Past Trauma Compels Unsafe Sex In Many Drug-Abusing Women

June 24, 1998

A study of HIV-positive African American women incarcerated for abusing crack cocaine has shown that most shared childhood and adult histories of sexual and physical abuse, which in turn engendered feelings of powerlessness that led to unsafe sex and a greatly increased risk of HIV infection. The study appeared in the June, 1998, issue of Women's Health: Research on Gender, Behavior, and Policy.

Lead author Susan G. Sherman, MPH, a third-year doctoral student in Health Policy and Management, at the Johns Hopkins School of Public Health, suggested that HIV prevention and substance abuse programs could become more successful if counselors appreciated how their clients' family histories and pre-incarceration environments encourage risky behaviors that lead to HIV infection.

"Although smoking crack cocaine is not in itself a biological risk factor for HIV infection," said Sherman, "it is one of a cluster of behaviors stemming from the pasts of these women that place them at an increased risk for HIV infection."

African American women are becoming infected with HIV at a faster rate than any other population in the United States, and past studies suggest that the heterosexual transmission of HIV among crack users may soon spread the virus as efficiently as the use of contaminated drug paraphernalia.

The researchers conducted in-depth interviews with 14 women prison inmates, all of whom had been incarcerated for reasons stemming directly or indirectly from their crack addiction. The study explored the women's families, history of incarceration, drug use histories; experiences with sexual and physical violence; sexual histories; and feelings about being at risk of HIV infection.

Thirteen of the 14 women were African American. Ten grew up in families with a history of substance abuse; and eight reported being victims of or witnesses to physical violence as children. Five of those who grew up in violent homes, and four from homes that were not abusive, reported being physically or sexually abused as adults, often by their partners. These women in particular expressed strong dependency needs for men, needs felt at least since their teenage years when they sought escape from intolerable home environments.

A sense of powerlessness over their intimate relationships pervaded the women's stories, often reflected in a willingness to have casual and unprotected sex, behaviors that put them at increased risk for HIV infection. Only two women expressed positive feelings about condoms; five thought that having unprotected sex not only signaled trust in one's partner but also showed respect for the importance placed on child-rearing by the African American culture.

"In the face of many negative factors in their lives," said Sherman, "sex offers these women a sense of belonging. Rehabilitation programs must therefore help women identify the benefits of safer sex and, when encouraging behavioral change, offer substitutes for the voids that accompany sobriety."

In spite of their traumatic backgrounds, many of the women also displayed courage and resourcefulness, standing up to violent partners and maintaining sobriety in the face of extremely difficult life circumstances. Six of the women described either protecting themselves from or leaving abusive situations.

In the United States, close to five percent of all persons with AIDS are in prison, and in nine out of ten jurisdictions the rates of infection among women are close to double those of men, ranging from 0.2 percent in Nevada to 20 percent in New York.
This study was supported by the North Carolina Governor's Task Force on Substance Abuse Public Policy Scholars Program.

Editor's note: Lead author, Susan Sherman, will only be available for brief interviews June 24 and 25, 1998. She will be available for interviews starting June 28 at the 12th Annual World AIDS Conference in Geneva, Switzerland.

Johns Hopkins University Bloomberg School of Public Health

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