Although global HIV prevention and treatment efforts have resulted in a 38% decrease of new infections since 2001, transmission rates remain unacceptably high with more than 2 million individuals newly infected in 2013.1 Substance use continues to fuel the epidemic by increasing the likelihood that individuals will engage in high-risk behaviors, including unsafe sexual practices and the sharing of contaminated injection equipment. Recent research has clearly demonstrated the importance of early testing and treatment in preventing the spread of HIV, particularly among substance abusing populations2; yet, more than half of infected individuals worldwide are unaware of their status.1 To successfully implement proven prevention strategies such as the seek, test, treat, and retain paradigm, it is essential to identify and target high-risk populations who are currently underutilization testing and treatment services.
Globally, women comprise 50% of all adults infected with HIV; in areas most affected this number is as high as 59%.1 Although in many regions, the prevalence of HIV infection is higher among women who inject drugs than among men who inject drugs, female drug users have poorer access to HIV prevention, treatment, and care services.3,4 Multiple factors contribute to these gender disparities. In many countries, long-standing cultural perspectives on gender roles and stigma present significant barriers to treatment access for women.4,5 Economic dependence, dependent children, and the experience or fear of abandonment, gender-based violence, stigma, and discrimination act as deterrents to the access of HIV services and treatment.6 Concurrently, women are susceptible to a number of factors that increase their vulnerability to HIV infection, including gender discrimination, sex work, and sexually violent experiences.1
Despite a clear need to address the impact of gender on HIV prevention and treatment efforts, particularly among female substance users, there is a paucity of research conducted to date on this topic. This special supplement of the Journal of Acquired Immune Deficiency Syndromes provides a number of articles by leading researchers highlighting the complex interaction of gender-specific factors and substance use among women. The articles included integrate the authors' individual perspective and research in this area, providing valuable scientific insight into aspects of the intertwined epidemics of HIV and substance use unique to women. The National Institute on Drug Abuse is committed to supporting research that identifies barriers to the prevention and treatment of HIV in vulnerable substance-using populations.
1. UNAIDS. The Gap Report. UNAIDS, Geneva, Switzerland; 2014.
2. National Institute on Drug Abuse. Antiretroviral Treatment Reduces Spread of HIV Among Injection Drug Users Available at: http://www.drugabuse.gov/news-events/nida-notes/2012/04/antiretroviral-treatment-reduces-spread-hiv-among-injection-drug-users
. Accessed March 31, 2015.
3. UNAIDS. Guidance Note: Services for People Who Inject Drugs. UNAIDS, Geneva, Switzerland; 2014.
4. Azim T, Bontell I, Strathdee S. Women, drugs and HIV. Int J Drug Policy. 2015;26:S16–S21.
5. Nudelman A. Gender-Related Barriers to Services for Preventing New HIV Infections Among Children and Keeping Their Mothers Alive and Healthy in High-burden Countries. UNAIDS, Geneva, Switzerland; 2013.
6. UNAIDS. A Focus on Women: A Key Strategy to Preventing HIV Among Children. UNAIDS, Geneva, Switzerland; 2014. Issue Brief.