Question

Discuss in detail HIV harm reduction in women

Answer 1

Harm reduction refers to strategies that aim to reduce the harms associated with psychoactive drug use, and is most widely associated with injection drug use. Harm reduction programmes aim to prevent the spread of HIV and reduce other harms associated with drug use.

Women are the backbone of society. Therefore, keeping women healthy is not just the right thing to do; it’s the smart thing to do. The simple truth is that empowering women and girls to protect themselves and their families from AIDS is key to turning the tide. For women who inject drugs, the stigma of injection drug use is added to gendered discrimination; these factors combined can push women into behaviors that increase their risk of HIV, according to a report published by the International Harm Reduction Development Program. There is a higher likelihood that women drug users will provide sex in exchange for housing, sustenance, and protection; suffer violence from sexual partners; and have difficulty insisting that their sexual partners use condoms. Women drug users may also rely on men to inject them with drugs and to acquire drugs and injection equipment, a behavior shown to increase the likelihood of injection with contaminated equipment.

HIV harm reduction in women looks at factors that reduce women drug users’ access to health care including punitive policies, discrimination by police and health care providers, the intense social stigma attached to drug use by women, a preponderance of harm reduction and drug treatment programs directed primarily toward men, an absence of sexual and reproductive health services for drug users, and poor access to effective outpatient drug treatment, in which methadone or buprenorphine are prescribed to reduce cravings for illicit opiates. Pregnant drug users are particularly vulnerable. In too many instances, they receive little or no accurate information about drug use during pregnancy or prevention of mother-to-child transmission of HIV. In some countries pregnant drug users are rejected by health care providers, threatened with criminal penalties or loss of parental rights, or coerced into having an abortion or abandoning their newborns to the state. Poor access to medication-assisted treatment jeopardizes the pregnancies of opiate-dependent drug users.

The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) strongly recommend harm reduction as an approach to HIV prevention, treatment and care for people who inject drugs. Specifically, they advocate for a comprehensive package including:

• NSPs
• OST and other drug dependence treatment
• HIV testing and counselling (HTC)
• antiretroviral treatment (ART)
• prevention and treatment of sexually transmitted infections (STIs)
• condom programmes for people who inject drugs and their sexual partners
• targeted information, education and communication for people who inject drugs and their sexual partners
• prevention, vaccination, diagnosis and treatment of viral hepatitis
• prevention, diagnosis and treatment of tuberculosis (TB).

Types of harm reduction programmes

Needle and syringe programmes (NSPs)

NSPs allow people who inject drugs to obtain new, sterile needles at little or no cost to reduce the risk of HIV infection. NSPs have the added bonus of preventing the transmission of other blood-borne viruses such as hepatitis B and C.

Opioid substitution therapy (OST)

OST is the practice of replacing an illegal opiate (such as heroin) with a prescribed medicine such as methadone or buprenorphine that are typically administered under medical supervision. In many places, OST has proved highly effective in reducing injecting drug use among opioid-dependent people, limiting their risk of HIV transmission.

Drug consumption rooms

Drug consumption rooms (DCRs) allow people who inject drugs to inject under medical supervision. They enable an immediate response to overdosing and decrease the transmission of blood-borne diseases such as HIV through access to sterile injecting equipment and education on safe injection practices. They can also provide access to healthcare as well as HIV testing and counselling.

Pharmacy sale of syringes

Many argue that pharmacies are an important but under-used resource in preventing the transmission of HIV and other blood-borne infections among people who inject drugs. Pharmacists are some of the most accessible healthcare professionals and are in an ideal position to reach this group who are often socially marginalised and wish to remain anonymous.

Pharmacists can fulfil a number of harm reduction roles including the sale of condoms, educating on safer sex practice, selling clean needles and syringes, and dispensing oral methadone for opioid dependence. Research has shown how the sale of over-the-counter syringes to people who inject drugs can reduce HIV prevalence among this group. One study of 96 metropolitan areas in the USA recorded an average HIV prevalence of 13.8% among people who inject drugs in areas with anti-over-the-counter laws compared to 6.7% across areas without such laws.

Benefits of Harm Reduction Programs

• Reducing harm to those involved and to their family, friends and society.
• Reduces the spread of HCV/HIV.
• Empowers people to choose what is best for them and when they are ready to take the next step.
• Offers opportunity to stabilize their lives.
• Decreases crime.
• Increasing access to care and services.
• Reduces isolation.
• Increases support system