Theme: Epidemiology & Public Health Research Year: 2024
Background: Women who use drugs face heightened HCV and HIV risk; yet, underlying gender differences in social and injection networks are not well understood, particularly in resource-limited countries.
Methods: We enrolled 3153 people who inject drugs (PWID) from needle and syringe programs in Kenya using respondent driven sampling. Participants completed baseline HIV, HCV, and HBV testing, and biobehavioral and social network surveys. Network members (NMs) were defined as people participants reported using drugs with and knew by name. Chi-squared and Fisher’s exact tests were conducted for associations between gender, social network, and injection behaviors.
Results: Participants were predominantly male (90.3%, N=2846), 18.9% HCV antibody-positive (N=597), and 9.6% HIV-positive (N =304). Women were significantly more likely to be HCV antibody-positive (25% vs. 18.4%, p=0.006) and HIV-positive (31.2% vs. 7.6%, p < 0.001) than men. Despite having similarly-sized networks (3.4 vs. 3.3, p=0.800) on average; compared to men, women are significantly more likely to report women as NMs (45.8% vs. 16.3%, p<0.001), have ever had sex with their NMs (17.0% vs. 4.8%, p<0.001), report more HCV-positive (6.5% vs. 2.9%, p<0.001) and HIV-positive (19.3% vs. 8.4%, p<0.001) NMs, and have injected with fewer NMs in the last 30 days (57.2% vs. 65.8%, p=0.003). Women were significantly less likely to report having injected with their female NM than males were (49.3% vs. 68.3%, p<0.001). Women in women’s networks were significantly more likely to be identified as friends (90.7% vs. 62.9%, p<0.001), while women in men’s networks are more likely to be identified as injection partners (42.5% vs 18.6%, p<0.001) and injection “patients” (11.9% vs 1.4%, p<0.001) than those in women’s networks.
Conclusion: Women face differential HCV- and HIV-related risk depending on the gender make-up of their networks. Given women’s roles within their networks vary depending on their NM’s gender, network-based interventions accounting for gender-based risks should be considered.
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