title: Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia.
abstract: BACKGROUND
  While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection.
  
  
  OBJECTIVE
  To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission.
  
  
  METHODS
  A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping.
  
  
  RESULTS
  Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT.
  
  
  CONCLUSIONS
  Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.
authors.affiliation: a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.|c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Wickersham
authors.affiliation: a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.|b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA.
authors.forename: Kelsey B
authors.initials: KB
authors.lastname: Loeliger
authors.affiliation: a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.affiliation: c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Veena
authors.initials: V
authors.lastname: Pillai
authors.affiliation: a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.|c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.affiliation: a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.|b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA.|c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult
keywords: Malaysia; injection drug use; pregnancy; substance abuse; women