Substance use, childhood sexual abuse, and sexual risk behavior among women in methadone treatment.

Substance use and a history of childhood sexual abuse (CSA) are risk factors for unprotected sex among women, yet questions remain as to how their combined influence may differentially affect sexual risk. The current study investigated how complex relationships among drug use and CSA may contribute to unprotected sexual occasions (USO). A Generalized Linear Mixed Model was used to examine the interaction between current cocaine/stimulants and opioid use and CSA on a number of USOs in a sample of 214 sexually active women in outpatient methadone maintenance treatment. For women with CSA, an increase in days of cocaine/stimulant use was associated with a significant increase in USOs. In contrast, an increase in days of opiate use was associated with a significant decrease in USOs. For the group of women who did not report CSA, there was a significant increase in USOs with increased opiate use.

Findings indicate that CSA is related to unprotected sexual occasions depending on drug type and severity of use. Therefore, women with CSA using cocaine are at particularly high risk for having unprotected sex and should be specifically targeted for HIV prevention interventions.

More research is needed to untangle the complex relationships between CSA, drug use, and sexual risk behavior. Understanding how a history of trauma may be related to drug abuse and sexual behavior is important for assessing and treating female substance use populations and an integral component for management of sexual risk. Given that sexual behavior of CSA survivors can take many forms, it is also important to assess individual differences.

Related protocols: CTN-0019