Sexual violence among a cohort of injection drug users

Abstract

The objective of this study was to determine the prevalence of, and factors associated with, sexual violence in childhood, adolescence and adulthood, among injection drug using men and women. The Vancouver Injection Drug User Study is a prospective cohort of injection drug users (IDU) begun in 1996. The analysis included all individuals who completed the baseline questionnaire who responded to a question about sexual assault. Multivariate modeling was used to determine and to what extent a history of sexual violence at different ages is predictive of HIV risk and other health risk behaviors. HIV prevalence was calculated as the total current number of HIV-positive individuals in the cohort. Of the 1437 eligible individuals, 36% reported a lifetime history of sexual violence; 68% of women, and 19% of men (p<0.001). After adjusting for fixed sociodemographics, these individuals were more likely to have ever been in the sex trade, to knowingly share needles/rigs with HIV-positive people, to have attempted suicide, to have ever accidentally overdosed, to binge on alcohol, and to have been diagnosed with a mental disorder/disability. The prevalence of child sexual abuse in this cohort is 21%; 33% for women, and 13% for men. The data show a dose-response relationship between age at first sexual violence and most risk behaviors examined. These relationships are further mediated by gender. The prevalence of HIV among individuals who ever experienced sexual violence was 25%, compared to 19% among those who never experienced sexual violence (p=0.006). Sexual violence, and especially child sexual abuse, is highly prevalent among this cohort, particularly among women. Child sexual abuse has worse consequences for both genders than sexual violence later in life. Nevertheless, women and men are affected differently by sexual violence at different ages, and this has significant implications for health promotion programs, and specifically HIV prevention.

Physical violence among a prospective cohort of injection drug users: A gender-focused approach

“…Participants were able to provide more than one answer to these additional questions. We restricted our analysis to reports of physical violence since a study examining the characteristics and predictors of sexual violence among this cohort of IDU has been reported previously (Braitstein et al, 2003).…”

“…The experience of violence among IDU has also been associated with an array of HIV-related risk behaviours (Braitstein et al, 2003;El-Bassel et al, 2000;Gilbert et al, 1997;Vlahov et al, 1998). The majority of these studies have focused on the past traumatic experiences and current social-and individual-level factors that result in a concomitant relationship between violence and HIV risk among marginalized, injection drug using women.…”

“…For example, one study examining violence and HIV risk behaviours among female partners of male IDU observed that almost half had been physically assaulted by their sex partners; furthermore, those who had experienced physical violence were more likely to engage in unprotected anal intercourse (He et al, 1998). A study of IDU living in Vancouver found historical sexual abuse to be associated with sex trade work, sharing syringes with HIV-positive people, and other health-related harms such as accidental overdose (Braitstein et al, 2003). Intimate partner violence among women in methadone treatment has been associated with visiting shooting galleries, living with someone with drug or alcohol abuse problems, and exchanging sex for money or drugs (El-Bassel et al, 2000).…”

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

“…[5][6][7][8] Women who are forced to have sex with an HIV-positive partner could be exposed to infection, and living with violence or the fear of abuse by an intimate partner can limit women's ability to negotiate safe sex behaviors. [9][10][11][12][13][14][15][16] Conversely, women who are HIV-positive might experience abuse upon disclosure of their HIV status. 17,18 HIV/AIDS and IPV are of particular concern among women abusing drugs and alcohol because this additional risk factor increases vulnerability and exposure to both health issues.…”

“…[27][28][29][30][31][32][33] Living with HIV has also been associated with increased depression; studies show that HIV-positive women experience higher rates of depressive symptoms compared to their sociodemographically comparable HIV-negative counterparts. 9,32 Finally, associations between depressive symptoms and substance use have been documented; the rate of depression among women abusing illegal substances was found to be significantly higher than that of nonsubstance abusing women and the general population. 34,35 While individual associations are well-documented in the literature, and some studies show that being HIV-positive and experiencing IPV simultaneously increases the odds of depression, 36,37 no study has evaluated the combined effect of IPV, HIV, and substance use on depressive symptoms among urban women.…”