Despite widespread recognition of the gendered nature of HIV risk, globally, women are underrepresented in HIV and drug treatment programs. Women are less likely than men to access needle/syringe exchange programs and have less access to and use of opioid substitution therapy. Women who use drugs encounter gender-related barriers to receiving appropriate and necessary HIV and drug use treatment and care, including stigma and lack of appropriate services. Moreover, women who use drugs have HIV-related risks that differ from men's risks. Women encounter HIV risks related to drug use, sex, and a constellation of personal, economic, and social factors. Female drug users also often experience high levels of poverty, financial dependence, and violence and abuse, which limit their ability to negotiate relationships and safer sex practices. The World Health Organization and UNAIDS, among others, have recognized the need for gender-specific prevention, treatment, and care programs and services; and a broad range of services for drug users that are accessible and convenient. In order to build comprehensive HIV prevention strategies that address the multiple contributors to women's HIV vulnerability, it is first necessary to understand existing systems of care, gaps in services, and the ways in which those at risk for HIV access and interact with service systems. This study will conduct a comprehensive assessment of HIV and drug use-related services for women in Ukraine to guide the development of a gender-informed, integrated service strategy that addresses the unique HIV-related risks and service needs of women who use drugs. Ukraine has one of the most severe HIV epidemics in Eastern Europe, and together with Russia accounts for almost 90 percent of Eastern Europe and Central Asia's newly reported HIV diagnoses. Women in Ukraine represent up to 40% of all HIV cases, but HIV prevention and drug use treatment programs that holistically address women's unique HIV-related needs are rare. In this 2-year project, we will conduct in-depth, qualitative interviews with 60 female drug users and 60 treatment and service providers in 2 Ukrainian cities. Interviews with women who use drugs will explore sources of support, including utilization of social safety net programs; and experiences seeking help and substance abuse treatment from governmental and nongovernmental entities. Interviews with service providers will ask about their experiences working with women who use drugs, assess their degree of gender- responsiveness, and explore how responsive they are to gender-specific contributors to women's HIV vulnerability. We will create a resource map to identify existing services and service gaps, and how service providers in a given area relate to one another (e.g., collaborative partnerships, referral systems, or antagonistic relationships). This information will be used to develop an integrated service strategy for women who use drugs that reflects the health and social service context in Ukraine. In a future, R01 study, this woman-tailored set of services and programs will be compared to existing standard packages of services.
The proposed R21 study addresses a highly relevant public health issue: how to best meet the HIV and drug use related health and social needs of women who use drugs in Ukraine, a country with one of the highest HIV rates in Eastern Europe. It seeks to identify ways to improve women's access to necessary services to help reduce their HIV risks and improve their mental, physical, and social well-being. If successful, this project has the potential to inform the development of new strategies to reach and serve this underrepresented population.
