HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: A forgotten issue

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Abstract

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

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.

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