HIV prevention interventions for women who use substances

 Key take-home messages

• Generally, there is extensive research conducted on the intersection of substance use and HIV; however, there is a need for HIV prevention interventions specifically focused on women who use substances.

• HIV prevention interventions for women who use substances examined in the published literature can be divided into three broad categories: therapy and counselling; education and skill building; and biomedical interventions.

• Studies show that various adaptations of therapy interventions (e.g., Cognitive Processing Therapy, group therapy, couple-based counselling) that focused on promoting safer substance use and sexual health behaviours were associated with a significant reduction in self-reported HIV risk behaviours among women using substances, including Black, Latina and Indigenous women. Increased condom use (16), a decrease in unprotected sexual activities, and lower alcohol use were HIV risk reduction behaviours achieved by these counselling and therapy interventions.

• HIV/STI risk awareness and improved HIV risk-reduction skills among women who use substances were associated with a decrease in sexual risk behaviours (e.g., less unprotected vaginal or anal sex, more frequent condom use). Interventions that aimed to improve HIV knowledge and promote HIV prevention techniques reported an increase in safer sexual and drug-related behaviours, including increased condom use, less unprotected sex, and reduced drug and alcohol use.
• The literature on pre-exposure prophylaxis (PrEP) among women who use substances is limited, and PrEP uptake in this population remains low. Interventions such as integration of PrEP into a community-based syringe program and a patient-centred decision aid demonstrated an increase in PrEP uptake. However, PrEP adherence, stigma, fear of side effects, and accessibility issues were reported to be challenging for PrEP initiation and maintenance among women who use substances.
• The U.S. Centers for Disease Control and Prevention (CDC) online Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention categorizes the four-session group-based HIV prevention intervention (WORTH) and the culturally-tailored five-session intervention for Black women (E-WORTH) as evidence-based HIV prevention interventions (EBIs) for women who use substances.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Social support
  • Health services
  • Stigma/discrimination
• Population(s)
  • Women
  • People who use drugs
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Sexual risk behaviour
  • Drug use behaviours/harm reduction
  • Biomedical interventions
  • Education/media campaigns
• Substance Use
  • Alcohol
  • Nonmedicinal drugs
  • Tobacco
  • Other
• Health Systems
  • Delivery arrangements