Ariel is Afro-Indigenous/white, descendant of Carib Indians, the Indigenous people of Venezuela and Trinidad and Tobago. She is a doctoral candidate at Columbia University School of Social Work. She works collaboratively with Black, Indigenous, and queer communities who use drugs, experience IPV, and are involved with the criminal-legal system.

Globally women who use drugs face pronounced disparities in health status and care. Mutually reinforcing epidemics of gender-based violence (GBV), drug use and HIV known as the “SAVA syndemic” are a key driver of such disparities. We explore, for the first time, the state of interventions to mitigate the harms wrought by the SAVA syndemic among women who use drugs, and provide recommendations for policy and practice.

We evaluated the literature via systematic review, identifying 28 trials evaluating 23 distinct interventions co-targeting two or more syndemic outcomes including GBV, HIV risk behaviors, and mental health symptoms that may mediate syndemic outcomes, published between January 1st 2000 to April 29, 2021.

Among included trials, 17 were RCTs (74%), while 6 were employed quasi-experimental designs (26%). Four (17%) interventions were pilot or feasibility studies, the majority of which were single-arm designs. Most trials (n=18; 78%) were based in the U.S. Included interventions targeted one of four syndemic indicators: drug use (n=19; 83%), mental health (13; 57 %), HIV (n=18; 78%) and gender-based violence (n=19; 3%). Seven interventions addressed all four syndemic indicators. Interventions were delivered in community-based and clinical settings, including harm reduction services, drug treatment, carceral settings, domestic violence shelters, and refugee centres. Of the 16 interventions that were adapted to meet the needs of specific subpopulations of women, only 1 was designed for transgender women.

Intervention research targeting the nexus of syndemic risk among women remains focused in the U.S., leaving entire geographic regions with high burdens of drug use unrepresented. Most studies are at the pilot stage, pointing to the urgent need for implementation research to take promising approaches to scale in communities. Future interventions should target underserved key populations of women at high risk of syndemic comorbidities, including transgender women and adolescent girls.