Results from qualitative study

1. treatment programs that would address specific needs of women. Lack of
confidentiality represents the principal problem and there is very little assurance that
service providers would not disclose a woman’s drug-using status to others. Various
issues related to the structure of programs were mentioned, such as absence of a
separate entrance to the building, standing in a line (for agonist medication) at
dispensing area together with men patients and taking the preparation in front of
them, lack of privacy when speaking with their doctors in the presence of other
patients and medical personnel.
It is estimated that Georgia has 40,000 adult “problem drug users”
(systematic users of hard and/or injecting drugs)1 of whom
approximately 2,000–3,000 are women. Women-centred drug
treatment services are not available in Georgia.
The purpose of this study is to explore drug use (e.g., types and
patterns), HIV and HCV injection and sexual risk behaviors, comorbid
conditions (e.g., interpersonal violence, comorbid psychiatric
disorders), and treatment barriers and experiences (e.g., gender
discrimination, stigma) among IDU Georgian women.
Stigma, violence, and the lack of confidentiality:
The need for comprehensive, women-centered drug treatment in Georgia
I.KIRTADZE1, D. Otiashvili1, K. O’Grady2, W. Zule3, E. Krupitsky4, W. Wechsberg3 H. Jones5,6
1 – Addiction Research Center, Alternative Georgia, Tbilisi 0177 Georgia (Republic of); 2 -Department of Psychology, University of Maryland, College Park, MD 20742, USA;
3 - RTI International, Research Triangle Park, NC 27709, USA; 4 -Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg 192019, Russia; 5– UNC Horizons Program, Department of
Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; 6 – Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins
University, Baltimore, MD 21224, USA
Supportedby NIDA grant R01 DA029880
3. Study Methods
Background Results (continued)
A qualitative study was conducted during April-September, 2011 in
three cities of Georgia. All participants provided written informed
consent prior to participating in an interview.
Participants A total of 67 potential participants were contacted. Of
these, 4 refused participation during initial assessment and 8 were
determined to be ineligible to participate, leaving a final sample of 55
women.
Eligibility criteria included: conversant in Georgian; 18 years of age or
older; able to provide informed consent; injection of illicit drugs in the
past 30 days as verified by venepuncture stigmata; sexually active at
least once in the past 30 days.
Interviews and Qualitative analysis All individual in-depth interviews
were audio-recorded and then transcribed. A qualitative analysis
software nVivo9 was used for content and thematic analyses.
Methods
Women in Georgia experience high levels of guilt and shame in acknowledging their
substance use. They feel guilt and fear because they deviate from accepted norms
and violate traditional gender role expectations in a country where conservative
orthodox Christianity dominates. This guilt and shame is experienced in a society
with a judgmental approach towards women who use drugs. This fear of social
isolation and rejection causes substance-using women to delay seeking help, not
simply for the treatment of their substance use, but also for their general health and
psychosocial needs.
Factors hindering access to and demand for drug treatment services by drug-using
women included: Societal stigma, stigma and vulnerability within drug treatment by
men and providers, low awareness regarding available treatment services, fear of
confidentiality violations, and cost of drug treatment. Physical, sexual, and emotional
violence were common aspects of life for drug-using women, often leading to high
vulnerability to HIV risk. Respondents indicated that psychological manipulation and
threats by partners and family members related to their children were the most
severe forms of violence. Drug-using women were reported to lack negotiation,
communication, and general life coping skills.
There is a critical need for the development of comprehensive women-centered
drug treatment services that are accessible, confidential, receptive, and non-
judgmental. Empowering women through education, skills building, vocational
development, and strategies for violence reduction will serve to increase self-
esteem and the capacity for an independent life.
Conclusions
Demographic characteristics
Participants age range varied 18-55 years of age, and 30 (54.5%) had
11 (equivalent to a high school in the United States) or more years of
education. On average, each participant has a child; 12 (%) had no
children (but 2 were pregnant at interview); of the 43 participants with
children, 5 live with their parents, 11 with partners, 10 with husband
and children, 16 with their children only; and 1 lives alone without her
child. None of respondents had ever been in residential treatment, only
Results
indicated they had even been in medication-assisted treatment (MAT), and only 14 (26%)
in a needle and syringe program (NSP). 37 (67%) had never heard about either MAT or
NSP.
Stigma Most respondents have never been tested for HIV or HCV. Testing appears to be
a threat for women and they are afraid to find out the results. Only a few participants
indicated that they had been tested regularly for STIs. Respondents believe that having
HIV/AIDS is highly stigmatizing in Georgia, and so an HIV-positive person tries to conceal
her/his status, as public knowledge of her/his disease status might affect heavily her/his
life and devastate relationships with family and friends.
W15: ”… some are HIV infected but don’t say it out loud because they are afraid people
would look at them differently”.
Social stigma and public attitudes towards women who use drugs were viewed as playing
a major role in women’s treatment-seeking desire, and was seen as a major barrier for
women to seek drug treatment.
W19: “Maybe women are afraid of someone finding out about their drug use, they are
hiding from family… that’s Georgian mentality. If family finds out about her it depends on
a family … Mother will be nervous, father too, who likes to have drug user child. Depends
on a family, what is their position; they might banish you or on the contrary support you
and talk to you”.
Violence Violence towards women who use drugs from male partners, drug dealers,
and/or family members occurs on a regular basis. It was also noted that depending on
woman’s personality she could be both victims and abuser. Most participants felt that
emotional abuse is much harder to overcome than physical abuse. Some were
concerned that in many cases a woman did not realize that she was a victim of violence –
degrading or abusing treatment becomes a “normal” part of life. Importantly, no
respondent who had experienced violence was ever referred to police, a physician, or a
psychologist. In many cases, abused women shared their experiences with friends only.
W04: “I also had similar situation when police told me that I was not worth being a mother
and that they should take away my baby… They would not dare to say that [she can’t
raise a child], if you see my child you would never say that her mother is a drug addict
because she is well raised and for god’s sake has everything.”
Lack of confidentiality
Few women were knowledgeable about treatment for substance use disorders. Some
participants have fragmented information about either medication-assisted withdrawal or
medication-assisted treatment; others did not even know what types of treatment were
available in Georgia. The majority of respondents indicated that there are no available
Results (continued)
Contact Information: Irma Kirtadze, M.D., Senior Researcher
Addiction Research Center, Alternative Georgia.
Address: 14a Nutsubidze Str., Office 2. 0177 Tbilisi, Georgia
Phone: +995577716711 Email: irma@altgeorgia.ge