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Mana qullqipaq. Eight women miners get fed up with their lifestyle and decide to try crime. After successfully pulling off a jewelry store robbery, they are busted by narcs when they try to buy cocaine.

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Aswan buy cocaine

You have full access to this open access article. Women account for one in every three people who use drugs worldwide and tend to progress to drug use disorders in a shorter time than men. There is limited understanding of the situation of women who use drugs in the Middle East and North Africa. A multi-stakeholder rapid situation assessment RSA was conducted which aimed to investigate gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs WWUD in Egypt. An updated profile of female service user characteristics was sought via mapping of addiction and harm reduction services in the National Drug Observatory system. Thematic analysis and triangulation across data sources occurred. Eight themes emerged: profile of women who use drugs ; access to drugs and settings for female drug use ; dimensions of stigma ; trauma and drivers of female drug use ; networks and intimate partner relationships ; high-risk behaviours and harms ; barriers to help-seeking and accessing services ; and enhancing gender-responsive and gender-transformative evidence-based services. Recommendations are made to enhance harm reduction awareness and uptake and to integrate gender-responsive care within existing maternal, addiction and harm reduction service structures. Women tend to progress more rapidly to drug use disorders and are more likely to be diagnosed with a psychiatric illness and less likely to enter treatment Agterberg et al. WWUD face a range of negative health consequences. The convergence of risky injecting practices e. This is due to cultural stigma; low engagement of women in treatment and harm reduction services; and access difficulties for research purposes. Whilst Egypt is classed as a transit country for drugs, it continues to experience an increasing drug problem creating significant social and health problems. Recreational substance use among male youth and university students is common Khafagy et al. Levels of drug use disorder, particularly of tramadol, heroin and cannabis, have risen steeply in recent years in Egypt Balha et al. The latest size estimate of people who inject drugs is 90, 71,—, Mahmud et al. A prevalence rate of In terms of fully understanding their needs, few studies explicitly focus on women. Bio-behavioural surveillance and research studies on injecting drug use in Egypt have excluded women due to their small numbers, or have restricted recruitment to street girls and female sex workers due to difficulties in reaching WWUD Anwar et al. Several clinical studies have reported on the strong association between female substance use, adverse childhood experiences, mental health issues and exposure to violence El-Sawy et al. The year evaluation of MedNET network of the Council of Europe Pompidou Group noted the lack of willingness among Egyptian women to declare their drug problem and access treatment, the lack of specialized addiction services for them, the restriction of community based services to males and the lack of in-depth research on these women Van Hout, In response, MedNET assessed the need for gender-responsive services for women in Egypt Sabry, and, in cooperation with government, supported the development of several specialized addiction clinics for women including pregnant women Van Hout, We conducted a recent multi-stakeholder rapid situation assessment RSA which aimed to investigate gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs WWUD in Egypt. The ultimate aim of the RSA was to respond to the gap in the evidence base and to develop a more comprehensive picture of WWUD in Egypt in order to refine a gender-responsive national strategy for WWUD and inform the further development of gender-responsive and gender-transformative evidence-based harm reduction and treatment services. The RSA adopted a multi-level approach by scrutinizing three levels of determinants potentially impacting on future policy and service development and coverage for WWUD: the individual women and their drug using networks; their surroundings comprising family members, addiction treatment and harm reduction staff, police etc. The assessment design adhered to the core features of RSA in terms of using mixed methods to assess the situation of WWUD in Egypt; operating under a strict rapid timeline of 6 weeks; and using a multi-pronged team approach of government officials, UN agencies and academics to collect and analyse multiple sources of data in an iterative cycle, with participation of active and former WWUD McMullen et al. Specific objectives included retrieval of current information on WWUD in terms of female drug use trends; levels of awareness around risks and harms; settings and motives for use; addiction treatment and harm reduction service uptake; level of gender responsiveness in government and community service provision; and impact of HIV and other health harms. Whilst the data collection focused largely on urban areas, the RSA included attention on rural aspects of drug use including injecting and accessing of services by women and, where possible, probed into the experiences of WWUD who had been in prison El Kanater see Tables 1 and 2. Written and verbal informed consent was obtained from each participant. All were assured of anonymity and confidentiality and participated voluntarily with the ability to withdraw at any stage. A mixed method approach consisted of the National Drug Observatory data, interviews with professional key informants and focus groups with WWUD in various clinical and community harm reduction settings across Egypt. Qualitative guides were based on an in-depth review of literature and multi-disciplinary team consultation. Six females and seven males were interviewed in the government cohort, consisting of experienced nursing specialists, psychiatrists and addiction counsellors. Two addiction counsellors were former users. Interviews explored the specific needs of WWUD relating to drug use; mental health and co-morbidities; WWUD awareness of harm reduction and addiction support services; factors motivating help-seeking and female-specific barriers to intake, retention and engagement in treatment; harm reduction and rehabilitation; and the identified needs of WWUD for enhanced gender-sensitive services in Egypt, spanning hospital and community settings, where possible prison settings were included. Focus group discussions explored contextual aspects of female vulnerability to drug use; their drug use trajectories and pathways toward high-risk use and drug use disorder; experiences of trauma, mental health and co-morbidities; WWUD awareness and factors motivating help-seeking; and gendered barriers to treatment and specific gaps to inform development of future gender-responsive and gender-transformative evidence-based services. Data collection, analysis and triangulation across methods and sources were conducted concurrently. Interview and focus group transcripts were translated into English using back translation for consistency. Thematic analysis was conducted and adhered to six steps to ensure scientific rigor Braun et al. Eight themes emerged: profile of WWUD ; access to drugs and settings for female drug use ; dimensions of stigma ; trauma and drivers of female drug use ; networks and intimate partner relationships ; high-risk behaviours and harms ; barriers to help-seeking and accessing services ; and enhancing gender-responsive and gender-transformative evidence-based services. Each theme is presented with illustrative participant quotes. This trend was also reflected in the women participating in the focus groups. The most significant proportion was aged 26—30 years Very few were aged over 46 years. Injection drug use was reported by 9. Prevalence of heroin The use of Strox remained relatively stable at 4. Similar trends were reported by key informants and WWUD themselves who reported that most common drugs used by women in Egypt are heroin, tramadol, hash, cannabis, synthetic cannabis and cocaine. There were some reports by WWUD of progression toward iatrogenic dependence on opioids for menstruation pain management, with subsequent displacement to injection of heroin. They observed that the proportion of women injecting drugs was low compared to women using tablets or inhaling drugs for recreational purposes. There was one report by an NGO key informant about tropicamide Mydrapid injecting. Women in focus groups described various settings for the use of drugs generally in the home, particularly regarding injection of drugs with husbands, partners including sex work clients, friends and siblings often brothers , and also on the street. All key informants observed similar settings, and that use of drugs by women was rarely alone. At an NGO in Upper Egypt, several women in focus groups reported that close family relatives introduced them to drugs in order to relieve emotional distress and trauma due to domestic violence and aborted pregnancies. Access to drugs was viewed as easy via peers and user networks. Cultural norms and values in the conservative Egyptian society were described by the majority of key informants as heightening stigma of drug use among women and subsequent experiences of discrimination, isolation and marginalization. Perceptions of individual, familial and community stigma and gender discrimination were also pervasive in the narratives of many women consulted across hospital, HIV-VCT and NGO settings, who said:. For women, being divorced in our community is stigmatizing just like using drugs. Psychiatric hospital: Cairo. All key informants described how substantial levels of self-perceived, familial and community-level stigma of WWUD result in discriminatory experiences, feelings of hopelessness and poor mental health and hinder their attempts to enter treatment and receive support. This was also especially evident in the narratives from professionals working in NGOs who said:. They always have shame, blame, depression, self-stigma and this is what keeps them from seeking help. NGO: Alexandria. The stigma and discrimination from society towards women who use drugs prevents them from requesting health services and health support. NGO: Upper Egypt. Various dimensions of stigma were observed relevant to the WWUD. For example, stigma is particularly exacerbated, if the woman is living with HIV, injecting drugs and engaging in commercial sex work. A broad range of motives for the use of drugs were illustrated by the women consulted. This included self-medication for physical and menstrual pain; the self-medication of symptoms of psychological stress anxiety, depression and insomnia due to marital stress, inter-familial addiction and bereavement including of children ; and for recreational intoxication purposes, due to boredom and for the enhancement of sexual activity. For example, two women described their experiences and said:. I faced a great shock when I lost my son. He was 22 years old and died, my husband was taking drugs and I tried with him to pass my mental suffering NGO: Alexandria. I was depressed and sad since my husband got prisoned for 5 years. When he got out, he left me. Many women across the hospital, HIV-VCT and NGO settings experienced substantial trauma and discrimination and voiced their fears about being a poor role model and fears around loss of custody of their children. My son used to see me smoking hash, he is 13 years old and now he has started smoking hash with his friends, I do not want him to be an addict. I am blaming myself for being a bad role model for my son. Psychiatric hospital. The community and my neighbours stigmatized me, and they began to curse my children… so I wanted to stop using drugs for them NGO. Very few women reported contact with the criminal justice system. Key informants all observed that intimate partner relationships; membership of an existing network of people who use drugs; and clients of sex work support continued drug use by women and hinder their efforts to seek help. Their sexual partners prevent them from seeking help or seeking harm reduction tools. NGO: Cairo. Most cases I witnessed started using with the husband, which makes it difficult for them to seek treatment or even maintain their abstinence unless the husband is also seeking treatment. Several women at psychiatric hospitals and NGOs in both Cairo and Upper Egypt reported using and injecting drugs with and often under coercion from their husband generally heroin. Many reported marital difficulties, use of drugs during sexual relations and exposure to intimate partner violence. The hidden nature of female drug use was observed by all key informants to exacerbate high-risk activity. High-risk experiences included unwanted sexual relationships, multiple sex partners, commercial and transactional sex work, exploitation, kidnapping, unwanted pregnancies and unsafe injecting practices. Additional risks included crimes of poverty for example, stealing, drug dealing. Two women illustrated their experiences of coercion and said:. NGO: Greater Cairo. My partner negotiates with me to have sexual relations in return for drugs or money for drugs. Elevated risk behaviours such as sharing of injecting equipment and having unprotected sex were observed to hamper efforts to seek help and enter treatment. NGO key informants working in the community observed:. Several reported using the same needle twice, particularly when pharmacies did not provide clean syringes. At a HIV-VCT centre in Delta, one woman described how she used to share with her sister but then her sister was diagnosed with HIV via sexual transmission by her husband , and so she stopped sharing. She then shared with her husband and became infected with HIV. One woman at an NGO in Cairo described sharing needles in prison. Across the sample of women consulted, there was some awareness and experience of overdose, both personally and that of peers and husbands in Cairo and in Upper Egypt. There were some reports of thoughts to overdose intentionally. Harm reduction principles and practices were observed to be not widely known in drug using networks, due to cultural sensitivities. Low-level awareness of harm reduction services was reported by the women, with most not knowing anything about harm reduction. However, many women reported attempts to reduce harm and more serious forms of drug use, by tapering, replacing with over the counter medications and switching from injection to insufflation. Several said:. I tried powder inhalation \[sniffing\] with my first husband and tried injections with my friend after marital problems, but I got really sick so I went back to inhalations. To reduce the harm of using, I can change the way I use heroin, to be sniffing instead of injection. Psychiatric hospital: Upper Egypt. Displacement between heroin, tramadol and hash was described by several women. Having mixed services for men and women and the location of centres was seen as discouraging to women seeking help. Geographic coverage across the country was observed to be inadequate, where centres were not available in all governates. Self-referral and via outreach were also described. NGOs in particular were deemed to be a vital and trusted lifeline for engaging with WWUD and encouraging help-seeking. Various comments included:. The most important point is getting help from people around her and the community, either from family or work. Secrecy, Trust, Safety. What influences the women is the services provided by the NGO without any stigma or discrimination. Barriers to engaging with services and reluctance to seek help centred on fears of losing custody of children and exposure to gender-based violence including intimate partner violence in the home. Various triggers to initiate help-seeking and enter treatment were described by the women consulted. They included pregnancy, mental health conditions including drug-related psychosis, fear of contracting blood-borne viruses, fear of divorce, losing child custody and death:. Some women engaging with harm reduction NGOs were afraid to enter treatment and change their behaviours. In contrast, many women receiving treatment voiced that they were tired of addiction. All women consulted described their experiences in seeking help for their drug use, with pathways toward treatment hampered by a lack of awareness about available drug detoxification and treatment modalities, a lack of awareness of harm reduction practices and services, a lack of specialized clinics for women and a lack of services for them in some governorates outside of Cairo for example Asiut, Port Saied. Examples included:. Most of my user friends were not aware of available services for the treatment of addiction for women. I come to the hospital with my brother who is mentally ill, and I used this opportunity to try treatment for my addiction problem. There was little awareness of the provision of treatment in prison. Two women reported denial of drug use disorder treatment in prison. Key informants all observed the existing concentration of services in the Cairo and Delta governorates, mainly in big cities. Government-level key informants observed the need to address the lack of centres in some governates mainly the Upper Egypt governorates Assiut, Aswan, Qena and some Delta governorates Sharqeya, Gharbia , the lack of trained staff, the lack of specialist centres for women and the lack of social integration initiatives for women within rehabilitation and aftercare. Many women consulted remarked on the need for treatment services to adopt a more accepting approach for those seeking help. They voiced concerns about privacy and confidentiality of treatment and highlighted their wishes to undergo treatment and individual counselling in preference to group therapy. I am afraid of the idea of group therapy. I find it difficult to talk about what concerns me in a group, I prefer individual sessions Psychiatric hospital: Upper Egypt. All women with caregiving responsibilities voiced the importance of care of children whilst in treatment and recovering. Most women were concerned around the general attitudes of healthcare providers toward them. At an NGO in Greater Cairo, two women illustrated discriminatory experiences by medical professionals:. A range of suggestions to achieve an enhanced, appropriate and credible response to the needs of WWUD were documented. Many participants recommended to scale up and intensify efforts to sensitize and reduce stigma and discrimination against WWUD. All recognized the value of trusted NGOs operating in the community, and many indicated that a more strengthened and visible role by NGOs could support female outreach and raise awareness of available drug treatment and harm reduction services and practices, harm reduction uptake and retention and progression toward treatment. All observed the need for staff capacity building and the presence of specialized female staff for operating gender-sensitive and trauma-informed treatment to support a confidential and professional approach. Strengths of the RSA centre on its geographic coverage and sample size inclusive of the voices of those providing and receiving drug treatment and harm reduction services in Egypt. Limitations centre on its rapid nature, with data collection confined to a short timeframe in , with not all governates reached. Findings from diverse multi-stakeholder perspectives across Egypt underscore the need to continue to prioritize women in harm reduction and treatment service configurations and geographic coverage, with a particular emphasis on stigma reduction, specialist gender-responsive care and integration of evidence-based drug use disorder treatment for women into primary care and sexual and reproductive health units. Notably, many women consulted in this RSA had completed university-level education. Female drugs of choice reflect general trends in Egypt heroin, tramadol, hashish, synthetic cannabinoids Balha et al. Low levels of harm reduction awareness and overdose reports, both personal and that of peers, are of concern. Narratives of the WWUD revealed low levels of needle sharing but with some reusing of needles including in prisons , with reports of self-tapering or switching to self-perceived less harmful forms of drug use. Pharmacies do not provide sufficient clean needles when requested. This occurs even though people who use drugs are identified as a target group for HIV. Substantial stigma and discrimination is experienced by WWUD, fuelling hidden and harmful forms of drug use. The disproportionate effects of stigma, discrimination, drug-related health issues including psychiatric co-morbidities and blood-borne virus acquisition and negative familial and social impacts of drug use bereavement, incarceration, loss of child custody, divorce , which are navigated by WWUD in Egypt, are evident. The triple stigmas of being a woman, using drugs and engaging in transactional and coerced sexual activity were observed, compounding their health, fuelling harmful drug use and hindering help-seeking. The association of adverse and traumatic experiences including sexual exploitation and coercion to take drugs by partners, husbands and sex work clients; exposure to inter-personal violence; mental health issues; and poverty is also observed in other Egyptian studies El-Sawy et al. Evidence and recommendations generated here are intended to build on progress to date MENAHRA, ; Sabry, ; UNODC, and support the further development of a culturally sensitive scaled-up and sustainable gender-responsive approach to drug use disorder treatment and harm reduction coverage in Egypt. A trauma-informed and trauma-responsive approach provided by specialized female staff is also an imperative given the vulnerabilities and prior exposure to many forms of violence of WWUD in Egypt. Findings are likely to be useful to other MENA countries. Table 4 illustrates a series of guiding principles for multi-stakeholder consideration and action planning. 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Abstract Women account for one in every three people who use drugs worldwide and tend to progress to drug use disorders in a shorter time than men. Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barcelona, Spain Article Open access 19 October Use our pre-submission checklist Avoid common mistakes on your manuscript. Egypt: Drug Profile and Related Health Consequences Whilst Egypt is classed as a transit country for drugs, it continues to experience an increasing drug problem creating significant social and health problems. Table 1 Multi-stakeholder professional key informant interviews Full size table. Table 2 Focus group discussions with women who use drugs Full size table. Nobody in my family wants to deal with me. NGO: Alexandria The stigma and discrimination from society towards women who use drugs prevents them from requesting health services and health support. He was 22 years old and died, my husband was taking drugs and I tried with him to pass my mental suffering NGO: Alexandria I was depressed and sad since my husband got prisoned for 5 years. Psychiatric hospital The community and my neighbours stigmatized me, and they began to curse my children… so I wanted to stop using drugs for them NGO. NGO: Cairo Most cases I witnessed started using with the husband, which makes it difficult for them to seek treatment or even maintain their abstinence unless the husband is also seeking treatment. NGO: Greater Cairo My partner negotiates with me to have sexual relations in return for drugs or money for drugs. I tried quitting drugs using analgesics and it worked. Psychiatric hospital: Cairo I want to get clean for my children. Psychiatric hospital: Cairo I come to the hospital with my brother who is mentally ill, and I used this opportunity to try treatment for my addiction problem. Psychiatric hospital: Upper Egypt I am afraid of the idea of group therapy. Psychiatric hospital: Upper Egypt I find it difficult to talk about what concerns me in a group, I prefer individual sessions Psychiatric hospital: Upper Egypt. Doctor refused to deliver me while I was using drugs at the same time. Table 4 Matrix of evidence with recommended multi-agency responses Full size table. References Agterberg, S. Article Google Scholar Braun, V. Article Google Scholar Chambers, R. Article Google Scholar Cifuentes, E. Article Google Scholar Greenfield, S. Article Google Scholar Harrop, E. Article Google Scholar Khattab, H. Google Scholar Khattab, H. Google Scholar Mahmud, S. Accessed 19 May Mohamed, S. Book Google Scholar Palinkas, L. Article Google Scholar Phillips, C. Article Google Scholar Sabry, N Article Google Scholar Strathdee, S. Article Google Scholar Tripodi, S. Article Google Scholar Download references. View author publications. 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Aswan buy cocaine