Fresh out of August – a month in which we recognise our womxn warriors who fought the oppressive doctrine of the white minority government of Apartheid South Africa – we spring into September reflecting on the Womxn in Harm Reduction.
WHOA MXN, DO YOU SEE OUR WOMXN?
Over Africa Policy Week 2023, womxn led many of the conversations on Harm Reduction, both in the parallel and plenary sessions. The insights offered through both the presented research and lived experiences – of the researchers and researched both – provide the kind of levity that is often amiss in the politicised spaces created around Cannabis. How often has Myrtle Clarke not been the only womxn calling for reasonable approaches and expectations in a room full of dingalings?
One of the realities of our world is that womxn are indeed a marginalised group in any society. This varies in degrees, of course, and contexts influence how marginalisation is enforced. For Womxn Who Use Drugs, the margins are even harsher, as informed by the social norms and practices that others womxn in just about any context. The social norms that underpin the kind of discrimination and criminalisation afforded by the inhumxn War on Drugs means that womxn of all walks are denied their basic Humxn Rights.
This extends to those (womxn and mxn) who engage in sex work – an industry that remains criminalised across Africa despite this standing in direct contradiction with basic Constitutional Rights, as discussed by Zintle Tsholwana, advocacy officer of SISONKE. Zintle also presented on policies around sex work in the plenary session Be Careful What you Wish for: Lessons in Decriminalisation & Regulation. This session featured Myrtle, who presented on how Cannabis regulations have a ways to go yet in South Africa, and that even the best outcomes for some can be the worst for others.
Tuesday (15 Aug) saw a deeply informative plenary session titled Power, Policy & People in Africa: Putting People First. The session, moderated by Colleen Daniels of Harm Reduction International, explored and analysed the interconnected dynamics between power, drug policy, and the people affected most by the decisions made for them but without them. The night before at the opening, Shaun Shelly highlighted that “what you without me, you do to me”.
This understanding was illustrated brilliantly in the presentation by Charity Monareng, Parliamentary & Policy Research Officer at TB HIV Care. Charity opened her presentation acknowledging the failure of the War on Drugs and how badly formulated drug policies give police disproportionate power over People Who Use Drugs (PWUD). Often arrest quotas are the only driver behind persecuting PWUD, with communities suffering unduly. Ultimately, police are nothing more than tools in the drug economy to be utilised by both the law and the illicit trade of drugs.
Charity further discussed the exertion of power by foreign states and the compromise of power this places on the sovereignty of states. This kind of power struggle deeply undermines discussions on Harm Reduction, reducing the ability to implement Harm Reduction strategies in favour of continuing prohibitionist approaches. Disturbingly, with funding to the UN from wealthier countries, poorer member states like those in Africa are forced to align with the International Drug Conventions in a way that perpetuates colonialism.
Charity followed Maria-Goretti Loglo of the International Drug Policy Coalition, who explored the nature of prohibitionist interpretations of the Drug Conventions and how this informs Drug Policy. Maria started with the dire state prohibitionist approaches leave communities in where resources are directed toward police enforcement rather than evidence-based approaches aimed at effectively reducing harms – social, legal, personal – and honouring Humxn Rights.
Maria highlighted how the impediments imposed by laws prevent people from accessing necessary pain relief, even in hospitals. Naturally, this prohibitionist precedent was not set in Africa, but by the Global North.
Balancing her talk, Maria brought focus to the fact that Africa is seeing a shift in Drug Policy, with reforms steadily happening, albeit slowly. Humxn Rights conversations have helped bring about consideration in some countries about their Drug Policies, and there is a trend in the African Union to review how they interpret the Drug Conventions and how this translates to their own Drug Policies growing.
Maria, while expressing appreciation for the growing trend of Harm Reduction approaches, also called for laws to not impede these processes, and for better capacitation of services through policies based on evidence not opinion. Additionally, Maria posed the pertinent question on how we get our governments to direct funding into spaces where Harm Reduction is most needed, if not already being implemented.
Looking at our own 2018 Constitutional Court ruling, Maria highlighted how we are only part of the way there in that the law of the land continues to criminalise Cannabis users despite decriminalising its cultivation, use, and possession in private. This is one of the points Myrtle also covered in her presentations earlier in the day.
WE ARE WOMXN
Wednesday (16 Aug) hosted a plenary session dedicated specifically to the various pioneering Harm Reductionists working with marginalised womxn across various African contexts. The session, titled Womxn Working in Harm Reduction introduced a wider conversation on the needs of womxn living in the margins maintained by unjust policies and practices.
Moderated by Julie MacDonell of TB HIV Care, the session focused specifically on the punitive policies meted out against Womxn Who Use Drugs. Expanding on this, the presenters also exposed the barriers to medical care, legal recourse, and escaping violence from law enforcement, domestic partners, and those who seek to exploit their vulnerabilities.
A core point in the discussion centred on how womxn are seldom seen as PWUD – society generally accepts substance use as something done by mxn. Womxn are conversely perceived to be nurturers and so their substance use is often seen as tainting to their imposed role and image within societies. The stigmatisation of womxn due to their relationship with a drug means access to medical care can be denied, children can be lost in custody battles or by the hands of law enforcement, and their chances to access basic services diminished.
Harm Reduction for womxn by womxn means that facilities providing these services can be better capacitated to deal with the problems womxn face, particularly those who are socially marginalised.
Julie, in introducing this gender-centric session, brought focus to how Harm Reduction goes beyond needle and syringe programs and opioid substitution. Indeed, Harm Reduction is so much more – it is a “pragmatic, empathic way of engaging and providing service delivery to People Who Use Drugs that is meaningful, non-punitive, and person-centred”.
Bernice Apondi – a major driver of Harm Reduction in Kenya through VOCAL (Voices of Community Action and Leadership) and as part of the Cannabis Africana team – presented on the victories and gaps within her homeland that her 15 years in the field have exposed her to. With her background in mental health, Bernice brings vital questions to the fore through her Harm Reduction advocacy.
Recognising how Womxn Who Use Drugs are left far behind, even in Kenya where Harm Reduction celebrates 10 years of implementation, Bernice highlights that access is not equal. Cities generally provide the best programmes while those in less developed areas are effectively ignored.
External funding is not enough to drive programmes, particularly where no accountability is afforded the distribution of these funds. Corrupt governance also leads to false reporting, while the needs of communities are left ignored.
Part of Bernice’s research focuses on Womxn in Harm Reduction who are knowledgeable about the services they can access, which means they are more likely to do so with a feeling of security. However, if a womxn is poorly treated by healthcare providers because of their appearance or background, they are less likely to return for care. Shame is a major barrier to safe access for all PWUD, but it is most profoundly noted by Womxn in Harm Reduction.
Measuring how we treat those we work for in any space is key in ensuring that we provide safe spaces where Harm Reduction can be properly implemented, as best suited to each particular context.
In this, understanding womxn’s health – mental and physical – Bernice calls for particular focus on sexual reproductive health. Womxn need to be able to consult with womxn educated in Harm Reduction to ensure the best possible outcomes without fear of shame.
THE FORGOTTEN WOMXN
Stacy Doorly-Jones, who works with rural communities in rural areas spanning the Overberg (presently) and the Cape Winelands (formerly) through STAND (Social Transformation Action Defined), followed Bernice to provide a local perspective on how Harm Reduction may work if properly capacitated. Focused on forgotten womxn – biological and transgender – in rural areas, Stacy explored the impacts of the persistent dop-stelsel or “liquor-for-pay” model on rural and marginalised communities within the Winelands.
The Cape Winelands provide a brilliant scope for understanding the disparities that exist around substance use and service access. While those of higher classes can enjoy a good bottle of wine, those who produce it are directly impacted by low access to healthcare and the highest levels of substance use and abuse outcomes like Foetal Alcohol Syndrome Disorder.
Lack of access to drug-friendly facilities also means that many more are forgotten in how policy is crafted. Lack of confidentiality and ongoing discrimination as well as severe economic pressures from both their partners and employers undermines these forgotten womxn in the most disparaging ways.
Stacy’s involvement in projects in the Winelands since 2008, has helped her develop a deep understanding for the extreme ostracising enacted upon these communities where alcohol and stimulant use continue to rise. Experiencing a functioning Harm Reduction programme run dead, Stacy takes a no-nonsense approach in calling for municipalities to do better in fulfilling their role in their communities.
Municipalities that refuse to take-up their “statutory responsibility” are the biggest barriers PWUD face. This instance highlights that provincial governments need to mandate Harm Reduction in rural and peri-urban areas, with local municipalities being held accountable.
STAND already has evidence that the lack of political will of the sort seen in the Cape Winelands need not be a barrier and that communities can rise up, provided that they have the funding required, the support of local law enforcement, the Department of Health, and other official bodies.
It is also evident that co-operation between civil society organisations like STAND, SANPUD, TB HIV Care, as well as local government bodies and community leaders can and will get the most done!
LESSONS IN HOPE
Dimakatso Nonyane, a clinical associate working with the Pretoria -based initiative COSUP(Community Oriented Substance Use Programme) continued the message of hope while recognising that progress is an individual experience, particularly in Harm Reduction.
Drawing on a case study of a womxn who entered the programme offered by COSUP, who was nervous about accessing care due to her identity as a womxn, Dimakatso illustrated how womxn need womxn in every space where Harm Reduction is provided. This womxn was faced with a male peer counsellor, and this triggered her past traumas with mxn. This individual also gave reason to why womxn’s voices and experiences need to take focus as their needs are varied and different.
Contextual approaches need to contribute to the quality of the experience womxn face in accessing services. Ensuring the highest possible quality means that individual needs are met at every level – mental health, psychosocial health, physical health – in a fully localised way.
Watch the video and see for yourselves how much can go right when we refuse to allow our sense of morals to prevent us from doing what is right.
X (Not the Twitter Rebrand)
The use of humxn, womxn, and mxn in this series is intentional – it is meant to offer pause and consideration for how we see ourselves and to ask what this perception stems from. Harm Reduction requires us to challenge how we view ourselves in relation to those we other for their relationship with drugs. It also offers us the chance to question the propaganda that continues to inform how we see the drugs we enjoy versus those we deem as “dirty” as those who use them.
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