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Risks, Experiences, and Needs of Female Intravenous Drug Users

Executive Summary

1. Which of the following act as a predictor for initiation into injecting drug use?

A. Engagement in sex work

B. Lifetime history of sexual abuse

C. Same-sex attracted women

D. All of the above


2. Women are almost universally more likely to cite social influence or peer pressure as their primary motivation for transitioning to injecting and to be transitioned by their male sex partners.

A. True

B. False


3. For many women, the emotional benefits they receive from their IDU relationship outweighs the risks they face from injecting.

A. True

B. False


4. Unsafe sexual practices are common in IDU partnerships and women report:

A. More high-risk sexual behaviors than men.

B. Higher rates of HIV than men.

C. Both (A) and (B).

D. None of the above.


5. Women are less likely to share equipment than men.

A. True

B. False


6. Female IDU who have had female sexual partners consistently have higher prevalence rates of HIV than strictly heterosexual women.

A. True

B. False


7. Which of the following is the primary source of risk that may explain the higher rates of HIV among female IDU sex workers?

A. The types of partners that these females take.

B. The behaviors these females are willing to engage in.

C. Both (A) and (B).

D. None of the above.


8. Opioid substitution treatment is the preferred method of treatment for pregnant opioid users with _____ showing high levels of efficacy and safety for both the mother and the child.

A. Methadone

B. Buprenorphine

C. Both (A) and (B)

D. None of the above


Initiation to Injection

9. It has been hypothesized that the period during which injectors may be at greatest risk stems from new injector engagement in risky behaviors because of:

A. Ignorance of the risks.

B. Lack of planning around injections.

C. The influence of their initiators.

D. All of the above.


10. Engagement in sex work for women has been linked to an increased risk of initiation to injecting drug use.

A. True

B. False


11. All of the following are reported as commonly used in developed countries in the lead-up to an injector’s first injection, except for:

A. Sedatives

B. Alcohol

C. Non-injected heroin

D. Amphetamines


12. A US study of non-injecting heroin users who transitioned to injection found that one of the strongest individual attribute predictors of initiating to injecting included:

A. Having friends who thought it was acceptable to inject drugs.

B. Engagement in sex work.

C. Having ever been in a foster home or orphanage.

D. Self-identifying as gay, lesbian, bisexual, or transgender.


13. Engagement in early delinquent behaviors such as _____ have been shown to have strong associations with initiation to injecting drug use in women.

A. Truancy

B. Juvenile arrests

C. Running away

D. All of the above


14. Which of the following associations have been found with being younger than 17 years at initiation of injection?

A. Not planning the first injection.

B. Shorter and less diverse pre-injecting drug career.

C. Reporting curiosity as the primary motivation for injecting.

D. All of the above.


15. Women, compared to men, are less likely to _____ at the time of their first injection.

A. Inject alone

B. Inject in a social setting

C. Have their sexual partner present

D. All of the above


16. Injection with heroin relative to other drugs has been associated with increased risk of syringe sharing, trading sex, and is the drug most predictive of HIV positive status among drug users.

A. True

B. False


Women, Their Partners and Injecting Drug Use

17. Which of the following is a potential impact on the life of a non-injecting woman partnered with an IDU?

A. They may have a significant financial responsibility within the partnership.

B. They may have a significant discordance in sexual desire and practice with that of the injecting partner.

C. They are exposed to the risk of acquiring HIV and other blood-borne diseases through the injection and sexual risk behaviors of their partner outside of the relationship.

D. All of the above.


18. Risky sex may be a more significant risk factor for HIV transmission than injection behavior.

A. True

B. False


19. Prevention research has consistently demonstrated how socially embedded meanings tied to intimacy, such as trust, may lower the perception of risk attached to needle-sharing and unprotected sex between IDU partners encouraging them to engage in otherwise risky behaviors.

A. True

B. False


20. Studies have found that characteristics and risks _____ contributed to higher rates of HIV among women.

A. Of non-steady sexual partnerships

B. Taken within steady partnerships

C. Both (A) and (B)

D. None of the above


21. Studies have found that women who are dependent on their partner for housing or drugs are ten times less likely to ask them to use condoms than non-dependent women.

A. True

B. False


22. Compared to men, women are more likely to experience injecting-related problems, in particular:

A. Endocarditis

B. Prominent scarring or bruising

C. Difficulty in finding a vein

D. Swelling of hands and feet


23. Overall, couple-based approaches to HIV risk reduction have been found to be efficacious in _____ among drug-involved couples.

A. Increasing condom use

B. Decreasing drug use

C. Decreasing HIV risk behaviors

D. All of the above


24. Experiencing IPV:

A. Reduced the likelihood of always using condoms and requesting partners to use condoms.

B. Is associated with having multiple intimate partners and sex work while not using condoms.

C. Is associated with injecting drugs.

D. All of the above.


Women, Sex Work and Injecting Drug Use

25. Findings suggest that female sex workers have _____ compared to women from the general community - a factor that puts them at increased risk for contraction of HIV and other blood-borne diseases.

A. Higher rates of illicit drug use

B. Heavier use of alcohol and tobacco

C. Higher rates of sharing injecting equipment

D. All of the above


26. Generally, where prohibited activities are used as an income source to procure drugs, high costs associated with illegal substance deter and regulate drug use among all individuals.

A. True

B. False


27. While initial involvement in sex work may serve as a temporary means of supporting a drug habit, the psychological distress resulting from involvement in sex work may actually lead to increased drug use, creating a cyclical effect.

A. True

B. False


28. Which of the following has been reported as a positive effect of sex work?

A. Income generation opportunities

B. A potential source of positive body image

C. Autonomy and empowerment

D. All of the above


29. Many of the harms of commercial sex work are related to all of the following, except for:

A. The sexual activity involved

B. The risky environments

C. The larger socio-legal context

D. All of the above are directly related to the harms of commercial sex work


30. Female IDU sex workers accept drug using clients who have been rejected by higher status sex workers.

A. True

B. False


31. A study of IDU street sex workers found that where clients were willing to offer more money or drugs, the women were often willing to engage in unsafe sexual practices citing their need for money or drugs as a greater concern than the possibility of disease.

A. True

B. False


32. It is suggested that:

A. Injection or injection risk behaviors are a product of engagement in sex work.

B. Engagement in sex work may include environmental factors that necessitate some of the injection risks and that those engaged in sex work may have higher levels of dependence that require more frequent and urgent injection.

C. Both (A) and (B).

D. None of the above.


33. All of the following are personal characteristics associated with female IDU who initiate into sex work, compared with female IDU not engaged in sex work, except for:

A. Younger age of initiation to injecting

B. Less likely to be married

C. Shorter injection careers

D. Reporting greater than once daily injections


34. Given the high levels of sex work within the IDU community, harm minimization services should be included in all sex work outreach programs and safer sex messages should be included with all IDU outreach programs.

A. True

B. False


Women IDUs, HIV Prevention and Drug Treatment

35. Treatment modalities most likely to be entered by pregnant women are:

A. Methadone and long-term residential programs.

B. Outpatient programs.

C. Detoxification programs.

D. All of the above.


36. Studies have shown that female IDU are more likely to enter and remain in treatment when:

A. Their IDU partners do the same.

B. They do not have an IDU partner.

C. Both (A) and (B).

D. None of the above.


37. For each additional year of drug use there has been found to a _____ increase in the likelihood of membership in the higher motivation for treatment group.

A. 4%

B. 12%

C. 25%

D. 47%


38. Which type of treatment is designed to reach vulnerable clients who may need a safe place away from violence, as well as other practical supports such as clean injecting equipment, safer sex aids, food, shelter, and clothing?

A. Residential

B. Outpatient

C. Low threshold

D. All of the above


39. Outpatient treatment is designed to maximize contact and access by not requiring clients to stop using, determining where substance users gather, offering drop-in rather than appointment-based services, not requiring clients to identify themselves, offering basic survival services and opening at convenient times.

A. True

B. False


40. Results generally suggest that treatment with _____ provides benefits to the mother but may attenuate NAS.

A. Buprenorphine

B. Methadone

C. Both (A) and (B)

D. None of the above


41. Needle exchange programs have not been shown to reduce HIV incidence in IDU.

A. True

B. False


42. Which of the following is a variable directly associated with treatment entry?

A. HIV-risk injecting behavior

B. Prior treatment experience

C. Lengthy duration of drug use

D. All of the above


43. Stigma around women drug users stereotype them as:

A. Engaging in deviant sexual behaviors

B. Being ‘bad women’

C. Being incapable of caring for their children and families

D. All of the above


44. The main structural barrier to seeking treatment is:

A. Lack of childcare

B. Rigid program schedules

C. Insufficient service provision for injectors

D. Location and cost of treatment programs


45. Which of the following is a structural barrier in the US that hinders access to outpatient methadone maintenance programs?

A. The need to pay back bills.

B. To prove at least a two-year history of heroin use.

C. Both (A) and (B).

D. None of the above.


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