This illustrates the importance of understanding the link between alcohol use and sexual activity among this clinic population. Qualitative analyses among adolescents, men who have sex with men MSM , and college students have provided important insight into the complex relationship between alcohol use and sexual behavior. Such qualitative explorations inform our understanding of how individuals experience and perceive the sexual consequences of drinking and the broader contexts in which these events occur.
Meanwhile, qualitative studies among MSM have found that alcohol use facilitates engaging in stigmatized sexual behaviors Parsons et al. Among college students qualitative studies focused on the role of alcohol in sexual violence illustrate how alcohol use interacts with gender norms to facilitate sexual victimization Cowley, Although past qualitative analyses have shed light on the complex relationship between sexual health and alcohol use, qualitative explorations of this link among adult urban women are sparse.
Our prior qualitative work among women attending an urban STI clinic specifically focused on sex-related alcohol expectancies and illuminated reasons why women drink, including to increase sexual desire and sexual power Hutton et al. The next step in this work is to examine what precise sexual events occur when women drink that may lead to emotional or physical harms. The purpose of this study was to qualitatively explore the subjective experiences of unintended sexual events occurring while drinking among urban women attending a public STI clinic.
Further insight into alcohol use and its perceived role in these events is an essential step to informing both quantitative analyses and future interventions seeking to reduce the harm associated with drinking.
We purposively sampled women age 18 or greater, presenting for care in the STI clinic, whom reported either binge drinking 4 or more drinks on one occasion in the past six months or engaging in vaginal or anal intercourse while under the influence of alcohol. Providers at the clinic were provided with inclusion criteria, and all participants were recruited through provider referral.
No participants were excluded from the study. Informed consent was obtained in a private room by a research coordinator. Participants were told that the purpose of the study was to understand the reasons they may drink alcohol before or during social situations or situations with a sexual partner and how alcohol affects their decisions in risky situations.
The study purpose, procedures and risks were reviewed with participants as described in the informed consent form ICF. Their understanding of study purpose, procedures and risks was then assessed through a predetermined set of standard questions. No women refused to participate in the study. Interviews were conducted by a female clinical psychologist HH or a female physician GC.
Interviews were conducted using a semi-structured guide, which allowed for probing and clarification regarding alcohol and sexual activity Bernard Interviews lasted on average one hour. The guide queried situations or moods that increased the likelihood of drinking alcohol, alcohol and sexual risk behaviors, condom and sex partners, and consequences of alcohol use. Participants were continuously enrolled until thematic saturation was obtained for the primary research question.
Saturation was defined as the point at which no new information or themes were observed in the data Greg Guest, Data analysis Interviews were audio-recorded and transcribed verbatim. Transcribed interviews were reviewed and coded iteratively until saturation was reached using a grounded theory approach Charmaz, Two graduate-level research assistants with advanced training in qualitative interviewing coded the data.
Concepts were viewed as grounded in the data, leading successive phases of analysis to identify themes as they emerged through a process of coding. On secondary analysis, a medical student with previous qualitative experience DL and a nurse practitioner TA queried codes related events occurring while drinking including sexual, social and violent events. These events were used to guide the creation of a second codebook.
Codes in the first five interviews were categorized, collapsed and reordered to create a secondary, agreed upon, codebook. Memos were created and shared, further informing the codebook and the themes that emerged. Codes fell into one of four categories: Remaining interviews were coded iteratively, whereby new domains that emerged across interviews subsequent to the development of codebook led to additions and alterations to the codebook that was then re-applied to interviews.
Data were managed in excel. All discrepancies were resolved with consensus. The research team then analyzed all events and selected those that had potential sexual health consequences, including STIs, unintended pregnancy, and sexual trauma. Individual events were then analyzed as to whether they were desired or undesired, and intended or unintended.
Ambiguous codes were labeled as such. Sexual events that were both undesired and unintended were used to generate themes. Accounts of violent rape were coded and analyzed separately. In the past 3 months, 19 of 20 women had engaged in anal or vaginal intercourse.
Of these, 19 women had sex with somebody they consider to be a main partner, 7 with a casual partner, and 4 with an unknown partner. Five major unintended sexual consequences emerged from the interviews: All events occurred with males with the exception of an identified alternative sexual activity, group sex. Themes often overlapped, and sexual victimization was a common thread throughout multiple themes. Alcohol and prey Most participants described that drinking, and sometimes simply being in a bar, made them prey to male predators.
Participant 17 explained this vulnerability to targeting that many participants spoke of: Yeah, girls like easier when they're drunk And when you're easy, you can easily persuade us, manipulate us. You just say whatever that click inside. Some guys will not come up to a girl, will not pay attention to a girl, until he knows that she's had drinks because then it's not the same result as if she was sober when he talks to her That's the mission for the guys in the bar, to see who they can take home, and for a woman your mission should be to not get that wasted, that somebody can just take you home And this guy will put two drinks in your hands at one time, but before you can finish this one he's bringing you another one and he'll sit there all night, you know, small conversation.
You want a shot? But not knowing that this man is buying you this drink to get in your pants, and you know, he's buying a big bottle so you can get really, really wastedthen you wake up with your pants down and he's gone, nowhere to be found. These were usually individuals who they wouldn't have had sex with had they been sober. I've had sex with guys that if I'm sober, I wouldn't even speak to. I've heard the saying where when it's light when you're in a club and you're drinking, a person who looks so good, how do you say?
Just look like whatever, a million bucks. You wake up next to him in the morning he looks like ten cent. They don't look good no more because you're not drunk any more It's not night lights any more, so now you can see He don't got no AIDS. He probably got children. They're so caught up in the heat of passion. And in their eyes, he ain't got no flaws. He ain't got nothing. Nothing wrong with him. He the perfect man. If you're already drunk off of alcohol, somebody may touch you and it may turn you on It could be an ugly person who can touch you, and he could be the ugliest dude in the world where if you were sober, you wouldn't dare.
Participant 18 explained how men use women's vulnerability to manipulate them: Because she can't say yes, and she can't say no. She can't say whether she want it and whether she does not want it. Like what the hell was this? Like get out, like that type of thing I cannot believe I just did that. I never did anal sex until I was drunk one time. So alcohol will do that It's like with alcohol, I don't know I ain't going to say it's hard to say no, but you're more likely to say yeah Like because, you know, that might ask and you'll be like, nah, kind of not want to do it.
And they'll just keep, you know, begging and trying to persuade them. And eventually, you're like okay, I'll try it. But then your body get this numbness to it So anything that you're not willing to do That's all you feel is pleasure. One participant described this in terms of anal sex: You know, they'll let them do that when, if they were sober, oh, no, we're not going there, but they're drunk out of their mind and the guy just totally just takes advantage of them and does whatever--and they have no means to say stop, anything like that, because they're so out of it.
Rough and aggressive sex included pulling hair, scratching backs, using handcuffs, fighting, and choking. Sometimes, rough sex was the result of both partners becoming more aggressive. Yet, participants also described being solely on the receiving side of the aggression. In this context, men were rougher during sex than they would be if sober because the alcohol made women less likely to resist the aggression.
Some guys like to be real rough. They like, you know, they know, she's drunk, she can't do nothing, so I'm going to take advantage of her. So, he'll tend to get, you know, choke up a little bit, it ain't choking her to hurt her, it's choking her to make him feel better. Like, you know, that's what he likes.
Yeah, it could get dangerous.