Gender differences between predictors of HIV status among PWID in Ukraine

Abstract

Background The HIV epidemic in Ukraine is among the largest in Europe. While traditionally the epidemic has spread through injection risk behavior, sexual transmission is becoming more common. Previous research has found that women in Ukraine have higher rates of HIV and engage in more HIV risk behavior than men. This study extended that work by identifying risk factors that differentially predict men and women’s HIV status among people who inject drugs (PWID) in Ukraine. Methods From July 2010 through July 2013, 2480 sexually active PWID with unknown HIV status were recruited from three cities in Ukraine through street outreach. The average age was 31 years old. Results Women, who made up twenty-eight percent of the sample, had higher safe sex self-efficacy (p<0.01) and HIV knowledge (p<0.001) than men, but scored higher on both the risky injection (p<0.001) and risky sex (p<0.001) composite scores than men. Risky sex behaviors were associated with women’s HIV status more than men’s. We also report results identifying predictors of risky injection and sex behaviors. Conclusions Gender-specific interventions could address problem of HIV risk among women who inject drugs in a country with a growing HIV epidemic. Our findings suggest specific ways in which intervention efforts might focus on groups and individuals who are at the highest risk of contracting HIV (or who are already HIV positive) to halt the spread of HIV in Ukraine.

In their own voices: Breaking the vicious cycle of addiction, treatment and criminal justice among people who inject drugs in Ukraine

“…Despite evidence supporting OAT, <3% of PWIDs (∼8,000 PWIDs) in Ukraine (Degenhardt et al, 2014; Wolfe, Carrieri, & Shepard, 2010) are receiving OAT (UCDC, 2015). Of those on OAT, approximately 20% are female corresponding to the sex distribution of PWIDs surveyed in Ukraine (Balakireva, 2012; Corsi et al, 2014), and 40% are HIV-infected. On the other hand, incarceration in Ukraine is high (305 people imprisoned per 100,000 population, compared to a mean global incarceration rate of 144 per 100,000), excluding those detained by police or in pre-trial detention (Walmsley, 2014).…”

Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs

“…61,62 In some contexts, sexual risks may contribute to HIV infection among women who use drugs to a greater extent than among men who inject drugs. 63,64 There are several reasons why sexual transmission of HIV may be greater among women who use drugs compared with men. As the receptive partner, a woman is at greater risk of heterosexual HIV transmission through vaginal or anal sex than a male insertive partner, although risk varies depending on the context and setting.…”

“…65 In a number of studies, women who use and inject drugs reported having engaged in more sexual HIV risk behaviors than their male counterparts. 60,64,66 Furthermore, there may be greater overlap between women’s sexual and drug use networks, such that women who use drugs are more likely than men who use drugs to have sexual partners who are also drug users. 19,20 …”

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

“…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 in Ukraine also report more sex- and injection-related risk behaviors than men despite having higher levels of HIV knowledge (Corsi et al, 2014). …”

“…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).…”