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Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer

El-Bassel, Nabilaa; Wechsberg, Wendee M.b; Shaw, Stacey A.a

Current Opinion in HIV and AIDS: July 2012 - Volume 7 - Issue 4 - p 326–331
doi: 10.1097/COH.0b013e3283536ab2
INJECTING DRUG USE AND HIV: Edited by Lisa Maher and Nick Walsh

Purpose of review This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies.

Recent findings Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs.

Summary HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.

aColumbia University School of Social Work, New York, New York

bSubstance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, North Carolina, USA

Correspondence to Nabila El-Bassel, DSW, Columbia University, School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA. Tel: +1 212 851 2391; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.