title: Dual HIV risk and vulnerabilities among women who use or inject drugs:  no single prevention strategy is the answer.
abstract: OBJECTIVE
  This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies.
  
  
  RESULTS
  Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs.
  
  
  CONCLUSIONS
  HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.
authors.affiliation: Columbia University School of Social Work, New York, New York, USA. ne5@columbia.edu
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Shaw
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D003140:Communicable Disease Control / Q000379:methods; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*