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Sexual Risk among Impoverished Women: Understanding the Role of Housing Status

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Abstract

HIV/AIDS increasingly affects women, and housing status is important to understanding HIV risk behaviors among women. The goal of this study is to enhance understanding of the association between housing status and a key sexual risk behavior, having multiple sex partners, by investigating the extent to which housing status differences can be accounted for by hypothesized explanatory factors. In a probability sample of 833 women in Los Angeles, results indicated that homeless African American and Hispanic women had from two to almost five times greater odds than low-income housed women of having multiple sex partners in the past 6 months. These disparities in risk behavior were accounted for by housing status differences in perceived susceptibility to HIV/AIDS, recent victimization by physical violence, drug use severity, and avoidant coping. Findings provide further evidence that interventions should address a multifaceted context of HIV risk for impoverished women.

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Notes

  1. The median monthly income of women in this study was $692; the federal poverty level for 2001 for a family of one was $716. Source: Federal Register Vol. 66, No. 33, February 16, 2001, pp. 10695–10697.

References

  • Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 1–15.

    Article  Google Scholar 

  • Amaro, H., & de la Torre, A. (2002). Public health needs and scientific opportunities in research on Latinas. American Journal of Public Health, 92(4), 525–529.

    Google Scholar 

  • Amaro, H., Raj, A., Vega, R., Mangione, T., & Perez, L. N. (2001). Racial/ethnic disparities in the HIV and substance abuse epidemics: Communities responding to the need. Public Health Reports, 116, 434–448.

    PubMed  CAS  Google Scholar 

  • Amato, P. R., & Rogers, S. J. (1997). A longitudinal study of marital problems and subsequent divorce. Journal of Marriage & the Family, 59(3), 612–624.

    Article  Google Scholar 

  • Ashery, R., Wild, J., Zhao, Z., Rosenshine, N., & Young, P. (1997). The wheel project: Women helping to empower and enhance lives. Journal of Substance Abuse Treatment, 14, 113–121.

    Article  PubMed  CAS  Google Scholar 

  • Avins, A. L., Woods, W. J., Lindan, C. P., Hudes, E. S., Clark, W., & Hulley, S. B. (1994). HIV infection and risk behaviors among heterosexuals in alcohol treatment programs. JAMA, 271, 515–518.

    Article  PubMed  CAS  Google Scholar 

  • Banyard, V. L., & Graham-Bermann, S. A. (1998). Surviving poverty: Stress and coping in the lives of housed and homeless mothers. American Journal of Orthopsychiatry, 68, 479–489.

    Article  PubMed  CAS  Google Scholar 

  • Bassuk E. L., Weinreb L. F., Buckner J. C., Salomon A., & Bassuk S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. JAMA, 28, 640–646.

    Article  Google Scholar 

  • Bray, R. M., Schlenger, W. E., & Craddock, S. G. (1982). Approaches to the assessment of drug use in the treatment outcome prospective study. Research Triangle Park, NC: Research Triangle Institute.

    Google Scholar 

  • Caetano, R., & Hines, A. M. (1995). Alcohol, sexual practices, and risk of AIDS among blacks, Hispanics, and whites. Journal Acquired Immune Deficiency Syndrome and Human Retrovirus, 19, 554–561.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2004a). HIV/AIDS among women. Atlanta: US Department of Health and Human Services, Center for Disease Control and Prevention.

  • Centers for Disease Control and Prevention (CDC). (2004b). HIV/AIDS surveillance report, 2003, Vol. 15. Atlanta: US Department of Health and Human Services, Center for Disease Control and Prevention.

  • Clements, K., Gleghorn, A., Garcia, D., Katz, M., & Marx, P. (1997). A risk profile of street youth in northern California: Implications for gender-specific human immunodeficiency virus prevention. Journal of Adolescent Health, 20(5), 343–353.

    Article  PubMed  CAS  Google Scholar 

  • Culhane, D. P., Gollub, E., Kuhn, R., & Shpaner, M. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilization in Philadelphia. Journal of Epidemiology and Community Health, 55, 515–520.

    Article  PubMed  CAS  Google Scholar 

  • D’Amico, E., Barnes, D., Gilbert, M., Ryan, G., & Wenzel, S. L. (2006). A tripartite intervention for impoverished young women in the transition to adulthood: Preventing substance use, HIV risk, and violence and victimization (under review).

  • DeHovitz, J. A., Kelly, P., Feldman, J., Sierra, M. F., Clarke, L., Bromberg, J., Wan, J. Y., Vermund, S. H., & Landesman, S. (1994). Sexually transmitted diseases, sexual behavior, and cocaine use in inner city women. American Journal of Epidemiology, 140, 1125–1134.

    PubMed  CAS  Google Scholar 

  • Deren, S., Shedlin, M., & Beardsley, M. (1996). HIV-related concerns and behaviors among Hispanic women. AIDS Education and Prevention, 8, 335–342.

    PubMed  CAS  Google Scholar 

  • Edlin, B. R., Irwin, K. L., Faruque, S., McCoy, C. B., Word, C., Serrano, Y., Inciardi, J. A., Bowser, B. P., Schilling, R. F., & Holmberg, S. D. (1994). Intersecting epidemics: Crack cocaine use and HIV infection among inner-city young adults. New England Journal of Medicine, 331, 1422–1427.

    Article  PubMed  CAS  Google Scholar 

  • El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Gaeta, T., Schilling, R. F., & Wada, T. (2003). Intimate partner violence and substance abuse among minority women receiving care from an inner-city emergency department. Women’s Health Issues, 13, 16–22.

    Article  PubMed  Google Scholar 

  • Elliott, M. N., Golinelli, D., Hambarsoomian, K., Perlman, J., & Wenzel, S. L. (2006). Sampling with field burden constraints: An application to sheltered homeless and low-income housed women. Field Methods, 18, 43–58.

    Article  Google Scholar 

  • Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS risk behavior. Psychological Bulletin, 111, 455–474.

    Article  PubMed  CAS  Google Scholar 

  • Garcia-Moreno, C., & Watts, C. (2000). Violence against women: Its importance for HIV/AIDS. AIDS, 14(Suppl. 3), S253–S265.

    Google Scholar 

  • Gelberg, L., Gallagher, T. C., Andersen, R. M., & Koegel, P. (1997). Competing priorities as a barrier to medical care among homeless adults in Los Angeles. American Journal of Public Health, 87, 217–220.

    PubMed  CAS  Google Scholar 

  • Gibson, D. R., Lovelle-Drache, J., Young, M. T., & Chesney, M. (1992). HIV risk linked to psychopathology in IV drug users. In International Conference on AIDS, Abstract POC, 4691, Amsterdam.

  • Goldberg, M. (1995). Substance-abusing women: False stereotypes and real needs. Social Work, 40(6), 789–798.

    PubMed  CAS  Google Scholar 

  • Huba, G. J., Melchior, L. A., Greenberg, B., Trevithick, L., Feudo, R., Tierney, S., Sturdevant, M., Hodgins, A., Remafedi, G., Woods, E. R., Wallace, M., Schneir, A, Kawata, A. K., Brady, R. E., Singer, B., Marconi, K., Wright, E., & Panter, A. T. (2000). Predicting substance abuse among youth with, or at high risk for, HIV. Psychology of Addictive Behavior, 14(2), 197–205.

    Article  CAS  Google Scholar 

  • Huntington, N., Moses, D. J., & Veysey, B. M. (2005). Developing and implementing a comprehensive approach to serving women with co-occurring disorders and histories of trauma. Journal of Community Psychology, 33(4), 395–410.

    Article  Google Scholar 

  • Institute for the Study of Homelessness, Poverty (2004). Homelessness in Los Angeles. Los Angeles: Institute for the Study of Homelessness and Poverty.

    Google Scholar 

  • Kalichman, S., Malow, R., Devieux, J., Stein, J. A., & Piedman, F. (2005). HIV risk reduction for substance using mentally ill adults: Test of the information-motivation-behavior skills model. Community Mental Health Journal, 41(3), 277–290.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Williams, E. A., Cherry, C., Belcher, L., & Nachimson, D. (1998). Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. Journal of Women’s Health, 7, 371–378.

    PubMed  CAS  Google Scholar 

  • Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H.-U. (1998). The World Health Organization Composite International Diagnostic Interview Short-Form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171–185.

    Article  Google Scholar 

  • Kish, L. (1995). Survey sampling. New York, NY: Wiley.

    Google Scholar 

  • Koegel, P., & Burnam, M. A. (1991). Course of homelessness among the seriously mentally ill. Rockville, MD: National Institute of Mental Health.

    Google Scholar 

  • Lazarus, R. S., & Folkman, S. (1984). Coping and adaptation. In W. D. Gentry (Ed.), Handbook of behavioral medicine (pp. 282–325). New York: Guilford Press.

    Google Scholar 

  • Levinson, D. (2004). Encyclopedia of homelessness, Vol. 1. Thousand Oaks, CA: SAGE.

    Google Scholar 

  • Los Angeles County Department of Health Services (2000). An epidemiologic profile of HIV and AIDS. Los Angeles: Los Angeles County Department of Health Services.

    Google Scholar 

  • Los Angeles County Department of Health Services (2004). An epidemiologic profile of HIV and AIDS. Los Angeles: Los Angeles County Department of Health Services.

    Google Scholar 

  • Malow, R. M., Devieux, J. G., Jennings, T., Lucenko, B. A., & Kalichman, S. C. (2001). Substance-abusing adolescents at varying levels of HIV risk: Psychosocial characteristics, drug use, and sexual behavior. Journal of Substance Abuse, 13, 103–117.

    Article  PubMed  CAS  Google Scholar 

  • Maman, S., Campbell, J., Sweat, M. D., & Gielen, A. C. (2000). The intersections of HIV and violence: Directions for future research and interventions. Social Science and Medicine, 50, 459–478.

    Article  PubMed  CAS  Google Scholar 

  • Martin, J. I., Pryce, J. G., & Leeper, J. D. (2005). Avoidance coping and HIV risk behavior among gay men. Health and Social Work, 3, 193–201.

    Google Scholar 

  • Martinez, T. E., Gleghorn, A., Marx, R., Clements, K., Boman, M., & Katz, M. H. (1998). Psychosocial histories, social environment, and HIV risk behaviors of injection and no injection drug using homeless youths. Journal of Psychoactive Drugs, 30(1), 1–10.

    PubMed  CAS  Google Scholar 

  • Milburn, N., & D’Ercole, A. (1991). Homeless women: Moving toward a comprehensive model. American Psychologist, 46, 1161–1169.

    Article  PubMed  CAS  Google Scholar 

  • National AIDS Housing Coalition (2005). Housing and HIV/AIDS policy paper: Housing is the foundation of HIV prevention and treatment. Washington, DC: The National AIDS Housing Coalition.

    Google Scholar 

  • Nyamathi, A. M., Stein, J. A., & Swanson, J. M. (2000). Personal, cognitive, behavioral, and demographic predictors of HIV testing and STDS in homeless women. Journal of Behavioral Medicine, 23, 123–147.

    Article  PubMed  CAS  Google Scholar 

  • Nyamathi, A., Flaskerud, J., Keenan, C., & Leake, B. (1998). Effectiveness of a specialized vs. traditional AIDS education program attended by homeless and drug-addicted women alone or with supportive persons. AIDS Education and Prevention, 10, 433–446.

    PubMed  CAS  Google Scholar 

  • Ojikutu, B. O., & Stone, V. E. (2005). Women, inequality, and the burden of HIV. New England Journal of Medicine, 352(7), 649–652.

    Article  PubMed  CAS  Google Scholar 

  • O’Leary, A., Jemmott, L. S., Goodhart, F., & Gebelt, J. (1996). Effects of an institutional AIDS prevention intervention: Moderation by gender. AIDS Education and Prevention, 8, 516–528.

    PubMed  CAS  Google Scholar 

  • Proulx, J., Koverola, C., Fedorowicz, A., & Kral, M. (1995). Coping strategies as predictors of distress in survivors of single and multiple sexual victimization and nonvictimized controls. Journal of Applied Social Psychology, 25(16), 1464–1483.

    Article  Google Scholar 

  • Rayburn, N. R., Wenzel, S. L., Elliott, M. N., Hambarsoomian, K., Marshall, G. N., & Tucker, J. S. (2005). Trauma, depression, coping, and mental health service seeking among sheltered homeless and low-income housed women. Journal of Consulting and Clinical Psychology, 73(4), 667–677.

    Article  PubMed  Google Scholar 

  • Roberts, A. C., Wechsberg, W. M., Zule, W., & Burroughs, A. R. (2003). Contextual factors and other correlates of sexual risk of HIV among African American crack-abusing women. Addictive Behaviors, 28, 523–536.

    Article  PubMed  Google Scholar 

  • Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American Psychologist, 41, 813–819.

    Article  PubMed  CAS  Google Scholar 

  • Schenker, N., & Gentleman, J. F. (2001). On judging the significance of differences by examining overlap between confidence intervals. The American Statistician, 55, 182–186.

    Article  Google Scholar 

  • Schilling, R., El-Bassel, N., Ivanoff, A., Gilbert, L., Su, K. H., & Safyer, S. M. (1994). Sexual risk behaviors of incarcerated drug-using women. Public Health Reports, 109, 539–547.

    PubMed  CAS  Google Scholar 

  • Semple, S., Zians, J., Grant, I., & Patterson, T. L. (2005). Impulsivity and methamphetamine use. Journal of Substance Abuse Treatment, 29(2), 85–93.

    Article  PubMed  Google Scholar 

  • Sheeran, P., Abraham, C., & Orbell, S. (1999). Psychosocial correlates of heterosexual condom use: A meta-analysis. Psychological Bulletin, 125, 90–132.

    Article  PubMed  CAS  Google Scholar 

  • Sherbourne, C. D., Hays, R. D., Ordway, L., DiMatteo, M. R., & Kravitz, R. L. (1992). Antecedents of adherence to medical recommendations: Results from the Medical Outcomes Study. Journal of Behavioral Medicine, 15, 447–468.

    Article  PubMed  CAS  Google Scholar 

  • Skinner, C. J. (1989). Domain means, regression, multivariate analyses. In C. J. Skinner, D. Holt, & T. M. F. Smith (Eds.), Analysis of complex surveys (pp. 59–88). New York: Wiley.

    Google Scholar 

  • Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised conflict tactics scale (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283–316.

    Article  Google Scholar 

  • Tucker, J. S., Wenzel, S. L., Elliott, M. N., & Hambarsoomian, K. (2006). Predictors of unprotected sex with non-cohabitating primary partners among sheltered and low-income housed women in Los Angeles County. Journal of Health Psychology, 11(5), 697–710.

    Article  PubMed  Google Scholar 

  • US Census Bureau (2003). Poverty: 1999. U.S. Department of Commerce, Economics and Statistics Administration, Washington, DC.

  • UNAIDS/WHO (Joint United Nations Programme on AIDS/World Health Organization) (2004). AIDS Epidemic Update 2004. Geneva: World Health Organization.

    Google Scholar 

  • Upchurch, D. M., Kusunoki, Y., Simon, P., & Doty, M. M. (2003). Sexual behavior and condom practices among Los Angeles women. Women’s Health Issues, 13, 8–15.

    Article  PubMed  Google Scholar 

  • Weinreb, L., Goldberg, R., Lessard, D., Perloff, J., & Bassuk, E. (1999). HIV-risk practices among homeless and low-income housed mothers. Journal of Family Practice, 48, 859–867.

    PubMed  CAS  Google Scholar 

  • Wenzel, S. L. (1999). Drug abuse, violence, and HIV/AIDS in impoverished women (R01 DA 11370). Rockville, MD: National Institute on Drug Abuse.

    Google Scholar 

  • Wenzel, S. (2004). Prevention for impoverished young women in shelters (R21 DA019183). Rockville, MD: National Institute on Drug Abuse.

    Google Scholar 

  • Wenzel, S. L., Hambarsoomian, K., D’Amico, E. J., Ellison, M., & Tucker, J. S. (2006). Victimization and health among indigent young women in the transition to adulthood: A portrait of need. Journal of Adolescent Health, 38(5), 536–543.

    Article  PubMed  Google Scholar 

  • Wenzel, S. L., Koegel, P., & Gelberg, L. (2000). Antecedents of physical and sexual victimization among homeless women: A comparison to homeless men. American Journal of Community Psychology, 28(3), 367–390.

    Article  PubMed  CAS  Google Scholar 

  • Wenzel, S. L., Tucker, J. S., Elliott, M. N., Hambarsoomian, K., Perlman, J., Becker, K., Kollross, C., & Golinelli, D. (2004a). Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: A comparison of sheltered vs. low-income housed women in Los Angeles County. Preventive Medicine, 39, 617–624.

    Google Scholar 

  • Wenzel, S. L., Tucker, J. S., Elliott, M. N., Marshall, G. N., & Hambarsoomian, K. (2004b). Physical violence against impoverished women: A longitudinal analysis of risk and protective factors. Women’s Health Issues, 14, 144–154.

    Article  Google Scholar 

  • Whitbeck, L., & Simons, R. (1993). A comparison of adaptive strategies and patterns of victimization among homeless adolescents and adults. Violence and Victims, 8(2), 135–152.

    PubMed  CAS  Google Scholar 

  • Windle, M. (1997). The trading of sex for money or drugs, sexually transmitted diseases (STDs) and HIV-related risk behaviors among multisubstance using alcoholic inpatients. Drug and Alcohol Dependence, 49, 33–38.

    Article  PubMed  CAS  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (1998). Rape among African-American women: Sexual, psychological and social correlates predisposing survivors to HIV infection. Journal of Women’s Health, 7, 1–8.

    Article  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (2000). Application of the Theory of Gender and Power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27, 539–565.

    Article  PubMed  CAS  Google Scholar 

  • Wingood, G. M., DiClemente, R. J., McCree, D. H., Harrington, K., & Davies, S. L. (2001). Dating violence and the sexual health of black adolescent females. Pediatrics, 107, E72.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization (2005). WHO multi-country study on women’s health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women’s responses. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • Wu, E., El-Bassel, N., Witte, S. S., Gilbert, L., & Chang, M. (2003). Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS and Behavior, 7, 291–301.

    Article  PubMed  Google Scholar 

  • Wyatt, G. E., Myers, H. F., Williams, J. K., Kitchen, C. R., Loeb, T., Carmona, J. V., Chin, D., & Presley, N. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665.

    PubMed  Google Scholar 

  • Wyatt, G. E., Newcomb, M. D., & Riederle, M. H. (1993). Sexual abuse and consensual sex: Women’s developmental patterns and outcomes. Newbury Park, CA: Sage.

    Google Scholar 

  • Zierler, S., Feingold, L., Laufer, D., Velentgas, P., Kantrowitz-Gordon, I., & Mayer, K. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. American Journal of Public Health, 81, 572–575.

    Article  PubMed  CAS  Google Scholar 

  • Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This research was supported by grant R01 HD41712 from the National Institute of Child Health and Human Development. We thank Judy Perlman, Kirsten Becker, and Crystal Kollross for data collection.

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Wenzel, S.L., Tucker, J.S., Elliott, M.N. et al. Sexual Risk among Impoverished Women: Understanding the Role of Housing Status. AIDS Behav 11 (Suppl 2), 9–20 (2007). https://doi.org/10.1007/s10461-006-9193-4

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