AIDS and Behavior

, Volume 4, Issue 4, pp 329–340 | Cite as

Drug-Using Women's Sexual Risk: An Event Analysis

  • Stephanie Tortu
  • James McMahon
  • Rahul Hamid
  • Alan Neaigus


Using event analysis, this study describes the most recent sexual events of drug-using women and their male partners and identifies relationship-specific and event-specific determinants of condom use. Women drug users (n = 320) were recruited from the streets of East Harlem. After validation of drug use, they participated in structured interviews and were offered HIV testing and counseling. Interview topics included the following: (1) demographic characteristics of respondents, (2) relationship factors, including age difference, race/ethnicity concordance, and HIV serostatus of partners, and (3) event-specific factors, including sexual repertoire, communication about condom use, and perception of HIV risk. Univariate and multivariate analyses identified five major variables associated with event-specific condom use: (1) closeness to partner, (2) perceived dyadic serostatus, (3) sexual repertoire, (4) communication about condoms, and (5) perceived control of condom use. Behavioral interventions to reduce sexual risk should target dyads with long-standing sexual relationships and focus on the dynamics of the relationship, especially the issues of dyadic serostatus, intimacy, communication, and control.

women and HIV sexual risk drug use and HIV social context event analysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Auerbach, J. D., Wypijewska, C., and Brodie, H. K. H. (Eds.). (1994). AIDS and behavior: An integrated approach, Washington,DC: National Academy Press.Google Scholar
  2. Beardsley, M., Deren, S., Tortu, S., Goldstein, M. F., Ziek, K., and Hamid, R. (in press). Trends in injection risk behaviors in a sample of New York City injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology.Google Scholar
  3. Booth, R. E. (1995). Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers. American Journal of Drug and Alcohol Abuse, 21, 419–432.PubMedGoogle Scholar
  4. Booth, R. E., Watters J. K., and Chitwood, D. D. (1993). HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. American Journal of Public Health, 83, 1144–1148.PubMedGoogle Scholar
  5. Brown, P. L. (1999, April 11). The ‘Leonardo' of condoms. The New York Times, pp. 1, 3.Google Scholar
  6. Centers for Disease Control and Prevention. (1994). HIV/AIDS Surveillance Report, No. 5 (1994).Google Scholar
  7. Centers for Disease Control and Prevention. (1997). HIV/AIDS Surveillance Report, No. 8 (1997).Google Scholar
  8. Centers for Disease Control and Prevention. (1998). HIV/AIDS Surveillance Report, No. 10 (1998).Google Scholar
  9. Chesney, M. A. (1994). Prevention of HIV and STD infections. Preventive Medicine. 23, 655–660.PubMedGoogle Scholar
  10. Clark, R. A., Kissinger, P., Bedimo, A. L., and Albertin, H. (1997). Determination of factors associated with condom use among women infected with human immunodeficiency virus. International Journal of STD and AIDS, 8, 229–233.PubMedGoogle Scholar
  11. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  12. Cottler, L. B., Leukefeld, C., Hoffman, J., Desmond, D., Wechsberg, W., Inciardi, J. A., Compton, W. M., Ben Abdallah, A., Cunningham-Williams, R., and Woodson S. J. (1998). Effectiveness of HIV risk reduction initiatives among out-of-treatment non-injection drug users. Psychoactive Drugs, 30, 279–290.Google Scholar
  13. Coyle, S. L., Needle, H., and Normand, J. (1998). Outreach-based HIVprevention for injecting drug users:Areview of published outcome data. Public Health Reports, 113, 19–30.PubMedGoogle Scholar
  14. Crosby, R. A. (1998). Condom use as a dependent variable: Measurement issues relevant to HIV prevention programs. AIDS Education and Prevention, 10, 548–557.PubMedGoogle Scholar
  15. DeHovitz, J. A., Kelly, P., Feldman, J., Sierra, M. F., Clarke, L., Bromberg, J., Wan, J. Y., Vermund, S. H., and Landesman, S. (1994). Sexually transmitted diseases, sexual behavior, and cocaine use in inner-city women. American Journal of Epidemiology, 140, 1125–1134.PubMedGoogle Scholar
  16. Elias, C., and Coggins, C. (1996) Female-controlled methods to prevent sexual transmission of HIV. AIDS, 10, S43–S51.Google Scholar
  17. Evans, B. A., Kell, P. D., Bond, R. A., and MacRae, K. D. (1995). Heterosexual relationships and condom-use in the spread of sexually transmitted diseases to women. Genitourinary Medicine, 71, 291–294.PubMedGoogle Scholar
  18. Falck, R. S., Wang, J., Carlson, R. G., and Siegal, H. A. (1997). Factors influencing condom use among heterosexual users of injection drugs and crack cocaine. Sexually Transmitted Diseases, 24, 204–210.PubMedGoogle Scholar
  19. Fitterling, J. M., Matens, P. B., Scotti, J. R., and Allen, J. S., Jr. (1993). AIDSrisk behaviors and knowledge among heterosexual alcoholics and non-injecting drug users. Addiction, 88, 1257–1265.PubMedGoogle Scholar
  20. Fortenberry, J. D., Orr, D. P., Katz, B. P., Brizendine, E. J., and Blythe, M. J. (1997). Sex under the influence: A diary selfreport study of substance use and sexual behavior among adolescent women. Sexually Transmitted Diseases, 24, 313–319.PubMedGoogle Scholar
  21. Friedman, S. R., DesJarlais, D. C., Ward, T. P., Jose, B., Neaigus, A., and Goldstein, M. F. (1994). Drug injectors and heterosexual AIDS. In L. Sherr (Ed.), AIDS and the heterosexual population (pp. 41-65). Chur, Switzerland: Harwood.Google Scholar
  22. Gillespie, C. C. (1997). Women's HIV risk reduction efforts and traditional models of health behavior: A review and critique. Women's Health: Research on Gender, Behavior, and Policy, 3, 1–30.Google Scholar
  23. Graves, K. L, and Hines, A. M. (1997). Ethnic differences in the association between alcohol and risk sexual behavior with a new partner: An event-based analysis. AIDS Education and Prevention, 9, 219–237.PubMedGoogle Scholar
  24. Ickovics, J. R., and Yoshikawa, H. (1998). Preventive interventions to reduce heterosexual HIV risk for women: Current perspectives, future directions. AIDS, 12, 197–208.PubMedGoogle Scholar
  25. Kenen, R. H., and Armstrong, K. (1992). The why, when and whether of condom use among female and male drug users. Journal of Community Health, 17, 303–317.PubMedGoogle Scholar
  26. Larrat, E. P., Zierler, S., and Mayer, K. (1994). Cocaine use and heterosexual exposure to human immunodeficiency virus. Epidemiology, 5, 398–403.PubMedGoogle Scholar
  27. Leonard, L., and Ross, M. W. (1997). The last sexual encounter: The contextualization of sexual risk behaviour. International Journal of STD and AIDS, 8, 643–645.PubMedGoogle Scholar
  28. Logan, T. K., Leukefeld, C., and Farabee, D. (1998). Sexual and drug use behavior among women crack users: Implications for prevention. AIDS Education and Prevention, 10, 327–340.PubMedGoogle Scholar
  29. Malow, R. M., Corrigan, S. A., Cunningham, S. C., West, J. A., and Pena, J. M. (1993). Psychosocial factors associated with condom use among African-American drug abusers in treatment. AIDS Education and Prevention, 5, 244–253.PubMedGoogle Scholar
  30. McMahon, J., and Tortu, S. (1998). Sexual risk behavior and condom use among women at high risk for HIV infection. Presented at the American Public Health Association 126th Annual Meeting, November 15-19, 1998, Washington, D.C.Google Scholar
  31. Molitor, F., Truax, S. R., Ruiz, J. D., and Sun, R. K. (1998). Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine, 168, 93–97.PubMedGoogle Scholar
  32. Montoya, I. D. (1998). Social network ties, self-efficacy, and condom use among women who use crack cocaine: A pilot study. Substance Use and Misuse, 33, 2049–2073.PubMedGoogle Scholar
  33. Moore, J., Harrison, J. S., Kay, K. L., Deren, S., and Doll, L. S. (1995). Factors associated with Hispanic women's HIV-related communication and condom use with male partners. AIDS Care, 7, 415–427.PubMedGoogle Scholar
  34. Morrill, A. C., Ickovics, J. R., Golubchikov, V. V., Beren, S. E., and Rodin, J. (1996). Safer sex: Social and psychological predictors of behavioral maintenance and change among heterosexual women. Journal of Consulting Clinical Psychology, 64, 819–828.Google Scholar
  35. Nyamathi, A. M., Lewis, C. L., Flaskerud, J., and Bennett, C. (1995). Barriers to condom use and needle cleaning among impoverished minority female injection drug users and partners of injection drug users. Public Health Reports, 110, 166–172.PubMedGoogle Scholar
  36. Padian, N. S., Shiboski, S. C., Glass, S. O., and Vittinghoff, E. (1997). Heterosexual transmission of human immunodefi-ciency virus (HIV) in Northern California: Results form a tenyear study. American Journal of Epidemiology, 146, 350–357.PubMedGoogle Scholar
  37. Prince, A., and Bernard, A. L. (1998). Sexual behaviors and safer sex practices of college students on a commuter campus. Journal of the American College of Health, 47, 11–21.Google Scholar
  38. Reitmeijer, C. A., and Fichtner, R. R. (1998). Use of condoms at last sexual intercourse: an example of advantages and pitfalls of standardizing questions surveys for HIV and STD risk behavior. In 12th International Conference on AIDS, Geneva (Abstract 43427).Google Scholar
  39. Roberts, K. L. (1998). Correlates of condom use and attitudes to condoms and AIDS in a group of Darwin women. Australian Journal of Rural Health, 6, 5–11.PubMedGoogle Scholar
  40. Siegal, H. A., Falck, R. S., Wang, J., and Carlson, R. G. (1996). History of sexually transmitted diseases infection, drug-sex behaviors, and the use of condoms among midwestern users of injection drugs and crack cocaine. Sexually Transmitted Diseases, 23, 277–282.PubMedGoogle Scholar
  41. Skurnick, J. H., Abrams, J., Kennedy, C. A., Valentine, S. N., and Cordell, J. R. (1998). Maintenance of safe sex behavior by HIV-serodiscordant heterosexual couples. AIDS Education and Prevention, 10, 493–505.PubMedGoogle Scholar
  42. Sloboda, Z. (1998). What we have learned from research about the prevention of HIV transmission among drug abusers. Public Health Reports, 113, 194–204.Google Scholar
  43. Sly, F., Quandagno, D., Harrison, D. F., Eberstein, I., and Riehman, K. (1997). The association between substance use, condom use and sexual risk among low-income women. Family Planning Perspectives, 29, 132–136.PubMedGoogle Scholar
  44. St. Lawrence, J. S., Eldridge. G. D., Reitman, D., Little, C. E., Shelby, M. C., and Brasfield, T. L. (1998). Factors influencing condom use among African American women: Implications for risk reduction interventions. American Journal of Community Psychology, 26, 7–28.PubMedGoogle Scholar
  45. Tortu, S., McMahon, J. M., and Haid, R. (1999, July). The social ecology of exchanging sex for drugs or money in East Harlem, NYC: An event analysis focused on women drug users. In AIDS Impact. Fourth International Conference on the Biopsychosocial Aspects of HIV Infection (p. 207). Canadian PsychologicalAssociationGoogle Scholar
  46. Tortu, S., McMahon, J. M., Hamid, R., and Neaigus, A. (1998). The social ecology of drug using women's sexual risk in East Harlem, NYC: An event analysis. In 12th World International Conference on AIDS, Geneva (Abstract 23493).Google Scholar
  47. Wasserheit, J. (1991). Epidemiology synergy: Interrelationships between HIV infections and other STDs. In L. Chen et al. (Eds.), AIDS and women's reproductive health (pp. 47–72). New York: Plenum Press.Google Scholar
  48. Watkins, K. E., Metzger, D., Woody, G., and McLellan, A. T. (1993). Determinants of condom use among intravenous drug users. AIDS, 7, 719–723.PubMedGoogle Scholar
  49. Watters, J., and Biernacki, P. (1989). Targeted sampling: Options for the study of hidden populations. Social Problems, 6, 416–430.Google Scholar
  50. Weinstock, H., Lindan, C., Bolan, G., Kegeles, S. M., and Hearst, N. (1993). Factors associated with condom use in a highrisk heterosexual population. Sexually Transmitted Diseases, 20, 14–20.PubMedGoogle Scholar
  51. White, D., Phillips, K., Mulleady, G., and Cupitt, C. (1993). Sexual issues and condom use among injecting drug users. AIDS Care, 5, 427–437.PubMedGoogle Scholar
  52. Wingood, G. M., and DiClemente, R. J. (1997). The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. American Journal of Public Health, 87, 1016–1018.PubMedGoogle Scholar
  53. Wingood, G. M., and DiClemente, R. J. (1998). Partner influences and gender-related factors associated with noncondom use among young adult African American women. American Journal of Community Psychology, 26, 29–51.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Stephanie Tortu
    • 1
  • James McMahon
    • 2
  • Rahul Hamid
    • 2
  • Alan Neaigus
    • 2
  1. 1.Tulane University School of Public Health and Tropical MedicineNew Orleans
  2. 2.National Development and Research Institutes, Inc.New York

Personalised recommendations