What Works for Women and Girls

of a sexual relationship with a primary partner (Cleland et al., 2007) and that women are morelikely than men to borrow or share injection equipment, particularly with their sexual partners.Women are also more likely to be injected by a friend or partner, which increases risk(Pinkham et al., 2008). There is also greater HIV risk in the overlap between injecting druguse and sex work. Studies in South America, Tanzania, China and Vietnam have found that sexworkers who are injecting drug users are at higher risk of acquiring HIV than sex workers whoare not injecting drug users (Bautista et al., 2006; Nguyen et al., 2008a; Azim et al., 2006;Ross et al., 2008; Galvez-Buccollini et al., 2009; Lau et al., 2007b).Women Face Greater Stigma and Lesser Access to Harm Reduction Programs Than MenAlthough they are at high risk of HIV acquisition, female IDUs in every country have lesseraccess to services than male IDUs. “Harm reduction seeks to reduce the spread of HIV associatedwith injection drug use through outreach, education in safer practices, needle andsyringe exchange programs, access to counseling and drug treatment, and non-judgmentalapproaches…Harm reduction programs are supported by an extensive body of evidence toshow that they are cost-effective, can reduce HIV and other blood-borne pathogen transmissionand can serve as effective bridges to drug treatment and health care” (Des Jarlais andFriedman, 1998 cited in Gauri et al., 2007: 314). Women lack access to harm reduction andother health services because of even greater stigmatization than male injecting drug users aswell as women IDUs’ fear of losing custody of their children (Malinowska-Sempruch, 2002).Increasing women drug users’ access to needed services, including drug treatment, harmreduction programs, and sexual and reproductive health care services, is crucial. Women IDUsalso need legal services to reduce police and health service abuse, to access services and togain custody of children (OSI, 2008). Achieving this goal requires policies that encouragewomen to seek drug treatment and harm reduction rather than punishing or stigmatizingthem for drug use during pregnancy or motherhood; increasing availability of opioid substitutiontherapy; incorporation of sexual and reproductive health and other women’s servicesinto harm re-education programs; flexible, low-threshold services that are more convenient forwomen with children; and links between harm re-education, drug treatment, women’s shelters,and violence prevention services” (Pinkham and Malinowska-Sempruch, 2007: 3).Harm Reduction Programs Can be Scaled UpIt is critical to ensure that governments, donors, and service providers are aware of the HIVrisk for female IDUs; that HIV prevention, treatment, and care interventions take account ofthe needs of female drug users; and that female IDUs participate in policy and program development.There are effective evidenced-based interventions that reduce HIV risk for femaleIDUs and some of them are being brought to scale (see example on China, Sullivan and Wu,2007 in this section). However, many harm reduction programs remain at a pilot stage foryears, due to a lack of political will to bring them to scale (IHRD, OSI, 2008). It is time forsuccessful programs to be scaled up in order to more effectively reduce HIV prevalence, particularlyamong IDUs.WHAT WORKS FOR WOMEN AND GIRLS91