The WHRIN and ICW intern recently (November 2022) interviewed Daniel Wolfe, harm reduction specialist with the Global Fund. This resulting blog will be of particular interest to people involved in harm reduction services and rights protection for women and who are helping to guide programming
plans for the next round of funding in Global Fund countries.
How does the Global Fund try to address gender inequities in harm reduction?
The new NMF 4 Cycle has new elements for countries that apply for harm reduction funding as follows: Harm reduction is now an HIV prevention program essential, meaning that countries must address the status of and progress toward programming for people who use drugs in their application. Priority harm reduction interventions are needle and syringe programming, opioid substitution therapy and naloxone for overdose. There is a new harm reduction technical brief meant to help guide country applications that specifically notes that sexual and reproductive health services should be integrated with HIV services, and that the needs of women who use drugs should be recognised. An interview on women who use drugs and the Global Fund
The WHRIN and ICW intern recently (November 2022) interviewed Daniel Wolfe, harm reduction specialist with the Global Fund. This resulting blog will be of particular interest to people involved in harm reduction services and rights protection for women and who are helping to guide programming plans for the next round of funding in Global Fund countries.
How does the Global Fund try to address gender inequities in harm reduction?
Technical brief: harm reduction for people who use drugs Emphasis on community – led monitoring – the harm reduction brief highlights the key role for people who inject drugs in planning, delivery and evaluation of services and policy change.
Clarity on hepatitis B and C – For NFM4, the Global Fund can fund hepatitis B and C treatment for people who inject drugs regardless of HIV status if a strong epidemiological case is made and that HBV and HCV treatment is part of comprehensive HIV prevention programming for people who inject drugs.
Human rights “program essentials” – Four human rights program areas are also regarded as essential and must be addressed in funding requests – integrating human rights protections into HIV and TB services; removing stigma in health care and other settings; increasing access to justice/legal support; and advocacy, including community led advocacy, on decriminalisation and other policy change.The GF strategy also includes a particular emphasis on gender-related barriers and how to remove them. Technical brief: removing human rights-related barriers to HIV services
This is really the first time that harm reduction and human rights programming are highlighted as
program essentials, and the technical review panel (which is the independent body of experts that
looks at all the global fund applications) is going to be looking these elements when evaluating
proposals.
In terms of gender, a Global Fund priority is removing gender-related barriers to HIV services. This
means much greater attention on whether or not countries have factored gender into country plans
for action. For example, does the proposal include plans to address women who use drugs (not just
people who use drugs) and gender responsive services in their harm reduction effort? Are there
plans for drop-in spaces or places where women who inject drugs can feel safe to go and have their
needs met, outreach workers who are women or trans and gender-diverse people, and plans
addressing the kinds of stigma women, trans and gender diverse individuals face in seeking to access
services? Has the case for funding involved a gender analysis, including human rights barriers and
responses? Technical brief: gender equity
How does the Global Fund encourage countries to include gender sensitive programming for women who use drugs?
In addition, a new Global Fund technical brief directs particular attention not just to HIV services in the community, but also to the question of what happens to people – including women – in police lock-up or pre-trial detention and prison. Technical brief: prisons and other closed settings
Globally, what percentage of Global Fund harm reduction funding is issued specifically for women’s harm reduction programming?
The Global Fund does not have currently have ways to measure what percentage of funding is used especially for women’s harm reduction programming. Communities are definitely encouraged as part of monitoring in their country to request data on what percentage of the Global Fund is issued for women’s harm reduction programming. Right now, communities and others make a lot of requests for data and disaggregation from the Global Fund, but the people at the Secretariat who track the spending don’t necessarily have the data or specifics on programming and budgeting to easily answer the question. Analysis of harm reduction spending requires going through a long list of countries and looking in detail at the budgets – and even then, it might not be clear, for example, how much of a harm reduction program’s budget goes for gender responsive or women-focused services.
Women who use drugs are at the center of many intersecting structural sources of risk and addressing these intersections can be an advocacy point for communities to engage on with the Country Coordinating Mechanism and with consultants or UN agencies who often assist with the application process. Addressing gender related barriers and discrimination is a strategic priority for the Global Fund, so this can be a leverage point in the country dialogues that lead up to each funding request.
Every country that is applying has to have done assessments of human rights and gender-related
barriers to HIV services. Some countries have done this before, but there are many countries that
have not previously included gender analysis. Countries often report on how many people with HIV
are getting services or how many people at risk for HIV are receiving prevention services, but do not
separate or disaggregate data by gender. This is critical – as are plans to address the gaps in services
and support.
Women generally, and women who use drugs especially, are often not proportionally represented in
strategic planning and funding allocation processes. The needs of those women might not be visible
to the people who are dropping into the country or dropping in from the capital to do needs assessment. Public health people talk all the time about ‘hard-to-reach’ populations (including women who use drugs) but the truth is that those populations are not hard to reach if you are part of the network that includes them. This is why community-led monitoring and assessment is so important because again women who use drugs or women living with HIV who use drugs often know each other and are part of networks.
Global Fund proposals are meant to be country led, which means that countries need to set their own targets for spending and service prioritization. The funding allocated by the Global Fund to a country does not set targets for particular spending areas, so these emerge from the country process. But decreasing the incidence of new HIV infections and increasing the role of communities at the center of the response are strategic priorities for the Global Fund – and women who use drugs in many countries are central to both aims.
What is your take on why women who use drugs are not proportionally included, heard and engaged in the HIV sector??
We have seen a lot of harm reduction services in the world that don’t spend much time or aren’t particularly comfortable talking about and are not knowledgeable about sexual and reproductive health beyond giving people a condom. Many are oriented and staffed to provide services to men. Harm reduction services need to be supported to pay more attention to gender and integrating sexual and reproductive health services. At the same time, we see services for women with HIV – reproductive health services, violence shelters and others – with no comfort or knowledge around drugs issues. Some even exclude women who are using drugs. This needs to change.
Anything else you would like to say around this subject?
It is important to acknowledge and understand intersectional risk for women who use drugs: sex work, having a partner who is HIV-positive, injecting drugs with a partner and being second on the needle – and all of the dynamics that make it particularly important to address women’s needs. We hear more and more about “chemsex” in HIV prevention circles, usually to refer to men combining drugs and sex with other men. The issue is important, but the exclusive focus on illegal drugs and men who have sex with men can be problematic. First, many people in the world combine mind – altering substances, including alcohol as well as illegal drugs – and sex. And many people who are not MSM, including women (and not just women who are engaged in sex work), use stimulants at the same time as having sex. Bringing risks possible when combining drugs and sex to consciousness, and supporting people to reduce those risks, is a critical part of HIV prevention for all. It is also interesting and important to note that this year the Global Fund’s “modular framework” used by countries to budget and plan for activities – actually has a place for harm reduction for people who use drugs other than opioids. That includes harm reduction for women (and men) who don’t inject drugs but are combining sex and stimulants.
