Structural Interventions for HIV Prevention Among Women Who Use Drugs

Abstract

We briefly review extant literature on the contextual sources of HIV risk among drug users—the drug user risk environment—and on structural interventions to address drug user vulnerability to HIV. We argue that issues of gender inequality and gendered power relations are largely absent from this literature. We then identify 5 contextual factors that are critical for understanding women's HIV-related vulnerability and whose impacts are exacerbated among women who use drugs, including a division of reproductive labor in which women bear primary responsibility for family caretaking, women's lack of full access to or control of productive resources and decision making, women's vulnerability to sexual and physical violence, and especially, intimate partner violence, women's (particularly heterosexual women's) relationship dependency and limited power in sexual interactions, and harmful gender norms that reinforce these other factors. We discuss a range of structural interventions and structural intervention approaches with the potential to address these contextual factors and call for more research, both to better understand the risk environment of women who use drugs and the impacts of structural interventions on it. We argue that our understanding of and ability to impact on the HIV-related risk environment of drug users is incomplete if we do not fully incorporate the analysis of gender inequality and gendered power relations.

Prescription opioid use, illicit drug use, and sexually transmitted infections among participants from a community engagement program in North Central Florida

“…A recent study showed that women who used alcohol and other illicit drugs had an STI rate of 7.9%, compared to their male counterparts of 1.5% (McHugh et al, 2012). This suggests and corroborates with other studies that call for more female targeted STI prevention and testing in general (Blankenship, Reinhard, & El-Bassel, 2015; El-Bassel & Strathdee, 2015). Our finding that those with 12 or more years of education had decreased odds of an STI has been reported previously (Solomon et al, 2008; Harling et al, 2013).…”

“…Studies have shown that an intersection between higher rates of risky sexual behaviors such as unprotected sex, multiple sex partners, and drug use (Blankenship, Reinhard, & El-Bassel, 2015; Dyer et al, 2013; El-Bassel & Strathdee, 2015; Islam et al, 2013; Chorba et al, 2012; McHugh et al, 2012; Patrick et al, 2012; Shoptow et al, 2014). Specifically, the rates of prescription drugs used non-medically are rising, now becoming one of the leading substance used (Dunn et al, 2013; Benotsch et al, 2011; Lankenau et al, 2012; Mackey, Liang, & Strathdee, 2013).…”

Predictors of injection cessation and relapse among female sex workers who inject drugs in two Mexican-U.S. border cities

“…Overall, the creation of womenonly drug treatment programs could be instrumental to decreasing FSW-PWID vulnerability by changing the physical and social context within which risk and treatment occur. 50 …”

“…The provision of child care and support for child custody may then be an important motivator for women to enter and stay in MMTPs or other harm reduction programs. 50 More research examining motivations for entering drug treatment among FSW-PWID in this context is needed.…”

Substance Use and HIV Among Female Sex Workers and Female Prisoners

“…1). In this special issue, Blankenship et al 26 discuss structural intervention strategies that alter the physical risk environment, which may reduce women’s vulnerability to HIV infection, such as the provision of child care at harm reduction programs and women-only drug treatment programs.…”