HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: A forgotten issue
Introduction
Over the past decade, violence against women has become increasingly recognized as an issue of clinical and public health importance Moore, 1999, Spitz & Marks, 2000. Substance-abusing men have been recognized as a risk group for inflicting violence against women Abbot et al., 1995, Byles, 1979, El-Bassel et al., 2000, Fagan & Wexler, 1987, Gilbert et al., 2000, Gilbert et al., 2000, Hotaling & Sugarman, 1986, Leonard et al., 1985, Miller, 1990, Miller et al., 1993, O'Leary & Wingood, 2000. Estimates of percentage of batterers who ever assaulted their partners while intoxicated range from 48% to 87%, with most research indicating a 60–70% rate for alcohol abuse and a 13–20% rate for drug abuse (Gorney, 1989). In a study with 234 men who perpetrated violence against women who had charges filed against them, Roberts (1988) reported that 70.5% were under the influence of alcohol and/or drugs during the battering incident.
Drug-involved men are also at increased risk for HIV transmission (El-Bassel, Schilling, et al., 2000). Consequently, drug treatment programs serve a disproportionate number of men for whom partner violence and HIV risks should be matters of great concern.
Recent research, based on reports from abused women, has linked intimate partner violence with a number of sexual risks for HIV transmission, including: (1) engaging in unprotected sex Amaro, 1995, Amaro et al., 1990, Cunningham et al., 1994, Fernandez, 1995, Gilbert et al., 2000, Wingood & DiClemente, 1997, Worth, 1989, Wyatt, 1991; (2) higher rates of sexually transmitted diseases (STDs) El-Bassel et al., 2000, Gilbert et al., 1996; (3) sex with multiple sexual partners Gilbert et al., 2000, Gilbert et al., 2000; (4) disclosure of an STD or HIV status North & Rothenberg, 1993, Rothenberg & Paskey, 1995; and (5) having a risky sexual partner (e.g., one who injects drugs, is HIV-positive and/or has had sex with multiple partners) El-Bassel et al., 1998, Gilbert et al., 2000. Two new studies with female samples have found that, abused women were four times more likely than nonabused women to have had sex with a risky partner, after controlling for demographic variables El-Bassel et al., 1998, Gilbert et al., 2000, Gilbert et al., 2000.
Although a growing number of studies have examined how a woman's HIV risk behavior may be associated with partner violence Cunningham et al., 1994, El-Bassel et al., 2000, Gielen et al., 1997, Johnsen et al., 1995, Morrill & Ickovics, 1996, Rothenberg et al., 1995, van der Straten et al., 1995, Wingood & DiClemente, 1998, Zierler, 1997, the relationship between partner violence and HIV risk has not been studied from the perspective of the men who abuse their female intimate partners. Research is needed to explore whether a male partner's HIV risks may influence his perpetration of intimate violence.
This paper is the first attempt to explore the relationship between perpetrating physical abuse against a female intimate partner and engaging in HIV risk behaviors with data collected from men in methadone maintenance treatment programs (MMTPs). More specifically, the purpose of this study is to examine (1) the prevalence of self-reported perpetration of physical abuse against a female intimate partner in the past 12 months, and (2) the association between perpetrating physical violence and various HIV risk factors, including (a) having more than one intimate partner; (b) sex with multiple partners; (c) unprotected vaginal sex; (d) engaging in anal sex; (e) unprotected anal sex; (f) sex with an HIV-positive sexual partner; (g) sex with a drug-injecting sexual partner; (h) exchanging sex for money or drugs; (i) contracting an STD; (j) injecting drugs; (k) sharing needles; (l) never tested for HIV; (m) being HIV-positive; and (n) a high score on a total HIV risk index. The findings will help identify differences in HIV risk profiles between men who perpetrate physical violence against their intimate partners and their counterparts. Understanding such profiles is an important first step to improving HIV prevention interventions for men, women, and couples in drug treatment programs.
Section snippets
Sample recruitment and selection
Study participants were recruited from four inner-city methadone clinics from May to July 1999. Recruiters handed out flyers about the study to potential participants in the waiting rooms of the methadone clinics. Participants were also referred to the study by the clinic staff. A total of 408 men were recruited and agreed to participate in a 15-min screening interview. One of the purposes of this brief interview was to determine eligibility for participation in focus groups and in-depth
Sociodemographic characteristics
The majority of the men in the study sample (N=273) were Latino (54.2%, n=148) or African American (30.8%, n=84). Their average age was 41.3 years (S.D.=7.62), with a mean education level of 11.6 years (S.D.=2.23). Nearly two-thirds (63.6%, n=164) of the men were married or living with someone whom they identified as their “common-law wife.”
The median monthly income during the past 12 months was US$482, although nearly two-thirds (64.7, n=176) were unemployed at the time of the interview. About
Discussion
The findings showed that more than a third of the men in this study sample reported perpetrating intimate physical abuse and 15% reported perpetrating severe physical abuse in the past 12 months. Although similar prevalence rates have been reported on female-to-male abuse, studies have shown that women are more seriously affected by men's aggression (physical, sexual, etc.) than vice versa (Cascardi, Langhinrichsen, & Vivan, 1992). It is important to note that rates of partner violence for this
Acknowledgements
The study was supported by the National Institute on Drug Abuse grant DA12335, awarded to Dr. El-Bassel.
References (51)
- et al.
The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: implications for public health
Child Abuse and Neglect
(1994) - et al.
Correlates of problem drinking among drug using incarcerated women
Addictive Behaviors
(1995) Substance abuse among men who batter their intimates: the dangerous mix
Journal of Substance Abuse Treatment
(1988)- et al.
Domestic violence against women: incidence and prevalence in emergency department populations
Journal of the American Medical Association
(1995) Love, sex and power: considering women's realities in HIV prevention
American Psychologist
(1995)- et al.
Violence during pregnancy and substance abuse
American Journal of Public Health
(1990) Needle sharing in context: patterns of sharing among men and women injectors and HIV risks
Addiction
(1993)Violence, alcohol problems and other problems in disintegrating families
Journal of Studies on Alcohol
(1979)- et al.
Marital aggression: impact, injury, and health correlates for husbands and wives
Archives of Internal Medicine
(1992) The domestic assault of women: psychological and criminal justice perspectives
(1995)
A comparison of HIV risk between women and men who inject drugs
AIDS Education and Prevention
Social support and social networks among women on methadone
Social Service Review
Fear and violence: raising the HIV stakes
AIDS Education and Prevention
Drug abuse and partner violence among women in methadone treatment
Journal of Family Violence
Sex trading and psychological distress in a street-based sample of low-income urban men
Journal of Psychoactive Drugs
Women and substance abuse
Crime at home and in the streets
Violence and Victims
Latinas and AIDS: challenges to HIV prevention efforts
Women's disclosure of HIV status: experiences of mistreatment and violence in an urban setting
Women and Health
The converging epidemics of mood-altering-drug use, HIV, HCV, and partner violence: a conundrum for methadone maintenance treatment
Mt. Sinai Journal of Medicine
Partner violence and sexual HIV risk behaviors among women in methadone treatment
AIDS and Behavior
Domestic violence and chemical dependency: dual problems, dual interventions
Journal of Psychoactive Drugs
An analysis of risk markers in husband to wife violence: the current state of knowledge
Violence and Victims
Cited by (71)
Computer-enhanced interventions for drug use and HIV risk in the emergency room: Preliminary results on psychological precursors of behavior change
2014, Journal of Substance Abuse TreatmentCitation Excerpt :Computer-enhanced BIs allow for capturing data on potential active intervention components (i.e., “the black box of intervention) and process variables that may influence the efficacy of BIs (e.g., beliefs about drug use; Ondersma et al., 2011). BIs can concurrently target multiple risk behaviors, such as HIV risk behaviors (e.g., injecting drugs, risky sex) which often occur among adults who use drugs (e.g., El-Bassel, Fontdevila, Gilbert, Voisin, Richman, & Pitchell, 2001; Petry, 2001; Tross, Hanner, Hu, Pavlicova, Campbell, & Nunes, 2009) yet are not addressed in most BIs. HIV risk behaviors may respond to BIs because decreased drug use may lead to involvement in fewer risky situations during which unprotected sex could occur and/or fewer episodes of intoxication which may lead to sexual risk behavior at the event level (Bryan, Schmiege, & Magnan, 2012; Stein, Anderson, Charuvusta, & Friedmann, 2001).
HIV risk among women from domestic violence agencies: Prevalence and correlates
2013, Journal of the Association of Nurses in AIDS CareCitation Excerpt :Fifty-eight percent of the women who engaged in sexual risk behaviors identified their abusive partners as having more than one sexual partner, and 16% did not know if their abusive partners had other sexual partners. Studies have shown that abusive men engage in greater sexual risk behavior compared to nonabusive men (Decker et al., 2009; Frye, et al., 2011); for example, El-Bassel et al. (2001) reported that abusive men were twice as likely to have more than one sexual partner than nonabusive men. One third of the women who engaged in sexual risk behaviors in our study reported having more than one sexual partner themselves, and nearly 26% had sexual partners who injected drugs.
Effects of receiving additional off-site services on abstinence from illicit drug use among men on methadone: A longitudinal study
2010, Evaluation and Program PlanningFactors associated with the perpetration of sexual violence among wine-shop patrons in Chennai, India
2010, Social Science and MedicineCitation Excerpt :In our study, having more than one current sex partner and self-reported STD symptoms were associated with sexual violence, corroborating findings from other studies that have found that abusive men report higher levels of STD sexual risk behaviors (Dunkle et al., 2007; Martin, Kilgallen et al., 1999; Raj et al., 2006; Silverman et al., 2007) and STDs (Martin, Kilgallen et al., 1999). Further research is needed to clarify if sexual violence is a marker for sex with a potentially high-risk partner (Dunkle et al., 2006; el-Bassel et al., 2001; Gilbert, El-Bassel, Wu, & Chang, 2007; Martin, Kilgallen et al., 1999; Peedicayil et al., 2004; Raj et al., 2006; Schensul et al., 2006; Silverman et al., 2007), or if sexual violence increases risk of STDs through unprotected forced sex (Decker et al., 2008; Raj et al., 2006), or both. Our study underscores the potentially positive role of social connection in the context of sexual violence among men.
Intimate Partner Violence Experiences Among Men Living with HIV in Rural Appalachia
2019, AIDS and BehaviorDomestic violence, gateways for clinical practice
2019, Revue Medicale de Bruxelles