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The study is assessing the development of an efficacious comprehensive women-centered drug treatment model. This presentation demonstrates results from qualitative research.
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Risk and stigma in seeking care and policy implications
I.KIRTADZE1, D. Otiashvili1, K. O’Grady2, W. Zule3, E. Krupitsky4, W. Wechsberg3 H. Jones5,6
1 – Addiction Research Center, Alternative Georgia, Tbilisi 0177, Georgia (Republic of)2 – Department of Psychology, University of Maryland, College Park, MD 20742, USA3 – RTI International, Research Triangle Park, NC 27709, USA4 – Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg 192019, Russia5 – UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA6 – Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
Supported by NIDA grant R01 DA029880
Outline
• Georgian Context
• Study Design
• Qualitative Results- Drug using women- Health care providers
• Current & Future Directions
All authors declare that they have no conflicts of interest related to this presentation.
Background
● Territory - 69,700 square kilometers
● Current population - 4.3 million
● One of the first countries to adopt Christianity
● Suffered from civil unrest and economic crisis
during the 1990s until the Rose Revolution of 2003
● 40,000 problem drug users
● WOMEN drug users?
• Use of home-made drugs is common: “Vint” and
‘Jeff’ (made from pseudoephedrine) and crocodile
(made from codeine)
Studies about female drug use No prior studies had been conducted IMEDI: HIV and Drug Use in Georgian Women – Supported by NIDA grant
R01 DA029880 Aim 1. Explore drug use, risky behaviors, treatment barriers and
experiences among Georgian women who inject drugs. Aim 2. Treatment providers practices and perceptions regarding women
who inject drugs. Aim 3. Adapt and pilot Reinforcement-Based Treatment (RBT) that
integrates the evidence-based Women’s Co-Op HIV prevention, and a case management approach for Georgian women who inject drugs
Aim 4. Small-scale RCT
Methods
• 55 qualitative in-depth interviews with female who use drugs (FWUD)
• snowball sampling
Eligibility for participation included: - conversant in Georgian
- able to provide informed consent- age 18 or older- actively injecting drugs (injected within the past 30 days, as evidenced by venipuncture stigmata)
- sexually active (at least once in the past 30 days)
• 34 qualitative in-depth interviews with health care providers (HCP)
• purposive samplingEligibility for participation included - conversant in Georgian
- willing to participate in the study- have 2 or more years of working experience in health care sector
- have had contact with women who inject drugs during past 2 months
Mean (SD) Age, in years 35.7 (9.5)
Education
School 30 (55%)
College 5 (9%)
University (unfinished) 5 (9%)
University 15 (27%)
Unemployed 48 (87%)
Marital Status
Single 5 (9%)
Cohabiting 12 (22%)
Separated/Divorced/Widowed 16 (29%)
Marriage 15 (27%)
Remarriage 7 (13%)
Mean (SD) Number of Children 1.3 (1.0)
(Kirtadze et al., 2013; Otiashvili et al., in press)
Demographic Characteristics of Females (N=55)
Georgian 34 (100%)
Females 24 (71%)
Mean (SD) Age, in years 42.6 (9.9)
Mean (SD) Years of Education 17.0 (1.4)
Highest Degree
PhD 4 (12%)
MD 22 (65%)
Nurse 2 (6%)
Undergraduate 6 (18%)
(Kirtadze et al., 2013; Otiashvili et al., in press)
Demographic Characteristics of Providers (N=34)
Results
• Risks
- Context of orthodox Georgian society
- Low self-esteem / STIGMA
- No respondent who had experienced violence was ever referred
to police, a physician, or a psychologist
- Drug-using women are twice stigmatised
- HIV/AIDS is highly stigmatizing in Georgia
(Kirtadze et al., 2013; Otiashvili et al., in press)
Results
• Barriers to being in Treatment or Receiving Services:
- Lack of women focused services in the country
- Lack of information about drug addiction treatment among
women who use drugs
- Drug-using partner / family
- Stigma related to treatment entry
- Hostile and judgmental attitude of health service providers
- Lack of confidentiality / Strict national drug policy
(Kirtadze et al., 2013; Otiashvili et al., in press)
Limitations
♦ Sampling approach was not random. ♦ Thus, sample may not be fully representative of injection-drug-
using women in Georgia. ♦ Findings are based on self-reports provided during in-depth
interviews, creating a potential bias in reporting that threatens the validity of our findings.
However, to minimize this threat participants were guaranteed confidentiality and individual face-to-face interviews were conducted in private settings.
Conclusions Women who use illicit drugs represent a marginalized and
vulnerable segment of the drug-using population in Georgia. Broader social norms and a gender-driven power imbalance
impacts on her treatment seeking behavior. There is a critical need for developing comprehensive women-
centered drug treatment services that are accessible, confidential, and non-judgmental.
Empowering women through education, skills-building, vocational development, and strategies for violence reduction will serve to increase their self-worth and their capacity for an independent life.
There is critical need for policy reform
Publications
Publications
Acknowledgement• Study participants• IMEDI US/GEO team
– Kevin O’Grade– Keryn Merphy– Natia Topuria– Marina Chavchanidze– Mariam Sinjikashvili– Lika Kirtadze– Mariam Chelidze– Lile Batselashvili
• Special thanks to Hendree Jones and Wendee Wechsberg
• NIDA R01 DA029880
