Drugusing women and HIV Kasia MalinowskaSempruch kmalinowskasorosny'org

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Drug-using women and HIVKasia
Malinowska-Sempruch kmalinowska_at_sorosny.org
Photo Jacqueline Mia Foster
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• Data
• Women drug users
• Sexual health issues
• Pregnancy
• Sex work
• Drug-related services
• Policy recommendations

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Epidemics among injecting drug users are explosive

• Svetlagorsk 67 IDUs infected within one year of
  first HIV case (Dehne and Kobyschka 2002).
• St. Petersburg 0.3 HIV prevalence among IDUs in
  1998, 19.3 by 2000 (Dehne and Kobyschka 2002).
• Yili prefecture (Xianjiang, China) HIV infection
  among IDUs 9 in January 1996. By August, 76 of
  IDUs were infected
• (UNAIDS/UNODCCP 2000).
• Chiang Rai, Thailand HIV prevalence among IDUs
  increased from 1 in 1988 to 61 in 1989.

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HIV Epidemics mostly or almost entirely among
drug users, fSU

• Russia as many as 1.6 million HIV cases, 87
  IDUs, fastest growing epidemic in the world
  (UNAIDS 2006)
• Ukraine estimated 410,000 HIV cases, 68 IDUs.
  In Odessa and Simferopol, 58 of IDUs are HIV
• (UNAIDS 2006)
• Lithuania 79 of HIV cases are among IDUs
• Moldova 74 of HIV cases are among IDUs
• Central Asia injecting drug use accounts for
  70-90 of HIV infections
• Kazakhstan 77 of HIV cases are among IDUs
• Kyrgyzstan 78 of HIV cases among IDUs
• Tajikistan 70 of HIV cases among IDUs

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HIV Epidemics mostly or almost entirely among
drug users -- Asia

• Largest number of HIV infections outside Africa
  with potential for greatest growth
• China 860,000 HIV cases, 44 IDUs (largest share
  of HIV cases) (UNAIDS/WHO 2005)
• Malaysia 75 of HIV cases among IDUs (Malaysian
  Ministry of Health 2005)
• Iran 62 of HIV cases are among IDUs (WHO 2004)
• Vietnam 52 of all HIV cases are among IDUs. HIV
  cases double (to 260,000) between 2002-2005
• (UNAIDS 2006)
• 80 IDUs HIV in Manipur, India (UNODC 2006)
• In Indonesia, 80 of new HIV cases in last two
  years via injection. Estimated 25 of prison
  inmates are HIV
• (UNAIDS 2006)

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Photo Jacqueline Mia Foster
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Women in drug-related data

• Data about women drug users is often incomplete.
• Women are underrepresented--at the largest harm
  reduction program in Iran, only 2 to 5 of
  clients are women, and in Krakow, Poland, 20 of
  clients are women. In a study conducted across 13
  cities in Ukraine, Belarus, Kazakhstan and
  Moldova, women who participate in needle exchange
  programs and use harm reduction outreach services
  only represent 10 to 20 of all attendees.

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Photo Hans Jürgen Burkard
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Generalized epidemics from drug using communities

• In addition to addressing drug-related needs of
  drug users (needle exchange, substitution and
  other drug treatment), addressing sexual health
  issues holds a key to effective prevention

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Sexual health of drug users

• Survey in St. Petersburg one third of clients
  reported multiple sexual partners in the last 30
  days and 70 percent reported unprotected sexual
  activity
• (AIDS Education Prevention, 2002).
• A recent study in Tbilisi funded by the European
  Commission and the South Caucuses Anti-Drug
  program reports that while needle exchange
  significantly improves HIV risk among clients,
  there was no significant change in the level of
  sexual risk behavior (2006).

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Pregnancy-related needs

• In 19962001, most HIV-infected infants in
  Ukraine and the Russian Federation were born to
  mothers who were either injecting drug users or
  sexual partners of injecting drug users (Hamers
  2003).
• Low enrollment of drug users in pre-natal
  services (50 not in care pre-delivery in
  Poland). During a study in six obstetric clinics
  in Poland, of those who identified themselves as
  drug users during birth, 52 were HIV positive
  and 23 stated that this was a planned pregnancy
  (Niemiec, 2006).
• Drug-using and HIV positive women are forcefully
  counseled into abortion. In Kazakhstan, 395
  pregnancies were recorded among HIV positive
  women by June of this year, from which 236
  children were born (Kazakhstan National Center
  for AIDS, 2006).
• Vertical transmission in Ukraine (2000-2004)
  among women who acquired HIV through injecting
  drug use was as high as it was in Western Europe
  prior to introduction of perinatal antiretroviral
  therapy (AIDS, 2006).
• In China, pregnant women are excluded from
  methadone programs.

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Sex worker outreach in Volgograd
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Sex work and drugs

• The link between sex work and drug use is strong
  some women turn to drugs in order to help cope
  with harsh conditions of being sex workers, while
  others turn to sex work to support their drug
  use.
• 44 of sex workers in Moscow inject drugs
• (Epidemiology of Infectious Diseases, 1998).
• In Tashkent, HIV prevalence of 10 was found
  among female sex workers who were non-users and
  increased to 58 for women who identified
  themselves as drug users (UNAIDS/WHO, 2005).

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Photo Hans Jürgen Burkard
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Barriers to HIV and Drug Treatment for Women

• Stigma and consequences of using drug-related
  services
• Overwhelming presence of men at treatment
  programs
• Burdensome administrative procedures, ie state
  registration, residency requirements
• Very few drug treatment centers where women can
  be admitted with their children, forcing a
  separation that later may become permanent

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Syringe exchange in Astrakhan
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Other issues

• Drug use, being an illicit activity, makes
  accessing health services difficult
• Drug trafficking is a serious matter, especially
  in Central Asian countries, and the number of
  women incarcerated for it has grown dramatically
• When drug using women report sexual violence, law
  enforcement and judiciary bodies, are not
  interested at best abusive and at worst

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For our consideration.

• Syringe exchange, substitution treatment and
  other outreach services to drug users must become
  a central part of a national response to drug
  use, and special efforts should be made for these
  programs to include drug-using women.
• Effective drug treatment that respects the rights
  of drug users and addresses their individual
  needs, such as parenting, must be widely
  available to all who request it.
• Provisions must be made by service providers that
  addressing drug users needs to fully incorporate
  sexual health matters into their interventions,
  with particular attention to the fact that a
  significant number of drug users are selling
  sexual services
• Official registration of drug users must be
  abolished, as it presents a severe obstacle to
  seeking health services
• Reasonable provisions must be made for those
  unable to meet residency requirements, in order
  for them to benefit from health care services,
  including sexual health services.

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For our consideration. (2)

• Law enforcement must be properly instructed and
  held accountable for any mistreatment of drug
  users, including for sexual offences of women
• National guidelines for drug-related services
  must acknowledge that in order for services to
  include women, they must recognize and make
  provisions to address their needs
• Sexual and reproductive health services must be
  significantly strengthened and expanded to allow
  stigma-free inclusion and participation of drug
  users
• Punitive drug policies and administrative
  procedures for drug use and personal drug
  possession must be brought in line with public
  health goals
• Epidemiological studies of drug use itself,
  sexual behavior of drug users, special needs of
  drug using women and HIV prevalence among
  injecting drug users need to be supported to
  ensure fuller understanding of the problem and
  its scope