Gender-Based Risks for HIV among Drug Users
by Jeffrey Laurence, M.D.
a stellar month for the publication of research linked to amfAR-funded fellows.
And it was a very international representation. Three of these young
researchers, all Mathilde Krim fellows, described their work in major
biomedical journals: Rogier Sanders from Amsterdam reported on the role of
dendritic cells in mucosal transmission of HIV; Andres Finzi of Harvard explored
methods of evaluating the efficiency of drugs blocking HIV entry into cells;
and Navid Madani, also of Harvard, examined encapsulation of anti-HIV compounds
in fat as one type of microbicide. But here I’ll report on the accomplishments
of a fourth young scientist from London, amfAR fellow Gail Gilchrist.
one in six injecting drug users are HIV-positive, but the numbers are skewed
toward women. Dr. Gilchrist, working with colleagues from the Substance Use
Disorders Research Group in Barcelona, examined behavioral and psychiatric
differences between male and female drug users that might put women at greater
risk for acquiring and transmitting HIV. Writing in the journal AIDS and Behavior, she notes that
several studies have shown that women who use drugs more often require
assistance injecting drugs and engage more in sex trading and unsafe sex with a
regular partner than men who use drugs. But Gilchrist and colleagues wanted to
delve deeper into this sexual dichotomy.
that there is a higher prevalence of intimate partner violence among female drug
users than non-drug users. And among women who are HIV-positive or at risk for
HIV, the prevalence of such violence is at least 30 percent, which is three
times, greater than in the general population. Women who have experienced such violence are
less likely to use condoms and more likely to share needles, have more sexual
partners, and trade sex.
studied 118 female drug users, 27 percent of whom were HIV-positive, over a 22-month
period. Psychiatric, behavioral, and social risk factors for HIV were analyzed.
The qualitative findings, related to personality and major depressive disorders,
illuminated the multiple ways in which psychiatric conditions and male
drug-using partners interact and contribute to heightened HIV risk among
drug-using women. For example, abusive male partners impacted a woman’s ability
to negotiate safer sex. Unprotected sex
with drug dealers was the norm. And depression, associated with drug use and
sexual risk behaviors, was linked to HIV acquisition. “Interventions should
address all aspects of female drug users’ lives to reduce HIV,” the authors