Correlates of Sexual Coercion among People Who Inject Drugs (PWID) in Los Angeles and San Francisco, CA

Abstract

Experiences of coerced or forced sex have been associated with risk for HIV infection for all adults and may be more common for gays, lesbians, bisexuals (GLB) and people who inject drugs (PWID). In this study, we explored factors associated with prior 12-month experiences of forced or coerced sex among a sample of PWID, with a focus on sexual orientation and gender. PWID (N = 772) from Los Angeles and San Francisco were recruited using targeted sampling methods in 2011-2013 and surveyed on a range of items related to demographics, drug use, HIV risk, and violence, including experiences of forced or coerced sex in the prior 12 months. In this racially/ethnically diverse, mostly homeless, and low-income sample of PWID, 25% of participants were female and 15% identified as GLB. Sexual coercion was reported by 9% of gay and bisexual men, 8% of heterosexual females, 5% of lesbians and bisexual women, and less than 1% of heterosexual men. In multivariate analyses, compared to heterosexual males, gay or bisexual males (adjusted odds ratio [AOR] = 10.68; 95% confidence interval [CI] = 2.03, 56.23), and heterosexual females (AOR = 9.69; 95% CI = 2.04, 45.94) had increased odds of coerced sex in the prior 12 months. Having a paying sex partner (AOR = 3.49; 95% CI = 1.42, 8.54) or having had forced sex prior to the age of 16 by someone at least five years older (AOR = 4.74; 95% CI = 1.88, 11.93) also elevated the odds of coercive sex. Sexual coercion is common among PWID, but especially for gay and bisexual men and heterosexual females. Efforts to reduce sexual violence among PWID are urgently needed.

HIV Pre-exposure Prophylaxis for People Who Inject Drugs: The Context of Co-occurring Injection- and Sexual-Related HIV Risk in the U.S. Northeast

“…rape) emerged as a common experience among some participants in this sample, in the context of both transactional and non-transactional sex. Prior research has found that female PWID, and in particular, female PWID who engage in sex work, are disproportionately impacted by sexual violence (Williams, Dangerfield, Kral, Wenger, & Bluthenthal, 2019). As victims of rape and other forms of sexual violence, they may not have agency over condom use (Medina-Perucha et al, 2019); as such, interventions focused on condom use without PrEP may still render some PWID, particularly female PWID who engage in sex work, vulnerable to HIV infection in instances of sexual coercion and violence.…”

HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016–2018

“…Additionally, the US is experiencing increases in acute hepatitis C virus (HCV) infections related to injection drug use (Zibbell et al, 2018), indicating that PWID are engaging in injection practices that increase risk for HIV transmission. Importantly, PWID face a dual risk for HIV from injection and sexual behaviors (Hill et al, 2018;Kral et al, 2001;Neaigus et al, 2013;Strathdee & Sherman, 2003), including transactional sex (Astemborski, Vlahov, Warren, Solomon, & Nelson, 1994;Jenness et al, 2011;Rondinelli et al, 2009) and forced sex (Williams, Dangerfield, Kral, Wenger, & Bluthenthal, 2018). This may be why there is a higher prevalence of sexually transmitted infections among PWID compared to the general population (Roth et al, 2016), leading to a growing need to prevent infectious disease spread among PWID.…”

Interest in linkage to PrEP among people who inject drugs accessing syringe services; Miami, Florida

“…There is clear evidence that sharing needles and syringes is a direct route for transmission of HIV-1 in 10 new HIV infections in the United States is among people who inject drugs (PWID) [1]. In addition to injection risk, PWID more frequently experience sexual coercion, sexual violence, and condomless sex, increasing risk of sexual transmission of HIV [2,3]. A culture of sharing injection equipment and high risk sexual behaviors results in PWID's having 22 times the risk of HIV infection compared to the population overall [4].…”