#IWD2018: Honoring the Marginalized Women in Five SIG Studies Who Have Pressed for Progress on Female-Specific Health and Social Problems

This year, 110 years after its founding, International Women’s Day announced the theme of Press for Progress, with the goal of “motivating and uniting friends, colleagues and whole communities to think, act and be gender inclusive.”

It’s a beautiful beacon. From empowering young women to pursue STEM education to achieving women’s equality in sports to ensuring that women receive equal pay for equal work, looking around us in the United States we immediately see areas where progress is desperately needed.

Looking further around the globe, we continue to witness tremendous gender inequalities, such as discriminatory laws, gender-based violence, social inequities and lack of access to resources and power. In particular women have less access to education and health care than men, and are more likely to experience violence.

“Violence against women and girls still is one of the most widespread, and devastating human rights violations in the 21st century,” reports Dr. Nabila El-Bassel, Willma and Albert Musher Professor of Social Work at the Columbia School of Social Work. As the director of the School’s Social Intervention Group (SIG), Professor El-Bassel is renowned for her studies of the intersecting epidemics of addiction, HIV and violence against women, on which she has published over 260 multidisciplinary peer-reviewed papers.

Dr. El-Bassel added that research gaps exist for these often-forgotten women. “Certain populations of drug-using women and adolescent girls have been neglected by research, prevention, and treatment,” she says.

Over the past 25 years, Dr. El-Bassel and her research team at SIG have conducted research and designed interventions for the most vulnerable women, such as those who use drugs, trade sex to survive, or are refugees. Their studies, which employ both qualitative and quantitative methods, have been conducted in drug treatment programs, homeless shelters, street-based venues, jails and probation sites, primary care facilities, emergency departments and related settings. But despite the hopelessness of some of these settings, the team has been struck, time and again, by the way female participants have grown stronger and more vocal about advocating for their specific needs.

Here are five examples of studies that illustrate this point:

1: NOVA Project
SIG’s NOVA project was launched to support behavioral change and income-generating activities for sex workers in Kazakhstan. A structural intervention, it provided micro-finance and job-skills trainings to empower women and reduce their reliance on sex work.

“I used to be a prostitute,” begins one of the women involved in the project, which took place in collaboration the Global Health Research Center of Central Asia (GHRCCA), an offshoot of SIG that is headquartered in Almaty, Kazakhstan. “NOVA teachers…treated me as an equal rather than as social garbage. My self-esteem increased,” she continued. Eventually, “I left all my clients and started working. Some savings appeared and I became more confident.”

Another participant said she “learned to communicate with men in different way—imposing my own opinion.”

Dr. Assel Terlikbeiav, an alumna of the Columbia School of Social Work and a medical doctor, directs GHRCCA’s regional office in Almaty. She says that “NOVA is not only important for women in Kazakhstan, but to all Central Asia and globally. Women who inject or use drugs and trade sex to survive are motivated to engage in programs that help them to live healthier a lifestyle.”

2: Project WORTH
While the overall rate of incarceration has declined in the United States nationally, the rate of female incarceration has increased at nearly double the rate of male incarceration since 2002.

SIG’s Project WORTH (Women On the Road To Health) is a group-level intervention for drug-involved female offenders under community supervision. Designed to provide such women with the skills to protect themselves from HIV- and gender-based violence while also linking them to care, WORTH was identified by the CDC as an example of best practice for evidence-based HIV studies.

But the findings go beyond HIV prevention, as many of the women spoke up about how their health needs are often neglected, since men continue to make up the majority of the prison population. Using data from WORTH, SIG T32 Fellow Anindita Dasgupta co-authored an article “Reproductive Health Concerns among Substance-Using Women in Community Corrections in New York City: Understanding the Role of Environmental Influences” in one of last year’s issues of the Journal of Urban Health (abstract).

The paper addresses a major gap in the literature by describing sexual reproductive health—including abortion, miscarriage, contraceptive use, access, and use of reproductive services—of substance-using women involved in the criminal justice system.

The authors write:

“It is important that we consider the unique health concerns of this population. Women in the criminal justice system do not receive the health care they need and have lower rates of utilization prior to entering.”

3: Project PACT

Women in relationships who become involved in the criminal justice system face unique challenges. Project PACT is SIG’s most recent study for men and their female sex partners. For this project, drug-using heterosexual couples, who had been recruited from community supervision programs in New York City, were brought together in a safe environment and encouraged to adopt strategies to protect themselves and each other from HIV, build a healthy relationship and/or seek HIV treatment and care (if needed). The project found that couples treated in this way tend to reduce their risky behaviors, lower their incidence of HIV and hepatitis C virus (HCV) transmission, and avoid drug overdoses.

“Our ‘it takes two’ approach also supports the integration of HIV and reproductive health care,” Dr. El-Bassel explains.

Project Director Dr. Dawn Goddard-Eckrich adds that female participants in particular responded well to the intervention. “Women are a fast-growing criminal justice population due to having experienced poverty, racial and health disparities and gender-based violence like sexual abuse and other types of victimization,” she says. “Our evidence based-interventions target this vulnerable population while recognizing women’s strengths and drawing from their social support systems.”

4: Project WINGS

Often, women most at risk of experiencing violence have a lack of social support. SIG has also led a project called WINGS: Women Initiating New Goals of Safety to help identify women at greatest risk of intimate partner violence and gender-based violence and empower them with coping skills while also linking them to substance use treatment and HIV prevention and treatment.

WINGS was found to significantly reduce the rates of physical and emotional abuse among women over a three-month follow-up period—remarkable.

Dr. Louisa Gilbert, director of Project WINGS and the co-director of SIG, says she was impressed by the speed at which many of the women participants were able to transform their lives:

“We honor these women today who have taught so much. They are daughters, sisters and mothers who hold the power to transform their communities into vibrant social and economic spaces for all to thrive.”

5: ASPIRE

No matter how dire their circumstances, women worldwide have shown that they are their own best advocates once their voices are raised and heard. As a co-investigator for SIG’s newest project, ASPIRE: Responding to Refugees through Research, Dr. Anindita Dasgupta has experienced this principle firsthand in her work with women who are Syrian refugees.

“Women are resilient and know exactly what type of support and resources are necessary to improve their own health, and the health of their loved ones,” Dr. Dasgupta says. “We felt it was important to speak directly to women for this reason, and ensure that the voices of women are central in our research.”

According to Dr. Dasgupta, ASPIRE will use Syrian refugee women’s voices to develop and implement evidence-based interventions and programming for this population of women and their families in the areas of health and mental health.

* * *

International Women’s Day is a single day. But in the world occupied by SIG researchers, women’s voices, particularly those of women on the margins, are pressing for progress daily. As the SIG research team has discovered through the above five studies (among many others), far from being “social garbage”, many marginalized women are capable of advocating for changes that address their specific needs, while also, in many cases, benefiting the rest of womankind.

To read more about these five studies and how SIG is closing the research gap on marginalized female populations in need of interventions, see SIG’s 2017 End-of-Year Report.

This article was submitted by the communications staff of the Social Intervention Group, with input from Nabila El-Bassel, Louisa Gilbert, Anindita Dasgupta, Dawn Goddard-Eckrich, and others.

Related links:

• The HIV/AIDS Crisis Will Not End Unless We Take These Five Steps by 2030 (28 November 2017 news article)
• Social Work School Leads University-wide Project to Promote Educational Advancement of Syrian Refugees (10 January 2017 news article)
• Out of the Shadows: Female Drug Users and HIV/AIDS (7 January 2016 news article)
• New Study: Savings-led Microfinance Reduces HIV Risk for Vulnerable Women in Mongolia (30 March 2015 news article)
• Learning to Thrive: How These Three Female Social Work Academics Reached the Top (9 November 2015 news article)
• Nabila El-Bassel Is a Guest Editor for JAIDS Special Issue on Women Who Use Drugs (8 June 2015 news article)
• SWM014: Marking 10 Years of Health Research in Central Asia, with Louisa Gilbert and Angela Aifah (16 December 2014 podcast)
• Increasing HIV/STI Prevention Among Women on Probation: New Study (18 November 2014 news article)
• Talking to Professor Nabila El-Bassel about Setting, and Stepping Up, the Pace of AIDS Intervention (22 July 2014 news article)

Related External Link
Journal of Acquired Immune Deficiency Syndromes (JAIDS) 69:S93, June 1st, 2015: “Global Epidemiology of HIV and the State of Prevention and Treatment for Women Who Use or Inject Drugs.”