On the occasion on World AIDS Day, celebrated on 1st December every year, our Office is pleased to present a training manual on 'Reaching out to female sex partners of injecting drug users'. The manual was recently produced for the National AIDS Control Organization (NACO), Government of India with support from UNODC. The manual highlights the need to reach out to female partners of injecting drug users, as they form a group that is extremely vulnerable to HIV and is often inadequately covered by programmatic interventions.

India: Reaching out to female partners of injecting drug users

Over the last two decades, women in India have moved from being the least affected by HIV to becoming a group where HIV is becoming a major concern. Today, out of the estimated 2.27 million people living with HIV, women account for approximately 39 percent. More than 90 percent of these women acquired HIV infection from their husbands or their intimate sexual partners. While women are biologically more susceptible to HIV, prevailing socio-cultural norms increase their risk and vulnerability to contract HIV as very often women are not able to negotiate safe sex or refuse sexual relations. Exposure to violence further adds to this risk. Women suffer even more if they are married or are partners to male drug users. Both as female drug users and as female partners of male drug users, they often face double stigma and discrimination and hardly have access to services, also because of a lack of specific services for them.

Injecting drug use (IDU) is one of the major drivers of HIV in India. As per the available estimates, about 1 in every 10 injecting drug users (IDUs) in India is HIV positive. While evidence of risk of transmission of HIV from male IDUs to their female sexual partners had been present for a long time from north-east India (Panda et al 2000[1]) and Chennai city in south India (Panda et al 2005[2]), recent multisite studies have documented the risk in almost all other parts of the country.

As a response to the dual problem of IDU and HIV, the National AIDS Control Organization (NACO), Government of India has set up and is continually scaling up treatment and harm reduction interventions for injecting drug users. While there are several operational guidelines and training manuals addressing different aspects of the issue, there has been an absence of specific intervention guidelines and manuals on reducing the risk of sexual transmission of HIV from IDUs to their partners.

To address this gap, UNODC has recently developed a training manual titled 'Reaching out to Female Sex Partners of Injecting Drug Users'. The manual lays out the design and content for a training programme which addresses the needs of spouses and female partners of IDUs, such as providing information and awareness on preventing and treating HIV and sexually transmitted infections (STIs), as well as related services, such as antenatal care. It is designed as a guide for facilitators who provide training to service providers (i.e. NGOs involved in service delivery for IDUs) who work with female partners of injecting drug users. For instance, outreach workers whose predominant job involves reaching out to female partners/ wives of male IDUs.

The entire training programme, which covers topics such as HIV prevention and treatment, drug related harm, reproductive health, referral and linkage services, communication and family skills, has been designed to be participatory in nature, incorporating  group exercises,  games and power point presentations.  It can easily be adapted to local needs depending on the experience levels of the group, the setting, the culture etc. As most of the service providers are usually geared to provide services to male IDUs, reaching out and providing services to female partners of IDUs is likely to be newer area for them. This would require certain attitudinal changes along with adoption of new knowledge and skills. The manual strives to address this issue.

This manual has been field tested through training programmes organised for NGOs from twelve states in India. The feedback and suggestions derived from these trainings have been incorporated into the final publication.

Click here to access the digital version of the manual.

Click here to read UNODC Executive Director, Mr Yuri Fedotov's message for World AIDS Day 2011.

To get hard copies of the manual and the accompanying CD, please email Mr. R.Gunashekar, Regional Advisor, HIV and AIDS at r.gunashekar@unodc.org



[1] Panda, S et al (2000)."Transmission of HIV from injecting drug users to their wives in India." International Journal of STD and AIDS, 11(7), 468-473

[2] Panda, S et al (2005)."Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India." Journal of Acquired Immune Deficiency Syndrome, 39, 9-15