title: HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: implications for HIV prevention, research, and policy.
abstract: BACKGROUND
  Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission.
  
  
  METHODS
  This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics.
  
  
  RESULTS
  The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01).
  
  
  CONCLUSIONS
  Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States. Electronic address: ne5@columbia.edu.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Louisa
authors.initials: L
authors.lastname: Gilbert
authors.affiliation: Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan.
authors.forename: Assel
authors.initials: A
authors.lastname: Terlikbayeva
authors.affiliation: Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7141, Baltimore, MD 21205, United States.
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Elwin
authors.initials: E
authors.lastname: Wu
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Shaw
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Mingway
authors.initials: M
authors.lastname: Chang
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
authors.forename: Tim
authors.initials: T
authors.lastname: Hunt
authors.affiliation: School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, United States.
authors.forename: Leyla
authors.initials: L
authors.lastname: Ismayilova
authors.affiliation: Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan.
authors.forename: Sholpan
authors.initials: S
authors.lastname: Primbetova
authors.affiliation: Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozental
authors.affiliation: Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan.
authors.forename: Baurzhan
authors.initials: B
authors.lastname: Zhussupov
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D040261:Harm Reduction; D006291:Health Policy; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Central Asia; Female partners of men who inject drugs; HCV; HIV; Injection drug use