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

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Abstract

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.

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Acknowledgments

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).

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Authors and Affiliations

  1. Yale University, 428 Columbus Avenue, New Haven, CT, 06519, USA

    Divya Balaji & R. Douglas Bruce

  2. Department of Community and Global Health, The University of Tokyo, Tokyo, Japan

    Linda B. Mlunde

  3. Pangaea Global AIDS Foundation, Oakland, CA, USA

    Olivia C. Tran, Barrot Lambdin & R. Douglas Bruce

  4. Department of Global Health, University of Washington, Seattle, WA, USA

    Barrot Lambdin

  5. RTI-International, San Francisco, CA, USA

    Barrot Lambdin

  6. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Barrot Lambdin

  7. Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Jessie Mbwambo & Cassian Nyandindi

  8. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania

    Eva Matiko

  9. Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

    Michael Copenhaver

  10. Cornell Scott-Hill Health Center, New Haven, CT, USA

    R. Douglas Bruce

Authors
  1. Divya Balaji
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  2. Linda B. Mlunde
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  3. Olivia C. Tran
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  4. Barrot Lambdin
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  5. Jessie Mbwambo
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  6. Cassian Nyandindi
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  7. Eva Matiko
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  8. Michael Copenhaver
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  9. R. Douglas Bruce
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Corresponding author

Correspondence to R. Douglas Bruce.

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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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Balaji, D., Mlunde, L.B., Tran, O.C. et al. First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania. AIDS Behav 21, 2093–2100 (2017). https://doi.org/10.1007/s10461-016-1529-0

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