Larney, S., Mathers, B.M., Poteat, T., et al. Journal of Acquired Immune Deficiency Syndromes (June 2015), doi: 10.1097/QAI.0000000000000623.
The authors conducted a literature review focused on women and girls who use and/or inject drugs to explore risk factors and determine HIV prevalence and mortality rates among these groups. They found that although crude mortality rates were consistently lower among women who use and inject drugs compared with men, standardized mortality ratios were higher among women who use and inject drugs. Their findings suggest that these women experienced relatively greater mortality than their age-matched peers in the broader community compared with men who use drugs. Social exclusion, stigma, and discrimination can increase HIV risk and undermine HIV prevention and treatment programs for this group. These women and girls are reluctant to disclose their drug use and do not access health services, including drug treatment, for fear of discrimination. Moreover, they may be excluded from family support structures, and those with limited financial or employment options may be more likely to engage in sex work, increasing sexual HIV risk and attracting additional stigma. The authors concluded that special efforts (such as stratified sampling) may be needed to recruit women and girls into studies of drug use and HIV prevalence and risk among people who inject drugs, to ensure adequate recruitment of women and improve the reliability of sex-specific prevalence statistics.