Perceived Partner Relationships and HIV Risk Behaviors Among Recovering Female Injecting Drug Users in Jakarta

Background: The number of women who inject drugs is rapidly increasing, and women now comprise 25% of new HIV infections in Indonesia. Many women are now in recovery programs, but little is known about them. This study explored HIV risk behaviors and partner relationships among women recovering from drug use in Indonesia.

Method: 26 women who were recovering from drug use were recruited from 3 non-governmental organizations (NGOs). Ages ranged from 22-41 years, and women were drug-free for 1-5 years. Interviews were audiotaped, transcribed and translated into English. Guided by the Theory of Gender and Power (TGP), which identifies three interconnected constructs (the sexual division of labor, power, and cathexis or emotional attachment), directed content analysis was used to identify themes within this group.

Results: Women described the importance of partner and family support when they quit using drugs, and their satisfaction in gaining a “normal life” after recovery. All women engaged in HIV risk behaviors when they still used drugs, and 21 women and 12 current partners were HIV positive. Currently, 11 were either not having sex or using condoms consistently. However, 15 still engaged in unprotected sex. Women identified all three constructs as important in relationships, especially cathexis, which they described as open communication, trust and closeness. Seventeen of the 23 sexually active women said they had gender balanced relationships that included high cathexis, equal decision-making power, and economic independence or shared control over finances. Half of women in gender balanced relationships had unprotected sex. Women in male dominant relationships had gendered inequality in at least two areas, and all had unprotected sex. All but one of the women who used condoms consistently spontaneously reported that they received NGO counseling regularly.

Discussion: Despite cultural norms of male dominance in Indonesia, most women described their relationships as gender balanced. Gender and power in their relationships did not relate to their HIV risk behaviors. These results suggest that recovery programs should incorporate partner and family support and HIV education that address the needs of couples. NGO counseling services should be increased for marginalized populations, such as recovering female IDUs.