Influence of age on sexual risk behaviors and condom use attitudes among heterosexual women with histories of methamphetamine use and partner violence

Background: Intersecting epidemics of HIV and partner violence (PV) disproportionately affect drug-using women, yet few studies have identified the health risks associated with age. Purpose: This study compared sexual risk behaviors, condom use attitudes and HIV knowledge between midlife/older women (ages 45+) and younger women (ages 18-44), reporting methamphetamine (MA) use and PV. Methods: A sequential mixed methods design used themes from qualitative in-depth interviews (n=19) to inform logistic regression analysis of data from HIV-negative, heterosexual, MA-using women enrolled in an HIV behavioral intervention trial in San Diego, CA, who reported lifetime physical or sexual PV (n=154). Results: Qualitative themes included: age appropriateness of prevention methods, physiological barriers, condom use attitudes and former high-risk behaviors. Of the 154 women, 21.4% were aged ≥ 45, 80.5% were unemployed and 51.3% had a felony conviction. Midlife/older age was associated with fewer episodes of unprotected vaginal sex with a steady partner, greater number of sex partners within the last 60 days, lower condom use self-efficacy, lower positive outcome expectancies for condom use and lower HIV knowledge scores. In multivariate logistic regression, age remained independently associated with unprotected vaginal sex with a steady partner (AdjOR: 0.94; 95% CI: 0.91-0.98), number of sex partners (AdjOR: 1.054; 95% CI: 1.00-1.119), condom use self-efficacy (AdjOR: 0.27; 95% CI: 0.13-0.59) and HIV knowledge (AdjOR: 0.03; 95% CI: <0.001-1.13). Conclusion: Midlife/older drug-using women with histories of PV may have different HIV sexual risk profiles than their younger counterparts that should be addressed when developing future interventions.