

The attitude got worse, disparaging, they tried to humiliate me…

They tried to force me into sex…

40% of those surveyed who said they were involved in sex work stated that they had been subjected to active violence by the police:

"Subbotniki" [volunteer work, in this case sexual], physical violence…

Humiliation, subbotniki…

They said that if I didn't work for them, I couldn't go to the trassa [streets]…

They are insulting, extort money, use intimidation…

They offer that if I provide services they'll let me go…

Physical…

They intimidated me, said that if you don't give it, you'll wind up in prison…

So as not to pay, but have it for free…

They extort money, force sex…

I provided sexual services for free…

It should be noted that among the respondents there was an exceptionally poor knowledge of the law. Many respondents said that they did not know anything about what rights they have. Among the others a small portion said that they knew their rights, but this knowledge amounted to specific aspects associated with the quantity of drugs they could possess, or that there was no article concerning sexual services.

You can carry up to one gram…

I have the right to work and go to school…

They don't incarcerate you for sex work…

I know the entire criminal code…

I know the constitution…

They get information, as many women stated, from places of incarceration, from acquaintances, from volunteers, and from leaflets and brochures.

Eighty-two (82) percent did not know that it was possible to receive free legal assistance. Out of the small percentage that stated they did know this, 9% "just heard that it exists." The nonprofit Parents Against Drugs and the NGO Podruga [female friend] were mentioned by 9% of respondents as sources of free legal assistance.

Out of all respondents, only 5 had actually obtained free legal assistance.

4. Recommendations

This study uncovered problems that confront female drug users in Kyrgyzstan. As consequence of the closed nature of the group, female drug users are a group most subject to risk and are beyond the reach of prevention programs. The following recommendations are directed at NGOs working in HIV/AIDS prevention and harm reduction and at government bodies. We hope that improved interaction between all parties will draw a larger number of female IDUs into prevention and treatment programs.  

1. Educate women drug users, health care providers, and the population at large in the area of HIV transmission, safe sex, and reproductive health:

For NGOs:

Conduct a series of educational seminars for female IDUs and sex workers about condom use. The seminars should include information about the importance of using a condom not just as a contraceptive, but as a means of protecting against STIs, HIV, and hepatitis. It is important to cover the question of how to convince clients or partners to use condoms and to identify ways to overcome barriers and prejudices women face when they try to justify condom use. It is also important to shed light on the use of disposable syringes and to provide arguments for using their own injection equipment among friends and with their partner.

With help from community leaders, a series of educational seminars should be held for men explaining the dangers of sexual promiscuity and risky behaviors such as injecting drugs and having sex without condoms. It is also recommended that the seminars identify the main barriers and prejudices preventing men from using condoms and discuss how inconsequential they are when compared with the risk of HIV infection. The negative consequences of violence against women for the family, children, and society overall should also be discussed.

In cooperation with specialists from the narcological dispensary and doctors from friendly clinics, conduct a series of educational seminars for gynecologists explaining the need to support such difficult-to-reach groups as female IDUs and sex workers and the effectiveness of substitution therapy during pregnancy.

At the conclusion of educational seminars with gynecologists, create multidisciplinary teams consisting of gynecologists and NGO social workers that will be capable of doing "on site" checkups, i.e., at syringe exchange points and in places where sex workers congregate. Where such teams are financially untenable, arrange a system for accompanying or referring clients to friendly gynecologists, other NGOs, etc.

For head doctors of gynecology departments:

In cooperation with regional drug treatment centers and local NGOs, improve the knowledge of senior and junior medical personnel regarding drug dependency and treatment models, such as substitution therapy.

Increase the quantity of Friendly Offices, where in addition to an examination clients can be given medicines to treat acute illnesses, since the study shows a high rate of gynecological disease despite existing programs.

2. Expand access to medical and social services and to harm reduction and drug treatment programs:

For NGOs:

 

Use leaders identified over the course of the study to improve the flow of information between NGOs and the community of female IDUs. What is first needed is an elementary system to inform female IDUs about existing organizations. A series of handouts should be developed aimed at female IDUs that lists services offered by existing medical and social assistance programs, harm reduction programs, clinics, and AIDS centers; that describe how to protect oneself against hepatitis and HIV/AIDS; and that provide reliable information about substitution therapy programs and the positive attributes of this therapy, especially during pregnancy. This last task should be carried out with the staff of the Osh Narcological Dispensary and friendly gynecology clinics throughout the area.

The next step will be development of a self-help group and mutual assistance group for female IDUs through existing organizations. Since there are no narcotics anonymous groups or 12-step programs for female IDUs, efforts should be launched to found such groups through existing organizations and in cooperation with the narcological dispensary.

In cooperation with the district AIDS center, more female IDUs should be convinced to come in for HIV testing. Pre- and post-test counseling should definitely be provided as well as subsequent motivational and psychological support.

For Republic and District Drug Treatment Services:

Through cooperation with NGOs working in the area of harm reduction, a greater number of women should be brought into Substitution Therapy in Osh and this therapy program should be expanded to Jalal-Abad. Perhaps it will be necessary to re-examine the existing program and think through how to provide access to substitution theory while maintaining maximal confidentiality. For example, the opening of an additional site at the district clinic will permit female IDUs to receive substitution therapy without disclosing their status as drug users by making regular visits to a drug treatment center.

Improve efforts to bring women into short-term detoxification programs by allowing them to undergo treatment in wards separate from the men's wards.

In order to improve the effectiveness of short-term detoxification, provide a place for narcotics anonymous groups and 12-step program groups conducted in cooperation with the staff of local NGOs.

Provide information and access to substitution therapy to pregnant IDUs in cooperation with district clinics and gynecologists.

For the District AIDS Center

1. Improve cooperation with the district narcological dispensary and NGOs providing harm reduction services in order to provide pre- and post-test counseling as well as to ensure adherence to ART for female IDUs either by bringing them into substitution therapy programs or by providing quality social accompaniment services.

3. Expand access to legal services and ensure tolerance on the part of law enforcement:

For NGOs:

 

1. Establish contact with district police stations through broad-based social work.

2. Conduct a series of educational trainings with district police stations about the spread of HIV infection, ways to protect against HIV, and how to prevent the spread of the epidemic through cooperation with harm reduction programs.

Bringing in existing resources such as lawyers, conduct a series of educational seminars for female IDUs/sex workers on fundamental legal questions. Based on the results of the seminars, create booklets listing women's basic rights in "pocket" format so that female IDUs could carry one with them.

 

Identify interested lawyers. Where necessary, approach existing national and regional organizations that are already engaged in providing assistance to IDUs and sex worker and that are interested in sharing experiences. With the help of interested lawyers, create a system for tracking cases where the rights of female IDUs and sex workers have been violated and bringing them to trial.

An Expression of Gratitude

The Asteria research team wishes to express its gratitude to everyone who participated in the study for providing the information, showing the understanding, and investing the time needed to prepare this report on the needs and requirements of female drug users. We would like to express particular gratitude to Asteria's partners for their assistance: field workers; the director of the Oblast Narcological Dispensary, U. Shadiev; director of the NGO Parents against Drugs, M. Burkhanov; T. Abdiraimova, director of the Podruga NGO; B. Ermatov, director of the NGO Tais Plius Dva; as well as to the social and outreach workers. We would also like to extend our special thanks to all the members of the Asteria research team: the volunteers and social workers D. Khaitov and E. Khalipova, whose dedication and enthusiasm were the engine that drove the study toward attaining its goals.

Acronyms

IDU Injection drug user
PLH People living with HIV
SW Sex workers
MST Methadone substitution therapy
HIV Human immunodeficiency virus
AIDS Acquired immune deficiency syndrome
STI Sexually transmitted infection
NGO Nongovernmental organization
NF Nonprofit foundation
NA Nonprofit association
SEP Syringe exchange program
NA Narcotics anonymous (12 step program)
AA Alcoholics anonymous (12 step program)
Detox Pharmaceutical treatment for addiction
   

Notes on respondent slang:

 

Yama – a place where narcotics are sold.

Baryga – a pusher, someone who sells drugs.

Hanka– raw opium.

Anasha – marijuana, cannabis.

Lomka – the physical pain experienced during withdrawal from narcotics

Peredoz – A narcotics overdose.

“Kumarit'” – To be ill due to withdrawal from narcotics.

“Otrava” – Heroin, opium.

Trassa – Street, road, or sauna: anyplace sex workers work.

Appendix

Study Questions:

Questions for drug users:

How do you earn money to live on?

Does anybody give you financial help?

Do you have your own place to live?

Have you sought medical care?

How would you assess your health at present?

Have you been tested for HIV/AIDS and hepatitis C?

Do you have identity documents?

How long have you been using drugs?

What kinds of drugs are you currently using?

Who were you with when you first tried drugs?

Why did you start using drugs?

Are you married?

If yes, does your spouse know that you use drugs?

Does your spouse use drugs?

Have you gotten any of your friends involved in using drugs?

Have you been charged with any crimes?

Have you had any abortions since you've been a drug user?

Do you know about contraceptives?

Did health care providers determine that you use drugs?

Have there been instances when you were refused medical care because of your drug use?

Have there been instances when you were turned down for a job because of your drug use?

Have you been detained by the police because drugs?

How did you resolve the situation of being detained for drugs?

How did the police treat you once they learned that you use drugs?

Have you been subjected to violence by the police?

Have you been a victim of violence in general?

Do your relatives know that you use drugs?

Do your acquaintances and neighbors know that you use drugs?

What do you know about your rights?

If you do, what is your source of information about your rights?

Have you been through detox in a drug treatment center?

Have you been through rehabilitation (ambulatory treatment)?

Have you attempted to give up drugs?

Do you know about methadone substitution therapy?

Are you interested in being given methadone?

Do you know about any services for the drug dependent?

Are there any services that you need?

Do you know about free legal assistance?

Do you know about free syringe exchange points?

If you went to these organizations for services, tell us what you think of their work?

What kind of help do you need?

 

Questions for female drug users with children:

How many children do you have?

What are their ages?

Do they attend kindergarten?

Do they attend school?

Are your children involved in any other activities (special interest or educational clubs, sports…)?

How many times per year are your children sick?

Do your children visit a doctor?

Have your children experienced discrimination because of your drug use (they were not accepted into school or kindergarten, they were refused treatment in a hospital)?

Do your children see you or your friends using drugs?

Have you ever sent your child to the drug dealer for a dose?

Do your children work?

Do your children have enough:

a. food

b. clothing

c. school supplies

d. toys

other

What is your relationship with your children (difficult, trusting, indifferent…)?

Have you been deprived of parental rights due to drug use?

What other problems do you have associated with raising children?

 

Questions for sex workers:

Why did you become a sex worker?

Do you always use a condom?

While working (as a sex worker), have you experienced bad treatment on the part of the police?

How did the police treat you once they found out that you use drugs?

Have you been subjected to violence by the police because you work as a sex worker?

Have you gotten any of your friends involved in working in the sexual services sphere?

How old are these people?

What help or services do you need?

Age

Education

Nationality [Ethnicity]

[1] The questions used in the questionnaires can be found in the Appendix to this report.

[2] At the time the study was being conducted, these sums equaled US$26 and US$66 respectively.

[3] From US$2.50 to US$5.00 and from $US16 to US$18 respectively.

[4] From US$13 to US$22 and US$4.50 respectively.

[5] Doherty, MC, Garfein, RS, Monterroso, E, Latkin, C, Vlahov, D (2000). "Gender difference in the initiation of injecting drug use among young adults," Journal of Urban Health, 77(3), 397. Sherman, S, Latkin, C, Gielen, A (2001). "Social factors related to syringe sharing among injecting partners: A focus on gender," Substance Use & Misuse, 36(21), 13-36.

[6] Berezhnova I, Platt L, Rhodes T, Kamaletdinova N, Webster E. Bobkov Ye (2005). "HIV/AIDS, sex work and injecting drug use: comparative analysis of behavioral risk factors amongst representatives from vulnerable groups in three Russian regions" (in Russian). Presentation before the 14th International Conference on AIDS, Cancer and Public Health.

[7] Regional Study on Drug Use and HIV/AIDS, Regional Summary Kyrgyzstan, Tajikistan and Uzbekistan. UNODC. Regional Office for Central Asia, Tashkent. 2007.

[8] Program for Countering the HIV/AIDS Epidemic in the Republic of Tajikistan, 2007-2010.

[9] The Republic of Kyrgyzstan Ministry of Health information portal: http://www.med.kg.

[10] Kyrgyz Republic Demographic and Health Survey, 1997, compiled by the Kyrgyzstan. Ministry of Health. Research Institute of Obstetrics and Pediatrics, and Macro International. Demographic and Health Surveys [DHS]. Bishkek, Kyrgyzstan, Ministry of Health, Research Institute of Obstetrics and Pediatrics, 1998 Aug.:63-71. http://www.popline.org/docs/1284/137654.html

[11] Historical abortion statistics, Kyrgyzstan http://www.johnstonsarchive.net/policy/abortion/ab-kyrgyzstan.html

[12] Electronic correspondence with the head doctor at the Republic Drug Center, Ainura Tursunbekova Esenamanova.

[13] Drug Abuse in Central Asia: Trends in Treatment Demand 2003-2005. UNODC 2006.

[14] US$50 and US$112 respectively.