Kyrgyzstan: Women Are a Hidden Population of Drug Users

Nadira, a 24-year-old sex worker, sits on the doorstep of her room in Dormitory No. 9 brothel. (Photo: Rena Effendi)

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Six months ago, Gulya started taking methadone to kick her 17-year drug habit. The drug, administered clinically at a government-run health center, silences her cravings to inject heroin, making it possible for her to care for her two children.

"It helps me," Gulya said. "It doesn't give me withdrawal – I don't run around trying to find drugs, or find money for drugs. I drink it, and can attend to what I need to do."

When it comes to populations affected by drugs in Central Asia, women drug users have long sat at the bottom of the priority list. Despite the attention and funding given to the topic of drugs in the region, much of the focus is on big-picture issues such as the eradication of heroin production and trafficking. Those programs that do exist to help drug users themselves, such as needle exchange or drug treatment, are predominantly used by men.

Given the traditions of a male-dominated, conservative society, women are a hidden population, often by choice. In regions where even smoking tobacco can be taboo for women, there is a fierce incentive to hide drug use. This stigma makes it especially difficult for them to access clean needles or drug treatment, particularly when combined with women's greater family responsibilities and household demands.

Given the low profile of women drug users, it can be hard to design programs that meet their needs. Umar Shadiev, the Head Doctor of the Osh Narcological Dispensary, admitted that little is known about this population. "We have no such research [or] statistics" on women drug users, he said.

Women use drugs for different reasons, and according to different rules, than men. Often they start using with a sexual partner who leads the way.

Irena Ermolayeva, Director of the Kyrgyz NGO Asteria, which helps connect women drug users to health and social services, explained that husbands or boyfriends can sometimes coerce their partners to use drugs. "They say, 'either you shoot up with me, or we're breaking up,'" Ermolayeva said. [Asteria is a grantee of the Open Society network. EurasiaNet operates under the auspices of the Open Society Institute.]

Katya Burns, a consultant who has researched women drug users, said that social customs increase women's risk of contracting HIV. "When women are in a group injecting together, women will often inject last," she said. Sharing needles with a sexual partner is considered a symbol of trust, she explained, as is having sex without a condom.

In order to maintain a drug habit and avoid the pain of withdrawal, some women also turn to sex work to earn money. According to Burns, this creates a vicious cycle: since drug-using sex workers are seen as less desirable, they are paid less and thus have to work more to finance their habit.

The common belief that all women drug users are also sex workers can lead to exploitation, Ermolayeva said. "If police catch a male user, they'll take his money. If they catch a woman, they propose sex services [to avoid] prison," she said. "There's a rule: if a woman uses, she should offer [police] sex for free."

Lena works as a social worker at Asteria. She found out two years ago that she was HIV positive, most likely from letting a friend in withdrawal use her needle first. Not long afterward, she was sentenced to five years in prison for possession of a single dose of heroin. Released after serving two years of her sentence, she had to start anew. "For a man, it's easier. He comes home [from prison], and let's say his mom or wife or someone meets him, right?" Women have less support, she said. "I myself need to start and do everything."

The social ties that women rely on for assistance can dissolve in the face of drug use, making it even harder to get help. "A lot of women have these informal networks where the neighbors will take the kids, or extended family will take the kids, but if she's alienated from her family because of her drug use then she'll have less support, and it'll be harder to get someone to take care of the children while she goes for treatment," Burns said.

Making health services accessible to women drug users is not impossible, some care providers say. Tailoring hours to women's schedules is critical, as is providing free incentives, such as childcare for women who want to enter drug treatment or gynecological exams.

Adara, a project of the NGO Population Services International, works in Osh to inform sex workers, some of whom are drug users, on where to find health services, often physically accompanying women on visits to the doctor's or to the local AIDS Center.

Jypariza Karymshakova, the project's program coordinator, said women often will not take such steps on their own. "They are ashamed," she said, of being discovered as a drug user or sex worker.

According to Lena, women's place in Central Asian culture makes their reintegration crucial. "Much more of the spectrum [of daily life] depends on women – family, for example – than on men," Lena said, thus making it especially important to "return women in particular to society."