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Burlew AK, McCuistian C, Lanaway D. Culturally adapted safer sex skills building: development and initial testing of an HIV prevention intervention for Black women using substances in the United States. HEALTH EDUCATION RESEARCH 2023; 38:527-536. [PMID: 37791870 DOI: 10.1093/her/cyad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Black women who use substances in the United States face unique human immunodeficiency virus (HIV) risk factors. However, interventions addressing cultural factors relevant for preventing HIV risk behaviors among Black women are limited. This project aimed to develop and initially test the effectiveness of a culturally adapted version of safer sex skills building (SSSB), an evidence-based HIV prevention intervention for reducing HIV risk among Black women who use substances. The cultural adaptation procedures involved (i) review of existing literature, (ii) use of Delphi process and theater testing to generate an adapted version, (iii) theater testing of the culturally adapted version and (iv) initial testing. Forty-eight Black women recruited from a substance use treatment clinic in the United States participated in three 2.5-h sessions of a culturally adapted or a generic version of the intervention. More (48%) women in the culturally adapted version self-reported condom use with casual partners compared to women in the generic (29%) version at a 6-week follow-up. The two groups did not differ on self-reported condom use with main partners. The culturally adapted SSSB offers a promising intervention for sexual risk reduction among Black women who use substances. Moreover, the findings advance the field by illustrating a concrete methodology for cultural adaptation.
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Affiliation(s)
- A K Burlew
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - C McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., San Francisco, CA 94110, USA
| | - D Lanaway
- Department of Psychiatry, University of Texas Southwestern, 5161 Harry Hines Blvd., Dallas, TX 75390, USA
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Carter A, McManus H, Ward JS, Vickers T, Asselin J, Baillie G, Chow EPF, Chen MY, Fairley CK, Bourne C, McNulty A, Read P, Heath K, Ryder N, McCloskey J, Carmody C, McCormack H, Alexander K, Casey D, Stoove M, Hellard ME, Donovan B, Guy RJ. Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019. Med J Aust 2023; 218:223-228. [PMID: 36854387 PMCID: PMC10952992 DOI: 10.5694/mja2.51864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health. DESIGN, SETTING Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS). PARTICIPANTS First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019. MAIN OUTCOME MEASURES Positive infectious syphilis test rate; change in annual positive test rate. RESULTS 180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years. CONCLUSION The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.
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Affiliation(s)
- Allison Carter
- The Kirby InstituteSydneyNSW
- Australian Human Rights InstituteSydneyNSW
| | | | | | | | - Jason Asselin
- Centre for Population HealthBurnet InstituteMelbourneVIC
| | | | - Eric PF Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Marcus Y Chen
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
| | - Christopher K Fairley
- The Kirby InstituteSydneyNSW
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Christopher Bourne
- New South Wales Ministry of HealthSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
| | - Anna McNulty
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
- University of New South WalesSydneyNSW
| | - Phillip Read
- The Kirby InstituteSydneyNSW
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Kevin Heath
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Nathan Ryder
- Hunter New England Sexual Health Pacific ClinicNewcastleNSW
| | | | | | | | - Kate Alexander
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | - Dawn Casey
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | | | | | - Basil Donovan
- The Kirby InstituteSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
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Duby Z, Bergh K, Jonas K, Reddy T, Bunce B, Fowler C, Mathews C. “Men Rule… this is the Normal Thing. We Normalise it and it’s Wrong”: Gendered Power in Decision-Making Around Sex and Condom Use in Heterosexual Relationships Amongst Adolescents and Young People in South Africa. AIDS Behav 2022; 27:2015-2029. [PMID: 36441410 PMCID: PMC10149448 DOI: 10.1007/s10461-022-03935-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
AbstractWe examined power and decision-making in heterosexual relationships amongst South African adolescents and young people. A survey conducted with 515 adolescent girls and young women (AGYW) included items from the Sexual Relationship Power Scale (SRPS) adapted for South African women. Qualitative interviews with fifty AGYW aged between 15 and 24, and nine males aged 18 years and above, explored decision-making in heterosexual relationships, particularly relating to timing of sex and condom use. Theories of gendered power, sexual relationship power and sexual scripting were used in interpreting the data. Findings showed that the power AGYW have in sexual relationships determines their ability to use condoms, and that males generally control condom use and timing of sex. Both survey and interview data suggest that male control over female partners’ behaviour also extends beyond the sexual domain. Although while male power is pervasive and enduring, it is simultaneously contested and negotiated. Despite some young people believing that gendered power in decision-making should be equal, it is not always possible for AGYW to enact agency in the dyadic context of heterosexual relationships. Whilst adolescents and young people in South Africa move away from traditional cultural gendered expectations, relationship power inequity and hegemonic masculinities continue to legitimise men’s power over women, constraining the sexual agency of adolescent girls and young women and discouraging them from taking control of their own sexual interests and sexual health.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Brittany Bunce
- Institute for Global Sustainable Development (IGSD), University of Sheffield, Sheffield, UK
| | - Chantal Fowler
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Recent Partner Violence, Sexual Relationship Power, and STIs among Women Who Use Methamphetamine: Does Type of Sexual Partner Matter? J Urban Health 2020; 97:387-394. [PMID: 32232654 PMCID: PMC7305268 DOI: 10.1007/s11524-020-00435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Methamphetamine use, sexual relationship power (SRP), and partner violence (PV) are associated with increased risk of sexually transmitted infections (STIs) among women. The objective of our study was to examine the association of recent PV and SRP on STIs by partner type among HIV-negative, heterosexual women who use methamphetamine in San Diego, CA. Using baseline survey data from 209 women enrolled in FASTLANE II, an HIV behavioral intervention trial, we conducted logistic regression analyses to examine associations between PV, SRP, and self-reported lifetime STIs (e.g., chlamydia, gonorrhea). Models focused on PV perpetrated within the past 2 months by: (1) spouse, live-in, or steady sexual partners and (2) casual or anonymous sexual partners. Seventy-eight percent of women reported lifetime physical PV and 57% reported lifetime sexual PV. In the past 2 months, 19.6% reported physical and/or sexual violence by a spouse, live-in, or steady sexual partner, and 7.2% reported physical and/or sexual PV by a casual or anonymous partner. Median SRP score was 2.36 (interquartile range: 2.02-2.68). Twenty-six percent of women reported ever being diagnosed with ≥ 1 STI. While recent physical violence and sexual violence were not associated with STI history among women in steady relationships, women who reported recent sexual violence by casual/anonymous partners were approximately 8 times more likely to ever have an STI compared with those with no history of recent PV by casual/anonymous partners (AOR: 7.70; 95% CI: 1.32, 44.84). SRP was not associated with lifetime STIs among women who reported either partner type. Our findings support a relationship between recent sexual violence perpetrated by casual/anonymous partners and women's STI history. Women who use methamphetamine need help in navigating partner violence experiences. Risk reduction interventions to support this marginalized population are needed.
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Stokes LR, Brody LR. Self-Silencing, but Not Sexual Relationship Power Associated with Condom Use for Black College-Aged Women. Behav Sci (Basel) 2019; 9:E13. [PMID: 30696006 PMCID: PMC6406997 DOI: 10.3390/bs9020013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/23/2019] [Accepted: 01/26/2019] [Indexed: 11/23/2022] Open
Abstract
Black adolescent and young adult women in the United States experience a disproportionately higher rate of HIV infections than White and Hispanic adolescent and young adult women. Heterosexual sexual activity is the main route of infection for women, regardless of race or ethnicity. We examined two potential barriers to reducing Black adolescent and young adult women's HIV risk: high levels of self-silencing and low levels of sexual relationship power. Data were collected on a small convenience sample of sexually active Black college-aged women (N = 57, Mage = 19.6, SD = 1.4) who answered questions about their current or most recent dating relationship. We found that higher levels of self-silencing were significantly related to lower condom use frequency and to a lower likelihood of reporting condom use at last sex. No significant associations were found between sexual relationship power and condom use (frequency or at last sex). Data from this study suggest that self-silencing, which involves putting the needs of others ahead of one's own in order to avoid conflict in relationships, is an important variable to consider when examining potential risk factors for sexually transmitted HIV among Black college-aged women. Implications for future studies on HIV risk are reviewed.
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Affiliation(s)
| | - Leslie R Brody
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA.
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Medina-Perucha L, Family H, Scott J, Chapman S, Dack C. Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review. AIDS Behav 2019; 23:222-251. [PMID: 30073636 PMCID: PMC6342849 DOI: 10.1007/s10461-018-2238-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner’s drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.
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Affiliation(s)
- L Medina-Perucha
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
- 5 West, 2.52, Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
| | - H Family
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - J Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - S Chapman
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - C Dack
- Department of Psychology, University of Bath, Bath, UK
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Pulerwitz J, Mathur S, Woznica D. How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya. PLoS One 2018; 13:e0199733. [PMID: 30024908 PMCID: PMC6053148 DOI: 10.1371/journal.pone.0199733] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/12/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gendered power dynamics within couple relationships can constrain women from achieving positive sexual and reproductive health outcomes. But little is known about relationship power among adolescents, and tools to measure it are rarely validated among adolescents. We tested the Sexual Relationship Power Scale (SRPS) among adolescent girls and young women (AGYW) and examined associations with select health outcomes. METHODS A 16-item adaptation of the SRPS was administered to AGYW aged 15-24 in Kenya (n = 1,101). Confirmatory factor analysis (CFA) and theta coefficients assessed scale performance for three age bands: 15-17, 18-20, and 21-24 years old. Relationship power levels were examined and multivariate logistic regressions assessed the relationship between power, and partner violence and HIV risk outcomes. RESULTS CFAs confirmed a one factor structure for each subgroup, and thetas for final 15-item scales were robust (>.82). Most respondents reported limited power in their sexual relationships, however older respondents consistently reported lower levels of power. Relationship power was strongly associated with several outcomes, even when controlling for socioeconomic status and schooling. For example, AGYW who reported more relationship power were 12, 6, and 7 times less likely (ages 21-24, 18-20, and 15-17, respectively) to experience sexual violence (p<0.001). Significant relationships were also found in multivariate analyses for physical partner violence (all three age bands), using a condom at last sex (18-20-year-olds), and increased knowledge of partner's HIV status (21-24-year-olds). CONCLUSIONS The SRPS is a good measure of relationship power for several age bands within AGYW, and power is experienced differently by older and younger AGYW. Low relationship power was a consistent predictor of partner violence, as well as an important predictor of HIV risk. Interventions seeking to address HIV and violence should also explicitly address relationship power and utilize validated tools (like the SRPS) to evaluate impacts.
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Affiliation(s)
- Julie Pulerwitz
- HIV and AIDS Program, Population Council, Washington, DC, United States of America
| | - Sanyukta Mathur
- HIV and AIDS Program, Population Council, Washington, DC, United States of America
| | - Daniel Woznica
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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Morris MD, Montgomery ME, Briceno A, Evans JL, Andrew EVW, Page K, Hahn JA. A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners. Subst Use Misuse 2018; 53:1281-1287. [PMID: 29286888 PMCID: PMC6063526 DOI: 10.1080/10826084.2017.1404105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To date, research applying the Sexual Relationship Power Scale (SRPS) has been limited to sexual risk behaviors. OBJECTIVE We measured levels of sexual relationship power and examined associations between sexual relationship power and injecting and sexual behaviors that place women at increased risk for blood borne infections. METHODS Using data from a cross-sectional study of young women who inject drugs (WWID) in San Francisco, USA, logistic regression analysis identified independent associations between SRPS and subscale scores (relationship control [RC] and decision making dominance [DMD]) and injecting and sexual behaviors. RESULTS Of the 68 young WWID, 24 (34%) reported receptive syringe sharing, 38 (56%) reused/shared a cooker to prepare drugs, and 25 (37%) injected someone else's drug residue during the three-months prior to enrollment. Most (60, 88%) reported condomless sex with main sex-partner, 8 (12%) reported transactional sex, and 36 (53%) had two or more recent sex partners. The median SRPS score was 2.98 (IQR: 2.65, 3.18), 3.23 (IQR: 3.23, 3.57) for RC and 2.40 (IQR: 2.20, 2.60) for DMD. No significant associations were detected between SRPS or DMD and injecting or sexual risk behaviors. After adjusting for gender and years injecting, for every one-point increase in RC, women had a 6.70 lower odds of recent condomless sex (95%CI: 0.92, 50.00, p = 0.06), and a 3.90 lower odds of recent transactional sex (95%CI: 1.22, 12.50, p = 0.02). CONCLUSION Our study findings suggest that some components of sexual relationship power may play a role in sexual risk, but not in injecting risk.
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Affiliation(s)
- Meghan D Morris
- a Department of Epidemiology & Biostatistics , University of California , San Francisco , California , USA
| | - Martha E Montgomery
- b Department of Emergency Medicine , Alameda Health System - Highland Hospital , Oakland , California , USA
| | - Alya Briceno
- a Department of Epidemiology & Biostatistics , University of California , San Francisco , California , USA
| | - Jennifer L Evans
- a Department of Epidemiology & Biostatistics , University of California , San Francisco , California , USA
| | - Erin V W Andrew
- c Department of Internal Medicine , University of New Mexico Health Center , Albuquerque , New Mexico , USA
| | - Kimberly Page
- c Department of Internal Medicine , University of New Mexico Health Center , Albuquerque , New Mexico , USA
| | - Judith A Hahn
- a Department of Epidemiology & Biostatistics , University of California , San Francisco , California , USA.,d Department of Medicine , University of California , San Francisco , California , USA
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Hayashi HD, Patterson TL, Semple SJ, Fujimoto K, Stockman JK. Risk Factors for Recent Intimate Partner Violence among Methamphetamine-Using Men and Women. J Psychoactive Drugs 2017; 48:135-45. [PMID: 27163712 DOI: 10.1080/02791072.2016.1170249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Substance Abuse, Violence, and HIV/AIDS (SAVA) syndemic model describes how the confluence of the three epidemics of substance abuse, violence, and HIV risk work synergistically to create excess burden among populations. We sought to identify risk factors associated with recent intimate partner violence (IPV) victimization among heterosexual methamphetamine (meth)-using men (n = 108) and women (n = 122) enrolled in FASTLANE-II, an HIV behavioral intervention in San Diego, CA. Women and men reported high rates of physical-only (women: 20%; men: 18%) and sexual (women: 25%; men: 23%) IPV. Multinomial regression analysis revealed that individuals who reported lower social support and individuals who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were more likely to report IPV versus no IPV. Women who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were 1.58 times more likely to report physical-only IPV versus no IPV, while men who reported similar behaviors were 1.15 times more likely to report physical-only IPV versus no IPV. Our findings highlight the influence of interpersonal factors on IPV. This research supports further study on gender-specific risk/protective factors and the development of gender-specific interventions targeting the SAVA syndemic among meth users.
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Affiliation(s)
- Hitomi D Hayashi
- a Pre-Doctoral Fellow, Department of Health Promotion and Behavioral Sciences , University of Texas School of Public Health , Houston , TX , USA
| | - Thomas L Patterson
- b Professor, Department of Psychiatry , University of California-San Diego , San Diego , CA , USA
| | - Shirley J Semple
- b Professor, Department of Psychiatry , University of California-San Diego , San Diego , CA , USA
| | - Kayo Fujimoto
- a Pre-Doctoral Fellow, Department of Health Promotion and Behavioral Sciences , University of Texas School of Public Health , Houston , TX , USA
| | - Jamila K Stockman
- c Division of Global Public Health, Department of Medicine , University of California-San Diego , San Diego , CA , USA
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Gallo MF, Legardy-Williams J, Steiner MJ, Macaluso M, Carter M, Hobbs MM, Hylton-Kong T, Anderson C, Costenbader E, Warner L. Sexual Relationship Power and Semen Exposure Among Female Patients at a Sexually Transmitted Infection Clinic in Kingston, Jamaica. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2157-2164. [PMID: 27305908 PMCID: PMC5500443 DOI: 10.1007/s10508-016-0771-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/05/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Women's power in sexual relationships is thought to be an important predictor of condom use. However, research on correlates of condom use often relies on participant reporting of behavior, which has questionable validity. We evaluated the association between scores from the modified Sexual Relationship Power Scale (SRPS-M) and biological detection of semen exposure in a prospective study of adult women attending a sexually transmitted infection clinic in Kingston, Jamaica with cervicitis or abnormal vaginal discharge in 2010-2011. At enrollment, women were counseled to avoid sex while on treatment and were asked to return in 6 days for a follow-up visit. At both study visits, women were administered a questionnaire and had vaginal swabs collected to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure. We found no significant association at enrollment or follow-up between SRPS-M scores and semen exposure, as measured with either self-reported data or PSA positivity. Semen biomarkers could be used to develop and validate new scales on relationship power and self-efficacy related to condom use.
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Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, 324 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210-1351, USA.
| | - Jennifer Legardy-Williams
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA, 30341-3724, USA
| | - Markus J Steiner
- Clinical Sciences Division, FHI 360, 2224 E NC Hwy 54, Durham, NC, 27713, USA
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, MLC 5041, 3333 Burnet Ave, Cincinnati, OH, 45229-3039, USA
| | - Marion Carter
- Health Services Research and Evaluation Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcia M Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, CB #7031, 8317 MBRB, Chapel Hill, NC, 27599, USA
| | - Tina Hylton-Kong
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, 55 Slipe Pen Rd, Kingston, Jamaica
| | - Clive Anderson
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, 55 Slipe Pen Rd, Kingston, Jamaica
| | | | - Lee Warner
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA, 30341-3724, USA
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Staton M, Strickland JC, Tillson M, Leukefeld C, Webster JM, Oser CB. Partner Relationships and Injection Sharing Practices among Rural Appalachian Women. Womens Health Issues 2017; 27:652-659. [PMID: 28882550 DOI: 10.1016/j.whi.2017.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The role of relationships in initiating and maintaining women's risk behaviors has been established. However, understanding factors that may underlie partner relationships and women's risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women's risky injection practices as a function of relationship power perception. METHODS Female participants were recruited from three rural jails in the Appalachian region. Women were selected randomly, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs during the year before entering jail (n = 199). MAIN FINDINGS Approximately three-quarters (76%) reported having a recent main male sexual partner with a history of injection drug use. Although having a risky partner independently increased the likelihood of women reporting shared injection practices, perceptions of relationship power significantly moderated the effect on shared needle (adjusted odds ratio, 0.02; 95% CI, 0.003-0.23; p = .001) and shared works (adjusted odds ratio, 0.17; 95% CI, 0.03-0.95; p = .04) use. CONCLUSIONS This interaction indicated that, for women who inject drugs with a recent injecting male partner, greater perception of relationship power was associated with a decreased likelihood of shared injection practices. Implications for clinical assessment and intervention are discussed.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky.
| | - Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - J Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carrie B Oser
- Department of Sociology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky
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Zakaras JM, Weiser SD, Hatcher AM, Weke E, Burger RL, Cohen CR, Bukusi EA, Dworkin SL. A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1121-1133. [PMID: 27507020 PMCID: PMC5299074 DOI: 10.1007/s10508-016-0828-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 06/02/2023]
Abstract
Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and nine control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.
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Affiliation(s)
- Jennifer M Zakaras
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Abigail M Hatcher
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shari L Dworkin
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
- UCSF School of Nursing, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA.
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Ahuama-Jonas C, Burlew AK, Campbell ANC, Tross S. Strength in the midst of pain: Abuse as a predictor of sexual relationship power among substance-abusing Black women. J Ethn Subst Abuse 2017; 16:432-444. [PMID: 28368690 DOI: 10.1080/15332640.2017.1300552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA). The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale. The findings suggest that designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices.
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Affiliation(s)
| | | | - Aimee N C Campbell
- b New York State Psychiatric Institute , Columbia University Medical Center , New York , New York
| | - Susan Tross
- c HIV Center for Clinical and Behavioral Studies , Columbia University College of Physicians and Surgeons , New York , New York
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Watt MH, Kimani SM, Skinner D, Meade CS. "Nothing Is Free": A Qualitative Study of Sex Trading Among Methamphetamine Users in Cape Town, South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:923-933. [PMID: 25567071 PMCID: PMC4496309 DOI: 10.1007/s10508-014-0418-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/22/2014] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
South Africa is facing an established epidemic of methamphetamine, known locally as "tik." Globally, methamphetamine has been linked to high rates of sexual risk behaviors, including sex trading. The goal of this study was to qualitatively examine the experiences of sex trading among methamphetamine users in Cape Town, South Africa. Individual in-depth interviews were conducted with 30 active methamphetamine users (17 men and 13 women) recruited from the community. Interviews were conducted in local languages using a semi-structured guide that included questions on sex trading experiences and perceptions of sex trading among methamphetamine users. Interviews were audio-recorded, transcribed, and analyzed using analytic memos and coding with constant comparison techniques. The data revealed that in a setting of high levels of addiction and poverty, sex was an important commodity for acquiring methamphetamine. Women were more likely to use sex to acquire methamphetamine, but men reported opportunistic cases of trading sex for methamphetamine. Four models of sex trading emerged: negotiated exchange, implicit exchange, relationships based on resources, and facilitating sex exchange for others. The expectation of sex trading created a context in which sexual violence against female methamphetamine users was common. Multiple sexual partners and inconsistent condom use in acts of sex trading put methamphetamine users at high risk of HIV. Interventions in this setting should address addiction, which is the primary driver of sex trading among methamphetamine users. Harm reduction interventions may include education about HIV and other sexually transmitted infections, availability of condoms and HIV testing, and sexual violence prevention.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA.
| | - Stephen M Kimani
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
| | - Donald Skinner
- Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christina S Meade
- Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC, 27708, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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15
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W Batchelder A, Lounsbury DW, Palma A, Carrico A, Pachankis J, Schoenbaum E, Gonzalez JS. Importance of substance use and violence in psychosocial syndemics among women with and at-risk for HIV. AIDS Care 2016; 28:1316-20. [PMID: 27110841 DOI: 10.1080/09540121.2016.1173637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women in the US continue to be affected by HIV through heterosexual contact. Sexual risk behaviors among women have been associated with a syndemic, or a mutually reinforcing set of conditions, including childhood sexual abuse (CSA), depression, substance use, violence, and financial hardship. Baseline data from a cohort of women with and at-risk for HIV (N = 620; 52% HIV+) were analyzed with Poisson regression to assess evidence for additive, independent and interactive effects among syndemic conditions in relation to reported sexual risk behaviors (e.g., unprotected and transactional sex) over the past 6 months, controlling for age and HIV status. The number of syndemic conditions was incrementally associated with more types of sexual risk behaviors. For example, women with all five syndemic conditions reported 72% more types of risk behaviors over 6 months, as compared to women without any syndemic conditions. Compared to women with no syndemic conditions, women with three syndemic conditions reported 34% more and women with one syndemic condition reported 13% more types of risk behaviors. Endorsing substance use in the past 6 months, reporting CSA, and experiencing violence as an adult were independently associated with 49%, 12%, and 8% more types of risk behaviors, respectively compared to women without these conditions. Endorsing both substance use and violence was associated with 27% more types of risk behaviors. These associations were not moderated by HIV status. Understanding specific relationships and interactions are needed to more effectively prioritize limited resources in addressing the psychosocial syndemic associated with sexual risk behavior among women with and at-risk for HIV. Our results identify interrelated psychosocial factors that could be targeted by intervention studies aiming to reduce high-risk sex in this population.
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Affiliation(s)
- Abigail W Batchelder
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,b Osher Center for Integrative Medicine , University of California , San Francisco , CA , USA
| | - David W Lounsbury
- c Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Yeshiva University , Bronx , NY , USA
| | - Anton Palma
- c Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Yeshiva University , Bronx , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Adam Carrico
- e Department of Community Health Systems, School of Nursing , University of California , San Francisco , CA , USA
| | - John Pachankis
- f Department of Chronic Disease Epidemiology , Yale School of Public Health , New Haven , CT , USA
| | - Ellie Schoenbaum
- c Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Yeshiva University , Bronx , NY , USA
| | - Jeffrey S Gonzalez
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,c Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Yeshiva University , Bronx , NY , USA.,g Department of Medicine (Endocrinology) , Albert Einstein College of Medicine, Yeshiva University , Bronx , NY , USA
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16
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Relationship Power in the Context of Heterosexual Intimate Relationships: A Conceptual Development. ANS Adv Nurs Sci 2016; 39:E31-43. [PMID: 27149233 DOI: 10.1097/ans.0000000000000113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Various theoretical frameworks have been utilized while examining the concept of relationship power. In addition, the conceptual definition and operational use are inconsistent throughout literature. A concept analysis was conducted on the basis of the guidelines provided by Walker and Avant. The proposed definition of relationship power is the relative, perceived, and actual ability to influence a relationship partner. Antecedents, attributes, and consequences are presented. Because of the various adverse outcomes related to relationship power (eg, intimate partner violence, depression), an understanding of this concept is essential. Furthermore, a clear understanding is needed to advance nursing knowledge, leading to future research and theory development.
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Depression, Abuse, Relationship Power and Condom Use by Pregnant and Postpartum Women with Substance Abuse History. AIDS Behav 2016; 20:292-303. [PMID: 26319131 DOI: 10.1007/s10461-015-1176-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Substance-abusing pregnant and postpartum women are less likely to maintain consistent condom use and drug and alcohol abstinence, which is particularly concerning in high HIV-prevalence areas. Data from 224 pregnant and postpartum women in substance abuse treatment were analyzed to examine effects of history of substance use, child abuse, and mental health problems on current substance use and condom-use barriers. Mediators were depression, relationship power and social support. Most participants (72.9 %) evidenced current depression. Less social support (-0.17, p < 0.05) and relationship power (-0.48, p < 0.001), and greater depression (-0.16, p < 0.05) predicted more condom-use barriers. History of mental health problems predicted condom-use barriers, mediated by recent depression and relationship power (0.15, p < 0.001). These findings suggest depression and diminished relationship power limit highest-risk women's ability to negotiate condom use and abstain from substance use, increasing their risk of acute HIV infection and vertical transmission.
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18
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Wickersham JA, Loeliger KB, Marcus R, Pillai V, Kamarulzaman A, Altice FL. Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:98-110. [PMID: 26636885 DOI: 10.3109/00952990.2015.1101467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. OBJECTIVES To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. METHODS A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. RESULTS Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. CONCLUSION Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.
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Affiliation(s)
- Jeffrey A Wickersham
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Kelsey B Loeliger
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA
| | - Ruthanne Marcus
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA
| | - Veena Pillai
- c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Adeeba Kamarulzaman
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
| | - Frederick L Altice
- a Department of Internal Medicine, Yale University School of Medicine, Section of Infectious Diseases , AIDS Program, New Haven , CT , USA.,b Department of Epidemiology of Microbial Diseases, Yale University School of Public Health , New Haven , CT , USA.,c Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur , Malaysia
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19
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Batchelder AW, Gonzalez JS, Palma A, Schoenbaum E, Lounsbury DW. A Social Ecological Model of Syndemic Risk affecting Women with and At-Risk for HIV in Impoverished Urban Communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:229-40. [PMID: 26370203 PMCID: PMC8344336 DOI: 10.1007/s10464-015-9750-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer-reviewed literature; secondary data analyses of a cohort dataset including women living with and at-risk of HIV in Bronx, NY (N = 620); and input from a Bronx-based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi-level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi-level interventions might bolster women's resilience by increasing self-worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder-informed model depicts how self-worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population.
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Affiliation(s)
- A W Batchelder
- Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, 3rd Floor, Box 1726, San Francisco, CA, 94115, USA.
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.
| | - J S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
- Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - A Palma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E Schoenbaum
- Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - D W Lounsbury
- Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
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20
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Damacena GN, Szwarcwald CL, Souza Júnior PRBD. HIV risk practices by female sex workers according to workplace. Rev Saude Publica 2015; 48:428-37. [PMID: 25119937 PMCID: PMC4203086 DOI: 10.1590/s0034-8910.2014048004992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/21/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.
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Affiliation(s)
- Giseli Nogueira Damacena
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Célia Landmann Szwarcwald
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Paulo Roberto Borges de Souza Júnior
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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21
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McMahon JM, Volpe EM, Klostermann K, Trabold N, Xue Y. A systematic review of the psychometric properties of the Sexual Relationship Power Scale in HIV/AIDS research. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:267-94. [PMID: 25331613 PMCID: PMC4324007 DOI: 10.1007/s10508-014-0355-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/29/2014] [Accepted: 04/22/2014] [Indexed: 05/20/2023]
Abstract
The Sexual Relationship Power Scale (SRPS) was developed over a decade ago to address the lack of reliable and valid measures of relationship power in social, behavioral and medical research. The SRPS and its two subscales (relationship control [RC], decision-making dominance [DMD]) have been used extensively in the field of HIV prevention and sexual risk behavior. We performed a systematic review of the psychometric properties of the SRPS and subscales as reported in the HIV/AIDS literature from 2000 to 2012. A total of 54 published articles were identified, which reported reliability or construct validity estimates of the scales. Description of the psychometric properties of the SRPS and subscales is reported according to study population, and several cross-population trends were identified. In general, the SRPS and RC subscale exhibited sound psychometric properties across multiple study populations and research settings. By contrast, the DMD subscale had relatively weak psychometric properties, especially when used with specific populations and research settings. Factors that influenced the psychometric properties of the various scales and subscales included the study population, mean age of the sample, number of items retained in the scale, and modifications to the original scales. We conclude with recommendations for (1) the application and use of the SRPS and subscales, (2) reporting of psychometric properties of the scales in the literature, and (3) areas for future research.
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Affiliation(s)
- James M McMahon
- School of Nursing, University of Rochester Medical Center, 601 Elmwood Ave., Box SON, Rochester, NY, 14642, USA,
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22
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Ulibarri MD, Roesch S, Rangel MG, Staines H, Amaro H, Strathdee SA. "Amar te Duele" ("love hurts"): sexual relationship power, intimate partner violence, depression symptoms and HIV risk among female sex workers who use drugs and their non-commercial, steady partners in Mexico. AIDS Behav 2015; 19:9-18. [PMID: 24743959 PMCID: PMC4201896 DOI: 10.1007/s10461-014-0772-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A significant body of research among female sex workers (FSWs) has focused on individual-level HIV risk factors. Comparatively little is known about their non-commercial, steady partners who may heavily influence their behavior and HIV risk. This cross-sectional study of 214 FSWs who use drugs and their male steady partners aged ≥18 in two Mexico-U.S. border cities utilized a path-analytic model for dyadic data based upon the Actor-Partner Interdependence Model to examine relationships between sexual relationship power, intimate partner violence (IPV), depression symptoms, and unprotected sex. FSWs' relationship power, IPV perpetration and victimization were significantly associated with unprotected sex within the relationship. Male partners' depression symptoms were significantly associated with unprotected sex within the relationship. Future HIV prevention interventions for FSWs and their male partners should address issues of sexual relationship power, IPV, and mental health both individually and in the context of their relationship.
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Affiliation(s)
- Monica D Ulibarri
- Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0849, USA,
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23
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Muldoon KA, Deering KN, Feng CX, Shoveller JA, Shannon K. Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting. AIDS Care 2014; 27:512-9. [PMID: 25402720 DOI: 10.1080/09540121.2014.978732] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is little information on the private lives of women engaged in sex work, particularly how power dynamics within intimate relationships may affect intimate partner violence (IPV). Using baseline data of sex workers enrolled in a longitudinal cohort, "An Evaluation of Sex Workers' Health Access" (AESHA), the present study examined the association between sexual relationship power and IPV among sex workers in non-commercial partnerships in Vancouver, Canada. Pulweritz's Sexual Relationship Power Scale (SRPS) and The World Health Organization (WHO) Intimate Partner Violence against Women Scale (Version9.9) were used. Bivariable and multivariable logistic regression techniques were used to investigate the potential confounding effect of sexual relationship power on IPV among sex workers. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were reported. Of 510 sex workers, 257 (50.4%) reported having an non-commercial intimate partner and were included in this analysis. In the past 6 months, 84 (32.7%) sex workers reported IPV (physical, sexual or emotional). The median age was 32 years, 39.3% were of Aboriginal ancestry, and 27.6% were migrants. After controlling for known confounders (e.g., age, Aboriginal ancestry, migrant status, childhood trauma, non-injection drug use), low relationship power was independently associated with 4.19 increased odds (95% CI: 1.93-9.10) and medium relationship power was associated 1.95 increased odds (95% CI: 0.89-4.25) of IPV. This analysis highlights how reduced control over sexual-decision making is plays a critical role in IPV among sex workers, and calls for innovation and inclusive programming tailored to sex workers and their non-commercial intimate partnerships.
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Affiliation(s)
- Katherine A Muldoon
- a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
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24
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Nkosi S, Rich EP, Morojele NK. Alcohol use, sexual relationship power, and unprotected sex among patrons in bars and taverns in rural areas of North West province, South Africa. AIDS Behav 2014; 18:2230-9. [PMID: 24699714 DOI: 10.1007/s10461-014-0764-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examined the relative importance of alcohol consumption and sexual relationship power (SRP) in predicting unprotected sex among 406 bar patrons in North West province, South Africa. We assessed participants' demographic characteristics, alcohol consumption, SRP, and number of unprotected sexual episodes in the past 6 months. In correlational analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP was significantly associated with frequency of unprotected sex for males and marginally associated for females. In multivariate regression analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP's association was marginally significant for females and not significant for males. Alcohol consumption is more strongly associated with unprotected sex than is SRP among bar patrons. Combination HIV prevention approaches to curb problem drinking and increase condom accessibility, and regular and effective use are needed in tavern settings. SRP needs further examination among tavern populations.
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Affiliation(s)
- Sebenzile Nkosi
- Alcohol & Drug Abuse Research Unit, Medical Research Council, Private Bag X385, Pretoria, 0001, South Africa,
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25
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Hutton HE, McCaul ME, Norris J, Valliant JD, Abrefa-Gyan T, Chander G. Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic. JOURNAL OF SEX RESEARCH 2014; 52:580-589. [PMID: 25110958 PMCID: PMC4324376 DOI: 10.1080/00224499.2014.931336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol-sexual risk reduction interventions for high-risk women.
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Affiliation(s)
- Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Jeanette Norris
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105 USA
| | - Julia D. Valliant
- Illinois Children's Environmental Health Research Center, and Family Resiliency Center, University of Illinois, Urbana-Champagne, Urbana, IL 61801 USA
| | - Tina Abrefa-Gyan
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD 21201 USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
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Muldoon KA, Duff PK, Birungi J, Ngolobe MH, Min JE, King R, Nyonyintono M, Chen Y, Shannon K, Khanakwa S, Moore D. Decisions, decisions: the importance of condom use decision making among HIV sero-discordant couples in a prospective cohort study in Uganda. Sex Transm Infect 2014; 90:408-12. [PMID: 24695989 DOI: 10.1136/sextrans-2013-051326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We examined sexual decision making type among couples in HIV sero-discordant partnerships in Uganda, and investigated how sexual decision making type changed over time and its effect on condom use. METHODS Data were drawn from a longitudinal cohort of HIV sero-discordant couples, recruited through the AIDS Support Organisation in Jinja, Uganda. Sexual decision making was measured using the Sexual Relationship Power Scale, and couples' individual self-report answers were matched to assess agreement for decision making type and condom use. Generalised linear mixed effects modelling was used to assess statistically significant differences in time trend of sexual decision making type, and to investigate the independent association of decision making type on condom use status over time. RESULTS Of the 533 couples included in this analysis, 345 (65%) reported using condoms at last sex at study enrolment. In the time trend analysis of decision making, the proportion of couples who decided together increased over time while the proportions of couples who reported that one partner decided or no one decided/did not use condoms, decreased over time (overall p<0.001). Compared with couples who decided together, those who disagreed (adjusted OR=0.42, 95% CI 0.28 to 0.64) and those where one partner decided (adjusted OR=0.20, 95% CI 0.12 to 0.34) had significantly lower odds of condom use at last sex, even after controlling for confounders. CONCLUSIONS Couples who disagreed on decision making, or agreed that one partner decides alone, had significantly lower odds of reporting condom use compared with couples who decided together. HIV counselling interventions that encourage joint sexual decision making may improve condom use within this population.
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Affiliation(s)
- Katherine A Muldoon
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Putu K Duff
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Jeong Eun Min
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rachel King
- University of California, San Francisco, California, USA Karolinska Institute, Stockholm, Sweden
| | | | - Yalin Chen
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
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Knudsen HK, Staton-Tindall M, Oser CB, Havens JR, Leukefeld CG. Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use. AIDS Care 2014; 26:1071-9. [PMID: 24410251 DOI: 10.1080/09540121.2013.878779] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven "thinking myths" about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.
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Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug & Alcohol Research , University of Kentucky , Lexington , KY , USA
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Walt LC, Hunter B, Salina D, Jason L. Romance, recovery & community re-entry for criminal justice involved women: Conceptualizing and measuring intimate relationship factors and power. JOURNAL OF GENDER STUDIES 2014; 23:409-421. [PMID: 25750487 PMCID: PMC4349489 DOI: 10.1080/09589236.2013.795113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Researchers have suggested that interpersonal relationships, particularly romantic relationships, may influence women's attempts at substance abuse recovery and community re-entry after criminal justice system involvement. The present paper evaluates relational and power theories to conceptualize the influence of romantic partner and romantic relationship qualities on pathways in and out of substance abuse and crime. The paper then combines these conceptualizations with a complementary empirical analysis to describe an ongoing research project that longitudinally investigates these relational and power driven factors on women's substance abuse recovery and community re-entry success among former substance abusing, recently criminally involved women. This paper is designed to encourage the integration of theory and empirical analysis by detailing how each of these concepts are operationalized and measured. Future research and clinical implications are also discussed.
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Affiliation(s)
- Lisa C Walt
- Department of Psychology, DePaul University, Chicago, USA
| | - Bronwyn Hunter
- Department of Psychology, DePaul University, Chicago, USA
| | - Doreen Salina
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Leonard Jason
- Department of Psychology, DePaul University, Chicago, USA
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29
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Matsuda Y, McGrath JM, Knafl GJ, Worthington EL, Jallo N, Corona R. Examining relationship/family planning factors and sexual relationship power among immigrant Latino couples in the United States. HISPANIC HEALTH CARE INTERNATIONAL 2014; 12:161-73. [PMID: 25521780 PMCID: PMC7386795 DOI: 10.1891/1540-4153.12.4.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The ability to influence partners' actions within an intimate relationship (sexual relationship power [SRP]) is a key concept in achieving optimum family planning (FP) among U.S. Latinos. The purpose of this study was to examine the associations between relationship/FP factors and SRP. The actor-partner interdependence model was used to analyze data for 40 couples. Both men's and women's sexual communications were positively associated with SRP, only women's relationship satisfaction was positively associated with SRP, women's general communication was negatively associated with men's SRP, and men's contraception attitudes were negatively associated with SRP. Couples interventions are needed, which account for SRP and gender differences. These findings provide direction for developing targeted interventions to achieve better FP for Latino couples.
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Affiliation(s)
- Yui Matsuda
- University of North Carolina at Chapel Hill, USA
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Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS One 2013; 8:e81044. [PMID: 24282566 PMCID: PMC3840028 DOI: 10.1371/journal.pone.0081044] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant health problem that has been associated with HIV infection in numerous studies. We aimed to systematically review the literature on relationships between IPV and HIV in order to describe the prevalence of IPV in people with HIV, the prevalence of HIV in people experiencing IPV, the association between IPV and HIV, and evidence regarding mechanisms of risk and interventions. METHODS Data sources were 10 electronic databases and reference lists. Studies were included if they reported data on the relationship between IPV and HIV. All records were independently reviewed by two authors at the stages of title and abstract review and full text review. Any abstract considered eligible by either reviewer was reviewed in full, and any disagreement regarding eligibility of full texts or data extracted was resolved by discussion. RESULTS 101 articles were included. Experiencing IPV and HIV infection were associated in unadjusted analyses in most studies, as well as in adjusted analyses in many studies. The findings of qualitative and quantitative studies assessing potential mechanisms linking IPV and HIV were variable. Few interventions have been assessed, but two identified in this review were promising in terms of preventing IPV, though not HIV infection. CONCLUSIONS Experiencing IPV and HIV infection tend to be associated in unadjusted analyses, suggesting that IPV screening and linkage with relevant programs and services may be valuable. It is unclear whether there is a causal association between experiencing IPV and HIV infection. Research should focus on defining parameters of IPV which are relevant to HIV infection, including type of IPV and period of exposure and risk, on assessing potential mechanisms, and on developing and assessing interventions which build on the strengths of existing studies.
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Affiliation(s)
| | - Nicole Findlay
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Schwandt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Liviana M. Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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31
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Sexual partnership types as determinant of HIV risk in South African MSM: an event-level cluster analysis. AIDS Behav 2013; 17 Suppl 1:S23-32. [PMID: 22956229 DOI: 10.1007/s10461-012-0294-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
While individual determinants of HIV risk among MSM have been widely studied, there is limited understanding of how relational characteristics determine sexual risk. Based on data collected among 300 South African men who have sex with men (MSM) and using cluster analysis, this study developed a typology of four partnership types: the "Race-Economic Similar," "Age-Race-Economic Discordant," "Non-regular Neighbourhood," and "Familiar" partnership types. Support for the meaningfulness of these types was found through associations of these partnership types with participant characteristics and characteristics of the last anal sex event. Furthermore, in a multivariate analysis, only partnership type independently predicted whether the last anal sex event was unprotected. Findings of the study illustrate the importance of taking into account the relational context in understanding unprotected sexual practices and present ways to target intervention efforts as well as identify relationship specific determinants of unprotected sex.
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Campbell ANC, Tross S, Hu MC, Pavlicova M, Nunes EV. Predictors of relationship power among drug-involved women. AIDS Behav 2012; 16:1532-41. [PMID: 22614746 DOI: 10.1007/s10461-012-0208-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Gender-based relationship power is frequently linked to women's capacity to reduce sexual risk behaviors. This study offers an exploration of predictors of relationship power, as measured by the multidimensional and theoretically grounded sexual relationship power scale, among women in outpatient substance abuse treatment. Linear models were used to test nine predictors (age, race/ethnicity, education, time in treatment, economic dependence, substance use, sexual concurrency, partner abuse, and sex role orientation) of relationship power among 513 women participating in a multi-site HIV risk reduction intervention study. Significant predictors of relationship control included having a non-abusive male partner, only one male partner, and endorsing traditional masculine (or both masculine and feminine) sex role attributes. Predictors of decision-making dominance were interrelated, with substance use × partner abuse and age × sex role orientation interactions. Results contribute to the understanding of factors which may influence relationship power and to their potential role in HIV sexual risk reduction interventions.
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Siedner MJ, Tsai AC, Dworkin S, Mukiibi NFB, Emenyonu NI, Hunt PW, Haberer JE, Martin JN, Bangsberg DR, Weiser SD. Sexual relationship power and malnutrition among HIV-positive women in rural Uganda. AIDS Behav 2012; 16:1542-8. [PMID: 22382629 DOI: 10.1007/s10461-012-0162-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inequality within partner relationships is associated with HIV acquisition and gender violence, but little is known about more pervasive effects on women's health. We performed a cross-sectional analysis of associations between sexual relationship power and nutritional status among women in Uganda. Participants completed questionnaires and anthropometric measurements. We assessed sexual relationship power using the Sexual Relationship Power Scale (SRPS). We performed logistic regression to test for associations between sexual relationship power and poor nutritional status including body mass index, body fat percentage, and mid-upper arm circumference. Women with higher sexual relationship power scores had decreased odds of low body mass index (OR 0.29, p = 0.01), low body fat percentage (OR 0.54, p = 0.04), and low mid-upper arm circumference (OR 0.22, p = 0.01). These relationships persisted in multivariable models adjusted for potential confounders. Targeted interventions to improve intimate partner relationship equality should be explored to improve health status among women living with HIV in rural Africa.
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34
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Langhorst DM, Choi YJ, Keyser-Marcus L, Svikis DS. Reducing Sexual Risk Behaviors for HIV/STDs in Women with Alcohol Use Disorders. RESEARCH ON SOCIAL WORK PRACTICE 2012; 22:367-379. [PMID: 24076752 PMCID: PMC3783343 DOI: 10.1177/1049731512441683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objective: A pilot randomized clinical trial (RCT) examined effectiveness of HIV/STD Safer Sex Skills Building + Alcohol (SSB+A) intervention for women with Alcohol Use Disorders (AUDs) in a residential treatment setting. Method: After randomizing thirty-six women with AUDs and reporting having intercourse with a male partner in the past 180 days to SSB+A or HE (standard HIV/STD education) groups, rates of penetrative intercourse with and without condoms at 60 day and 180 day follow-up were compared between SSB+A or HE groups. Results: There was a significant difference in mean number of sex acts with condoms between SSB+A and HE groups over time. Specifically, SSB+A and HE groups did not differ at 60 day follow-up, but at 180 day follow-up, mean sex acts with condoms among SSB+A group was significantly higher than HE. Conclusion: Pilot study findings affirm the effectiveness of the SSB+A in reducing sexual risk behaviors of AUD women and support the need for further research, testing the SSB+A intervention in a larger sample of women and across different treatment modalities. The present study also illustrates the critical link between practice and use of a step by step model of intervention research.
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Affiliation(s)
- Diane M Langhorst
- Addiction & Women's Health: Advancing Research and Evaluation (AWHARE), Virginia Commonwealth University
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35
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual methamphetamine users. J Psychoactive Drugs 2011; 43:79-88. [PMID: 21858954 DOI: 10.1080/02791072.2011.587390] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0680, USA
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