Women substance abusers, particularly those who are injecting drug users, are at high risk for HIV infection. It has been demonstrated that injecting drug users found out of drug treatment settings show different patterns of drug use and HIV risk than those who enter treatment. Previous studies, however, have not indicated the extent to which women injectors in and out of treatment exhibit these same differences. This study examines data from two studies sponsored by the National Institute on Drug Abuse to determine similarities and differences between women encountered by outreach efforts in four cities and those entering methadone treatment programs in the same cities.
The results indicate significant differences in race, drugs used (both injecting and non-injecting), injecting risk behavior, and treatment history. However, the two groups of women shared similar histories of first injecting use and sexual risk. Women who entered methadone treatment reported higher frequencies of injecting drug use and HIV risk behaviors, both direct (sharing needles) and indirect (sharing cookers, cotton, and water); yet they were also more likely to clean needles and to use new needles than the women encountered through outreach. The outreach women were more likely to be African American, to inject less than daily, and to use alcohol, crack, and non-injecting cocaine daily.
The results suggest that women injectors entering treatment and those encountered in outreach are very different in their injecting intensity and HIV risk behaviors. However, both groups are still at risk for HIV infection, particularly as a result of multiple sexual partners and little reported condom use. The need to identify the risk, reinforce risk reduction maintenance, and further develop HIV prevention strategies that successfully address both the needs of these women and the differences that exist between them will be essential to stopping the spread of HIV.
