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, California.
Findings
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).
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 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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Biography
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.
Biography
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.
Biography
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.
Biography
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.
Biography
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.
Biography
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.
Article info
Publication history
Published online: May 14, 2014
Accepted:
April 1,
2014
Received in revised form:
March 15,
2014
Received:
January 9,
2014
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
