Understanding HIV vulnerability among women who inject drugs in Mozambique, 2023.

BACKGROUND

Women who inject drugs (WWIDs) belong to a group of people with high-risk behaviors for contracting HIV. In Mozambique there is still limited coverage of combined HIV prevention strategies among WWIDs. These actions, however, are hampered by the scarcity of data. This study offers a better opportunity to inform the wide range of social, contextual, and individual factors that play a role in the HIV epidemic. At the same time, it will provide crucial explanations about how these diverse factors affect the vulnerability of WWID to HIV in Mozambique.

METHODS

A qualitative study was carried out, based on interviews with 18 key informants and 30 others participants in discussions in focus groups totalizing 48 women in representation of five cities in Mozambique in 2023. The study utilized semi-structured interviews, to collect data on the demographic characteristics of the WWID and open-ended questions that explored information regarding stigma, discrimination, challenges in accessing health services, and gender-based violence. Data was analyzed thematically using NVivo.

RESULTS

WWIDs engage in common practices of sharing and renting syringes for injecting drugs. Sex work combined with unprotected sex was identified as a frequent risk behavior. WWIDs encounter stigma and discrimination in the family, street encounters, interactions with police and health facilities. Awareness of harm reduction services varies among WWIDs, with some having limited or no knowledge. Accessing harm reduction services is considered a challenge for some participants. WWIDs face violence from men, including the police, often involving extortion of monetary amounts. Incidents of sexual violence are mentioned, with underreporting being a prevalent problem.

CONCLUSION

WWIDs in Mozambique navigate a lethal intersection of poverty, gendered violence, and systemic exclusion. Stigma and geographic disparities in harm reduction services perpetuate HIV transmission and healthcare avoidance. Urgent action is needed to decentralize methadone programs, integrate gender-based violence response into HIV care, and reform punitive policing practices. Prioritizing WWID in policy-through community-led harm reduction and anti-stigma campaigns-is essential to achieving Mozambique's HIV targets and health equity goals.