In Scotland more than half of those infected with HIV acquired their infection through injecting drug use; approximately one-third of these are women. Of concern for the future is the rising number of people infected heterosexually, of whom two-thirds are women (see Chapter 1). The majority of those infected with HIV are young, with women on average younger than men and those infected through drug use younger than those infected through other routes (Communicable Diseases (Scotland) Unit, 1991). Injecting drug use closely correlates with socio-economic deprivation and, since heterosexual spread in Scotland also usually has its origins in injecting drug use, many of those infected have a background of other social problems. The situation in Scotland clearly demonstrates that HIV infection has relevance for everyone, even though many will be unaware that they are at risk. It also demonstrates the major implications for women, for their own health, for their children’s health through the risk of vertical transmission, and consequently for their reproductive choices. In addition to coping with the possibility and actuality of HIV infection, many women will also have to deal with drug use or other problems due to socio-economic deprivation.
In my post as consultant obstetrician and gynaecologist I lead the team which provides the Glasgow Women’s Reproductive Health Service for women with social problems. Due to the correlation between injecting drug use and social deprivation we care for many women who use drugs or are partners of drug users and consequently women with HIV infection. Our service is multidisciplinary, with contributions from a wide range of professionals both medical and non-medical, and all members of our team are experienced in dealing with the issues involved. Care is delivered through community-based clinics where women can receive help with all their problems at the same time. They can reach the service by any route they choose, including self-referral, at any time they choose, with or without an