This document summarizes a study on risk, stigma, and policy implications related to seeking care among drug-using women in Georgia. Qualitative interviews found that drug-using women face high stigma due to conservative social norms and their drug use. They have low self-esteem and experience stigma both for their drug use and potential HIV status. There are also few women-focused treatment services and providers sometimes have hostile attitudes. This creates major barriers to women seeking and receiving care. The study concludes there is a need for more comprehensive, confidential, and non-judgmental women-centered treatment services, as well as efforts to empower women to reduce these risks and barriers.

1. 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, USA
3 – RTI International, Research Triangle Park, NC 27709, USA
4 – Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg 192019,
Russia
5 – UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
6 – Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins
University, Baltimore, MD 21224, USA
Supported by NIDA grant R01 DA029880

2. 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.

3. 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)

4. 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

5. 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 sampling
Eligibility 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

6. 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)

7. 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)

8. 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)

9. 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)

10. 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.

11. 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

12. Publications

13. Publications

14. 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

15. Thank you
Questions?
Critics?
Comments?
irma@altgeorgia.ge