“Violence and love and drugs…it all goes hand in hand”: A mixed methods analysis of the substance abuse, violence, and HIV/AIDS syndemic among women who use methamphetamine

Abstract

Background: The synergistic epidemics of substance use, violence, and HIV/AIDS, also known as the SAVA syndemic, disproportionately affects vulnerable women in the United States. Methamphetamine use is closely linked with physical and sexual violence, including intimate partner violence (IPV), which heightens women’s vulnerability to HIV. This mixed methods study examined the prevalence and correlates of violence among women who use methamphetamine, (n = 209) enrolled in an HIV intervention study in San Diego, California. Methods: At baseline, 209 women completed an interviewer-administered computer-assisted survey. A sub set of women who reported lifetime IPV (n = 18) also participated in qualitative interviews to contextualize our understanding of patterns of violence over time. Results: In the overall cohort, reports of lifetime (66.0%) and past 2-month (19.6%) IPV were prevalent. Moreover, women reported lifetime physical only (27.3%), sexual only (6.2%), or both forms of violence (50.7%) by multiple perpetrators. Factors independently associated with lifetime IPV were having unprotected sex with a steady partner (odds ratio [OR]: 2.50, 95% confidence interval [CI]: 1.04, 6.00) and being high on methamphetamine during unprotected sex with a steady partner (OR: 2.56, 95% CI: 1.30, 5.09) within the past 2 months. Our qualitative narratives illuminated how IPV in women’s steady relationships often reflects a culmination of violent victimization throughout their lifetime which is further exacerbated by methamphetamine use and sexual risk through gendered power dynamics. Conclusions: HIV prevention interventions should address the SAVA syndemic in a holistic manner, including the role of methamphetamine use in the context of women’s abusive steady relationships.

Keywords:

• Women
• methamphetamine
• intimate partner violence
• physical violence
• sexual violence
• HIV risk

Acknowledgements

We gratefully acknowledge the contributions of study participants and study staff to this research.

Additional information

Funding

This study was supported by the National Institute of Mental Health [Grant #R01MH061146, Patterson TL; Grant #R25MH080665, Stockman JK; Grant #R25MH080664, Stockman JK], the National Institute on Drug Abuse [Grant #K01DA031593, Stockman JK; Grant #R25DA025571, Stockman JK; Grant #T32DA023356, Syvertsen JL and Tsuyuki K; Grant #R36DA039012, Hayashi HD], and the National Institute on Minority Health and Health Disparities [Grant #L60MD003701, Stockman JK]. All authors acknowledge support from the San Diego Center for AIDS Research [Grant #P30AI036214]. The views expressed are those of the authors and not necessarily those of the National Institutes of Health. The funding agency had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.