Correlates of sexual risk among women who use crack cocaine
Crack cocaine use is associated with sexual risk behaviors and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). This dissertation includes three papers that examine the correlates of sexual risk among women who use crack cocaine. The data for this secondary analysis come from a woman-focused HIV intervention study among African American women crack users in Raleigh-Durham, North Carolina, funded by the National Institute on Drug Abuse (NIDA).
As a precursor to papers 2 and 3, the first paper compares the prevalence of abuse among women crack users who trade sex and women crack users who do not trade sex. The second paper examines the distal and proximal factors associated with trading sex among women who use crack cocaine. The third paper examines the distal and proximal factors associated with unprotected sex among women crack users who trade sex.
The results of paper I show a higher prevalence of physical, sexual, and emotional abuse among women who trade sex than among women who do not trade sex. This finding was observed for each of the time frames examined: lifetime, childhood, in the past year and in the past 30 days. The findings of paper 2 confirm the association between proximal factors, including heavier crack use, homelessness, and unemployment, and trading sex. In addition, the results show that childhood abuse is associated with trading sex and that this relationship is, in part, mediated by psychological distress. The results of paper 3 reveal that childhood abuse is also associated with having unprotected sex during sex trading encounters. This relationship is, in part, mediated by psychological distress and condom use self-efficacy. These findings underscore the importance for public health interventions to consider the various factors that contribute to and/or co-occur with women crack users' drug use which, in turn, may affect their sexual risk and overall well being.