Identifying Programmatic Gaps: Inequities in Harm Reduction Service Utilization among Male and Female Drug Users in Dar es Salaam, Tanzania

Abstract

IntroductionCurrent estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs.Materials and MethodsRoutine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males.ResultsFrom December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse.ConclusionsServices have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services.

Integration of Methamphetamine Harm Reduction into Opioid Harm Reduction Services in Iran: Preliminary Results of a Pilot Study

“…Males participated significantly more than females in the program sessions, which is consistent with international studies reported gender inequity in access to harm reduction services both in developed (27) and in developing countries (28). Despite the higher frequency of methamphetamine use and lower rate of participation in the intervention among females, analysis of data by gender revealed that an increase in the percentage of condom use in the last sexual intercourse and a decrease in unprotected sex due to methamphetamine effects were significant among females, but the decreasing trend was not significant among males.…”

Women, drugs and HIV

“…In Tanzania, 85% of FWID are sex workers and their HIV prevalence is 62%, compared to 28% among MWID (Lambdin et al, 2013)…”

Concentrated HIV subepidemics in generalized epidemic settings

“…Further, there is high overlap between female PWID and sex work in Dar es Salaam, with an estimated 31% of female PWID engaging in commercial sex work as compared to less than 1% for males. 43 …”