Influence of social norms and attitudes on drug use and HIV risk behavior among women who use

drugs in Georgia

I.KIRTADZE1, D. Otiashvili1, K. O’Grady2, W. Zule3, E. Krupitsky4, W. Wechsberg3 H. Jones5,6

1 – Addiction Research Center, Alternative Georgia, Tbilisi 0177, Georgia (Republic of)2 – Department of Psychology, University of Maryland, College Park, MD 20742, USA3 – RTI International, Research Triangle Park, NC 27709, USA4 – Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg 192019, Russia5 – UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA6 – Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA

Supported by NIDA grant R01 DA029880

Background MethodData regarding illicit drug use among women in Georgia are lacking. It has been speculated that women who use drugs comprise up to 10% of the drug injecting population in the country. The present study describes the trajectory and environment in which illicit drug use by women is initiated and maintained.

In-depth qualitative interviews with 55 drug-using women in 3 cities of Georgia.

ResultsDemographics• Participant age: M=35.67, SD=9.52; range = 18-55• 78% had at least one child and 2 were pregnant at

the time of the interviews • 55% had completed at least 11 years of education • 87% had never held any job • Most of the participants had never been in contact

with HIV prevention programs – only 33% had previous contact with a harm reduction program.

ResultsInitiation of drug use• Age of initiation of injection drug use was 21 (SD=4.07; range=15-30);• Injection typically beginning with heroin or with raw opium, buprenorphine,

and home made stimulants. Home-produced amphetamine-type stimulants and opioids were the current injection drugs of choice.

• Initiation of injection drug use began with a sex partner. “ Well I would say from my experience that I wanted to try drugs, nobody forced

me. When they say that: oh, he ruined my life, he forced me to start using drugs, that’s nonsense; we ruin lives on our own. I wanted to try drugs because I thought I would feel better, I wanted to get away from problems and at first I puked but I felt much better so I tried second, third time and then I got addicted. To say the truth, I never abstained whenever there was a chance to use, but when there are no drugs, men still try to find some but when you are a woman you don’t have strength to start looking for it so you have to lye and bear this pain.”

Results

Risky injection behaviors

• When needles are lacking women are “second in a row” after male injectors.

• In some instances women are forced to inject “vtariak” – secondary drugs, extracted from the cotton swabs and filters used by others.

• Alcohol is often added on top of drugs in order to mask being under the influence of drugs.

Risky sexual behaviors

• The use of condoms with regular sex partners was virtually non-existent, even when the woman knew her partner had sexual contacts outside their sexual relationship. Rather, condoms were apparently used as a means of birth control, rather than as a means of STI or HIV prevention.

Results“I have injected with my husband’s needle, he has Hep C and probably I have it too. I have never tested…There was a girl she was something like a girlfriend of my husband’s friend, she was also a hooker and I remember a lot of times they would inject her “watered” drug or left her without it while she had already paid money.”

” When you wake up in the morning you think about getting out from home, to drink coffee with friends, after you go home to take care of children then you start calling girls to gather in the evening. We have one place where we gather and talk about collecting money, how to go, whose car to use and things like that. Jeff [name of a home-made stimulant] makes you high for 4-5 minutes and then we drink beers to prolong the condition and after that you start to talk stupid things, laugh, you can’t look in the eyes of family members… It’s better they think I’m drunk rather than under influence of drugs.”

”It might happen then man leaves a woman on “vtariaks” when there is not enough drugs or a man is in a bad mood.”

Respondents used mostly negative attitudes and adjectives to describe themselves/women who use drugs

Results

Adjective or Phrase Count Adjective or Phrase Count

Disgusting 2 Poor 12

Sick | diseased 4 Locked in her thoughts 2

Filthy | untidy 2 Weak 5

Prostitute | Slut 3 Divorced 4

Traitor | rat 2 Unemployed 9

Liar 2 Has a tough life | her family life was ruined 2

She is capable of everything (in a bad manner) | bad person

3Can do everything after injection; she can wash, clean, take care of children, she is active always on the move

6

Inadequate/ terrible communicator 3 She takes care of herself/clean/tidy 6

Not taking an interest in anything, does not care for anything, careless

7 She is not a bad person, positive person 3

Conclusions Women who use illicit drugs represent a marginalized and vulnerable segment

of the drug-using population in Georgia. Broader social norms and a gender-driven power imbalance within social networks of drug-using adults put women at increased risk of overdose and blood-borne infections. These risks occur as a result of both injection practices and sexual behaviors that are common within these networks. Because most women were unemployed, sex in exchange for drugs or money was a frequent practice among most of the women.

There is a critical need for developing comprehensive women-centered drug treatment services that are accessible, confidential, and non-judgmental. Engaging sex partners in the treatment process should be considered a potentially important aspect of treatment.

Empowering women through education, skills-building, vocational development, and strategies for violence reduction will serve to increase their self-worth and their capacity for an independent life.