The advent of HIV and AIDS has affected everyone. In drug-using communities the impact on women is particularly acute. They are especially vulnerable, as both users and sexual partners of users, and they also carry the burden of possibly passing on the virus to their children.
Initially it was hoped that education and information about the virus would activate changes in behaviour. It has become increasingly evident that, while the basic facts about HIV transmission are known, the expected corresponding behaviour changes, especially the adoption of safer sex practices by women, have not occurred.
Issues for women around sexuality, pregnancy, self-esteem, and control in their lives have undermined the efficacy and success of HIV/AIDS education in this arena (see Chapter 8). Many women have contradictory feelings about their sexuality, perhaps desiring sex but feeling that they should be passive in sexual relationships. Being prepared for sex by using contraception means accepting that they are sexual and interested in sex. Women often express ambivalence about pregnancy, seeing it as the only creative thing they can do, and therefore are swayed by other emotions that make pregnancy seem attractive despite the risks or sacrifices that may be involved. Along with this, many young women have low self-esteem and feelings of lack of control over their lives, which foster neither assertiveness in sexual relationships nor an ability to negotiate safer sex.
In counselling women about safer sex it would seem that counsellors have a dual role. They must not only provide education and information about HIV and AIDS but, more importantly, they need to address the complex task of engaging women in counselling in order to examine and address the psychosocial factors which often precipitate, sustain and reinforce their current unsafe, high risk sexual practices.
As yet, we can prevent very little if they’re not talking to us! Although most women approach our drug counselling service for help with their drug problems, they tend to focus initially on problems of a practical nature such