Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective

Abstract

Although there have been significant reductions in the number of new HIV infections globally from 2009 to 2013, incidence remains unacceptably high for persons who use drugs. In many settings, women and girls who inject drugs (WWID) with HIV/AIDS experience poor treatment access, including evidence-based practices like antiretroviral therapy and drug treatment. Medication-assisted therapies (MAT) for substance use disorders are especially inaccessible, which in their absence, increases HIV transmission risk. Irrespective of setting or culture, drug treatment using MAT is not only effective but also cost-effective at reducing opioid use and linked injection and sexual risks. Data presented here for WWID address their access to MAT for opioid addiction and to treatments being developed that address the relationship, family, and vocational needs of this group. The most glaring finding is that globally, WWID frequently are excluded in surveys or studies with an impressive lack of disaggregated data by gender when surveying access to MAT—even in wealthy countries. Despite this, there have been some striking improvements in implementing drug treatment as prevention, notably in Iran and China. Still, real barriers remain for women and girls to accessing drug treatment, other harm reduction services, and antiretroviral therapy. Development and/or implementation of interventions that facilitate women and girls engaging in drug treatment that address their roles within society, work, and family/relationships, and outcome evaluation of these interventions are crucial.

The effects of opioid-agonist treatments on HIV risk and social stability: A mixed methods study of women with opioid use disorder in Ukraine

“…Additionally, the participants who knew CD4 counts or were using ART had already been linked to care; OAT often improves these measures by improving HIV+ PWID initial enrollment in care. Integrated systems of care and those with low barriers to entry, such as take-home doses of medication or the availability of prescriptions, are crucial for WWID (in Ukraine and elsewhere) because they often have limited resources to navigate complex systems of care and experience stigma both because of their sex and their drug use (Des Jarlais et al, 2012; Springer et al, 2015). …”

“…Though essentially all opioids are injected, primarily because they are available as a liquid, they may also be combined with amphetamines, especially in Southern Ukraine (Booth, Kwiatkowski, Brewster, Sinitsyna, & Dvoryak, 2006; Chintalova-Dallas, Case, Kitsenko, & Lazzarini, 2009). Women who inject drugs (WWID) are disproportionately infected with HIV: while women account for 27% of all PWID, they represent 45% of PWID who have HIV in Ukraine (Springer et al, 2015; Ukraine, 2014). In an analysis of PWID at three sites in Ukraine, being female was an independent predictor of HIV status (Booth et al, 2006) and in a study of 16 Ukrainian cities, women were more likely than men to have HIV (Taran, Johnston, Pohorila, & Saliuk, 2011).…”

“…Women, particularly those who are dependent on partners for basic subsistence needs, may lack autonomy to effectively negotiate condoms, thereby increasing sexual risk (Jolley et al, 2012; Lambdin et al, 2013; Larney et al, 2015). Compared to their male counterparts, WWID inject more frequently, have overlapping sex and drug partners (Corsi et al, 2014), are more likely to be injected by someone else (often a partner) and to be “second on the needle,” increasing vulnerability to HIV (Springer et al, 2015). Increased stigma, discrimination and greater personal demands to care for others impede access to treatment programs (Des Jarlais et al, 2012; Lambdin et al, 2013; Simmonds & Coomber, 2009).…”

HIV Prevalence Among People Who Inject Drugs in Greater Kuala Lumpur Recruited Using Respondent-Driven Sampling

“…In our study, it is possible that we undersampled women and non-Malay ethnic groups, but evaluating the representativeness of our sample is difficult without better data on the underlying population of PWID in Greater Kuala Lumpur. Few data are available on women who inject drugs in Malaysia or elsewhere (49). More than one third (36%) of participants reported knowing at least one woman who injected drugs and, on average, participants' reported networks included one woman who injected drugs for every eleven men, so it is likely that with no female participants in Kajang and only one in Shah Alam, women were undersampled.…”

Opioid Use among Women on a Stable Methadone Dose

“…Opioid use is a health problem in Iran, a vast Persian country in Western Asia (1,2). This is because of Afghanistan which smuggles opioids to Iran.…”