Promising international interventions and treatment for women who use and abuse drugs: focusing on the issues through the InWomen's Group

Effects of a social network intervention on HIV seroconversion among people who inject drugs in Ukraine: moderation by network gender composition

BACKGROUND

Women who inject drugs in Ukraine are disproportionately burdened by HIV. To help address the needs of this population, a greater understanding of how interventions may uniquely benefit women who inject drugs is needed.

METHODS

Data come from a randomized controlled trial of a social network intervention targeting people who inject drugs in Ukraine (N = 1195). Indexes, plus two of their injection network members, received HIV testing and counseling (control arm) or HIV testing and counseling plus a social network intervention (intervention arm), in which indexes were trained to influence network members' risk behaviors. We used Cox regressions with interaction terms to assess differences in time to HIV seroconversion between arms by network gender composition and gender of the index. For significant interaction terms, we calculated simple effects, generated survival functions using Kaplan-Meier methods, and compared survival curves using log-rank tests.

RESULTS

At 12 months, there were 45 seroconversions among women (40.0 [28.3, 51.7] per 100 person years) and 111 among men (28.4 [23.1, 33.6] per 100 person years) in the control arm; there were 27 seroconversions among women (17.1 [10.7, 23.6] per 100 person years) and 77 among men (18.7 [14.5, 22.9] per 100 person years) in the intervention arm. Network gender composition (but not gender of the index) moderated the intervention effect on HIV incidence (p < 0.05). Specifically, the intervention appeared to be even more protective against HIV acquisition as female gender composition increased. In the intervention arm, the HIV seroconversion hazard rate was 44% lower with 1 network female; 61% lower with 2 network females; and 72% lower with 3 network females.

CONCLUSIONS

A greater number of women in an injection network, coupled with the provision of risk-reduction strategies, is associated with HIV risk-mitigation, though the mechanisms through which this occurs remain unclear. Findings can support new research and practice directions that prioritize women who inject drugs and more thoughtfully support their health and wellbeing.

Gender Dynamics in Substance Use and Treatment: A Women's Focused Approach

Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.

Research on women with substance use disorders: Reviewing progress and developing a research and implementation roadmap

BACKGROUND

Research on women with substance use disorders has expanded, yet knowledge and implementation gaps remain.

METHODS

Drawing from topics discussed at the 2017 meeting of InWomen's in Montreal, Canada, this article reviews key progress in research on substance use among women, adolescents, and families to delineate priorities for the next generation of research.

RESULTS

The field has seen significant accomplishments in multiple domains, including the management of pregnant women with substance use and comorbid psychiatric disorders, caring for neonates in opioid withdrawal, greater inclusion of and treatment options for LGBTQ + communities, gendered instrumentation, and gender-focused HIV interventions for adolescent girls and women. Women who use alcohol and other drugs often experience other comorbid medical conditions (chronic Hepatitis C and HIV), contextual confounders (intimate partner violence exposure, homelessness, trauma), and social expectations (e.g., as caretakers) that must be addressed as part of integrated care to effectively treat women's substance use issues. Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. Few dedicated and gender-focused funding opportunities exist and research has been siloed, limiting the potential for collaborations or interdisciplinary cross-talk.

CONCLUSION

Given renewed attention to substance use in the context of the burgeoning opioid epidemic and shifts in global politics that affect women's substance use, the field requires a strategic rethink to invigorate a pipeline of future research and researchers.

Serious mental illness among young adult women who use drugs in the club scene: co-occurring biopsychosocial factors

Young women who regularly attend nightclubs are at risk for numerous health and social consequences, including mental distress, sexual and physical victimization and substance dependence. This paper uses a biopsychosocial framework to examine co-occurring mental health problems, victimization, substance dependence, sexual risk and physical pain among a sample of young women who use drugs (N = 222) in Miami's club scene. The majority of women were under 24 years old, Hispanic, and identified as heterosexual. Almost all the women reported past 90-day use of alcohol, ecstasy/MDMA, marijuana, cocaine and prescription opioids and benzodiazepines; 32% of women reported being in a monogamous relationship while 41.9% reported having three or more sexual partners in the past 90 days; 65.3% met DSM-IV criteria for substance dependence; 60.4% met DSM-IV criteria for serious mental illness (SMI) and 59.9% were victimized as minors. Women who had SMI had higher odds of substance dependence, concurrent physical pain, three or more sexual partners in the past 90 days, childhood victimization and severe abuse-related trauma. The high levels of interconnected mental health, victimization, trauma, physical pain, substance dependence and sexual risk factors observed are underreported in the literature, as young women club scene participants appear to be more similar to other marginalized drug-involved populations than previously considered. While further research is needed, it appears these young women are in great need of outreach for primary health, mental health, HIV prevention, increased social support and substance abuse treatment services.

Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions

The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.