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Empowered, connected, and respected: how harm reduction can help drug-using women

High-risk behaviors such as using illegal drugs have been one of the common causes of women’s coming into conflict with the law. In the Philippines, the antidrug campaign has resulted in more individuals, women included, getting apprehended, incarcerated, and, in some cases, treated inhumanely and unjustly. As part of the advocacy for alternatives to incarceration and improved access to justice by women in conflict with the law under the “Delivery of Women’s Legal Literacy and Access to Justice Services in the Philippines” Project, UN Women Philippines and the Partnership of Philippine Support Service Agencies (PHILSSA) organized a learning session on harm reduction, an emerging paradigm which seeks to regard with compassionate people who use drugs and thereby help minimize subjecting them to criminal prosecution and the unnecessary use of penal sanctions including imprisonment.

Held virtually on April 27, the learning session was attended by the project implementers—PILIPINA and Tambayan—and their community volunteers and paralegals. Ms Ma. Inez Feria, founder and executive director of NoBox Philippines, a member of the International Drug Policy Consortium (IDPC) and one of the pioneer advocates of harm reduction in the country, served as the resource person. After the welcome remarks given by Ms Jona Ang of UN Women Philippines and Ms Isabelita Antonio-Solamo of PHILSSA, Ms Feria talked about the experience of her organization in promoting harm reduction and how it can be used to reach out to persons, including women, who use drugs (PWUDs).

Creating safe spaces. NoBox’s tambayan (hang-out spots) in communities is an example of an intervention for PWUDs that uses the principles of harm reduction. Organized with the support of the barangay government, a tambayan gives PWUDs a safe space for sharing their stories, listening to others, and learning from one another. For people whose lives include the use of drugs (including peddlers), such an environment is important because the stigma surrounding individuals like them often gets in the way of them seeking help and treatment. Those known in their community to be included in the government drug watch list suffer greater shame and fear for their lives so the tambayan serves as their haven. Based on the experience of NoBox, women participants appreciate having a support group especially because gender-based discrimination is prevalent.

Ms Feria said that harm reduction pursues ways to make it easier for such individuals to reach out to others and for others to reach out to them. Typical programs are not always accessible to intended recipients. Some must leave their place and spend for transportation to take part in these programs, others have work and losing a day’s pay can spell hardship for their families.  But those that follow the harm reduction approach consider the “basic human behaviors and decision-making” of people who use drugs. Moreover, harm reduction underscores the building of partnership with the individuals for them to become “active actors rather than passive recipients” of programs and interventions. The need to establish relationships, build trust, and see the participants as people with dignity takes time, making harm reduction a long-term approach.

Programs based on harm reduction also respect the pace of the individuals’ journey, recognizing their other priorities and personal concerns. This contrasts with usual drug intervention programs that are time-bound and require participants to attend sessions and complete modules for them to be declared “drug-free”, delisted from the watchlist, and prevented from using drugs again. In NoBox’s tambayan, participants may miss a session but are continually reached out to. Instead of listening to lectures and talks, the participants are guided in understanding better that their situation which needs addressing encompasses issues other than simply their use of drugs. A harm reduction approach underscores the perspective that drug use happens in a “spectrum of realities”; one’s experience of using shabu, for example, is not the same as another person’s experience due to various factors such as the amount and purity of the substance.

Ms Feria added that harm reduction aims to understand the role that drugs play in a person’s life “in an objective manner,” avoiding outright judgment. Harm reduction veers away from the usual drug prevention education, which reinforces negative stereotypes and caricatures people who use drugs. Unlike most drug education programs that rely on hysterics about the dangers of drugs, harm reduction conveys correct information and encourages honest sharing. It expands the discussion about drugs to include understanding the reasons why people take them and ways to reduce the risks. For example, stimulants like shabu are used by adults to enable them to work longer and harder but during the tambayan sessions, participants are informed about the harms of continuous use of shabu such as paranoia and suppression of appetite. Other factors such as comorbidities are also identified to help the person understand how problematic drug use could affect their condition. This “neutral” discussion encourages participants to be open in sharing their experiences without the fear of judgment from others.

Going beyond “drug-free”. A harm reduction approach reminds service providers, including those from government, to be aware of the needs of PWUDs, especially women. It signals a shift from merely seeking to make a person “drug-free” to recognizing and, if feasible, addressing equally important issues such as poverty, history of violence and abuse, and experience of trauma during arrest or detention. Hence a person’s use (or selling) of drugs should not be seen in isolation from other issues she faces. A referral system, which many drug interventions try to establish, should go beyond informing women about who and where the providers are. It must involve helping them access the services easily. Many of the women in jails that NoBox have engaged with were not involved in problematic drug use but had bigger personal problems to deal with before their arrest, and these unfortunately were not given much attention by service providers.

Moreover, harm reduction challenges the usual approaches to dealing with the drug problem. Citing data from a United Nations report, Ms Feria said that people whose drug use is not problematic represent the majority of drug users, implying that drugs must not be used as a scapegoat for deep-seated social issues and cast as the biggest problem to be solved. The challenge is to integrate the issues of women who use drugs into existing drug interventions, identify the resources and capacities needed to do this, and continue and improve the strategies that work especially for looking after women’s health and quality of life. Service providers must also “not fall into the trap of numbers” by merely reporting the number of participants who “graduated” from a program, for example.

Integrating harm reduction into current drug interventions in the Philippines, however, has not been easy because the policy environment remains unchanged. Drug control laws, specifically Republic Act No. 9165, impose punitive sanctions against persons who use drugs or are found involved in drug-related activities such as sale and possession. By criminalizing drug use, the drug policy tends to hinder, rather than encourage, the adoption of alternatives to incarceration which are less harmful to women and their families, and other support services that can help these individuals. If drug use is recognized as one part of a person’s circumstances, other needs of the individual will surface and can be addressed. Even if a woman continues to use drugs occasionally, it should not be the reason for cutting her off from seeking help. “Abstinence from drug use should not be a precondition to be able to continue accessing the services,” Ms Feria said.

The law also punishes people who know and help those who use drugs but do not report to authorities. RA 9165, according to Ms Feria, “needs an overhaul.” “Mahirap mag-ayos kung ang foundation ay may problema na (It is hard to remedy a situation if the foundation [the policy] is problematic),” she added. The mandate to local government units to achieve the “drug-free” status is so strong that alternatives like harm reduction are hard to institutionalize.  “Instead of increased police visibility, it should be increased visibility of support services,” Ms Feria said.

Empowering women. Women need to be part of the conversation, and by encouraging their meaningful participation and building their capacity to take part, the harm reduction approach helps make their voices heard and their strengths recognized. “They need to feel empowered to be able to share their experiences and to be involved in designing the programs [for them],” Ms Feria said. This, she added, is important because society generally views them as useless and dangerous individuals. Moreover, building their capacity is not limited to teaching them to complete the modules or acquire certain livelihood skills but also helping them develop their sense of compassion and trust to be able to build healthy relationships with others. The goals of an intervention must be determined with the women so that they match the women’s needs and priorities.

Conveying the message. In response to the question by Ms Jona Ang of UN Women Philippines about how the principles of harm reduction can be explained to ordinary people, Ms Feria said that a key message of harm reduction is “to take away drugs from the equation momentarily” and see the drug user “as a person.” Knowing the circumstances, needs, and aspirations of the drug-using person will allow people to go beyond the view that persons who use drugs are a scourge (salot in Filipino) in society. They will see drug use, including the harms it causes, within a “range of reality” which hopefully could persuade them to relate with these individuals “without moral judgment.” Interventions aimed at harm reduction can have different targets such as helping the user gradually reduce her dependence on drugs or providing her opportunities to become more productive. The goal is to support the person in taking the path towards positive change. At the core of harm reduction, Ms Feria explained, is “to be human and to be human with each other.”

Harm reduction also challenges the prejudice-laden language used in the drug discourse. The term “drug surrenderee”, for example, has become widespread because of the anti-illegal drug campaign, when the real objective is to reach out to people who use drugs and may benefit from interventions. Such terms label people in a negative way and imply that they may be dangerous or have committed a crime.

Focus on the person. Ms Luz Canave-Anung shared that Tambayan plans to form a “support group” in Davao City composed of WICL, including those incarcerated because of drug offenses. One insight about harm reduction that struck her as important for the support group is the need to build and nurture relationships with and among the women and their families. Although her NGO has modules on self-awareness and trust-building, she asked if NoBox offers training sessions for interested facilitators and if there is a community of practice from which Tambayan can draw lessons and inspiration.

Ms Feria answered that NoBox organizes workshops where the principles and elements of harm reduction are explained in depth and the policy context in which it operates is examined further to identify needed reforms to advance the alternatives that harm reduction practitioners espouse. Most important, however, is the need to give women a “safe space… [to] take the lead [and identify] their priorities of support that they are looking for.” NoBox has had a project with women released from jail and the space provided them served as a venue to process their experiences even before they were arrested. In another project, it was found that the young drug users simply wanted to have a sense of belongingness and attaining this became the goal of the intervention. “We make the services as near to where [people] are rather than expecting them to come to us,” she added. The goal of harm reduction, she underscored, is not necessarily to make a person using drugs to stop using drugs.

Integrative, comprehensive programs. Reacting to the comment of Ms Bing Antonio-Solamo of PHILSSA that rehabilitation for drug users tend to be seen also as a punishment and can only be accessed by those who can afford such service, Ms Feria agreed that government programs, especially at the local level, must be integrative and comprehensive. Although there are various needs of people that must be addressed, this does not mean that programs should be in silos. For example, women using drugs (whose cases are handled by local drug abuse councils) may also need the services offered to victims of violence (especially if this experience is closely linked to their drug use) or to persons with illnesses. “When we talk about existing services for women, maybe these are entry points as well… from a harm reduction perspective, these become engagement points where they get the message that [the government] is concerned about their health, safety, and wellbeing. Then the [conversation about drugs] naturally comes in,” she added. “Hindi [sa drugs] nag-uumpisa ang kuwento niya (Her story does not start with her use of drugs).”

A community volunteer from Quezon City agreed that coming to terms with the root causes of drug use among women is needed. She shared the story of a mother who used to do drugs. Too overwhelmed by her family’s problems, the woman turned to her friends who, instead of giving her advice, influenced her to join “pot sessions”. She has been in prison a few times and because of shame and fear, she left home. Financial instability, the volunteer observed, fosters stress among women, especially mothers, increasing the likelihood of them engaging in risky behaviors. Sadly, the family, especially children, are also marginalized in the community.

The top-down, punishment-centered approach of most drug interventions has also affected how drug users relate with other people. One community volunteer in Davao City shared that a WICL (whom they call “reformist” instead of “drug surrenderee”) felt nervous when approached for an interview. She thought that she was visited again by police authorities and would be apprehended for a wrongdoing. In reaction to this story, Ms Ang, in her short concluding remarks, underscored the importance of trust building in the work of community volunteers and the NGOs engaging with WICL, especially women who use drugs.

Dr Anna Marie Karaos of the John J Carroll Institute on Church and Social Issues (ICSI) served as the session’s moderator. ■

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