Structural Interventions for HIV Prevention Among Women Who Use Drugs: A Global Perspective.

We briefly review extant literature on the contextual sources of HIV risk among drug users—the drug user risk environment—and on structural interventions to address drug user vulnerability to HIV. We argue that issues of gender inequality and gendered power relations are largely absent from this literature. We then identify 5 contextual factors that are critical for understanding women's HIV-related vulnerability and whose impacts are exacerbated among women who use drugs, including a division of reproductive labor in which women bear primary responsibility for family caretaking, women's lack of full access to or control of productive resources and decision making, women's vulnerability to sexual and physical violence, and especially, intimate partner violence, women's (particularly heterosexual women's) relationship dependency and limited power in sexual interactions, and harmful gender norms that reinforce these other factors. We discuss a range of structural interventions and structural intervention approaches with the potential to address these contextual factors and call for more research, both to better understand the risk environment of women who use drugs and the impacts of structural interventions on it. We argue that our understanding of and ability to impact on the HIV-related risk environment of drug users is incomplete if we do not fully incorporate the analysis of gender inequality and gendered power relations.