title: HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment.
abstract: BACKGROUND
  Although an estimated 3.5 million women inject drugs globally, women are outnumbered 4 to one by men who inject drugs and are often ignored or overlooked in the development and delivery of prevention and treatment services for this population. This study aimed to identify key comorbidities prevalent among women who inject drugs (WWID), consider factors that contribute to vulnerability of this population, and examine implications for prevention and treatment.
  
  
  METHODS
  The literature was reviewed to examine the specific challenges and needs of WWID. We searched health-related bibliographic databases and grey literature to identify studies conducted among WWID and studies conducted among people who inject drugs (PWID), where results were disaggregated by gender and policies/guidelines/reports relevant to WWID.
  
  
  RESULTS
  WWID face a range of unique, gender-specific, and often additional challenges and barriers. The lack of a targeted focus on WWID by prevention and treatment services and harm-reduction programs increases women's vulnerability to a range of health-related harms, including blood-borne viral and sexually transmitted infections, injection-related injuries, mental health issues, physical and sexual violence, poor sexual and reproductive health, issues in relation to childbearing and child care, and pervasive stigma and discrimination.
  
  
  CONCLUSIONS
  There is a need to improve the collection and reporting of gender-disaggregated data on prevalence of key infections and prevention and treatment service access and program coverage. Women-focussed services and integrating gender equity and human rights into the harm-reduction programming will be a prerequisite if improvements in the health, safety, and well-being of this often invisible and highly vulnerable population are to be achieved.
authors.affiliation: *Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney; †Department of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM; and ‡Australian Injecting and Illicit Drug Users League (AIVL), Canberra.
authors.forename: Jenny
authors.initials: J
authors.lastname: Iversen
authors.forename: Kimberly
authors.initials: K
authors.lastname: Page
authors.forename: Annie
authors.initials: A
authors.lastname: Madden
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D015897:Comorbidity; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000209:etiology* / Q000517:prevention & control; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology; D006526:Hepatitis C / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D009313:National Health Programs; D015819:Substance Abuse, Intravenous / Q000150:complications*; D035862:Vulnerable Populations; D016387:Women's Health; D014932:Women's Health Services