AIDS and Behavior

, Volume 15, Issue 1, pp 103–113

Age and HIV Sexual Risk among Women in Methadone Treatment

  • Malitta Engstrom
  • Tazuko Shibusawa
  • Nabila El-Bassel
  • Louisa Gilbert
Original paper


This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent condom use during vaginal sex. Age (35–44), having a main sexual partner with an HIV risk factor, IPV, and alcohol use are associated with using crack or cocaine during sex. Similarly, age (35–44), having a main sexual partner with an HIV risk factor, IPV, and drug use are associated with consuming four or more drinks prior to sex. The findings highlight the importance of age-appropriate HIV prevention and intervention strategies, as well as the need to address intimate partner violence, mental health, polysubstance use, and relational factors associated with HIV sexual risk behaviors among women in methadone treatment.


Sexual risk behavior HIV Midlife women Older women Methadone treatment 


  1. 1.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. 2007; Available at: Accessed February 18, 2008.
  2. 2.
    Mack KA, Ory MG. AIDS and older Americans at the end of the twentieth century. J Acquir Immune Defic Syndr. 2003;33(S2):S68–75.PubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(36):985–9.Google Scholar
  4. 4.
    Centers for Disease Control and Prevention. MMWR analysis provides new detail on HIV incidence in U.S. populations. CDC HIV/AIDS Facts, September 2008.Google Scholar
  5. 5.
    Kwiatkowski CF, Booth RE. HIV risk behaviors among older American drug users. J Acquir Immune Defic Syndr. 2003;33:S131–7.PubMedGoogle Scholar
  6. 6.
    Tuchman E. Methadone and menopause: the aging population of women in drug treatment. J Soc Work Pract Addict. 2003;3(2):14–26.Google Scholar
  7. 7.
    Weeks MR, Singer M, Schensul JJ, Jia Z, Grier M. Project COPE: preventing AIDS among injection drug users and their sex partners: descriptive data report. Hartford, CT: Institute for Community Research; 1993.Google Scholar
  8. 8.
    Weeks MR, Singer M, Himmelgreen DA, et al. Drug use patterns of substance abusing women: gender and ethnic differences in an AIDS prevention program. Drugs Soc. 1998;13(1/2):35–61.CrossRefGoogle Scholar
  9. 9.
    Evans JL, Hahn JA, Page-Shafer K, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO study). J Urban Health. 2003;80(1):137–46.CrossRefPubMedGoogle Scholar
  10. 10.
    Fernando D, Schilling RF, Fontdevila J, El-Bassel N. Predictors of sharing drugs among injection drug users in the South Bronx: implications for HIV transmission. J Psychoactive Drugs. 2003;35(2):227–36.PubMedGoogle Scholar
  11. 11.
    Iguchi MY, Bux DA, Kushner H, Lidz V. Correlates of HIV risk among female sex partners of injecting drug users in a high-seroprevalence area. Eval Program Plann. 2001;24(2):175–85.CrossRefGoogle Scholar
  12. 12.
    Krauss BJ, Wolitski RJ, Tross S, Corby NH, Fishbein M. Getting the message: HIV information sources of women who have sex with injecting drug users: a two-site study. J Appl Psychol. 1999;48(2):153–73.Google Scholar
  13. 13.
    Deren S, Davis R, Tortu S, Ahluwahlia I. Characteristics of female sexual partners. In: Brown B, Beschner B, editors. Handbook on risk for AIDS: injection drug users and sexual partners. Westport, CT: Greenwood Press; 1993.Google Scholar
  14. 14.
    Corsi KF, Kwiatkowski CF, Booth RE. Long-term predictors of HIV risk behaviors among IDUs. J Drug Issues. 2006;36(3):649–66.Google Scholar
  15. 15.
    Fullilove MT, Lown EA, Fullilove RE. Crack “hos and skeezers”: traumatic experiences of women crack users. J Sex Res. 1992;29:275–87.CrossRefGoogle Scholar
  16. 16.
    Hoffman JA, Klein H, Eber M, Crosby H. Frequency and intensity of crack use as predictors of women’s involvement in HIV-related sexual risk behaviors. Drug Alcohol Depend. 2000;58:227–36.CrossRefPubMedGoogle Scholar
  17. 17.
    Edwards JM, Halpern CT, Wechsberg WM. Correlates of exchanging sex for drugs or money among women who use crack cocaine. AIDS Educ Prev. 2006;18(5):420–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Longshore D, Anglin MD. Number of sex partners and crack cocaine use: is crack an independent marker for HIV risk behavior? J Drug Issues. 1995;25:1–10.Google Scholar
  19. 19.
    Wingood GM, DiClemente RJ. The influence of psychosocial factors, alcohol, drug use on African-American women’s high-risk sexual behavior. Am J Prev Med. 1998;15(1):54–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Stevens SJ, Estrada AL, Estrada BD. HIV sex and drug risk behavior and behavior change in a national sample of injection drug and cocaine using women. Women Health. 1998;27(1/2):25–48.PubMedGoogle Scholar
  21. 21.
    Levy JA. AIDS and injecting drug use later in life. Res Aging. 1998;20(6):776–97.CrossRefGoogle Scholar
  22. 22.
    Zablotsky D. Overlooked, ignored, and forgotten: older women at risk for HIV infection and AIDS. Res Aging. 1998;20(6):760–75.CrossRefGoogle Scholar
  23. 23.
    Zablotsky D, Kennedy M. Risk factors and HIV transmission to midlife and older women: knowledge, options, and the initiation of safer sexual practices. J Acquir Immune Defic Syndr. 2003;33:S122–30.PubMedGoogle Scholar
  24. 24.
    Hartel DM, Schoenbaum EE, Lo Y, Klein RS. Gender differences in illicit substance use among middle-aged drug users with or at risk for HIV infection. Clin Infect Dis. 2006;43:525–31.CrossRefPubMedGoogle Scholar
  25. 25.
    Hser Y-I, Hoffman V, Grella CE, Anglin MD. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58:503–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Johnson SD, Striley C, Cottler LB. Cormorbid substance use and HIV risk in older African American drug users. J Aging Health. 2007;19(4):646–58.CrossRefPubMedGoogle Scholar
  27. 27.
    Staton M, Walker R, Leukefeld C. Age differences in risk behavior among incarcerated substance-abusing women. J Addict Nurs. 2003;3-9:14.Google Scholar
  28. 28.
    Carneiro M, Fuller C, Doherty MC, Vlahov D. HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old. Drug Alcohol Depend. 1999;54:83–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Substance Abuse and Mental Health Services Administration Office of Applied Studies. Results from the 2007 national survey on drug use and health: national findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD; 2008.Google Scholar
  30. 30.
    Valliant GE. A long-term follow-up of male alcohol abuse. Arch Gen Psychiatry. 1996;53:243–9.Google Scholar
  31. 31.
    Schensul JJ, Levy JA, Disch WB. Individual, contextual, and social network factors affecting exposure to HIV/AIDS risk among older residents living in low-income senior housing complexes. J Acquir Immune Defic Syndr. 2003;33:S138–52.PubMedGoogle Scholar
  32. 32.
    Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med. 1990;150(1):197–200.CrossRefPubMedGoogle Scholar
  33. 33.
    Lindau ST, Schumm P, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Somlai AM, Kelly JA, McAuliffe TL, Ksobiech K, Hackl KL. Predictors of HIV sexual risk behaviors in a community sample of injection drug-using men and women. AIDS Behav. 2003;7(4):383–93.CrossRefPubMedGoogle Scholar
  35. 35.
    Richard AJ, Bell DC, Montoya ID. Age and HIV risk in a national sample of injection drug and crack cocaine users. Subst Use Misuse. 2000;35(10):1385–404.CrossRefPubMedGoogle Scholar
  36. 36.
    El-Bassel N, Gilbert L, Wu E, Go H, Hill J. HIV and intimate partner violence among methadone maintained women in New York City. Soc Sci Med. 2005;61:171–83.CrossRefPubMedGoogle Scholar
  37. 37.
    El-Bassel N, Cooper D, Chen D. Social support and social networks among women on methadone. Soc Serv Rev. 1998;72:379–401.CrossRefGoogle Scholar
  38. 38.
    Schilling RF, El-Bassel N, Gilbert L, Glassman M. Predictors of changes in sexual behavior among women on methadone. Am J Drug Alcohol Abuse. 1993;19(4):409–22.CrossRefPubMedGoogle Scholar
  39. 39.
    Semaan S, Kotranski L, Collier K, et al. Temporal trends in HIV risk behaviors among out-of-treatment women crack users: the need for drug treatment. Drugs Soc. 1998;13(12):13–33.CrossRefGoogle Scholar
  40. 40.
    Wechsberg WM, Cavanaugh ER. Differences found between women injectors in and out of treatment: implications for interventions. Drugs Soc. 1998;13(1/2):63–79.CrossRefGoogle Scholar
  41. 41.
    Theall KP, Elifson KW, Sterk CE, Klein H. Perceived susceptibility to HIV among women: differences in age. Res Aging. 2003;25(4):405–32.CrossRefGoogle Scholar
  42. 42.
    Sterk CE, Elifson KW, Theall KP. Women and drug treatment experiences: a generational comparison of mothers and daughters. J Drug Issues. 2000;30(4):839–62.Google Scholar
  43. 43.
    Grella CE, Anglin MD, Annon JJ. HIV risk behaviors among women in methadone treatment. Subst Use Misuse. 1996;31(3):277–301.CrossRefPubMedGoogle Scholar
  44. 44.
    El-Bassel N, Gilbert L, Krishnan S, et al. Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department. Violence Vict. 1998;13(4):377–93.PubMedGoogle Scholar
  45. 45.
    Gilbert L, El-Bassel N, Schilling RF, Wada T, Bennet B. Partner violence and sexual HIV risk behaviors among women in methadone treatment. AIDS Behav. 2000;4(3):261–9.CrossRefGoogle Scholar
  46. 46.
    Wu E, El-Bassel N, Witte SS, Gilbert L, Chang M. Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS Behav. 2003;7(3):291–301.CrossRefPubMedGoogle Scholar
  47. 47.
    Hutton HE, Treisman GJ, Hunt WR, et al. HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatr Serv. 2001;52(4):508–13.CrossRefPubMedGoogle Scholar
  48. 48.
    Wyatt GE, Myers HF, Williams JK, et al. Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. Am J Public Health. 2002;92(4):660–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Paxton KC, Myers HF, Hall NM, Javanbakht M. Ethnicity, serostatus, and psychosocial differences in sexual risk behavior among HIV-seropositive and HIV-seronegative women. AIDS Behav. 2004;8(4):405–15.CrossRefPubMedGoogle Scholar
  50. 50.
    Schönnesson LN, Atkinson J, Williams ML, et al. A cluster analysis of drug use and sexual HIV risks and their correlates in a sample of African-American crack cocaine smokers with HIV infection. Drug Alcohol Depend. 2008;97:44–53.CrossRefPubMedGoogle Scholar
  51. 51.
    Friedman S, Chapman TF, Perlis TE, et al. Modulators of “activated motivation”: event-specific condom use by drug injectors who have used condoms to prevent HIV/AIDS. AIDS Behav. 1999;3:85–98.CrossRefGoogle Scholar
  52. 52.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefPubMedGoogle Scholar
  53. 53.
    Dolezal C, Ehrhardt AA, Meyer-Bahlburg HFL, et al. Sexual risk behavior changes among HIV+ and HIV− female injecting drug users over 4 years. Women Health. 1998;27(4):1–17.CrossRefPubMedGoogle Scholar
  54. 54.
    Dixon DA, Antoni M, Peters M, Saul J. Employment, social support and HIV sexual-risk behavior in Puerto Rican women. AIDS Behav. 2001;54(4):331–42.CrossRefGoogle Scholar
  55. 55.
    El-Bassel N, Schilling RF. Social support and sexual risk taking among women on methadone. AIDS Educ Prev. 1994;6(6):506–13.PubMedGoogle Scholar
  56. 56.
    Miller M, Paone D. Social network characteristics as mediators in the relationship between sexual abuse and HIV risk. Soc Sci Med. 1998;47(6):765–77.CrossRefPubMedGoogle Scholar
  57. 57.
    Sobo EJ. Finance, romance, social support, and condom use among impoverished inner-city women. Hum Organ. 1995;54(2):115–28.Google Scholar
  58. 58.
    Levy JA, Holmes D, McKenzie S. Conceptual and methodological issues in research on age and aging. J Acquir Immune Defic Syndr. 2003;33:S206–17.CrossRefPubMedGoogle Scholar
  59. 59.
    Derogatis LR. Brief symptom inventory: administration, scoring, and procedures manual. Minneapolis: National Computer Systems; 1993.Google Scholar
  60. 60.
    Foa EB. Posttraumatic stress diagnostic scale manual. Minneapolis: National Computer Systems; 1995.Google Scholar
  61. 61.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  62. 62.
    Straus M, Hamby S, Boney-McCoy S, Sugarman D. The revised Conflict Tactics Scale (CTS2): development and preliminary psychometric data. J Fam Issues. 1996;17(3):283–316.CrossRefGoogle Scholar
  63. 63.
    Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52:30–41.CrossRefGoogle Scholar
  64. 64.
    StataCorp. Stata statistical software: release 10. College Station, TX: StataCorp LP; 2007.Google Scholar
  65. 65.
    Rubin D. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.CrossRefGoogle Scholar
  66. 66.
    Schafer J. Analysis of incomplete multivariate data. London: Chapman & Hall; 1997.CrossRefGoogle Scholar
  67. 67.
    Sormanti M, Shibusawa T. Predictors of condom use and HIV testing among midlife and older women seeking medical services. J Aging Health. 2007;19(4):705–19.CrossRefPubMedGoogle Scholar
  68. 68.
    Tawk H, Simpson J, Mindel A. Condom use in multi-partnered females. Int J STD AIDS. 2004;15(6):403–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Miller S, Exner TM, Williams SP, Ehrhardt AA. A gender specific intervention for at-risk women. AIDS Care. 2000;12(5):603–12.CrossRefPubMedGoogle Scholar
  70. 70.
    Sikkema KJ, Kelly JA, Winett RA, et al. Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low income housing developments. Am J Public Health. 2000;90(1):57–64.CrossRefPubMedGoogle Scholar
  71. 71.
    El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93:963–9.CrossRefPubMedGoogle Scholar
  72. 72.
    Auerbach JD, Coates TJ. HIV prevention research: accomplishments and challenges for the third decade of AIDS. Am J Public Health. 2000;90:1029–32.CrossRefPubMedGoogle Scholar
  73. 73.
    Wechsberg WM, Craddock SG, Hubbard RL. How are women who enter substance abuse treatment different than men? A gender comparison from the drug abuse treatment outcome study. Drugs Soc. 1998;13(1–2):97–115.CrossRefGoogle Scholar
  74. 74.
    Amaro H. Love, sex, and power: considering women’s realities in HIV prevention. Am Psychol. 1995;50(6):437–47.CrossRefPubMedGoogle Scholar
  75. 75.
    Fordyce EJ, Blum S, Balanon A, Stoneburner RL. A method for estimating HIV transmission rates among female sex partners of male intravenous drug users. Am J Epidemiol. 1991;133:590–8.PubMedGoogle Scholar
  76. 76.
    Wagstaff DA, Kelly JA, Perry MJ, et al. Multiple partners, risky partners and HIV risk among low-income urban women. Fam Plann Perspect. 1995;27(6):241–5.CrossRefPubMedGoogle Scholar
  77. 77.
    Hernandez-Avila CA, Rounsaville BJ, Kranzler HR. Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004;74(3):265–72.CrossRefPubMedGoogle Scholar
  78. 78.
    Engstrom M, El-Bassel N, Go H, Gilbert L. Childhood sexual abuse and intimate partner violence among women in methadone treatment: a direct or mediated relationship? J Fam Violence. 2008;23(7):605–17.CrossRefGoogle Scholar
  79. 79.
    McLellan AT, Hagan TA, Levine M, et al. Supplemental social services improve outcomes in public addiction treatment. Addiction. 1998;93(10):1489–99.CrossRefPubMedGoogle Scholar
  80. 80.
    Marsh JC, Dingcai C, D’Aunno T. Gender differences in the impact of comprehensive services in substance abuse treatment. J Subst Abuse Treat. 2004;27:289–300.CrossRefPubMedGoogle Scholar
  81. 81.
    Grella CE, Stein JA. Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders. Psychiatr Serv. 2006;57(7):1007–15.CrossRefPubMedGoogle Scholar
  82. 82.
    Schiff M, El-Bassel N, Engstrom M, Gilbert L. Psychological distress and intimate physical and sexual abuse among women in methadone maintenance treatment programs. Soc Serv Rev. 2002;76(2):302–20.CrossRefGoogle Scholar
  83. 83.
    Hien DA, Nunes E, Levin FR, Fraser D. Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat. 2000;19:31–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Morrissey JP, Jackson EW, Ellis AR, et al. Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatr Serv. 2005;56(10):1213–22.CrossRefPubMedGoogle Scholar
  85. 85.
    Finkelstein N, VandeMark N, Fallot R, et al. Enhancing substance abuse recovery through integrated trauma treatment. Sarasota, FL: The National Trauma Consortium; 2004.Google Scholar
  86. 86.
    Amaro H, McGraw S, Larson MJ, et al. Boston consortium of services for families in recovery: a trauma-informed intervention model for women’s alcohol and drug addiction treatment. Alcohol Treat Q. 2004;22(3–4):95–119.Google Scholar
  87. 87.
    Hien DA, Cohen LR, Miele GM, Litt LC, Capstick C. Promising treatments for women with comorbid PTSD and substance use disorders. Am J Psychiatry. 2004;161(8):1426–32.CrossRefPubMedGoogle Scholar
  88. 88.
    Ducharme LJ, Mello HL, Roman PM, Knudsen HK, Johnson JA. Service delivery in substance abuse treatment: reexamining “comprehensive” care. J Behav Health Serv Res. 2007;34(2):121–36.CrossRefPubMedGoogle Scholar
  89. 89.
    Friedman PD, Lemon S, Durkin EM, D’Aunno T. Trends in comprehensive service availability in outpatient drug abuse treatment. J Subst Abuse Treat. 2003;24:81–8.CrossRefGoogle Scholar
  90. 90.
    McFarland BH, Gabriel RM. Service availability for persons with co-occurring conditions. Psychiatr Serv. 2004;55(9):978.CrossRefPubMedGoogle Scholar
  91. 91.
    Mojtabai R. Which substance abuse treatment facilities offer dual diagnosis programs? Am J Drug Alcohol Abuse. 2004;30(3):525–36.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Malitta Engstrom
    • 1
  • Tazuko Shibusawa
    • 2
  • Nabila El-Bassel
    • 3
  • Louisa Gilbert
    • 3
  1. 1.School of Social Service AdministrationThe University of ChicagoChicagoUSA
  2. 2.Silver School of Social WorkNew York UniversityNew YorkUSA
  3. 3.Social Intervention Group, School of Social WorkColumbia UniversityNew YorkUSA

Personalised recommendations