What Works for Women and Girls

What Works—Prevention for Key Affected Populations: Women Drug Users and FemalePartners of Male IDUs1. Opioid substitution therapy, particularly maintenance programs with methadoneand buprenorphine, leads to reduction in HIV risk behavior among male and femaleIDUs, and is safe and effective for use by pregnant women.2. Comprehensive harm reduction programs, including needle exchange programs,condom distribution, substitution therapy and outreach, can reduce HIV riskbehaviors and prevalence among male and female IDUs.3. Peer education can increase protective behaviors among IDUs.4. Instituting harm reduction programs for IDUs in prisons can reduce HIV prevalencein female prison populations.Promising Strategies:5. Sex-segregated group sessions for IDUs can result in increased condom use and safeinjection behaviors.6. Women’s clubs along with peer education and condom distribution can reduce HIVprevalence among women who are sexual partners of male IDUs.7. Nonjudgmental targeted counseling for IDUs can reduce HIV risk behaviors.8. Increased access to voluntary HIV counseling and testing to learn one’s serostatusmay reduce needle sharing and other HIV risk behaviors.9. Programming to prevent initiation of injecting drug use shows promise in reducingthe number of IDUs and associated HIV risk behaviors.EVIDENCE1. Opioid substitution therapy, particularly maintenance programs with methadone andbuprenorphine, leads to reduction in HIV risk behavior among male and female IDUs,and is safe and effective for use by pregnant women (Metzger and Navaline, 2003; Demaanet al., 2002; Metzger et al., 2003; Ball et al., 1988 cited in Strathdee et al., 2006).A double-blind, double-dummy placebo-controlled randomized controlled trial inMalaysia of 126 detoxified heroin-dependent patients were randomly assigned to 24weeks of manual-guided drug counseling and maintenance either with naltrexone (43IDUs); buprenorphine (44 IDUs); or placebo. Buprenorphine was significantly associatedwith greater time to first heroin use and maximum consecutive abstinent days92 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS