Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs. 1. Introduction There are significant differences in the health status and risk practices of female injecting drug users (IDUs) as compared to male IDU. A recent comprehensive review by the Reference Group to the United Nations (UN) on HIV and injecting drug use found that compared to their male counterparts, women who inject drugs experience significantly higher mortality rates, increased likelihood of injection-related problems, faster progression from first drug use to dependence, higher levels of risky injection and/or sexual risk behaviors, and higher rates of HIV [1]. Similarly, a systematic review of studies from 14 countries found a significantly higher prevalence of HIV among female IDU than among male IDU in settings with high HIV prevalence [2], and a review of studies in nine European Union countries found that the average HIV prevalence was more than 50% higher among female IDU than among their male counterparts [3]. Research on women who inject drugs comes mainly from North America, Western Europe, and Australia. Although there is a growing body of research on female IDU in low- and middle-income countries, to date there has been no systematic analysis of the prevalence of injecting drug use among women internationally, and data on women as a percentage of people who inject drugs is sparse. In the global data holdings on injection drug use and HIV maintained by the Reference Group to the UN on HIV and injection drug use, none of the countries
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