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HIV, Sexually Transmitted Infections and Sexual Risk among Women who Use Methamphetamine

Abstract

This dissertation examines the prevalence of HIV and sexually transmitted infections (STIs), sexual risk behavior and violent victimization in a community-based sample of women who use methamphetamine in San Francisco, CA (N=322). Methamphetamine use has grown rapidly in the United States since the mid-1990's. Nearly half of methamphetamine users are female, a proportion higher than for most other illicit drugs. Among gay and bisexual men, methamphetamine use has been linked to sexual risk behavior and increases in HIV and STI infection. To date, however, little research has been conducted about the sexual health and risk behaviors of heterosexual women who use methamphetamine.

This work addresses the dearth of knowledge regarding sexual health (HIV, STIs) and sexual risk among heterosexual women who are active methamphetamine users, taking on three key issues. First, it assesses the prevalence of sexual risk behavior, HIV and STIs. Results point to high levels of risk behavior, but relatively low levels of HIV and STI infection. Second, this work examines the relationship between sex and methamphetamine use for women, using mixed methods (quantitative and qualitative). Findings suggest that women see the relationship between sex and methamphetamine in terms of pleasure rather than risk, and suggests that traditional risk behavior assessment approaches may not provide information sufficient to inform behavioral interventions. Third, this dissertation examines violence against methamphetamine-using women, and finds that suffering and violence go hand-in-hand, as women with the greatest subsistence difficulties also experienced the highest levels of non-intimate partner violence. This work regarding women who use methamphetamine brings forward new knowledge about an understudied and vulnerable population, and contributes to a basis for developing effective public health responses to the needs of women who are active methamphetamine users.

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