Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence

Jamila K Stockman¹, Natasha Ludwig-Barron¹, Monica A Hoffman², Monica D Ulibarri³, Typhanye V Penniman Dyer<sup>4

1</sup>Division of Global Public Health, Department of Medicine; ²Department of Communication and Science Studies; ³Department of Psychiatry, University of California, San Diego, La Jolla, CA; ⁴Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA

Abstract: The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence.

Keywords: human immunodeficiency virus, acquired immune deficiency syndrome, interventions, drugs, women, partner violence, gender-based inequalities