Promising international interventions and treatment for women who use and abuse drugs: focusing on the issues through the InWomen's Group

Abstract

Globally, an estimated 205 million people use illicit drugs and among them 25 million people are drug dependent. 1,2 Although women do not constitute the majority of all alcohol and other drug users, substance use has been steadily increasing among women and particularly among young women. 2–5 Furthermore, with a few exceptions, the majority of research on women's substance abuse, interventions, and treatment has been conducted in North America, Australia, and European countries. 5 Thus, the findings from these studies are likely not representative of all female drug users worldwide. 2,3 Women are child-bearers, so reaching them and offering harm reduction and/or treatment will not only help them but also their families and future generations. 6 In addition, many countries do not have treatment that is designated for women who use drugs, nor is this treatment typically sensitive to the contextual factors that intersect with drug use and risk and reinforce women's vulnerability. 7–9 Recent studies show that women who use or abuse substances are more at risk of being raped, physically assaulted and robbed, and more likely to contract human immunodeficiency virus (HIV). 10,11 In addition, in many settings around the world, vulnerable women who use drugs often face a further challenge of stigmatiza-tion from health care providers. 12 Unmet health care needs and basic inequality manifest in women's vulnerability to greater victimization, more severe substance dependence, and disease, especially HIV/acquired immunodeficiency syndrome (AIDS). 12 The United Nations 2015 Millennium Development Goal 3 (to promote gender equality and empower women) and Goal 5 (to improve maternal health) are still largely unmet. 13 Consequently, many women remain marginalized and vulnerable. And because they lack equity and equality, these women are underserved. Researchers and health providers worldwide are concerned about the continuing unaddressed gender inequities, the contextual and cultural compromises, and the comor-bidities that often plague women who use illicit drugs. 3,14,15 From drug use initiation to abuse, key questions remain unanswered. For example, why do women start using drugs? Who initiates women into drug use? Why do so many women continue to use drugs? How do sexual risk and gender-based violence interact? How does this interface