Journal of Urban Health

, Volume 96, Issue 3, pp 469–476 | Cite as

Correlates of Sexual Coercion among People Who Inject Drugs (PWID) in Los Angeles and San Francisco, CA

  • Jeffery E. Williams
  • Derek T. DangerfieldIIEmail author
  • Alex H. Kral
  • Lynn D. Wenger
  • Ricky N. Bluthenthal


Experiences of coerced or forced sex have been associated with risk for HIV infection for all adults and may be more common for gays, lesbians, bisexuals (GLB) and people who inject drugs (PWID). In this study, we explored factors associated with prior 12-month experiences of forced or coerced sex among a sample of PWID, with a focus on sexual orientation and gender. PWID (N = 772) from Los Angeles and San Francisco were recruited using targeted sampling methods in 2011–2013 and surveyed on a range of items related to demographics, drug use, HIV risk, and violence, including experiences of forced or coerced sex in the prior 12 months. In this racially/ethnically diverse, mostly homeless, and low-income sample of PWID, 25% of participants were female and 15% identified as GLB. Sexual coercion was reported by 9% of gay and bisexual men, 8% of heterosexual females, 5% of lesbians and bisexual women, and less than 1% of heterosexual men. In multivariate analyses, compared to heterosexual males, gay or bisexual males (adjusted odds ratio [AOR] = 10.68; 95% confidence interval [CI] = 2.03, 56.23), and heterosexual females (AOR = 9.69; 95% CI = 2.04, 45.94) had increased odds of coerced sex in the prior 12 months. Having a paying sex partner (AOR = 3.49; 95% CI = 1.42, 8.54) or having had forced sex prior to the age of 16 by someone at least five years older (AOR = 4.74; 95% CI = 1.88, 11.93) also elevated the odds of coercive sex. Sexual coercion is common among PWID, but especially for gay and bisexual men and heterosexual females. Efforts to reduce sexual violence among PWID are urgently needed.


Injection drug use Sexual violence Sexual coercion HIV risk 



The following research staff and volunteers also contributed to the study and are acknowledged here: Sonya Arreola, Vahak Bairamian, Philippe Bourgois, Soo Jin Byun, Jose Collazo, Jacob Curry, David-Preston Dent, Karina Dominguez, Jahaira Fajardo, Richard Hamilton, Frank Levels, Luis Maldonado, Askia Muhammad, Brett Mendenhall, Stephanie Dyal-Pitts, and Michele Thorsen. The research was supported by NIDA (grant nos: R01DA027689 and R01DA038965) and the National Science Foundation Graduate Research Fellowship Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We also thank the participants who took part in this study.

Compliance with Ethical Standards

The study protocol was reviewed and approved by Institutional Review Boards at the University of Southern California and RTI International.


  1. 1.
    Waldner-Haugrud LK, Gratch LV. Sexual coercion in gay/lesbian relationships: descriptives and gender differences. Violence Vict. 1997;12(1):87–98.CrossRefGoogle Scholar
  2. 2.
    Christopher FS. An initial investigation into a continuum of premarital sexual pressure. J Sex Res. 1988;25(2):255–66.CrossRefGoogle Scholar
  3. 3.
    Christopher FS, Frandsen MM. Strategies of influence in sex and dating. J Soc Pers Relatsh. 1990;7(1):89–105.CrossRefGoogle Scholar
  4. 4.
    He H, McCoy HV, Stevens SJ, Stark MJ. Violence and HIV sexual risk behaviors among female sex partners of male drug users. Women Health. 1998;27(1–2):161–75.CrossRefGoogle Scholar
  5. 5.
    Kalichman SC, Benotsch E, Rompa D, Gore-Felton C, Austin J, Luke W, et al. Unwanted sexual experiences and sexual risks in gay and bisexual men: associations among revictimization, substance use, and psychiatric symptoms. J Sex Res. 2001;38(1):1–9.Google Scholar
  6. 6.
    Kalichman SC, Rompa D. Sexually coerced and noncoerced gay and bisexual men: factors relevant to risk for human immunodeficiency virus (HIV) infection. J Sex Res. 1995;32(1):45–50.CrossRefGoogle Scholar
  7. 7.
    Lorvick J, Lutnick A, Wenger LD, Bourgois P, Cheng H, Kral AH. Non-partner violence against women who use drugs in San Francisco. Violence Women. 2014 Nov 1;20(11):1285–98.CrossRefGoogle Scholar
  8. 8.
    Ghanem A, Little SJ, Drumright L, Liu L, Morris S, Garfein RS. High-risk behaviors associated with injection drug use among recently HIV-infected men who have sex with men in San Diego, CA. AIDS Behav. 2011 Oct 1;15(7):1561–9.CrossRefGoogle Scholar
  9. 9.
    Braitstein P, Li K, Tyndall M, Spittal P, O’Shaughnessy MV, Schilder A, et al. Sexual violence among a cohort of injection drug users. Soc Sci Med. 2003 Aug;57(3):561–9.CrossRefGoogle Scholar
  10. 10.
    Magnus M, Kuo I, Phillips G, Rawls A, Peterson J, Montanez L, et al. Differing HIV risks and prevention needs among men and women injection drug users (IDU) in the district of Columbia. J Urban Health 2013 1;90(1):157–166.Google Scholar
  11. 11.
    Duncan DF. Prevalence of sexual assault victimization among heterosexual and gay/lesbian university students. Psychol Rep. 1990;66(1):65–6.Google Scholar
  12. 12.
    Baier JL, Rosenzweig MG, Whipple EG. Patterns of sexual behavior, coercion, and victimization of university students. J Coll Stud Dev. 1991;32(4):310–22.Google Scholar
  13. 13.
    Waterman CK, Dawson LJ, Bologna MJ. Sexual coercion in gay male and lesbian relationships: predictors and implications for support services. J Sex Res. 1989;26(1):118–24.CrossRefGoogle Scholar
  14. 14.
    Elliot P. Shattering illusions. J Gay Amp Lesbian Soc Serv. 1996;4(1):1–8.CrossRefGoogle Scholar
  15. 15.
    Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Probl. 1989;36(4):416–30.CrossRefGoogle Scholar
  16. 16.
    Kral AH, Malekinejad M, Vaudrey J, Martinez AN, Lorvick J, McFarland W, et al. Comparing respondent-driven sampling and targeted sampling methods of recruiting injection drug users in San Francisco. J Urban Health. 2010 Jun 26;87(5):839–50.Google Scholar
  17. 17.
    Bluthenthal R, Watters J. Multimethod research from targeted sampling to HIV risk environments. NIDA Res Monogr 1995. 1995;157:212–30.Google Scholar
  18. 18.
    Cagle HH, Fisher, D. G., Senter, T. P., Thurmond, R. D., Kaster A. J. Classifying skin lesions of injection drug users: a method for corroborating disease risk. [Rockville, MD]: Center for Substance Abuse Treatment; 2002.Google Scholar
  19. 19.
    Earls FJ, Brooks-Gunn J, Raudenbush SW, Sampson RJ. Project on Human Development in Chicago Neighborhoods (PHDCN): Master File, Wave 3, 2000–2002: Version 1 [Internet]. 2006 Oct [cited 2016 Feb 21]. Available from:
  20. 20.
    Curtin F, Schulz P. Multiple correlations and bonferroni’s correction. Biol Psychiatry. 1998;44(8):775–7.CrossRefGoogle Scholar
  21. 21.
    Braitstein P, Asselin JJ, Schilder A, Miller M-L, Laliberté N, Schechter MT, et al. Sexual violence among two populations of men at high risk of HIV infection. AIDS Care. 2006;18(7):681–9.Google Scholar
  22. 22.
    Buller AM, Devries KM, Howard LM, Bacchus LJ. Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis. PLoS Med. 2014;11(3):e1001609.CrossRefGoogle Scholar
  23. 23.
    Duncan DT, Goedel WC, Stults CB, Brady WJ, Brooks FA, Blakely JS, et al. A study of intimate partner violence, substance abuse, and sexual risk behaviors among gay, bisexual, and other men who have sex with men in a sample of geosocial-networking smartphone application users. Am J Mens Health. 2016;12:1557988316631964.Google Scholar
  24. 24.
    Finneran C, Stephenson R. Intimate partner violence among men who have sex with men: a systematic review. Trauma Violence Abuse. 2013;14(2):168–85.CrossRefGoogle Scholar
  25. 25.
    Beymer MR, Harawa NT, Weiss RE, Shover CL, Toynes BR, Meanley S, et al. Are partner race and intimate partner violence associated with incident and newly diagnosed HIV infection in African-American men who have sex with men? J Urban Health Bull N Y Acad Med. 2017;Google Scholar
  26. 26.
    Breiding MJ. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—National Intimate Partner and Sexual Violence Survey, United States, 2011. Morb Mortal Wkly Rep Surveill Summ Wash DC 2002. 2014;63(8):1–18.Google Scholar
  27. 27.
    El-Bassel N, Gilbert L, Wu E, Chang M, Gomes C, Vinocur D, et al. Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emerg Med J. 2007;24(4):255–9.CrossRefGoogle Scholar
  28. 28.
    Marshall BDL, Fairbairn N, Li K, Wood E, Kerr T. Physical violence among a prospective cohort of injection drug users: a gender-focused approach. Drug Alcohol Depend. 2008;97(3):237–46.CrossRefGoogle Scholar
  29. 29.
    Mateu-Gelabert P, Guarino H, Jessell L, Teper A. Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City. J Subst Abus Treat. 2015;48(1):13–20.CrossRefGoogle Scholar
  30. 30.
    Finkelhor D, Browne A. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthop. 1985;55(4):530–41.CrossRefGoogle Scholar
  31. 31.
    Johnsen LW, Harlow LL. Childhood sexual abuse linked with adult substance use, victimization, and AIDS-risk. AIDS Educ Prev Off Publ Int Soc AIDS Educ. 1996;8(1):44–57.Google Scholar
  32. 32.
    Tripodi SJ, Pettus-Davis C. Histories of childhood victimization and subsequent mental health problems, substance use, and sexual victimization for a sample of incarcerated women in the US. Int J Law Psychiatry. 2013;36(1):30–40.CrossRefGoogle Scholar
  33. 33.
    Pyett PM, Warr DJ. Vulnerability on the streets: female sex workers and HIV risk. AIDS Care. 1997;9(5):539–47.CrossRefGoogle Scholar
  34. 34.
    Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008;66(4):911–21.CrossRefGoogle Scholar
  35. 35.
    Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339:b2939.CrossRefGoogle Scholar
  36. 36.
    Surratt HL, Inciardi JA, Kurtz SP, Kiley MC. Sex work and drug use in a subculture of violence. Crime Delinquency 2004 Jan 1;50(1):43–59.Google Scholar
  37. 37.
    Footer KH, Silberzahn BE, Tormohlen KN, Sherman SG. Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc [Internet]. 2016 [cited 2017 Aug 28];19(4Suppl 3). Available from:
  38. 38.
    Tenni B, Carpenter J, Thomson N. Arresting HIV: fostering partnerships between sex workers and police to reduce HIV risk and promote professionalization within policing institutions: a realist review. PLoS One. 2015;10(10):e0134900.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  • Jeffery E. Williams
    • 1
  • Derek T. DangerfieldII
    • 2
    Email author
  • Alex H. Kral
    • 3
  • Lynn D. Wenger
    • 3
  • Ricky N. Bluthenthal
    • 1
  1. 1.Department of Preventive Medicine, Institute for Prevention Research, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.The REACH InitiativeJohns Hopkins School of NursingBaltimoreUSA
  3. 3.Behavioral and Urban Health ProgramRTI InternationalSan FranciscoUSA

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