Women then face the triple stigma and discrimination threat of being HIV positive, a sex worker and a drug addict.

“Even men who inject drugs stigmatize women who inject drugs, saying you shouldn’t be doing this. I shouldn’t do it either, but I’m a man, but you have responsibilities and family support,” he said.

In an effort to avoid law enforcement, injection drug users go underground or hide. But that only takes them further from care and treatment. It’s a similar situation for sexworkers and men having sex with men.

Both Nieberg and Carty said there are no easy answers for dealing with HIV positive drug users. But they said treating addiction as a disease instead of a crime could allow more addicts to seek help.

Counseling, needle exchange programs, the use of the heroin substitute methadone could all be part of the plan. Changes in U.S. policy made last year now allow more flexibility in foreign aid programs to deal with such issues