A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

Abstract

Background To date, research applying the Sexual Relationship Power Scale (SRPS) has been limited to sexual risk behaviors. Objective We measured levels of sexual relationship power and examined associations between sexual relationship power and injecting and sexual behaviors that place women at increased risk for blood borne infections. Methods Using data from a cross-sectional study of young women who inject drugs (WWID) in San Francisco, USA, logistic regression analysis identified independent associations between SRPS and subscale scores (relationship control [RC] and decision making dominance [DMD]) and injecting and sexual behaviors. Results Of the 68 young WWID, 24 (34%) reported receptive syringe sharing, 38 (56%) reused/shared a cooker to prepare drugs, and 25 (37%) injected someone else’s drug residue during the three-months prior to enrollment. Most (60, 88%) reported condomless sex with main sex-partner, 8 (12%) reported transactional sex, and 36 (53%) had two or more recent sex partners. The median SRPS score was 2.98 (IQR: 2.65, 3.18), 3.23 (IQR: 3.23, 3.57) for RC and 2.40 (IQR: 2.20, 2.60) for DMD. No significant associations were detected between SRPS or DMD and injecting or sexual risk behaviors. After adjusting for gender and years injecting, for every one-point increase in RC, women had a 6.70 lower odds of recent condomless sex (95% CI: 0.92, 50.00, p = 0.06), and a 3.90 lower odds of recent transactional sex (95%CI: 1.22, 12.50, p = 0.02). Conclusion Our study findings suggest that some components of sexual relationship power may play a role in sexual risk, but not in injecting risk.

Factors associated with skin and soft tissue infections among people who inject drugs in the United Kingdom: A comparative examination of data from two surveys

“…Women are particularly vulnerable to adverse consequences of identification as a person who injects drugs (such as loss of children, family support and/or sex-work income) and may transition early to injecting into less visible sites such as the groin (Harris and Rhodes, 2013). Gendered power dynamics can exacerbate risk of unsafe injecting, with women more likely than men to have limited control over drug purchase, injection equipment supply, drug injection preparation or administration (Hope et al, 2010;Morris et al, 2018). This can increase the likelihood of receiving injecting assistance and using injecting equipment after others (Wood, 2003).…”

“…Sex work among women is associated with more frequent injecting, and therefore SSTI risk (Kerr et al, 2016). However, as sex work may be undertaken to financially support high levels of injecting (Morris et al, 2018) it is spurious to imply a causal link. The majority of participants in both samples report injecting heroin or a heroin/crack cocaine combination.…”

Injecting-related trust, cooperation, intimacy, and power as key factors influencing risk perception among drug injecting partnerships

“…While previous studies have focused on the role of sexual power on injecting behaviors within sexual partnerships [41, 42], our study findings identify injecting-related power in the context of all types of injecting partnerships—not only sexual relationships. Moreover our finding that many interpersonal factors besides power (trust, cooperation, intimacy) play an important role in the way injecting partners perceive risk may explain the null association between the sexual relationship power scale, a quantitative measure of sexual power, and sharing behaviors among a similar sample of injecting partnerships [43]. Cooperation was closely tied to reciprocity related to procuring drugs, preventing overdose and withdrawal, and assisting injecting.…”

Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis

“…Correspondingly, in the literature, high sexual relationship power indicates a greater ability to communicate sexual preferences, especially in safe sex practices such as condom use and substance use abstinence [ 3 , 8 , 9 , 10 , 11 ]. For example, in a study examining sexual power in Black women, findings suggested that Black women had a greater ability to communicate sexual preferences and negotiate condom use when sexual relationship power was high [ 12 ].…”

“…Clear linkages have been made between decreased relationship power and increased instances of condom-less sex and substance use, numerous sexual partners, and participation in transactional sex [ 6 , 9 , 10 ]. The trauma of previous relationships often has enduring effects throughout an individual’s life.…”