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

Abstract

Background Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. Results Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. Conclusions There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia

“…This difference in substance use patterns is also observed in Southeast Asia generally, where the estimated age-adjusted prevalence of ATS dependence among women is 0.31% (95% CI: 0.23–0.42), while prevalence of opioid dependence is over three times lower at 0.09% (95% CI: 0.06–0.13)(29). Since medication-assisted therapies are not routinely available for the treatment of ATS-use disorders (5), counseling-based strategies are the mainstay for treating amphetamine addiction.…”

“…Likewise, power imbalances in intimate partner relationships often lead to high risk injection practices in which females are injected by male partners using the same equipment used to inject themselves (27, 28), placing females at greater risk for HIV infection. A recent review of data reported to the Joint United Nations Program on HIV and AIDS (UNAIDS) between 2011 and 2013 found that, in Malaysia, women who inject drugs were 1.48 times more likely to be HIV-infected than their male counterparts who inject drugs (29). While women may represent a smaller absolute number of PWID compared to men, these data highlight that women face a greater number of health-related risks, including HIV.…”

Women Who Use or Inject Drugs

“…Larney et al found that substance-using women experience greater excess mortality than men who use drugs. 7 Mortality from overdose of prescribed painkillers increased fivefold from 1999 to 2010, and excess mortality rates were also higher for women than for men. 6 About 5,600 women in the U.S. died from prescription opiate overdose in 2010; four times as many as from heroin and cocaine overdose combined.…”

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 general and in Ukraine specifically, WWID experience increased HIV risk due to converging biological, social, cultural and economic factors (Des Jarlais, Feelemyer, Modi, Arasteh, & Hagan, 2012; Larney, Mathers, Poteat, Kamarulzaman, & Degenhardt, 2015). 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).…”

“…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).…”