Women who inject drugs: A review of their risks, experiences and needs

This report summarises the existing peer reviewed and grey literature describing evidence on the nature and degree of risks and experiences of women who inject drugs and women whose partners inject. In collecting this literature, a range of search strategies were used in tandem with expert consultations across the key themes.
The literature shows that women who inject drugs have substantially different needs and face higher risks of disease and violence than do men who inject drugs. Given this difference, it is surprising that much of the literature on injection drug users (IDU) does not distinguish between men and women when discussing prevalence, needs, risks and outcomes of injection. This has led to a possible underrepresentation of the specific issues that female IDU face and a gap in appropriate policy development and understanding around their specific needs. Evidence suggests that women comprise the minority of IDUs in most countries which may be partly responsible for the lack of focus on their needs and risks. However, female IDU are notoriously hard to reach and maintain a relatively subordinate position to men in the drug using subculture which may also contribute to the general underreporting. Where women are discussed there is a tendency to focus on women of reproductive age who are sexually active, referring to them as 'bridges for disease' into the general population. This suggests that the epidemiological and policy concerns around these women in most cases are based on concerns for their sexual partners and children instead of their own human rights, health and wellbeing.
A focus on injecting women is important for many reasons including their significantly higher mortality rates, increased likelihood of facing injection related problems, faster progression from first use to dependence, higher rates of HIV and increased risky injection and/or sexual risk behaviours. Further, injection drug use is often seen as contrary to the socially derived roles of women as mothers, partners and caretakers leaving, female IDU to face greater stigma, risks and experience a range of specific harms at higher levels than male IDU.
As will become clear in this report, the specific issues faced by female IDUs are the same issues of subordination, discrimination and social marginalization faced by women in many parts of the world paired with the issues of social isolation, discrimination and social marginalization faced by IDU. As IDU women, they may lack of power in their communities and relationships, be exposed to sexual and physical violence, stigma, an imbalance in responsibilities for childcare, ongoing threats to their well being from multiple channels, be forced into transactional or street based sex work and face barriers in accessing services (both for HIV prevention and drug dependence treatment). This report describes the nature of these issues and explores how women enter into drug use, how they use drugs, the relationships that shape and drive their drug use and their experiences in accessing services and treatment.