‘Pure’ drug users, commercial sex workers and ‘ordinary girls’: gendered narratives of HIV risk and prevention in post-Soviet Ukraine

Abstract

International best practices call for a gender-responsive approach to HIV prevention for women, including those who use drugs and those who engage in sex work. This paper draws on multiple qualitative data sources collected over five years in Ukraine to explore the notions of gender, women and family that buttress HIV-related programmes for women. Our analysis reveals that service providers often cast women as hapless victims of unfortunate family circumstances and troubled personal relationships that produce sudden poverty, or social strivers who seek access to wealth and privilege at the expense of their health. Women are portrayed as most vulnerable to HIV when they lack a male 'protector'. We argue that the programmes constituted around these stereotypes of women and their vulnerabilities reflect new forms of institutional power that deflect attention away from gendered socio-economic processes that contribute to women's HIV vulnerability, including job insecurity and unemployment, workplace discrimination, unreliable social benefits and power imbalances within their relationships. We explore how to transform HIV prevention efforts to better address the causes of women's increased vulnerability to HIV in Ukraine and in Eastern Europe more generally.

Moral Economies of Care and Women Who Use Drugs in Ukraine

“…Research shows that gender-related factors negatively affect women who use drugs in Ukraine's access to harm reduction, drug treatment and reproductive and sexual health services (Pinkham & Malinowska-Sempruch, 2008). Moreover, service providers may view women's vulnerability to HIV and other harms as a product of lack of personal agency and motivation for self-care (Owczarzak et al, 2018) The experiences of Ukrainian women who use drugs occur against a backdrop of strong gender norms informed by Soviet ideologies, Ukraine's movement for national independence, and global and local feminist movements (Barth, 2021;Kis, 2005). Soviet gender policy guaranteed important socioeconomic and political rights for women, including opportunities for education and near universal literacy.…”

“…Research shows that gender-related factors negatively affect women who use drugs in Ukraine’s access to harm reduction, drug treatment and reproductive and sexual health services (Pinkham & Malinowska-Sempruch, 2008). Moreover, service providers may view women’s vulnerability to HIV and other harms as a product of lack of personal agency and motivation for self-care (Owczarzak et al, 2018)…”

Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach

“…The prevalence of STIs and co-infections is high among FSWs (9,18,20). Several factors determining the occurrence of STIs among FSWs have been reported, including age, lower education level (21), and unemployment (21,22). Factors such as frequent unsafe intercourse with various sex workers (21,23), current drug use, inconsistent condom use (24), HIV stigma (22), previous exposure to violence (25), lack of access to treatment, and the ability to pay for services (25) are among the most frequently identified determinants.…”

The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine

“…Women who use drugs must also navigate complicated bureaucratic systems that reinforce their marginalized status, create barriers to government support, and fail to meet their specific needs as mothers and people who use substances [ 13 , 14 , 15 ]. Research indicates that stigma, discrimination, and loss of confidentiality in the service delivery setting also impact the ability of women who use drugs to receive essential services [ 16 , 17 ].…”