Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Sex Roles Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42, 723–749.

    Article  Google Scholar 

  • Bailey, S. L., Camlin, C. S., & Ennett, S. T. (1998). Substance use and risky sexual behavior among homeless and runaway youth. The Journal of Adolescent Health, 23, 378–388.

    Article  PubMed  Google Scholar 

  • Bassuk, E. L., Weinreb, L. F., Buckner, J. C., Browne, A., Salomon, A., & Bassuk, S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 276, 640–646.

    Article  PubMed  Google Scholar 

  • Bernard, H. R. (2006). Research methods in anthropology: Qualitative and quantitative approaches. Lanham, MD: AltaMira Press.

    Google Scholar 

  • Brennan, P. (1992). Focus on psychometrics: The kappa statistic for establishing interrater reliability in the secondary analysis of qualitative clinical data. Research in Nursing & Health, 15, 153–158.

    Article  Google Scholar 

  • Cabral, R., Pulley, L., Artz, L., Brill, I., & Macaluso, M. (1998). Women at risk of HIV/STD: The importance of male partners as barriers to condom use. AIDS and Behavior, 2, 75–85.

    Article  Google Scholar 

  • Castañeda, D. (2000). The close relationship context and HIV/AIDS risk reduction among Mexican Americans. Sex Roles, 42, 551–580.

    Article  Google Scholar 

  • Center for Substance Abuse Treatment (CSAT). (1994). Practical approaches in the treatment of women who abuse alcohol and other drugs. Rockville, MD: SAMHSA.

    Google Scholar 

  • Centers for Disease Control and Prevention.(2007). HIV/AIDS Surveillance Report, 2005. Vol. 17. (Rev ed.). Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

  • Centers for Disease Control and Prevention (CDC). (2007). A glance at the HIV/AIDS epidemic. Atlanta, GA: CDC.

    Google Scholar 

  • Chaisson, R. E., Bacchetti, P., Osmond, D., Brodie, B., Sande, M. A., & Moss, A. R. (1989). Cocaine use and HIV infection in intravenous drug users in San Francisco. Journal of the American Medical Association, 261, 561–565.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1968). Weighted Kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin, 70, 213–220.

    Article  PubMed  Google Scholar 

  • Cooper, M.L. (2002). Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. Journal of Studies on Alcohol. Supplement, (14), 101–117.

  • Crabtree, B. F., & Miller, W. L. (1992). A template approach to text analysis: Developing and using codebooks. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research, pp. 93–109. Newbury Park, CA: Sage Publications.

    Google Scholar 

  • Davis, K. C., Hendershot, C. S., George, W. H., Norris, J., & Heiman, J. R. (2007). Alcohol’s effects on sexual decision making: An integration of alcohol myopia and individual differences. Journal of Studies on Alcohol and Drugs, 68, 843–851.

    PubMed  Google Scholar 

  • Dermen, K. H., & Cooper, M. L. (2000). Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Experimental and Clinical Psychopharmacology, 8, 198–206.

    Article  PubMed  Google Scholar 

  • Dermen, K. H., Cooper, M. L., & Agocha, V. B. (1998). Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol, 59, 71–77.

    PubMed  Google Scholar 

  • Edlin, B. R., Irwin, K. L., Faruque, S., McCoy, C. B., Word, C., Serrano, Y., et al. (1994). Intersecting epidemics—crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. The New England Journal of Medicine, 331, 1422–1427.

    Google Scholar 

  • El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., et al. (2005). Long-term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS and Behavior, 9, 1–13.

    Article  PubMed  Google Scholar 

  • Fisher, J., & Fisher, W. (2000). Theoretical approaches to individual-level change in HIV risk behavior. In J. Peterson & R. DiClemente (Eds.), Handbook of HIV prevention, pp. 3–56. New York: Kluwer/Plenum.

    Google Scholar 

  • Fromme, K., D’Amico, E. J., & Katz, E. C. (1999). Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? Journal of Studies on Alcohol, 60, 54–63.

    PubMed  Google Scholar 

  • Fullilove, R. E., Fullilove, M. T., Bowser, B. P., & Gross, S. A. (1990). Risk of sexually transmitted disease among black adolescent crack users in Oakland and San Francisco, Calif. Journal of the American Medical Association, 263, 851–855.

    Article  PubMed  Google Scholar 

  • George, W.H., Davis, K.C., Norris, J., Heiman, J.R., Stoner, S.A., Schacht, R.L., et al. (2008). Indirect effects of acute alcohol intoxication on sexual risk-taking: The roles of subjective and physiological sexual arousal. Archives of Sexual Behavior, e-publication ahead of print, April 23, 2008.

  • George, W. H., Stoner, S. A., Norris, J., Lopez, P. A., & Lehman, G. L. (2000). Alcohol expectancies and sexuality: a self-fulfilling prophecy analysis of dyadic perceptions and behavior. Journal of Studies on Alcohol, 61, 168–176.

    PubMed  Google Scholar 

  • Gutiérrez, L., Oh, H., & Gillmore, M. (2000). Toward an understanding of (EM) Power(Ment) for HIV/AIDS prevention with adolescent women. Sex Roles, 42, 581–611.

    Article  Google Scholar 

  • Harvey, S. M., Beckman, L. J., Gerend, M. A., Bird, S. T., Posner, S., Huszti, H. C., et al. (2006). A conceptual model of women’s condom use intentions: Integrating intrapersonal and relationship factors. AIDS Care, 18, 698–709.

    Article  PubMed  Google Scholar 

  • Heron, M. (2007). Deaths: leading causes for 2004. National Vital Statistics Reports, 56, 1–95.

    PubMed  Google Scholar 

  • Leigh, B. C. (2002). Alcohol and condom use: a meta-analysis of event-level studies. Sexually Transmitted Diseases, 29, 476–482.

    Article  PubMed  Google Scholar 

  • Leigh, B. C., Ames, S. L., & Stacy, A. W. (2008). Alcohol, drugs, and condom use among drug offenders: An event-based analysis. Drug and Alcohol Dependence, 93, 38–42.

    Article  PubMed  Google Scholar 

  • Leigh, B.C., & Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. The American Psychologist, 48, 1035–1045.

    Google Scholar 

  • Leigh, B. C., Vanslyke, J. G., Hoppe, M. J., Rainey, D. T., Morrison, D. M., & Gillmore, M. R. (2008). Drinking and condom use: Results from an event-based daily diary. AIDS and Behavior, 12, 104–112.

    Article  PubMed  Google Scholar 

  • Lincoln, Y.S., & Guba, E.G.(1985). Processing naturalistically obtained data. In Naturalistic Inquiry (pp. 344–356). Beverly Hills: Sage Publications.

  • Logan, T. K., Cole, J., & Leukefeld, C. (2002). Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin, 128, 851–885.

    Article  PubMed  Google Scholar 

  • Los Angeles Homeless Services Authority.(2006). 2005 Greater Los Angeles Homeless Count. Retrieved January 8, 2008, from http://www.lahsa.org/docs/homelesscount/LAHSA%20Report%20-%20Final%20Version6-4.pdf.

  • MacDonald, T. K., MacDonald, G., Zanna, M. P., & Fong, G. T. (2000). Alcohol, sexual arousal, and intentions to use condoms in young men: applying alcohol myopia theory to risky sexual behavior. Health Psychology, 19, 290–298.

    Article  PubMed  Google Scholar 

  • MacQueen, K., McLellan, E., Kay, K., & Milstein, B. (1998). Codebook development for team - based qualitative analysis. Cultural Anthropology Methods, 10, 31–36.

    Google Scholar 

  • Marin, B. V., Tschann, J. M., Gomez, C. A., & Gregorich, S. (1998). Self-efficacy to use condoms in unmarried Latino adults. American Journal of Community Psychology, 26, 53–71.

    Article  PubMed  Google Scholar 

  • McDonnell, K. A., Gielen, A. C., & O’Campo, P. (2003). Does HIV status make a difference in the experience of lifetime abuse? Descriptions of lifetime abuse and its context among low-income urban women. Journal of Urban Health, 80, 494–509.

    PubMed  Google Scholar 

  • McKirnan, D. J., Vanable, P. A., Ostrow, D. G., & Hope, B. (2001). Expectancies of sexual ’escape’ and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13, 137–154.

    Article  PubMed  Google Scholar 

  • Milburn, N., & D’Ercole, A. (1991). Homeless women. Moving toward a comprehensive model. The American Psychologist, 46, 1161–1169.

    Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative Data Analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Misovich, S. J., Fisher, J. D., & Fisher, W. A. (1997). Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes. General Psychology Review, 1, 72–107.

    Article  Google Scholar 

  • Morrill, A. C., Ickovics, J. R., Golubchikov, V. V., Beren, S. E., & Rodin, J. (1996). Safer sex: social and psychological predictors of behavioral maintenance and change among heterosexual women. Journal of Consulting and Clinical Psychology, 64, 819–828.

    Article  PubMed  Google Scholar 

  • Morrison, D. M., Gillmore, M. R., Hoppe, M. J., Gaylord, J., Leigh, B. C., & Rainey, D. (2003). Adolescent drinking and sex: Findings from a daily diary study. Perspectives on Sexual and Reproductive Health, 35, 162–168.

    Article  PubMed  Google Scholar 

  • Morse, J. M. (1994). Designing qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research, pp. 220–235. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Muhr, T. (1991). Atlas/ti-A prototype for the support of text interpretation. Qualitative Sociology, 14, 349–371.

    Article  Google Scholar 

  • National Institute on Alcohol Abuse and Alcoholism. (2002). Alcohol and HIV. Alcohol Alert, 57, 1–4.

    Google Scholar 

  • Nyamathi, A. (1994). Health Promotion among Homeless Women at Risk of AIDS. Rockville, MD: National Institute of Mental Health.

    Google Scholar 

  • Nyamathi, A. M., Stein, J. A., & Swanson, J. M. (2000). Personal, cognitive, behavioral, and demographic predictors of HIV testing and STDs in homeless women. Journal of Behavioral Medicine, 23, 123–147.

    Article  PubMed  Google Scholar 

  • Padgett, D. K., & Struening, E. L. (1992). Victimization and traumatic injuries among the homeless: associations with alcohol, drug, and mental problems. The American Journal of Orthopsychiatry, 62, 525–534.

    Article  PubMed  Google Scholar 

  • Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage Publications, Inc.

    Google Scholar 

  • Pulerwitz, J., Gortmaker, S. L., & DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42, 637–660.

    Article  Google Scholar 

  • Ryan, G., & Bernard, H. R. (2003). Techniques to identify themes. Field Methods, 15, 85–109.

    Article  Google Scholar 

  • Schilling, R., el-Bassel, N., Ivanoff, A., Gilbert, L., Su, K.H., & Safyer, S.M. (1994). Sexual risk behavior of incarcerated, drug-using women, 1992. Public Health Reports, 109, 539–547.

  • Seal, D. W., & Ehrhardt, A. A. (2004). HIV-prevention-related sexual health promotion for heterosexual men in the United States: pitfalls and recommendations. Archives of Sexual Behavior, 33, 211–222.

    Article  PubMed  Google Scholar 

  • Sikkema, K. J., Heckman, T. G., Kelly, J. A., Anderson, E. S., Winett, R. A., Solomon, L. J., et al. (1996). HIV risk behaviors among women living in low-income, inner-city housing developments. American Journal of Public Health, 86, 1123–1128.

    Article  PubMed  Google Scholar 

  • Soler, H., Quadagno, D., Sly, D. F., Riehman, K. S., Eberstein, I. W., & Harrison, D. F. (2000). Relationship dynamics, ethnicity and condom use among low-income women. Family Planning Perspectives, 32(82–88), 101.

    Google Scholar 

  • Spradley, J. P. (1979). The ethnographic interview. New York: Holt, Rinehart and Winston.

    Google Scholar 

  • St. Lawrence, J. S., Eldridge, G. D., Reitman, D., Little, C. E., Shelby, M. C., & 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.

    Article  PubMed  Google Scholar 

  • Steele, C. M., & Josephs, R. A. (1990). Alcohol myopia: Its prized and dangerous effects. The American Psychologist, 45, 921–933.

    Article  PubMed  Google Scholar 

  • Testa, M., & Collins, R. L. (1997). Alcohol and risky sexual behavior: Event-based analyses among a sample of high-risk women. Psychology of Addictive Behaviors, 11, 190–201.

    Article  Google Scholar 

  • Theall, K. P., Sterk, C. E., & Elifson, K. W. (2003). Male condom use by type of relationship following an HIV intervention among women who use illegal drugs. Journal of Drug Issues, 33, 1–28.

    Google Scholar 

  • Tortu, S., McMahon, J., Hamid, R., & Neaigus, A. (2000). Drug-using women’s sexual risk: An event analysis. AIDS and Behavior, 4, 329–340.

    Article  Google Scholar 

  • Tucker, J. S., Elliott, M. N., Wenzel, S. L., & Hambarsoomian, K. (2007). Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County. Health Psychology, 26, 644–649.

    Article  PubMed  Google Scholar 

  • Vanable, P. A., McKirnan, D. J., Buchbinder, S. P., Bartholow, B. N., Douglas, J. M,. Jr, Judson, F. N., et al. (2004). Alcohol Use and High-Risk Sexual Behavior Among Men Who Have Sex With Men: The Effects of Consumption Level and Partner Type. Health Psychology, 23, 525–532.

    Article  PubMed  Google Scholar 

  • Weeks, M. R., Schensul, J. J., Williams, S. S., Singer, M., & Grier, M. (1995). AIDS prevention for African American and Latina women: Building culturally and gender appropriate intervention. AIDS Education and Prevention, 7, 251–263.

    PubMed  Google Scholar 

  • Wenzel, S.L., Tucker, J.S., Elliott, M.N., & Hambarsoomians, K. (2007). Sexual risk among impoverished women: understanding the role of housing status. AIDS and Behavior, 11(6, Suppl), 9–20.

    Google Scholar 

  • Wenzel, S. L., Tucker, J. S., Elliott, M. N., Hambarsoomians, K., Perlman, J., Becker, K., et al. (2004). Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: a comparison of sheltered and low-income housed women in Los Angeles County. Preventive Medicine, 39, 617–624.

    Article  PubMed  Google Scholar 

  • Willms, D. G., Best, J. A., Taylor, D. W., Raymond, G. J., Wilson, D. M. C., Lindsay, E. A., et al. (1990). A systematic approach for using qualitative methods in primary prevention research. Medical Anthropology Quarterly, 4, 391–409.

    Article  Google Scholar 

  • Wingood, G. M., & 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.

    Article  PubMed  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27, 539–565.

    Article  Google Scholar 

  • Wood, D., Valdez, R. B., Hayashi, T., & Shen, A. (1990). Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family function characteristics. American Journal of Public Health, 80, 1049–1052.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. RAND Corporation, 1776 Main St., Santa Monica, CA, 90407-2138, USA

    Gery W. Ryan, Stefanie A. Stern, Lara Hilton, Joan S. Tucker, David P. Kennedy, Daniela Golinelli & Suzanne L. Wenzel

  2. University of Southern California, School of Social Work, Los Angeles, CA

    Suzanne L. Wenzel

Authors
  1. Gery W. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefanie A. Stern
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lara Hilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joan S. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David P. Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniela Golinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suzanne L. Wenzel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gery W. Ryan.

Appendix

Appendix

Stage-By-Topic Interview Protocol

figure afigure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11199-009-9610-z

Keywords

Search

Navigation