title: Meeting the needs of women who use drugs and alcohol in North-east India - a challenge for HIV prevention services.
abstract: BACKGROUND
  The North-east Indian states of Manipur and Nagaland consistently report relatively high HIV prevalence. The targeted HIV prevention interventions in these two states are mostly delivered by non-government organizations (NGOs), and prevention of HIV transmission by injecting drug use is their main focus. Most injecting drug users (IDUs) are male, and the services are primarily tailored to meet their needs, which are not necessarily the same as those for women. This qualitative study describes the health service needs of women who use drugs and alcohol in Manipur and Nagaland, with the goal of identifying strategies and activities that can be implemented by NGOs wanting to improve their reach among vulnerable women.
  
  
  METHODS
  In 2009-10, semi-structured in-depth interviews were conducted with 27 key informants and nine focus group discussions (FGDs) with women who use drugs and alcohol, and two FGDs with male IDUs. The thematic areas covered included: the context of female drug and alcohol use; drug and alcohol use patterns; HIV risk behaviours; barriers and facilitators of service use; perceived health needs; and expressed health service needs. The data were recorded, transcribed, translated and thematically analysed.
  
  
  RESULTS
  The most problematic substance for women from Nagaland was alcohol, and for women from Manipur it was heroin. The most commonly identified health problems were primarily related to the women's drug and alcohol use, reproductive health and mental health. Other problems of major concern included social exclusion, violence, children's welfare, and financial difficulties. The expressed service needs of these women were women-only integrated health services, women-only detoxification and rehabilitation services, mental health services, desensitization of mainstream health workers, free access to medicines, assistance to meet basic needs, and a safe place for engaging in sex work.
  
  
  CONCLUSIONS
  The expressed health and other service needs of women who use drugs and alcohol in Manipur and Nagaland do not match the services currently provided by HIV prevention NGOs, and this may, in part, account for the relatively poor uptake of these services by women. Strategies and activities that can be implemented by NGOs to strengthen their reach to vulnerable women are identified. However, many of these women's needs are beyond the scope of services typically offered by HIV prevention NGOs, and require a coordinated multi-sectoral response.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, 161 Barry St Carlton, Melbourne, Victoria, 3010, Australia. mkermode@unimelb.edu.au
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
authors.forename: Chinzaning Hangzo
authors.initials: CH
authors.lastname: Songput
authors.forename: Collins Z
authors.initials: CZ
authors.lastname: Sono
authors.forename: Temjen Nungsang
authors.initials: TN
authors.lastname: Jamir
authors.forename: Alex
authors.initials: A
authors.lastname: Devine
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation; D003153:Community Health Services; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D007194:India; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D036301:Qualitative Research; D017678:Sex Distribution; D012923:Social Class; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation; D055815:Young Adult