Psychosocial determinants of sexual practices among women using heroin and other drugs: a systematic literature review

Introduction Women using heroin and other drugs (WHOD) are at high risk of sexually transmitted infections (STIs) and blood-borne viruses (BBVs). However, little attention has been paid to identify the psychosocial determinants of sexual practices among these women. An overview of these determinants could be key for health professionals and policy makers, to tackle STIs and BBVs and promote health among WHOD. The main aims of this study were to review the literature on the psychosocial determinants of sexual practices among WHOD, and to determine the nature and quality of the evidence. Methods The search strategy included five databases: PubMed, EMBASE, PsycNET, Web of Science and Scopus. PsycEXTRA was used for grey literature and other publications. Search terms included ‘women*, ‘heroin use*’, ‘sexual behaviour*’, and ‘HIV’. Only publications in English, and published between 1995 and June 2016 were included. The PRISMA 2009 guidelines and the Hawken method were used for quality assessment purposes. This systematic review was registered with PROSPERO (Ref. CRD42016039842). Results Out of the 11 985 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n=27) quantitative studies (n=23), amounting 10 808 women. Psychosocial determinants identified included socio-demographic characteristics, sexual orientation, financial constraints, gender roles, gender-based violence, HIV status, feelings of love and trust, and unavailability of condoms. Conclusion This systematic review provides an insight into the psychosocial determinants of sexual risk practices of WHOD, and highlights the importance of conducting women-only studies. It also identifies research gaps, such as the need to focus on protective factors, relationship dynamics, sexual risks with non-paying partners, and the study of the broader sociocultural context of sex and sexuality. Overall, these findings could be crucial for the development of preventive strategies to tackle STIs and BBVs, and promote the sexual health and psychosocial wellbeing of WHOD.