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When, Where, Why and with Whom Homeless Women Engage in Risky Sexual Behaviors: A Framework for Understanding Complex and Varied Decision-Making Processes

Abstract

Impoverished women worldwide are at high risk for contracting HIV/AIDS. This study explores how homeless women make risky sex decisions and the role that alcohol and drugs play in this process. We analyze 56 in-depth qualitative descriptions of recent sexual episodes among 28 women living in shelters in Los Angeles, California, USA. The sample (age 18–63) was 46% African American, 21% Hispanic/Latina, and 21% White. Findings suggest that: (1) homeless women engage in multiple types of relationships and sexual behaviors; (2) emotion and attachment play critical roles in women’s risky sex choices; and (3) the role of alcohol and drugs on such choices varies across relationship commitment. Understanding the complexity of sexual decision-making among this population has implications for developing successful risk reduction interventions.

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Acknowledgements

This work was sponsored by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01 AA015301). Many individuals and institutions contributed to this work. First, we wish to thank the 28 homeless women living in temporary shelters in Los Angeles County who permitted us to interview them and provided candid descriptions of what they thought and felt about their relationships and risky sexual behaviors. We thank the homeless shelters for their help and collaboration to make it possible to reach these homeless women. We thank our frontline interviewers Crystal Kollross and Dionne Barnes who took on the complicated task of conducting all of the semi-structured interviews and the RAND Survey Research Group for their hard work in finding and coordinating with the shelter sites. We would also like to thank Hilary Rhodes for all her coding efforts and Leigh Rohr for her assistance in preparing this report. We could not have done it without all of you.

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Correspondence to Gery W. Ryan.

Appendix

Appendix

Stage-By-Topic Interview Protocol

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Ryan, G.W., Stern, S.A., Hilton, L. et al. When, Where, Why and with Whom Homeless Women Engage in Risky Sexual Behaviors: A Framework for Understanding Complex and Varied Decision-Making Processes. Sex Roles 61, 536–553 (2009). https://doi.org/10.1007/s11199-009-9610-z

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Keywords

  • Homeless women
  • Risky sexual behavior
  • Decision-making
  • Alcohol and drug use
  • Condom use