Substance Use, Violence, and Sexual Risk Among Young Cis-Gender Women Placed at High-Risk for Human Immunodeficiency Virus Infection.
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ABSTRACT:
SUBMITTER: Vavala G
PROVIDER: S-EPMC10003641 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
Publications
Substance Use, Violence, and Sexual Risk Among Young Cis-Gender Women Placed at High-Risk for Human Immunodeficiency Virus Infection.
Vavala Gabriella G Wang Qiao Q Jimenez Sergio S Ramos Wilson E WE Ocasio Manuel A MA Romero-Espinoza Adriana A Flynn Risa R Bolan Robert R Fernandez M Isabel MI Doan Pearl P Arnold Elizabeth Mayfield EM Swendeman Dallas D Comulada W Scott WS Klausner Jeffrey D JD
AIDS and behavior 20220318 9
The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual ...[more]
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Project description:BACKGROUND:To describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity. METHODS:Women 18-29?years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%). RESULTS:One-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms. CONCLUSIONS:Reproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.
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Project description:ImportanceDisproportionate levels of violence exist in lesbian, gay, bisexual, queer, asexual, and other sexual identity (LGBQA+) communities, often starting in adolescence and young adulthood, but little research exists on the range of sexual violence (SV) experiences.ObjectiveTo assess risk of experiences of sexual violence among California LGBQA+ adults during adolescence and young adulthood.Design, setting, and participantsThis survey study analyzed data from Cal-VEX 2020, a state-representative survey of California residents aged 18 years and older, to assess associations between LGBQA+ identification and types of SV experienced in adolescence (ages 13-17 years) and young adulthood (ages 18-24 years) using gender-stratified adjusted logistic regression. Forms of SV included verbal, cyber, and coercion or physically aggressive sexual harassment; homophobic or transphobic slurs; and forced sex.ExposureSexual identity.Main outcomes and measuresThe outcome of interest was experiences with any 5 forms of sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber sexual harassment, sexual coercion or physically aggressive sexual harassment, and forced sex) during adolescence or young adulthood.ResultsA total of 2102 contacted individuals (response rate, 26.2%) completed the Cal-VEX survey and were included in these analyses. Among these, the mean (SD) age was 46.6 (17.7) years, 1149 identified as female, 953 identified as male, and 214 respondents (9.6%) identified as LGBQA+. Compared with heterosexual individuals, LGBQA+ individuals had significantly higher odds of having experienced homophobic or transphobic slurs (women: AOR, 14.65; 95% CI, 5.14-41.77; men: AOR, 14.17; 95% CI, 6.96-28.86) and forced sex (women: AOR, 5.35; 95% CI, 2.74-10.43; men: AOR, 2.68; 95% CI, 1.01-7.10) in adolescence. LGBQA+ women also had higher odds of having experienced verbal and coercion or physically aggressive sexual harassment in adolescence (AOR, 2.33; 95% CI, 1.30-4.19). In young adulthood, LGBQA+ individuals also had higher odds of having experienced homophobic or transphobic slurs (women: AOR, 18.58; 95% CI, 7.12-48.49; men: AOR, 16.73; 95% CI, 8.26-33.92) in young adulthood. LGBQA+ men also had higher odds of having experienced homophobic or transphobic slurs (AOR, 16.73; 95% CI, 8.26-33.92); verbal (AOR, 3.29; 95% CI, 1.44-7.53), cyber (AOR, 6.32; 95% CI, 1.50-26.52), and coercion or physically aggressive (AOR, 5.54; 95% CI, 2.08-14) sexual harassment; and forced sex (AOR, 21.26; 95% CI, 5.63-80.35) in young adulthood.Conclusions and relevanceThis survey study found that adult LGBQA+ individuals were at increased risk for having experienced SV across the continuum during adolescence and young adulthood, consistent with prior research. Multifold solutions are needed to support LGBQA+ youth, including altering social norms accepting SV and homophobia, creating safer schools and other institutional environments, and supporting healthy sexual and romantic partnerships.
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Project description:Background This study focuses on sexual orientation and gender-based differences among Israeli young adult substance use behaviors. In addition, it evaluates young adult perception of substance use and acceptance of substances use by close friends. Methods We conducted a cross-sectional study. A self-reported anonymous questionnaire was distributed to a convenience sample of 496 young-adults (age: M?=?23.14, SD?=?2.48), which included 126 heterosexual males, 128 heterosexual females, 131 gay men, and 111 lesbians. Results This study revealed significant sexual orientation and gender differences in all outcomes examined. Significant substance usage differences were found for same-sex orientation as 52% reported cannabis use and 24% reported using other illegal substances during the past 12?months compared to 34 and 6% (respectively) among heterosexuals. Significant gender differences were found, as male participants reported 50% cannabis use and 19% reported other illegal substance use in the past 12?months compared to 35 and 11% (respectively) among females. Additionally, compared with heterosexuals, gay men and lesbians perceived/assessed significantly higher substance usage rates among their close friends and higher levels of substance use acceptance by close friends. Regression models indicated the important role of respondent perceived and acceptance of substance use among close friends. Binge drinking, cannabis use, and other illegal substance use were positively associated with participants’ perceived substance use and substance use acceptance level by close friends, after controlling for gender, sexual orientation, age, and level of education. Conclusions Close friends and community norms can play an important role in shaping substance usage among young adults, especially among gay men and lesbians. The results of the current study highlight the need for developing prevention and harm reduction drug policies for Israeli young adults, especially for gay men and lesbians. Interventions should also focus on young adult peers and community norms related to substance use by professionals in educational, policy-making, and therapeutic contexts.
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Project description:Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research, however, has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a National Institute on Drug Abuse Clinical Trials Network multisite trial of a women's HIV prevention intervention in community-based drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Possible explanations for these findings are discussed, and future research directions for examining power constructs and developing interventions targeting relationship power among drug-involved women are suggested.
| S-EPMC2791824 | biostudies-other
Project description:IntroductionExposure to violence victimization may help explain disparities of substance use among gender-nonconforming youth (i.e., those whose gender expression differs from societal expectations).MethodsIn 2015, three large urban school districts (2 in California and 1 in Florida) conducted a Youth Risk Behavior Survey that included the assessment of gender expression among a racially/ethnically diverse population-based sample of 6,082 high school students. Five categories of violence victimization were assessed (felt unsafe at school, threatened or injured with a weapon at school, bullied at school, electronically bullied, and forced sexual intercourse). In 2019, the effect of violence victimization on substance use disparities was examined by calculating sex-stratified prevalence ratios by gender nonconformity, adjusted for sexual identity, race/ethnicity, and grade (adjusted prevalence ratio 1 [APR1]), and comparing these with prevalence ratios adjusted for those variables plus violence victimization (adjusted prevalence ratio 2 [APR2]).ResultsAmong female students, only being threatened or injured with a weapon was significantly (p<0.05) associated with gender nonconformity and there were no substance use disparities by gender nonconformity. Among male students, every category of violence victimization was more prevalent among gender-nonconforming than among gender-conforming students and most substance use categories demonstrated significant gender nonconformity disparities. After controlling for violence victimization, these disparities decreased but remained statistically significant for the use of cocaine (APR1=2.84 vs APR2=1.99), methamphetamine (APR1=4.47 vs APR2=2.86), heroin (APR1=4.55 vs APR2=2.96), and injection drug use (APR1=7.90 vs APR2=4.72).ConclusionsSchool-based substance use prevention programs may benefit from strategies that support gender diversity and reduce violence victimizations experienced by gender-nonconforming students, by providing a safe and supportive school environment.
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Project description:Sexual minority men of color report intimate partner violence (IPV) and substance use at elevated rates compared to heterosexual peers, but little is known about how types (physical/sexual, controlling, monitoring, emotional) of perpetration and victimization are connected to types of substance use. Associations between past-6-month IPV experiences and substance use (tobacco, alcohol, cannabis, poppers, cocaine) were examined among sexual minority men (N = 414; 18-27 years). IPV victimization and perpetration were reported by 22% and 14% of the sample. Any victimization and controlling victimization were positively correlated with tobacco use, physical victimization was positively correlated with cocaine and poppers use, and monitoring victimization was negatively correlated with cannabis and poppers use. Any perpetration was positively correlated with tobacco use and binge drinking, and emotional perpetration was positively correlated with binge drinking. Understanding and addressing IPV victimization and perpetration experiences are critical for understanding risk conferred by IPV in this population.
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Project description:ObjectivesSexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women.DesignA single arm feasibility test and qualitative interviews of participants.ParticipantsSixty women, between 18 and 25 years of age, who reported trauma exposure, substance use and recent condom-less sex were recruited. Twenty participants were randomly selected for qualitative interviews.InterventionA six-session group-based intervention.Main outcome measuresWe examined the proportion of women who provided consent, completed counselling and were retained in the study. Qualitative interviews explored intervention acceptability. Preliminary effects of the intervention on substance use, mental health (depression, psychological distress and trauma symptoms) and sexual risk outcomes (STI symptoms, number of partners and condomless sex) were explored.ResultsOf the 66 eligible women, 91% were enrolled. Intervention completion rates were low; 35% attended all sessions. On average, participants attended four sessions (M=3.8, SD=1.3). A 93% follow-up rate was achieved at the 3-month endpoint. In this single group design, reductions in the proportion of participants who tested positive for methamphetamine, cannabis and methaqualone were observed at the 3-month endpoint. Symptoms of depression, psychological distress and trauma; number of STI symptoms; and number of sexual partners also decreased. Outcomes were similar for participants who completed up to four and those who completed five or more sessions. Participants thought the intervention was highly beneficial and proposed modifications to enhance acceptability.ConclusionsThis novel intervention seems acceptable and holds potential benefits for trauma-exposed women who use substances. Truncating the intervention may enhance the likelihood of its implementation. The efficacy of the intervention for improving substance use, sexual risk and mental health outcomes requires testing in a controlled design.
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Project description:Sexual violence is a public health issue that can be experienced across the life course. Public transport is a key site of sexual violence and harassment experienced by women and gender-diverse people in Australia, although victim-survivor voices have rarely been sought in addressing this issue. Through in-depth qualitative interviews with 41 diverse female and gender-diverse victim-survivors who were staff or students at two Australian universities, we sought to understand their experiences of sexual violence and harassment on public transport. We found that women and gender-diverse people, while often reporting on a significant experience of sexual violence or harassment on public transport, also had other, "everyday" experiences across their life course that impacted how they traveled and their confidence in the world. Overall, we argue that the significant impact of sexual violence and harassment on public transport should be addressed through targeting public transport as a key site for primary prevention of sexual violence and harassment.
| S-EPMC10515455 | biostudies-literature
Project description:BackgroundWe sought to estimate the prevalence and describe heterogeneity in experiences of gender-based violence (GBV) across subgroups of adolescent girls and young women (AGYW).MethodsWe used data from a cross-sectional bio-behavioural survey among 1299 AGYW aged 14-24 in Mombasa, Kenya in 2015. Respondents were recruited from hotspots associated with sex work, and self-selected into one of three subgroups: young women engaged in casual sex (YCS), young women engaged in transactional sex (YTS), and young women engaged in sex work (YSW). We compared overall and across subgroups: prevalence of lifetime and recent (within previous year) self-reported experience of physical, sexual, and police violence; patterns and perpetrators of first and most recent episode of physical and sexual violence; and factors associated with physical and sexual violence.ResultsThe prevalences of lifetime and recent physical violence were 18.0 and 10.7% respectively. Lifetime and recent sexual violence respectively were reported by 20.5 and 9.8% of respondents. Prevalence of lifetime and recent experience of police violence were 34.7 and 25.8% respectively. All forms of violence were most frequently reported by YSW, followed by YTS and then YCS. 62%/81% of respondents reported having sex during the first episode of physical/sexual violence, and 48%/62% of those sex acts at first episode of physical/sexual violence were condomless. In the most recent episode of violence when sex took place levels of condom use remained low at 53-61%. The main perpetrators of violence were intimate partners for YCS, and both intimate partners and regular non-client partners for YTS. For YSW, first-time and regular paying clients were the main perpetrators of physical and sexual violence. Alcohol use, ever being pregnant and regular source of income were associated with physical and sexual violence though it differed by subgroup and type of violence.ConclusionsAGYW in these settings experience high vulnerability to physical, sexual and police violence. However, AGYW are not a homogeneous group, and there are heterogeneities in prevalence and predictors of violence between subgroups of AGYW that need to be understood to design effective programmes to address violence.
| S-EPMC7549220 | biostudies-literature
Project description:BackgroundUnintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15-24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy.MethodsOur study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17-24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy.ResultsThe analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08-2.68).ConclusionOur study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.
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