How Ukrainian female drug users are fighting against stigma and abuse

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During the pandemic, the number of reports made by women drug users related to incidents of violence increased by 30 per cent. Overall, lawyers from the Ukrainian Network of Women who Use Drugs (UNWUD) have recorded about a thousand cases. In general, this corresponds with an increase in reports of violence against women. However, these more general reports are often made for slightly different reasons. Halyna Korniyenko, a programme manager with the UNWUD, explains the situation often faced by female drug users: “Very often men hire their wives out for sex work, so they can get money for drugs. During the quarantine, sex work stopped. There is no money. And who is to blame!?”

Due to transport restrictions during the lockdown, drug addicts who receive treatment have to choose between spending time on the road to hospitals, where they can get help (some patients have to travel dozens of kilometres), or care for their children. They often choose the second option and end up sacrificing their own health. The pandemic has exacerbated problems that have existed in the past, including stigmatisation, discrimination and rights violations.

Discriminatory legislation

Tetiana Lebed had been using street drugs in the past. Now she is the director of the UNWUD, leading the group’s efforts to defend rights of female drug users. “There are a lot of problems regarding access to medicine and the realisation of reproductive rights,” she says. “There are still no protocols on pregnancy management. Even in Kyiv, I was abused in a specialist maternity hospital for drug addicts. They said ‘Oh, what drug damage the child has!’, although everything was fine with the child in all respects, and I was on drug replacement therapy, on minimal doses. Imagine what happens to girls who do not know their rights.”

Women who take part in substitution maintenance therapy (SMT) will normally receive safe medications. On the other hand, they become even more vulnerable to law enforcement and social services. Human rights activists have recorded cases of  mothers being deprived of their children due to discriminatory legislation. Lebed believes that the government should amend an especially controversial article of the country’s Family Code. The article states that parents may be deprived of parental rights if they are “chronic alcoholics or drug addicts”. Despite this, medical legislation does not have such terms, referring only to “persons with mental and behavioral disorders due to opioid use”. “That is to say, there is no diagnosis, but there is an article”, explains the director of UNWUD.

“After one line of the article, theу can take the child away from the mother, because she is addicted. It doesn’t even matter what the living conditions are. Some women can’t stand it and just die. These are not exaggerations or fantasies. We conducted a survey, and 41 per cent of women said they had problems with the police, their rights were violated. And they would rather not call the police, even when being killed, because it would get even worse. We had such a case in Zaporizhia. The woman was beaten by a partner, and after the police were called, one child was taken away. She was pregnant at the time, and when she gave birth, the second child was taken away as well”, Lebed says.

According to her, the attitude of the police towards drug users has not changed since the 1990s, when she was a user herself. Instead of telling them how to get help or get substitution therapy, law enforcement officers either take bribes or try to throw the woman in jail. Among the UNWUD members, most of the women have served prison terms for possessing syringes and substances used for the preparation of drugs. According to the organisation’s data, three out of four women drug users have faced rights violations, stigma or discrimination from health workers, social services or the police. At the same time, 36 per cent of respondents were refused medical care because they use or had used drugs.

Halyna Korniyenko argues that “We have a punitive and demonstrative drug policy. And if you are a woman, you will also be told that ‘You are a woman, a guardian [of a family]!’ Everyone seems to think that addiction is a choice but no one would want such a fate if they knew what would happen.” She adds, “We constantly conduct training for doctors and police. Things are slowly changing. However, I do not know how many more years it will take for the society to start changing, for there to be more tolerance and real human rights.”

A ticket to a better life

Information support for people with drug addiction is provided by employees of the National Hotline for Drug Addiction and SMT. The UNWUD project has “Street Lawyers” specifically set up to fight discrimination against women drug users. These women activists have no professional legal education, but have been trained to help addicts. For instance, they help women deal with stigma, as well as write to medical professionals to ask for help. “They work like a bridge: they can go to the doctor, to a court, or help write a statement”, Lebed says. Usually activists manage to defend women’s rights. However, defending parental rights is more difficult. It is easier for human rights defenders to connect with women drug users if they themselves have lived with an addiction. The director and the head of the board of UNWUD both have first-hand experience. “Women understand that you went through the same things as they did, that all of your problems were similar”, explains Lebed.

During the pandemic, changes were made to the country’s main document that regulates the treatment of patients with drug addiction. The minimum period in which the patient can start to self-administer the replacement drug has been halved to three months. A patient can also now get a single prescription of drugs for a period of up to ten days. Psychiatrists and other trained doctors can now also help patients with the SMT. With the help of SMT, people addicted to opioids can receive safe medications instead of illegal street drugs. This helps to minimise harmful effects and improve the lives of patients. Since there is no injection, the method helps prevent the spread of HIV and Hepatitis B and C. In SMT rooms, patients are regularly tested for these viruses. Overall, it has also helped reduce drug-related crime.

“When there is a substitute drug, they can think of something else other than drugs. A lot of our patients are working, taking drugs and living a successful life”, says Ihor Harkusha, a social worker in the SMT department of Kyiv’s Sociotherapy clinic. He further notes that “The SMT programme is one of the most effective ways to help society. Neither detoxification nor rehabilitation centres give such a result.”

“SMT makes life easier for both patients and us”, adds Gela Kalandia, head of the department. He says that the decriminalisation of drug use is needed: “If a person is ill, he or she should not be imprisoned for it, but treated”. Among more than 15,000 patients receiving SMT in public clinics, there are less than 2,500 women.

Moving in the right direction

Public institutions provide SMT free of charge. There are also private ones, but sometimes they do not control the patient.

“As far as I know from acquaintances, in some clinics anyone can buy the drug. The public ones first treat the patient to find the right dosage. Also, unlike private clinics, the information about the public ones is freely available”, Lebed says.

“In private centres you can effectively buy as many prescriptions in one day as you want. You could go to ten clinics and receive ten prescriptions. In our clinic we control everything. On any given day we can ask the patient to show us that they have been using the drugs”, explains Ihor.

Illegal centres sometimes operate under the guise of private rehabilitation clinics. At the end of March, one such institution was exposed in the Kyiv region. People with alcohol and drug addiction were effectively tortured there. Those who worked at the facility constantly demanded money for “treatment”. Last year, more of these centres were found in the Ivano-Frankivsk region. They did not have any medical documentation.

“In Ukraine, the legislation on SMT is not bad when compared to European countries. Fortunately, we are moving in the right direction. And our substitution therapy itself is now not very stigmatised”, says Kalandia, the head of the SMT department. “There is a big difference between the stigma faced by my patients ten years ago compared to now. It’s much better now. However, discrimination and stigma are still the main problems. It is still often difficult to help a patient who clearly needs it. Not because you can’t help, but because of societal attitudes.”

Vladyslav Kudryk is a Ukrainian journalist based in Kyiv. He currently works as a social media editor at hromadske.ua.

drug abuse, prejudice, Ukraine