Making and Communicating Decisions About Sexual Consent During Drug-Involved Sex: A Thematic Synthesis

Adults' Understandings and Experiences of the Capacity to Consent to Substance-Involved Sexual Activity

Most research on capacity to consent to substance-involved sex has focused exclusively on the implications of alcohol with little attention given to other or additional psychoactive drugs. This study aimed to explore people's understanding and experiences of the capacity to consent to alcohol- and/or drug-involved sexual activity. UK adults (N = 354) completed an online mixed-methods survey on sexual consent during sober, alcohol- and/or drug-involved sex. Qualitative data were analyzed using thematic analysis. Themes for capacity to consent were: (1) "There is no normative understanding of substance-involved sexual consent," (2) "Moving beyond the binary of consciousness versus incapacitation" and (3) "Substance-involved sexual decisions are viewed as irresponsible." The findings illustrated that capacity to consent is nuanced and multidimensional, and that people's understandings and experiences of capacity to consent to substance-involved sex are not solely individual, but rather, they are also shaped by their environment. We call for a multidimensional view of capacity to consent, where a standard of "unimpaired," rather than sober, is used and modeled by academics, legislators, and educators.

Why Young Women Who Use Opioids Are at Risk for Rape: The Impact of Social Vulnerabilities and Sexually Coercive Drug Using Contexts

This study tests a theoretically informed model to understand why women who use opioids (WWUO) are at risk of rape while using drugs. Structured interviews were conducted with 168 WWUO. Three domains were hypothesized to increase risk: the sexually coercive context of drug use, women's social vulnerability, and drug use severity. Logistic regression examined the odds of being raped by domain. One-third of WWUO had been raped while using drugs. The sexually coercive context and social vulnerability domains significantly increased women's odds of being raped. Prevention efforts should target social and contextual factors.

Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey

Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the influence of drugs and its correlates among people who use drugs (PWUD) in Cambodia. We included 1147 PWUD from 12 provinces in this study. A multiple logistic regression analysis was conducted to identify factors associated with sex under the influence of drugs. Of the total, 39.7% reported having had sex under the influence of drugs in the past three months. After adjustment, sex under the influence of drugs was significantly associated with living in urban areas (AOR 2.97, 95% CI 1.68-5.27), having two to three (AOR 2.48, 95% CI 1.76-3.49) and four or more sexual partners (AOR 6.46, 95% CI 4.24-9.85), engaging in transactional sex (AOR 1.69, 95% CI 1.19-2.39), using methamphetamine (AOR 2.97, 95% CI 2.06-4.31), using drugs for three years or longer (AOR 1.67, 95% CI 1.15-2.41), having been to a drug rehabilitation center (AOR 1.77, 95% CI 1.18-2.41), having a network of ten or more PWUD (AOR 1.82, 95% CI 1.25-2.66), and having high psychological distress (AOR 1.66, 95% CI 1.25-2.22). This study documents the high prevalence of sex under the influence of drugs and its risk factors among male and female PWUD in Cambodia. These findings point to the need for integrating HIV and harm-reduction programs using innovative approaches to address the overlapping risks in this key population.

Comparing Transgender and Cisgender Experiences of Being Taken Advantage of Sexually While Under the Influence of Alcohol and/or Other Drugs

A small body of literature suggests that transgender people are more frequently exposed to sexual violence while they are under the influence of alcohol than cisgender counterparts. The goal of this study was to report any differences between transgender (n = 1,136) and cisgender (n = 74,277) respondents to the Global Drug Survey on their experiences of being taken advantage of sexually while under the influence of alcohol and/or other drugs. We found that transgender people were more likely than cisgender people to have experienced being taken advantage of in the last year (9.3% vs 4.2%) and more than 12 months preceding the survey (24.9% vs 14.3%). Non-binary participants were more likely than binary transgender participants (27.7% vs 17.8%) to report being taken advantage of sexually more than a year preceding the survey. Similarly, trans respondents assigned female at birth were more likely than trans respondents assigned male at birth to report this (30.0% vs 19.7%). Nonspecialist services for survivors of sexual violence should be adequately prepared for and accommodating toward transgender clients. Future research should explore their unique needs. Moreover, clinicians who assess transgender people should remain mindful of their increased likelihood of being taken advantage of sexually while under the influence of alcohol and other drugs and consider trauma-informed interventions.

Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis

Though the transmission of HIV is preventable, there were still 37,968 new documented cases in the United States in 2018. HIV incidence is disproportionate in sexual minority men of color. The purpose of this study was to examine sexual relationship power risk profiles to identify distinct subgroups within the profiles who carry the highest HIV risk. Latent class profile analysis was used to identify subgroups of sexual minority men of color at the highest risk for contracting HIV based on their sexual power profiles. Among 322 sexual minority men, we identified four latent profiles. Profile 1: Low transactional sex and high power (n = 133; 14.3%); Profile 2: Transactional sex, high decision-making in sexual relationships, and low control in sexual relationship (n = 99; 30.7%); Profile 3: Low transactional sex, low decision-making, and moderate control (n = 43; 13.4%); Profile 4: High transactional sex and low power (n = 47; 14.6%). LPA was useful to identify distinct subgroups based on measures of sexual risk and relationship sexual power. Findings carry significant implications for developing tailored strategies to increase HIV knowledge and related HIV prevention and risk reduction services for sexual minority men of color who engage in transactional sex.

Too Common to Count? "Mild" Sexual Assault and Aggression among U.S. College Women

National estimates indicate that approximately 1 in 5 women will experience sexual assault during her time in college. However, measures of assault often exclude "mild" experiences, such as incidents of unwanted touching that were not preceded by force, incapacitation, or coercion. We aimed to document the characteristics of "mild" sexual assault and aggression that college women experience at large parties and bars. In addition, we considered women's descriptions of assaultive and aggressive incidents in the context of campus climate survey items to evaluate the potential for measurement gaps. Across six focus groups (N = 36) at a large, public university in the midwestern U.S., women described routine experiences of "mild" sexual assault and aggression, so common that often only imprecise counts of their frequency (e.g., "all the time") were possible. Our findings document the many forms and frequencies of "mild" assault and aggression in college women's lives, as well as the limits of campus climate surveys in measuring the mundane sexual mistreatment of women in campus life. We develop the term "sexualized aggression" to capture such mistreatment and situate this concept within the larger body of research on campus sexual violence.

Internal and external sexual consent during events that involved alcohol, cannabis, or both

Background Substance-involved sexual activity is common. Even though people recognise that substance-related impairment can be a barrier to people's ability to consent to sexual activity, most do not believe that substance use automatically negates sexual consent. We extended previous work on substance-related effects on internal and external consent by investigating sexual events that involved alcohol, cannabis, or both.

METHODS

For 28 days, 113 participants (MAge = 29.2 years, 57.5% women, 70.8% White) responded to three surveys per day on their personal devices. At time points when participants reported having engaged in partnered sexual activity, they were asked to report their alcohol use, cannabis use, internal consent feelings, and external consent communication.

RESULTS

Across 1189 partnered sexual events, 31.5% involved alcohol, cannabis, or both. Sexual events that involved combined use were associated with diminished feelings of safety/comfort and feelings that the sexual act was consensual, compared with events that involved neither substance. Greater levels of alcohol consumption were descriptively associated with lower ratings of internal sexual consent.

CONCLUSIONS

We found that combined use of alcohol and cannabis may lead to lower internal sexual consent than using either substance alone - potentially due to greater levels of impairment associated with polysubstance use. Sexual health education programs should consider more nuanced approaches to teaching people how to navigate substance use and sexual consent.