title: First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania.
abstract: High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.
authors.affiliation: Yale University, 428 Columbus Avenue, New Haven, CT, 06519, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Balaji
authors.affiliation: Department of Community and Global Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Linda B
authors.initials: LB
authors.lastname: Mlunde
authors.affiliation: Pangaea Global AIDS Foundation, Oakland, CA, USA.
authors.forename: Olivia C
authors.initials: OC
authors.lastname: Tran
authors.affiliation: Pangaea Global AIDS Foundation, Oakland, CA, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.|RTI-International, San Francisco, CA, USA.|Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Barrot
authors.initials: B
authors.lastname: Lambdin
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Jessie
authors.initials: J
authors.lastname: Mbwambo
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Cassian
authors.initials: C
authors.lastname: Nyandindi
authors.affiliation: Centers for Disease Control and Prevention, Dar es Salaam, Tanzania.
authors.forename: Eva
authors.initials: E
authors.lastname: Matiko
authors.affiliation: Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Copenhaver
authors.affiliation: Yale University, 428 Columbus Avenue, New Haven, CT, 06519, USA. dbruce@cornellscott.org.|Pangaea Global AIDS Foundation, Oakland, CA, USA. dbruce@cornellscott.org.|Cornell Scott-Hill Health Center, New Haven, CT, USA. dbruce@cornellscott.org.
authors.forename: R
authors.identifier: http://orcid.org/0000-0003-4184-8748
authors.initials: R
authors.lastname: Douglas Bruce
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D000074386:Gender-Based Violence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D015995:Prevalence; D012747:Sexual Partners; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Female drug users; Gender-based violence; HIV; Heroin; Methadone