Exploring violence and HIV risk among drug-using women who have sex with women

Drug-using women who have sex with women (WSW) have higher rates of HIV-related risk behaviors and experience more violence as compared to women who have sex with men only (WSMO). We explored the relationship between violence victimization, sexual risk behavior and drug use among drug-using gay/lesbian/bisexual-identified (WSW, n= 75) and heterosexual-identified WSMO (WSMO, n=221) within a majority women of color sample. A total violence victimization score was created by summing four binary variables: childhood physical and sexual abuse, and past year physical and sexual intimate partner violence. The mean violence score was 1.37 (SD=1.3, range:0-4); WSW had higher mean scores than WSMO (1.9 vs. 1.2, p<0.001) and were more likely to experience each violence type. WSW were more likely to be injection drug users (IDUs), cocaine dependent, and have alcohol problems as well as have ≥2 sex partners and risky sexual partners (individuals who were IDUs, paid/were paid for sex, and/or were HIV-positive) in the last six months. In multivariate logistic regression models controlling for age and modeling sexual identity and violence, violence (not being a WSW) was significantly and positively associated with cocaine dependence and IDU or HIV-positive sex partners. Being a WSW (not violence) was significantly and positively associated with multiple sex partners and a partner who paid/was paid for sex. Violence and being a WSW were significantly and positively associated with alcohol problems. WSW experienced more violence as compared to WSMO; both sexual identity and violence were independently associated with HIV risk. Variation in HIV risk between WSW and WSMO may be partially explained by violence victimization.