Original article| Volume 24, ISSUE 4, e397-e405, July 2014

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



      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.


      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, California.


      Most women were not interested in female condoms owing 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).


      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 Food and Drug Administration-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.
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      Jamila K. Stockman, PhD, MPH, is an Epidemiologist and Assistant Professor of Medicine and Global Public Health at the University of California, San Diego. Her research focuses on the underlying mechanisms linking gender-based violence, substance abuse, and HIV among vulnerable populations.


      Jennifer L. Syvertsen, PhD, MPH, is Assistant Professor in the Department of Anthropology at the Ohio State University. Her research uses mixed ethnographic and epidemiologic methods to understand the health harms associated with drug use and sexual risk among vulnerable populations.


      Angela M. Robertson, PhD, MPH, is a Postdoctoral Fellow in Epidemiology at the Harvard School of Public Health and the Fenway Institute in Boston, Massachusetts. Her research investigates the social epidemiology of infectious disease transmission among vulnerable and underserved populations.


      Natasha T. Ludwig-Barron, MPH, is a Project Coordinator at the University of California, San Diego. She studies the health-related consequences of gender-based violence and substance use among women and influences of drug policy reform on drug tourism along the U.S.-Mexico border.


      Julie N. Bergmann, MHS, is a doctoral student in the joint doctoral program in Global Public Health at San Diego State University and the University of California, San Diego. Her research focuses on intimate partner violence and associated contraceptive use outcomes.


      Lawrence A. Palinkas, PhD, is the Albert G. and Frances Lomas Feldman Professor of Social Policy and Health at the USC School of Social Work. A medical anthropologist, his expertise is in preventive medicine, cross-cultural medicine and health services research.