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.
-end-
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.
-end-


Johns Hopkins University Bloomberg School of Public Health

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.