Abstract Background The intersection of drug use, sexual pleasure and sexual risk behavior is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma. Data were integrated for mixed methods analysis. Results While many participants reported sexual risk behavior unprotected vaginal or anal intercourse in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behavior and methamphetamine use in qualitative findings.
Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behavior while high on methamphetamine.
Findings were mixed on whether methamphetamine use increased sexual risk behavior. Conclusion The use of mixed methods afforded important insights into the sexual behavior and priorities of methamphetamine-using women. Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization.
And sometimes I wish that I could have that sexual pleasure feeling forever. Rather, research regarding HIV and sexual behavior among female drug users is dominated by a risk-focused epidemiological paradigm which narrowly defines risk behaviors, measures their prevalence and explores the correlates of these behaviors e.
Vital knowledge has been gained about drug-using women and sexual risk behavior such as unprotected sex and multiple male partners using epidemiological methods S. However, the focus on violence, trauma and social disadvantage often predominates to the degree that it obscures any sense of agency or pleasure women who use drugs may experience.
Nevertheless, the common-sense notion of agency as a measure of individual empowerment and efficacy is valued by drug users and can be a powerful component of successful drug treatment P. The pursuit of pleasure is one arena in which feelings of agency may play out. One explanation for this absence is the emphasis on pathological theories of drug use in the U.
Similarly, drug-related needs — not pleasure or desire — are seen as the primary motivation for sexual engagement. In this framework, it is difficult to make room to document the potentially positive aspects of sexual behavior and drug use. In addition, the widespread criminalization and social condemnation of drug use contributes to a research environment that rewards scientists for focusing on disease and risk, and provides little incentive to delve into areas like pleasure that appear vaguely disreputable, not to mention difficult to quantify and analyze Duff, The marginalization of desire and pleasure in HIV research may imperil our ability to develop effective prevention strategies.
To date, interventions to reduce sexual risk behavior among drug users, tested in randomized controlled trials, have been moderately successful at best. The lackluster showing of sexual risk behavior interventions suggests that we may be missing key information about sexual behavior among drug users, and that intensive efforts to date may not be pursuing a productive direction. An enhanced evidence base — one which incorporates the perceived rewards and benefits of sexual behavior in the context of drug use — may be needed to develop more effective sexual risk reduction strategies.
This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women who use drugs in San Francisco, CA.
Using mixed methods, it delves into different dimensions of sexual behavior and methamphetamine use — inclusive not only of the risk of unprotected intercourse, but of desire, pleasure and the challenges of overcoming trauma. Our goal was to understand sexual behavior as an experience rather than solely as a risk behavior. By extending the boundaries of conventional HIV risk assessment; this research strives to bring new depth and insights to understanding the sexual behavior of women who use drugs.
Rather, the two methodological approaches provide different perspectives on similar, but often not identical, issues. Interpreting data using mixed methods requires active engagement in both views Ciccarone, , much like looking through the dual lenses of a pair of binoculars. The study described here was designed to use mixed methods from its inception.
Based on the knowledge that sexual behavior among disadvantaged women is complex and multi-dimensional, the intention was to complement quantitative findings with qualitative data regarding the contexts and circumstances of unprotected sex.
Desire, pleasure and disinhibition arose as central themes relevant to sexual behavior and methamphetamine use, as well as to definitions of the self. Greene refers to the emergence of new concepts as a result of mixed methods analysis as initiation, the development of fresh insights and areas of inquiry Greene, Thus, in this paper, mixed methods served both the purposes of complementarity as planned and initiation as discovered.
Study Procedures Quantitative and qualitative data collection was conducted simultaneously from July — June in San Francisco, California. Participants were then given six coupons to recruit other methamphetamine-using women that they knew, and so on, using this process to build the quantitative sample.
Eligibility criteria for the study were a biological female; b age 18 or older; c methamphetamine use in past 30 days; d one or more male sexual partners in past 6 months; e referred by another participant with RDS recruitment coupon except initial recruits.
Eligibility was determined through a screening process that masked criteria by including several questions unrelated to eligibility. We also sought variation in sexual experiences and frequency of unprotected sex. In the process of strategically targeted sampling, the research team met weekly to discuss emerging quantitative and qualitative findings regarding methamphetamine use and sexual behavior, and identified potential candidates for in-depth qualitative interviews.
Similarly, as we began to note themes from qualitative findings, we selected participants and modified topics to further pursue our ideas, while simultaneously sampling strategically for the null hypothesis to control for potential subjective analytical bias and for potential distortions inherent to purposeful sampling Bourgois, Qualitative participants were recruited when they returned to the field site for HIV and STI results counseling, one week after the quantitative interview.
The repeated interactions with study participants 1 interview, 2 counseling sessions, and 1 qualitative interview provided further opportunities to collect qualitative observations regarding institutional interactions and structural vulnerabilities, made in the form of field notes by study staff.