Abstract
Individuals who use illicit drugs and belong to a sexual minority group often contend with elevated risks for adverse health outcomes. However, little is known about women who use drugs and have sex with women. We therefore sought to identify sociodemographic, substance use patterns, and exposures to social-structural factors associated with reporting sexual activity among women participating in three open prospective cohort studies of individuals who use illicit drugs in Vancouver, Canada. Generalized estimating equations were used to identify substance use patterns, violence, and other social and structural drivers of health-related harm among women who reported having sex with women (WSW) between December 2005 and May 2012. In multivariate analyses, younger age (adjusted odds ratio [AOR] 2.89; 95 % confidence interval [CI] 1.81, 4.60), violence (AOR 1.78; 95 % CI 1.22, 2.59), and homelessness (AOR 1.42; 95 % CI 1.00, 2.02) were associated with WSW. WSW were also less likely to report enrollment in addiction treatment (AOR 0.68; 95 % CI 0.46, 0.99). In a second model, sexual violence (AOR 3.47; 95 % CI 2.08, 5.78) in the previous 6 months was also found to be positively associated with WSW. These findings indicate a critical need for more thorough understandings of the intersections between sexual relationships, exposure to violence, and enrollment in addiction treatment among women who use illicit drugs, as well as the development of programs to address the unique needs of this population.
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Bayoumi, A. M., Strike, C., Jairam, J., Watson, T., Enns, E., Kolla, G., … Brandeau, M. (2012). Report of the Toronto and Ottawa supervised consumption assessment study. Toronto, ON: St. Michael’s Hospital and the Dalla Lana School of Public Health, University of Toronto.
Bell, A. V., Ompad, D., & Sherman, S. G. (2006). Sexual and drug risk behaviors among women who have sex with women. American Journal of Public Health, 96(6), 1066–1072. doi:10.2105/AJPH.2004.061077.
Button, D. M. (2012). Sexual minority youth victimization and social support: The intersection of sexuality, gender, race, and victimization. Journal of Homosexuality, 59(1), 18–43. doi:10.1080/00918369.2011.614903.
Bux, D. A. (1996). The epidemiology of problem drinking in gay men and lesbians: A critical review. Clinical Psychology Review, 16(4), 277–298. doi:10.1016/0272-7358(96)00017-7.
Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health, 31(1), 457–477. doi:10.1146/annurev.publhealth.012809.103636.
Degenhardt, L. (2005). Drug use and risk behaviour among regular ecstasy users: Does sexuality make a difference? Culture, Health & Sexuality, 7(6), 599–614. doi:10.1080/13691050500349875.
Everett, B. G. (2013). Sexual orientation disparities in sexually transmitted infections: Examining the intersection between sexual identity and sexual behavior. Archives of Sexual Behavior, 42(2), 225–236. doi:10.1007/s10508-012-9902-1.
Formby, E. (2011). Lesbian and bisexual women’s human rights, sexual rights and sexual citizenship: negotiating sexual health in England. Culture, Health & Sexuality, 13(10), 1165–1179. doi:10.1080/13691058.2011.610902.
Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E. M., & Stall, R. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494. doi:10.2105/ajph.2009.190009.
Gaetz, S., O’Grady, B., & Buccieri, K. (2010). Surviving crime and violence: Street youth and victimization in Toronto. Toronto, ON: Justice for Children and Youth.
Goodenow, C., Szalacha, L. A., Robin, L. E., & Westheimer, K. (2008). Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. American Journal of Public Health, 98(6), 1051–1058. doi:10.2105/AJPH.2005.080531.
Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278. doi:10.1037/a0025424.
Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21. doi:10.1016/j.drugalcdep.2006.05.012.
Greenfield, S. F., & Grella, C. E. (2009). What is “women-focused” treatment for substance use disorders? Psychiatric Services, 60(7), 880–882. doi:10.1176/appi.ps.60.7.880.
Grella, C., Greenwell, L., Mays, V., & Cochran, S. (2009). Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey. BMC Psychiatry, 9(1), 52. doi:10.1186/1471-244X-9-52.
Hequembourg, A. L., Parks, K. A., & Vetter, C. (2008). Sexual identity and gender differences in substance use and violence: An exploratory study. Journal of LGBT Issues in Counseling, 2(3), 174–198. doi:10.1080/15538600802119301.
Herek, G. M. (1990). The context of anti-gay violence: Notes on cultural and psychological heterosexism. Journal of Interpersonal Violence, 5(3), 316–333. doi:10.1177/088626090005003006.
Herek, G. M., Chopp, R., & Strohl, D. (2007). Sexual stigma: Putting sexual minority health issues in context. In I. Meyer & M. Northridge (Eds.), The health of sexual minorities (pp. 171–208). New York: Springer.
Herrick, A. L., Matthews, A. K., & Garofalo, R. (2010). Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies, 14(1), 80–92. doi:10.1080/10894160903060440.
Hughes, T. L. (2003). Lesbians’ drinking patterns: Beyond the data. Substance Use and Misuse, 38(11–13), 1739–1758. doi:10.1081/ja-120024239.
Hughes, T., Szalacha, L. A., & McNair, R. (2010). Substance abuse and mental health disparities: Comparisons across sexual identity groups in a national sample of young Australian women. Social Science and Medicine, 71(4), 824–831. doi:10.1016/j.socscimed.2010.05.009.
Lehavot, K., Molina, Y., & Simoni, J. (2012). Childhood trauma, adult sexual assault, and adult gender expression among lesbian and bisexual women. Sex Roles, 67(5–6), 272–284. doi:10.1007/s11199-012-0171-1.
Lenke, K., & Piehl, M. (2009). Women who have sex with women in the global HIV pandemic. Development, 52(1), 91–94. doi:10.1057/dev.2008.77.
Lhomond, B., & Saurel-Cubizolles, M.-J. (2006). Violence against women and suicide risk: The neglected impact of same-sex sexual behaviour. Social Science and Medicine, 62(8), 2002–2013. doi:10.1016/j.socscimed.2005.08.026.
Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103(4), 546–556. doi:10.1111/j.1360-0443.2008.02149.x.
Marshall, B. D. L., Wood, E., Shoveller, J. A., Patterson, T. L., Montaner, J. S. G., & Kerr, T. (2011). Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis. BMC Public Health,. doi:10.1186/1471-2458-11-20.
Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56(1), 23. doi:10.1037/a0014587.
Ompad, D. C., Friedman, S. R., Hwahng, S. J., Nandi, V., Fuller, C. M., & Vlahov, D. (2011). HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Substance Use and Misuse, 46(2–3), 274–284. doi:10.3109/10826084.2011.523284.
Pan, W. (2001). Akaike’s information criterion in generalized estimating equations. Biometrics, 57(1), 120–125. doi:Retrieved from http://www.jstor.org/stable/2676849
Poon, C., Saewyc, E., & Chen, W. (2011). Enacted stigma, problem substance use, and protective factors among Asian sexual minority youth in British Columbia. Canadian Journal of Community Mental Health, 30(2), 47–64. Retrieved from http://cjcmh.com/toc/cjcmh/30/2
Rosario, M. (2008). Elevated substance use among lesbian and bisexual women: Possible explanations and intervention implications for an urgent public health concern. Substance Use and Misuse, 43(8–9), 1268–1270. doi:10.1080/10826080802215130.
Rosario, M., Schrimshaw, E., & Hunter, J. (2012). Homelessness among lesbian, gay, and bisexual youth: Implications for subsequent internalizing and externalizing symptoms. Journal of Youth and Adolescence, 41(5), 544–560. doi:10.1007/s10964-011-9681-3.
Simpson, M., & McNulty, J. (2008). Different needs: Women’s drug use and treatment in the UK. International Journal of Drug Policy, 19(2), 169–175. doi:10.1016/j.drugpo.2007.11.021.
Strathdee, S. A., Patrick, D. M., Currie, S. L., Cornelisse, P. G., Rekart, M. L., Montaner, J. S., … O’Shaughnessy, M. V. (1997). Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS, 11, 1291–1304.
Travers, R., & Schneider, M. (1996). Barriers to accessibility for lesbian and gay youth needing addictions services. Youth & Society, 27(3), 356–378. doi:10.1177/0044118X96027003005.
Tyndall, M., Currie, S., Spittal, P., Li, K., Wood, E., O’Shaughnessy, M. V., & Schechter, M. T. (2003). Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS, 17(6), 887–893. doi:10.1097/01.aids.0000050859.71999.ae.
Williams, K. A., & Chapman, M. V. (2011). Comparing health and mental health needs, service use, and barriers to services among sexual minority youths and their peers. Health and Social Work, 36(3), 197–206. doi:10.1093/hsw/36.3.197.
Wood, E., Stoltz, J.-A., Montaner, J., & Kerr, T. (2006). Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Reduction Journal, 3(1), 18. doi:10.1186/1477-7517-3-18.
Worthington, C., Bruce, M., Huffey, N., Dittmann, D., Kitt, O., Patten, S., & Leech, J. (2008). Calgary youth, health and the street. Final Report. Calgary, AB: University of Calgary.
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Lyons, T., Shannon, K., Richardson, L. et al. Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness. Arch Sex Behav 45, 1403–1410 (2016). https://doi.org/10.1007/s10508-015-0508-2
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DOI: https://doi.org/10.1007/s10508-015-0508-2