Exploring patterns of substance use among highly vulnerable Black women at-risk for HIV through a syndemics framework: A qualitative study

Abstract

Black women who use alcohol, marijuana, and other drugs are disproportionately affected by health disparities. Black women's HIV diagnosis rates are 15 times higher than White women, and is among the leading causes of death among Black women in the US. Previous studies support the association between substance use and HIV risk, yet it is essential to better understand the specific factors experienced within the context of substance misuse and recovery among vulnerable Black women at-risk for substance misuse, HIV, and adverse life experiences. We conducted qualitative interviews with 31 black women (age M = 32.13, range 18-57) four times over six months. Eligible participants were 18+ years, identified as a Black/African-American woman, had unprotected vaginal or anal sex with a man in the past 30 days, and spoke fluent English. All transcripts were transcribed verbatim and were analyzed used thematic content analysis. Two groups of participants emerged: 1) those in recovery from their drug of choice (n = 11, 7 of whom misused alcohol or marijuana during the study), and 2) those who misused their drug of choice during the study (active use group; n = 20). Four themes emerged in the context of substance use: cultural factors, structural factors (i.e., housing and employment), past and present adverse life experiences, and individual factors (i.e., substance use to cope with stress, self-medicating with substances for mental health symptoms, intimate partner violence, and sex exchange). While participants in both groups used substances to cope with regard to these factors, the recovery group tended to use substances at lower frequencies and did not relapse with their drug of choice during the study. The active use group reported more substance use with regard to structural factors and recent adverse life events, had more difficulty regarding employment, and less instances of intimate partner violence (IPV) but were more likely to cope using substances. Substance use interventions tailored to vulnerable Black women should consider including trauma-informed interventions and support groups that address the structural, social, and individual factors to better serve their needs.

Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States

“…Female sex workers may be less likely to receive and access STI prevention services 77 than other at-risk populations, and drug use among FSWs may be associated with an even higher risk of STIs compared with FSW who do not use drugs 78 . Epidemics of substance use and syphilis among US heterosexual men and women can be considered syndemics, which are overlapping epidemics that share common root causes, including poverty, unemployment, intimate partner violence, and homelessness 79–83 …”

“…78 Epidemics of substance use and syphilis among US heterosexual men and women can be considered syndemics, which are overlapping epidemics that share common root causes, including poverty, unemployment, intimate partner violence, and homelessness. [79][80][81][82][83] Persons seeking treatment of STIs often have SUD. In a study of Baltimore sexually transmitted disease (STD) clinics, 57% of clients had SUD (35% alcohol, 31% cannabis, 11% opioids, and 8% stimulants), 84 which is higher than expected for the general US population.…”

Sexual Risk Behavior and Lifetime HIV Testing: The Role of Adverse Childhood Experiences

“…Risk factors for HIV transmission also remain stable, and include sharing of needles and syringes, having condomless intercourse, exchanging of sex for drugs, money, or other goods, and having other sexually transmitted infections [ 3 , 4 , 5 ]. These behavioral risk factors are additionally associated with a range of psychosocial sequelae, such as depression and suicidal ideation [ 6 , 7 , 8 ], psychological distress [ 9 , 10 ], alcohol and substance use and abuse disorders [ 11 , 12 , 13 ], disrupted social support [ 14 , 15 , 16 ], and experiences with violence [ 17 ]. Despite the extensive literature, which details HIV related risk behaviors and their synergistic impact on health outcomes, new perspectives that include a life-course perspective, are critical to ending the HIV epidemic.…”

A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S.

“…All interviews were conducted in English ( n = 17) or Spanish ( n = 1) by female interviewers. LAN who was trained in qualitative methods and conducted previous studies using these methods (McDaniel et al, 2023 ; Nydegger & Claborn, 2020 ; Nydegger et al, 2021a , 2021b ) conducted a majority of interviews; the remaining interviews were conducted by research assistants trained by LAN. Interviews were between 30 min and 3.3 h (M = 1.4 h), with interview 1 averaging 1.88 h (range 1.1–3.3 h), interview 2 averaging 0.97 h (range 0.53–1.47 h), and interview 3 averaging 1.35 h (range 0.5–2.45 h) .…”