Methamphetamine/sex/violence nexus: Implications for HIV risk

Aims: The nexus of methamphetamine (meth) use, risky sexual behavior, and intimate partner violence is not well understood. The aims of this paper are to explore women meth users' experiences of risky sexual behavior in relation to intimate partner violence, and to analyze these experiences with regard to HIV risk. Methods: Thirty women in residential treatment for methamphetamine dependence in Los Angeles County completed in-depth interviews about their life experiences, intimate relationships, sexuality, and perspectives on the impact of meth on behavior, including violent behavior. The average age of participants was 28.5 years; 56% are Latina, 30% are white, 7% are American Indian, and 7% are mixed race/ethnicity. Results: Eighty percent (n=24) of the participants reported experiencing violence: 67% (n=20) had violence perpetrated against them, 57% (n=17) had perpetrated violence against their partners or others, not necessarily in self-defense. Intimate partner violence was often associated with sexual issues, e.g., conflict about “unusual” sexual activities, sexual “performance,” and infidelity. Women who perpetrated violence typically did so as they were “coming down” off of meth, while male-perpetrated violence typically occurred during a meth high. None of the participants reported having protected sex at any time; condom use was considered a “joke.” Though none were HIV-positive, twenty-five percent of participants had a sexually transmitted disease. Conclusion: The “syndemic” (i.e., intertwined problems) of intimate partner violence, substance abuse, and HIV risk warrants attention among users of meth, who are particularly vulnerable considering the physiologic and interpersonal effects of the drug. Support: NIH NIDA K01-DA017647