What Works for Women and Girls

4. HIV and AIDS programmes are disrupted during raids and other policing mechanisms.Studies found that HIV prevention efforts are disrupted during raids and that carryingcondoms is used to prosecute sex workers.Gap noted in a meta-analysis of articles and reports of sex workers from 10 countries onfour continents (Ditmore, 2008); and China (Lau et al., 2007a).4B. Prevention for Key Affected Populations: WomenDrug Users and Female Partners of Male IDUs“It has been known sincethe early 1990s that HIV amongIDU can be effectively [and]safely…controlled by the earlyand vigorous implementationof a comprehensive packageof strategies known as ‘harmreduction.’ This package consistsof education, needle syringeprogrammes, drug treatmentand the community developmentof drug users…No country thathas started harm reduction hasever regretted doing so and thenterminated their programmes”(Wodak and McLeod, 2008:S81; S83; S88).Approximately 16 million people in 148 countries areinjecting drug users (IDUs). The largest numbers are inChina, the United States and Russia, with HIV prevalenceamong IDUs at 12% in China, 16% in the United States and37% in Russia. Worldwide, about three million people whoare IDUs are also HIV-positive (Mathers et al., 2008).Though precise data on women who are injecting drugusers are rarely available, women are estimated to representabout 20% of drug users in Eastern Europe, Central Asia andLatin America, 17–40% in various provinces of China and10% in some Asian countries (UNODC, 2004; UNODC,2005 cited in Pinkham and Malinowska-Sempruch, 2008;Ralon et al., 2008).Female IDUs Risk Acquiring HIV from NeedleSharing and Unsafe SexThere are two major sets of HIV-related risk behavior associatedwith IDUs: needle sharing, especially borrowing usedand contaminated needles from someone else (one of themost direct transmission pathways of HIV transmission),and unsafe sex (Choi et al., 2006). Yet country progress reports for UNGASS found that only30 out of 145 low- and middle-income countries reported on HIV knowledge and behavior,condom use, HIV testing, safe injecting practices or access to prevention services for IDUs.Median coverage of IDUs with any type of prevention and care services was only 24% andthree quarters of countries had prevention services for less than half of the IDUs (Degenhardtet al., 2008).Despite the limited research on female IDUs and HIV-related behavior, there is evidencethat the high HIV risk in female IDUs is associated both with injecting and sexual risk taking(Burrows, 2004). A study of 2,512 male and 672 female IDUs surveyed in 10 sites in developingcountries found that females were more likely to engage in risk behaviors in the context90 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS