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Depression, Abuse, Relationship Power and Condom Use by Pregnant and Postpartum Women with Substance Abuse History

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Abstract

Substance-abusing pregnant and postpartum women are less likely to maintain consistent condom use and drug and alcohol abstinence, which is particularly concerning in high HIV-prevalence areas. Data from 224 pregnant and postpartum women in substance abuse treatment were analyzed to examine effects of history of substance use, child abuse, and mental health problems on current substance use and condom-use barriers. Mediators were depression, relationship power and social support. Most participants (72.9 %) evidenced current depression. Less social support (−0.17, p < 0.05) and relationship power (−0.48, p < 0.001), and greater depression (−0.16, p < 0.05) predicted more condom-use barriers. History of mental health problems predicted condom-use barriers, mediated by recent depression and relationship power (0.15, p < 0.001). These findings suggest depression and diminished relationship power limit highest-risk women’s ability to negotiate condom use and abstain from substance use, increasing their risk of acute HIV infection and vertical transmission.

Resumen

Las mujeres embarazadas o en el postparto que abusan de sustancias adictivas tienden a ser menos propicias a perseverar en el uso consistente del condón y en el abstenerse del uso de las drogas y alcohol, circunstancias particularmente preocupantes en regiones con alta prevalencia de VIH. Datos de 224 mujeres embarazadas y en el postparto en tratamiento para al abuso de sustancias se analizaron para examinar los efectos de un historial de abuso de sustancias, abuso infantil, y problemas de salud mental en su uso actual de sustancias adictivas y su reporte de barreras al uso del condón. Factores que mediaban dichas relaciones eran la depresión, el poder en la relación íntima, y la percepción de apoyo social. La mayoría de las participantes (72.9 %) exhibían una depresión en el periodo de estudio. Menos apoyo social (−0.17, p < 0.05) y poder en su relación íntima (−0.48, p < 0.001), y severidad de la depresión (−0.16, p < 0.05) predecían más barreras al uso del condón. Un historial de problemas de salud mental predecía barreras al uso del condón, mediado por depresión reciente y menos poder en la relación íntima (0.15, p < 0.001). Estos hallazgos sugieren que la depresión y el déficit de poder en la relación íntima limitan la habilidad de las mujeres en más alto riesgo de poder negociar el uso del condón y evitar el uso de sustancias adictivas, aumentando su riesgo de infección aguda por el VIH y de la transmisión vertical.

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Acknowledgments

This study was funded by Grant 5 RO1 DA021521 from the National Institute of Drug Abuse. Data used for this study was collected from participants in a group level, HIV risk reduction intervention in Miami, Florida, USA.

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Authors and Affiliations

  1. Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Biscayne Bay Campus, 3000 NE 151 Street - ACI #260, Miami, FL, 33181, USA

    Jessy G. Dévieux, Michèle Jean-Gilles, Rhonda Rosenberg, Jennifer M. Attonito & Anshul Saxena

  2. Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Modesto Maidique Campus, 11200 SW 8 Street - AHC II -571A, Miami, FL, 33199, USA

    Consuelo Beck-Sagué

  3. Jane & Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA

    Judith A. Stein

  4. Department of Health Services Administration, Florida Atlantic University College of Business, 777 Glades Road, Boca Raton, FL, 33431, USA

    Jennifer M. Attonito

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Dévieux, J.G., Jean-Gilles, M., Rosenberg, R. et al. Depression, Abuse, Relationship Power and Condom Use by Pregnant and Postpartum Women with Substance Abuse History. AIDS Behav 20, 292–303 (2016). https://doi.org/10.1007/s10461-015-1176-x

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