AIDS and Behavior

, Volume 21, Issue 7, pp 2093–2100 | Cite as

First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania

  • Divya Balaji
  • Linda B. Mlunde
  • Olivia C. Tran
  • Barrot Lambdin
  • Jessie Mbwambo
  • Cassian Nyandindi
  • Eva Matiko
  • Michael Copenhaver
  • R. Douglas Bruce
Original Paper


High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case–control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11–0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04–0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01–0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.


Heroin HIV Female drug users Methadone Gender-based violence 



We are incredibly grateful to Godfrey Amadeus and Lutengano Julius (MAT peers) for their incredible dedication to fieldwork, the respondents of this study, and the Tanzania Network of People who use Drugs for linking us with other members of the study population. We also wish to thank Professor Stephen C. Stearns (Yale University), without whose support, none of this would have been possible; and Professors Elizabeth Bradley (Yale University) and the Yale Global Health Fellowship for the mentorship and academic advise. Finally, we thank the staff and clients of Muhimbili and Mwananyamala Methadone Clinics, and all concerned Community Based Organizations and Non-governmental organizations in Dar es Salaam, for their cooperation and support. Support for this manuscript was also provided by NIDA K02DA033139 (Copenhaver).

Compliance with Ethical Standards

Conflict of Interest

Divya Balaji, Linda B. Mlunde, Olivia Chang, Barrot Lambdin, Jessie Mbwambo, Cassian Nyandindi, Eva Matiko, Michael Copenhaver, and R. Douglas Bruce have no conflicts of interest

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Divya Balaji
    • 1
  • Linda B. Mlunde
    • 2
  • Olivia C. Tran
    • 3
  • Barrot Lambdin
    • 3
    • 4
    • 5
    • 6
  • Jessie Mbwambo
    • 7
  • Cassian Nyandindi
    • 7
  • Eva Matiko
    • 8
  • Michael Copenhaver
    • 9
  • R. Douglas Bruce
    • 1
    • 3
    • 10
  1. 1.Yale UniversityNew HavenUSA
  2. 2.Department of Community and Global HealthThe University of TokyoTokyoJapan
  3. 3.Pangaea Global AIDS FoundationOaklandUSA
  4. 4.Department of Global HealthUniversity of WashingtonSeattleUSA
  5. 5.RTI-InternationalSan FranciscoUSA
  6. 6.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  7. 7.Department of Psychiatry and Mental HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
  8. 8.Centers for Disease Control and PreventionDar es SalaamTanzania
  9. 9.Department of Allied Health SciencesUniversity of ConnecticutStorrsUSA
  10. 10.Cornell Scott-Hill Health CenterNew HavenUSA

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