HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs

Abstract

Introduction While an estimated 3.5 million women inject drugs globally, women are outnumbered four to one by men who inject drugs and are often ignored or overlooked in the development and delivery of prevention and treatment services for this population. The current study aimed to identify key comorbidities prevalent among women who inject drugs (WWID), consider factors that contribute to vulnerability of this population and examine implications for prevention and treatment. Methods The literature was reviewed to examine the specific challenges and needs of WWID. We searched health-related bibliographic databases and grey literature to identify studies conducted among WWID, studies conducted among people who inject drugs (PWID) where results were disaggregated by gender and policies/guidelines/reports relevant to WWID. Results WWID face a range of unique, gender-specific and often additional challenges and barriers. The lack of a targeted focus on WWID by prevention and treatment services and harm reduction programs increases women’s vulnerability to a range of health-related harms including blood borne viral and sexually transmitted infections, injection-related injuries, mental health issues, physical and sexual violence, poor sexual and reproductive health, issues in relation to child bearing and child care and pervasive stigma and discrimination. Conclusions There is a need to improve the collection and reporting of gender-disaggregated data on prevalence of key infections and prevention and treatment service access and program coverage. Women-focussed services and integrating gender equity and human rights into the harm reduction programming is a prerequisite if improvements in the health, safety and well-being of this often invisible and highly vulnerable population are to be achieved.

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

“…Consistent with previous reports 9,10,14 , high rates of HIV and syphilis infection were observed in the IDUs. IDUs have an increased risk for infection with microbial pathogens such as HIV, HCV, and Treponema pallidum because of their exposure to risk factors including shared syringes, contaminated drug paraphernalia, and unprotected sexual activity after drug use 10,14,15 .…”

“…IDUs have an increased risk for infection with microbial pathogens such as HIV, HCV, and Treponema pallidum because of their exposure to risk factors including shared syringes, contaminated drug paraphernalia, and unprotected sexual activity after drug use 10,14,15 . In consideration of both the management of patients and protection of medical staff from nosocomial infections, preoperative drug screening should be performed in patients undergoing emergency surgery.…”

“…Additionally, awareness of the drug’s pharmacodynamics, pharmacokinetics, and interactions with anesthetics and other medications is crucial to the proper management of IDUs during the perioperative period 7 . Moreover, it is not uncommon for IDUs to have infection with human immunodeficiency virus (HIV), hepatic C virus (HCV), syphilis, or other sexually transmitted diseases (STD) 8–10 , which may put medical staff in danger, especially those in the window period, in which the infection can not be detected but may still infect others.…”

Women Who Use or Inject Drugs

“…9 Additionally, Iversen et al demonstrate the extensive burden of HCV experienced by drug-using women: 60% of female injection drug users have been exposed to HCV, and 70 to 90% of HIV-positive women who inject drugs have co-morbid HCV infection. 10 HIV-infected female drug users have significant HIV- and non-HIV-related medical needs, yet, as shown by Metsch et al, HIV testing and access to care remains low. 11 Furthermore, Blankenship et al describe a range of structural barriers that complicate or prevent access to services for drug-using women.…”

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

“…Power imbalances predispose women to partner violence exposure, an independent risk factor for HIV infection (Campbell et al, 2008; Meyer, Springer, & Altice, 2011; Stockman, Lucea, & Campbell, 2013). For WWID, socioeconomic disadvantage may lead women to engage in transactional “survival” sex for drugs, money, or other goods, further increasing HIV risk (El-Bassel, Wechsberg, & Shaw, 2012; Iversen, Page, Madden, & Maher, 2015). …”