The syndemic of HIV, HIV-related risk and multiple co-morbidities among women who use drugs in Malaysia: Important targets for intervention

Addict Behav. 2016 Feb:53:31-9. doi: 10.1016/j.addbeh.2015.09.013. Epub 2015 Sep 25.

Abstract

Background: Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders.

Objectives: To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia.

Methods: A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities.

Results: One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77).

Conclusions/importance: Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.

Keywords: HIV; Malaysia; Sex work; Substance abuse; Violence; Women.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • Humans
  • Malaysia
  • Prevalence
  • Risk-Taking*
  • Sex Offenses / psychology
  • Sex Offenses / statistics & numerical data
  • Sex Work / psychology
  • Sex Work / statistics & numerical data
  • Sexual Behavior / psychology
  • Sexual Behavior / statistics & numerical data
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / psychology
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / psychology
  • Women's Health