WOMEN, DRUGS AND HIV
description
Transcript of WOMEN, DRUGS AND HIV
WOMEN, DRUGS AND HIV
Science Addressing Drugs And Health: State of the Art
20th International AIDS Conference 201421 July 2014, Melbourne
Tasnim Azim, icddr,b, Dhaka, BangladeshIrene Bontell, Karolinska Institutet, Stockholm, SwedenSteffanie Strathdee, University of California, San Diego, USA
WOMEN WHO INJECT DRUGS ARE SIGNIFICANT IN NUMBER: GLOBAL FIGURES
Number of people who inject drugs (PWID): ~16 million
Number of females who inject drugs (FWID): ~3.5 million
FWID are more likely to be HIV positive than males who inject drugs (MWID): 1.18 times
Mathers et al, 2008; Des Jarlais et al, 2012
HIV prevalence is higher among females who use drugs around the world
Southern and Eastern
Europé
North America
Latin America
and Caribbean
Western and Central
Europé
Central Asia
Tanzania Nepal0%
10%
20%
30%
40%
50%
60%
70%
33.0% 34.5%38.5%
42.8%
10.1%
62.0%
33.0%
27.9%31.3%
34.6%
40.3%
9.5%
28.0%
6.3%
FWIDMWID
Des Jarlais et al 2012 and 2013; Lambdin et al, 2013; Ghimire et al, 2013
HIV
WOMEN, DRUG USE AND SEX WORK: A DUAL RISK
The combination of selling sex and using illicit drugs is common
Women often sell sex to support their own or their partner’s drug use
Tanzania: 85% Nepal: 50% Bangladesh: 63%
Lambdin et al, 2013; Ghimire et al, 2013; Azim et al, 2006
FWID who sell sexFWID who do not sell sex
experience sexual violence
high-risk sex
sexual concurrency
sharing needles and syringes
Multiple vulnerabilities and risks faced by women who use drugs and sell sex result in a high risk of HIV
street based sex work
highly stigmatized
lack of control
HIV and STI risk
PWID ARE NOT AN ISOLATED POPULATION GROUP…..
PWID AS BRIDGE POPULATIONS FOR A GENERALIZED HIV EPIDEMIC
Des Jarlais et al, 2012
Transitions from PWID concentrated epidemics to heterosexual epidemics are likely to have occurred in at least six countries:
•Argentina•Brazil•China•Indonesia•Netherlands•Ukraine
WOMEN WITH PARTNERS WHO INJECT DRUGS
FWID are more likely to have MWID as their intimate partners and are often relying on them for acquiring and injecting drugs
The relationship is one of trust, fear and dependence – emotional and economic
BUT – often men control their lives
El-Bassel et al, 2014; Des Jarlais et al, 2012; Shanon et al, 2008
Relationship of FWID with
MWID partners
Control over drugs – obtaining, taking
Control over clients of FWID-SW - Role
as pimps
Control over condom use
Violence and threat of violence –
physical and sexual
Increased
vulnerability
to HIV/STI
NON-DRUG USING PARTNERS OF MWID
• Condom use is uncommon with intimate partners and often MWID have high levels of risk behaviour
• Violence or threat of violence by intimate partners – a voice from Bangladesh “…..if I don’t give money to my husband for his drugs, he beats me and threatens to kill me”
• Marginalised by society – they call me “wife of a heroinchi....”
Robertson et al, 2014; UNODC and icddr,b, 2010
SPECIAL NEEDS: REPRODUCTIVE HEALTH CARE
• Non-judgmental antenatal clinics
• Birth control• Advice on birth spacing• Point of Care STI
services• Pelvic exams• HPV vaccination• Abortion services
SPECIAL NEEDS: CHILD CAREHaving children and needing to provide care for them can be a motivation for making lifestyle changes including reducing drug use
Rolon et al, 2013; UNODC and icddr,b 2010; Maehira et al, 2013
Relapse following drug treatment more common among FWID and women without children to support were more than three times likely to relapse
Reasons for not accessing services for child care:•lack of child care services•fear of losing their children if they contact service providers
STIGMA AND DISCRIMINATIONFWID are highly stigmatized and discriminated by all strata of society
“when I visit any house they assume I am a thief” –FWID from Bangladesh “they (women who use drugs) are liars, big liars …and they are ready to go as far as possible… they are ready to sell themselves…” – Georgia, general view “generally the attitude of police towards a drug user is similar to their attitude towards criminals and not sick people… their attitude towards women is even worse than to men…” – FWID from Georgia
Stigma can be a barrier for access to services
UNODC and icddr,b 2010; Otiashvili et al, 2013; El-Bassel et al, 2014
VIOLENCEExperienced commonly - physical and sexual
Perpetrators include:• Law enforcement• Intimate partners• Clients
There is a general feeling by FWID-SW that clients will not be criminalized for the violence and that women will not be
protected by police
Otiashvili et al, 2013
INTERVENTIONS: WHAT CAN WORK•Behavioural interventions: •Safer sex and injection practices, enhanced negotiation skills, couple-based approaches
•Structural interventions:•Access to safe housing and spaces for sex work, access to non-discriminatory health services
•Biomedical interventions:•HIV testing and treatment, PrEP, PEP and TasP
CONCLUSIONS• FWID often have higher rates of HIV than MWID.
• FWID who sell sex are more likely to share injection equipment, have unprotected sex with their clients and their intimate partners, have high rates of STIs and to experience sexual and physical violence and incarceration
• Women are often reliant on their male partners and may be controlled by their intimate male partners for drugs, clients, condom use
• FWID have special needs e.g. pregnancy women and child care
• FWID are highly stigmatized by all strata of society and violence, both physical and sexual, is common
• Women who do not use illicit drugs but have MWID as their intimate partners are also stigmatised and vulnerable
• Behavioural, structural and biomedical interventions can work and should be made available
CONCLUSIONS
RECOMMENDATIONS• Harm-reduction, reproductive health and HIV services must
be available for women who use drugs in culturally sensitive and non-judgemental environments
• Since sex work is common among FWID, harm reduction should be included in all interventions for sex workers and safer sex messages should be part of all harm reduction programs for FWID.
• Couple-based interventions are effective for decreasing drug use and HIV risk behaviours and should be widely available
• Interventions must focus on strengthening the ability of women to achieve autonomy over HIV risk reduction practices, including freedom from pimps and police harassment and availability of safe places to take clients
WE GRATEFULLY ACKNOWLEDGE ALL WOMEN WHO USE DRUGS AND WHO HAVE SHARED
THEIR STORIES WITH US