Women's Perspectives on Female-Initiated Barrier Methods for the Prevention of HIV in the Context of Methamphetamine Use and Partner Violence

Abstract

BACKGROUND Female-initiated barrier methods for the prevention of HIV may be an effective alternative for drug-using women who are unable to negotiate safe sex, often as a result of physical and/or sexual partner violence. METHODS Utilizing a SAVA (substance abuse, violence, and AIDS) syndemic framework, we qualitatively examined perspectives on female condoms and vaginal microbicides among 18 women with histories of methamphetamine abuse and partner violence in San Diego, CA, USA. FINDINGS Most women were not interested in female condoms due to perceived discomfort, difficulty of insertion, time-intensive effort, and unappealing appearance. Alternatively, most women viewed vaginal microbicides as a useful method. Positive aspects included convenience, ability to disguise as a lubricant, and a sense of control and empowerment. Concerns included possible side effects, timing of application, and unfavorable characteristics of the gel. Acceptability of female-initiated barrier methods was context dependent (i.e., partner type, level of drug use and violence that characterized the sexual relationship). CONCLUSIONS Findings indicate that efforts are needed to address barriers identified for vaginal microbicides to increase its uptake in future HIV prevention trials and marketing of future FDA-approved products. Strategies should address gender-based inequalities (e.g., partner violence) experienced by drug-using women and promote female empowerment. Education on female-initiated barrier methods is also needed for women who use drugs, as well as health care providers and other professionals providing sexual health care and contraception to women with histories of drug use and partner violence.

Targeting the SAVA (Substance Abuse, Violence, and AIDS) Syndemic Among Women and Girls

“…Substance-using venues (e.g., bars, shooting galleries) have been linked to aggressive sexual behaviors and HIV risks. 15,16 The psychopharmacological effects of some substances (e.g., cocaine and alcohol), which lower levels of serotonin, may increase the likelihood of aggression and impair judgment and ability to recognize cues and fend off sexual violence for women under the influence. 8 Other drugs, such as heroin and benzodiazepines, are used to cope with the pain and stress from GBV, 5 further heightening their risk for revictimization and HIV.…”

Down in the valley: Trajectories of injection initiation among young injectors in California’s Central Valley

“…Research further suggests that women who use methamphetamine experience elevated risk for violence and associated health harms, including adverse reproductive harms and HIV infection (Abdul-Khabir, Hall, Swanson, & Shoptaw, 2014; Lorvick et al, 2012; Stockman et al, 2014). Media portrayals of methamphetamine have played on these harms to generate a particular kind of dehumanizing moral panic, including gendered representations of women as sexually depraved, irresponsible mothers who neglect their caretaking responsibilities and men as violent criminals who control the drug market and cajole women into using methamphetamine (Linnemann, 2010).…”

Mood, Meth, Condom Use, and Gender: Latent Growth Curve Modeling Results from a Randomized Trial

“…While taking such factors into account, interventions can also be developed that employ female-initiated prevention methods. In a qualitative study of women with a history of methamphetamine use and partner violence (50), women were not interested in using female condoms, but were interested in vaginal microbicides. The latter was viewed as convenient, and also offered a sense of control and empowerment.…”