Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Jessica M. Edwards, PhD, Pacific Institute for Research and Evaluation, 1516 E. Franklin Street, Suite 200, Chapel Hill, NC 27514-2812, 919-265-2636, jedwards@pire.org, Carolyn T. Halpern, PhD, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Rosenau Hall, CB 7445, Chapel Hill, NC 27599-7445, and Wendee M. Wechsberg, PhD, Substance Abuse Treatment Evaluations and Interventions, RTI International, 3040 Cornwallis Drive, P.O. Box 12194, Research Triangle Park, NC 27709-2194.

Background: Women who use crack cocaine and exchange sex for money engage in sexual risk behaviors, including high rates of unprotected sex, that place them at risk for HIV and other sexually transmitted infections (STIs). However, there is little understanding of the factors that contribute to engaging in unprotected sex in this population.

Objective: This study examined the correlates of unprotected sex among women who use crack cocaine and exchange sex for money or other things.

Methods: The data for this study came from a woman-focused HIV intervention study with African American women in Raleigh-Durham, NC who use crack cocaine. This analysis included 264 women who reported exchanging sex for money or something else in the past 30 days. We used logistic regression analysis to examine the likelihood of unprotected sex exchanges associated with sociodemographic factors, level of crack use, sexual behaviors, condom use self-efficacy, violence experiences, and psychological distress.

Results: Seventy-five percent of the women had unprotected sex when they exchanged sex in the past 30 days. Women who were physically abused in childhood were more likely to have unprotected sex exchanges. The relationship between childhood physical abuse and unprotected sex was mediated by psychological distress and lower condom use self-efficacy.

Discussion: These findings indicate that early traumatic experiences, such as childhood abuse, can have long-term negative consequences on women's mental and physical health, including risk for HIV. Interventions for enhancing women's ability to engage in safer sex should consider both proximal and distal influences on well-being.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Recognize factors that increase the risk for HIV among women who use crack cocaine and exchange sex for money.
• Discuss how both distal and proximal factors in women's lives may affect their well-being.

Keywords: Sexual Risk Behavior, Drug Use

Presenting author's disclosure statement:

Any relevant financial relationships? No