First responders: the peers providing psychological first aid for women who use drugs

A woman is sititng on a chair, speaking to a counsellor © Frontline AIDS/Corrie Wingate 2018
First Responders provide counselling and mediation to women and men who use drugs

Responding to the rising levels of intimate partner violence experienced by women who use drugs in Kenya during COVID-19

Reports from Kenya suggest violence against women who use drugs rose during the COVID-19 lockdown, fuelled by tensions as incomes disappeared and couples found themselves in close confinement with one another.

Both men and women who use drugs are also being unfairly blamed and beaten for petty crimes, often without evidence, which are on the increase due to a lack of wages.

But Kenyan partners from the Partnership to Inspire, Transform and Connect the HIV response (PITCH) are finding ways to address the situation. To link women to various forms of support they have formed a response team with police and a referral system with legal and medical services. Peer workers are also receiving training in counselling, mediation and conflict resolution, while advocacy is underway to ensure the lockdown experiences of women who use drugs are being heard and understood.

“Gender-based violence has escalated during lockdown, it has taken a turn for the worse,” says John Kimani, director of the Kenya Network of People using Drugs (KeNPUD). “Before, these cases [of violence] were there but there were not as many and they were not as extreme.

“We are seeing an increase in women becoming homeless as a result of this. Fewer women are also accessing healthcare, particularly antenatal care, for fear of emotional or verbal abuse.”

In Nairobi it is common for women who use drugs to engage in sex work to support themselves, their partner and their children. But Bernice Apondi, Policy Manager at VOCAL Kenya, says lockdown made sex work impossible as bars and lodges where many women find business shut down and curfews meant people were no longer allowed on the street.

She adds: “There has been a loss of income. These women cannot take care of their families in the way they did before, or they have become dependent on their male partners. Then add in the fact there is no money to purchase the daily dose of heroin – all this creates serious tensions and has led some situations to turn violent.

“The gender-based violence [has become] quite severe. But in Kenya we do not have safe houses, the government does not provide anywhere for these women to go.”

First responders

In July VOCAL Kenya began equipping peer outreach workers with the skills they need to address the rising levels of violence both women and men who use drugs are facing.

“The relationship [between peers and other people who use drugs] is a trusted one,” says Bernice. “They are part of the community, they have been living together, they know each other; these are the things that matter.

“Peers are the first contact-person when something happens – be it an overdose, be it violence – they are usually the first responders. It is very important they have skills that enable them to handle the situations they face.”

The first group of trainees consists of six women and four men, some of whom are living with HIV. Four are on methadone while four have completed the Opioid Substitution Therapy programme and no longer using drugs. If the training proves successful, VOCAL hopes to extend the scheme to other Kenyan cities.

“It is hardly acknowledged in Kenya that people who use drugs could have the capacity to execute such a programme,” says Bernice. “Some of our trainees are current and former university students, some of them have been to college, but no programme has tapped into their abilities.

“These peers already have their coverage area. The idea is to equip them with extra skills on how to probe when there is a problem, how to do follow up, and how to listen to someone – because sometimes people just need a listening ear.”

Once the peers have been trained they will provide counselling and mediation to women and men who use drugs who have recently experienced violence to help them cope with what has happened, and equip those involved with strategies to prevent violence from reoccurring. The peer worker will also assess whether the person who has experienced violence should be linked to a health facility or for specialist legal support, using the referral systems that are now in place. In addition, they will document the case to evidence what is happening.

One of the key issues is getting women who use drugs to understand they don’t have to put up with the violence they experience.

“Most of these women see it as normal, they don’t really understand the damage that comes with it,” explains John. “Mostly this is brought about by a lack of economic empowerment.”

KeNPUD is currently working to sensitise women who use drugs on reporting and responding to violence. Ultimately, the organisation wants to create a platform where women who use drugs can share and learn from each other in relation to gender-based violence. The space will also be somewhere that women who are trained in counselling can provide one-on-one sessions to their peers.

Advocacy

PITCH partners in Kenya are currently advocating to ensure policy-makers are aware of the COVID-related challenges facing women who use drugs and are persuaded to act. But ensuring such marginalised women are included in advocacy spaces can be difficult.

“Gender-based violence now, under the Ministry of Health, is very broad and the voices of women who use drugs can easily be swallowed,” says Bernice.

“There is a technical working group that is coming up on gender-based violence and we are advocating for women who use drugs to be invited so we can participate in that space.” Ideally, Bernice says VOCAL would like to see a technical working group on gender-based violence for those specifically working with women who use drugs.

One advocacy route that has proven successful for Kenyan PITCH partners in the past has been to work directly with members of parliament. The need to broaden government-run harm reduction services beyond the biomedical to include psychosocial and livelihoods support are now key asks.

“The health committee in parliament is able to help us shine spotlights on areas where there are gaps. We target parliament to get the Ministry of Health to the table,” explains Bernice.

“But we can only do that once we have the evidence. All the work we are doing now [working with peers to support women experiencing violence] will feed into the civil society advocacy agenda by showing policy-makers what is really happening on the ground.”

 

The Partnership to Inspire, Transform and Connect the HIV response (PITCH) is a joint partnership between Aidsfonds, Frontline AIDS and the Netherlands Ministry of Foreign Affairs. 

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Gender-based violenceHarm reductionpeer supportPITCH