Social contexts and HIV risk among low-income cocaine-, crack-, and heroin-using WSW/M of color

Introduction: Low-income cocaine-, crack-, and heroin-using WSW/M are women who have sex with women, and also have sex with men. Research has shown that these drug-using WSW/M prefer women as their relational and sexual partners, but often have sex with men out of economic necessity. Low-income drug-using WSW/M are a high-risk HIV population, with HIV seroprevalence ranging from 12.8% to 53%. In randomly selected samples of high HIV risk drug-using women, drug-using WSW/M comprise a sizable portion, and sometimes even a majority of drug-using women. Methods: This presentation is an extensive review of the literature on this population from 1992 to the present, including literature authored by the presenter based on empirical research. Results and Discussion: Several studies indicate that drug-using WSW/M are at higher HIV risk from both distal and proximal factors compared to drug-using women who have sex with men only (WSMO). Compared to drug-using WSMO, drug-using WSW/M are also much more likely to trade sex with men for drugs and/or money, and male partners of drug-using WSW/M tend to be at much more high risk, including MSM/W, IDUs, and/or HIV-positive, compared to the male partners of drug-using WSMO. Drug-using WSW/M are also considered a “bridge” population that can potentially infect men through sexual and IDU transmission and infect other women through IDU transmission. Drug-using WSW/M are more likely to perform “active” social roles compared to drug-using WSMO, which may provide economic, social, and psychological benefits to these women while also placing them at greater HIV risk. Among drug-using women, African American women are more often associated with WSW/M behavior compared to white women, and women of color comprise the majority of drug-using WSW/M. Drug-using WSW/M of color are often not accessed by conventional outreach or programs and have special needs that should be addressed.