Broken systems breaking people

By Fifa Rahman, Rumana Saifi

Fifa Rahman is of the Malaysian AIDS Council and Rumana Saifi is of the Centre of Excellence for Research in AIDS (CERiA), University of Malaya

Violence against women and HIV are inextricably linked, and for women of the populations most vulnerable to and affected by HIV this link is particularly strong. Research on violence experienced by women who use drugs in Malaysia provides insights into the nature of this relationship.

A qualitative study conducted among 38 women who use drugs in five states in Malaysia found that their lives were marked with pain, difficulty, violence and poverty. Unstable and fluid family environments were common, with frequent parental abuse in childhood, often followed by intimate partner violence in adulthood.

Early marriage (below the age of 20) was also common, which increases a young woman’s vulnerability because of differences in power in the relationship. Lacking a sense of equal power within the marriage can make it more difficult to negotiate condom use or to request a clean needle when he injects her, thereby increasing her risk of becoming infected by HIV. El-Bassel et al. 2010 note that women are often ‘second on the needle’, resulting in increased risk of HIV transmission. In addition to this, people who use drugs are often subject to repeated imprisonemt for drug use, keeping them away from healthcare services.

Lina Muhammad Malaysia 2

Lina Muhammad is living with HIV and supports female injecting drug users and women living with HIV. ©International HIVAIDS Alliance 

The Malaysian AIDS Council has examined trends of gender-based violence among recently imprisoned women in Malaysia through focus group discussions. Whilst the research is still incomplete, the first focus group discussions revealed traumatising and repeated experiences of verbal, physical, and sexual violence, both inside and outside of the prison.

Within prison, respondents were subject to humiliating and painful punishments for minor breaches of prison rules, for example the smuggling of a cigarette. Punishments include drinking large barrels of other inmates’ bathwater, stripping naked and marching within view of the men’s prison next door, and being asked to squat barefoot in Malaysia’s scorching thirty degrees heat from dusk til dawn.

The focus group discussions revealed traumatising and repeated experiences of verbal, physical, and sexual violence, both inside and outside of the prison

Inmates were frequently beaten by prison officials, and in the ultimate form of humiliation the women were forced to thank the officials for beating them. Being called ‘stupid’ by prison officials was an everyday occurrence. Some respondents were subjected to particularly derogatory name-calling by prison officials. In one incident, one respondent was told to ‘look at me and look at who you are – you should know your place.’

Experiences of trauma in prison result in women feeling ostracised and isolated upon release, with evidence showing that they don’t want to return to the communities where they’d lived before they were imprisoned.

Many of the women in the study, upon release from prison, returned to long-term male partners who also abused them. One respondent had been married at the age of 13 to a 47-year old man who repeatedly abused her. She bore him six children.

One woman had her arm in a cast from being ‘karate chopped’ by her boyfriend as a result of her wanting an abortion. A woman who is unable to make such an important decision about her health and wellbeing without facing violence is likely to find it difficult to control other aspects of her sexual and reproductive health, like asking him to wear a condom. When asked why she remained, she firmly said it was love.

Prisons and healthcare facilities do not address the root causes of drug use and HIV risk

Persistent financial, health, family and housing instability and repeated imprisonment are results of a broken system. Prisons and healthcare facilities do not address the root causes of drug use and HIV risk.

Governments and civil society must demand respectful treatment in prisons, decriminalisation of drug use, investment in services that address childhood abuse, parental skills support, domestic violence services integrated in health services, and access to comprehensive education for women. The systems in their current state masquerade as solutions, when in fact they are breaking women further.