amfAR, The Foundation for AIDS Research

Gender-Based Risks for HIV among Drug Users

by Jeffrey Laurence, M.D.

November was a stellar month for the publication of research linked to amfAR-funded fellows. And it was a very international representation. Three of these young researchers, all Mathilde Krim fellows, described their work in major biomedical journals: Rogier Sanders from Amsterdam reported on the role of dendritic cells in mucosal transmission of HIV; Andres Finzi of Harvard explored methods of evaluating the efficiency of drugs blocking HIV entry into cells; and Navid Madani, also of Harvard, examined encapsulation of anti-HIV compounds in fat as one type of microbicide. But here I’ll report on the accomplishments of a fourth young scientist from London, amfAR fellow Gail Gilchrist.  


Worldwide, one in six injecting drug users are HIV-positive, but the numbers are skewed toward women. Dr. Gilchrist, working with colleagues from the Substance Use Disorders Research Group in Barcelona, examined behavioral and psychiatric differences between male and female drug users that might put women at greater risk for acquiring and transmitting HIV. Writing in the journal AIDS and Behavior, she notes that several studies have shown that women who use drugs more often require assistance injecting drugs and engage more in sex trading and unsafe sex with a regular partner than men who use drugs. But Gilchrist and colleagues wanted to delve deeper into this sexual dichotomy.    

They note that there is a higher prevalence of intimate partner violence among female drug users than non-drug users. And among women who are HIV-positive or at risk for HIV, the prevalence of such violence is at least 30 percent, which is three times, greater than in the general population.  Women who have experienced such violence are less likely to use condoms and more likely to share needles, have more sexual partners, and trade sex.    

Dr. Gilchrist studied 118 female drug users, 27 percent of whom were HIV-positive, over a 22-month period. Psychiatric, behavioral, and social risk factors for HIV were analyzed. The qualitative findings, related to personality and major depressive disorders, illuminated the multiple ways in which psychiatric conditions and male drug-using partners interact and contribute to heightened HIV risk among drug-using women. For example, abusive male partners impacted a woman’s ability to negotiate safer sex.  Unprotected sex with drug dealers was the norm. And depression, associated with drug use and sexual risk behaviors, was linked to HIV acquisition. “Interventions should address all aspects of female drug users’ lives to reduce HIV,” the authors concluded.