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The intersection of drug use, sexual pleasure and sexual risk behavior is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma.
Data were integrated for mixed methods analysis. While many participants reported sexual risk behavior unprotected vaginal or anal intercourse in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behavior and methamphetamine use in qualitative findings.
Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behavior while high on methamphetamine. Findings were mixed on whether methamphetamine use increased sexual risk behavior. The use of mixed methods afforded important insights into the sexual behavior and priorities of methamphetamine-using women.
Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization. And sometimes I wish that I could have that sexual pleasure feeling forever. Rather, research regarding HIV and sexual behavior among female drug users is dominated by a risk-focused epidemiological paradigm which narrowly defines risk behaviors, measures their prevalence and explores the correlates of these behaviors e.
Vital knowledge has been gained about drug-using women and sexual risk behavior such as unprotected sex and multiple male partners using epidemiological methods S. However, the focus on violence, trauma and social disadvantage often predominates to the degree that it obscures any sense of agency or pleasure women who use drugs may experience. Nevertheless, the common-sense notion of agency as a measure of individual empowerment and efficacy is valued by drug users and can be a powerful component of successful drug treatment P. The pursuit of pleasure is one arena in which feelings of agency may play out.
One explanation for this absence is the emphasis on pathological theories of drug use in the U. Similarly, drug-related needs — not pleasure or desire — are seen as the primary motivation for sexual engagement. In this framework, it is difficult to make room to document the potentially positive aspects of sexual behavior and drug use. In addition, the widespread criminalization and social condemnation of drug use contributes to a research environment that rewards scientists for focusing on disease and risk, and provides little incentive to delve into areas Lookn 4a female that wants pleasure come over now pleasure that appear vaguely disreputable, not to mention difficult to quantify and analyze Duff, The marginalization of desire and pleasure in HIV research may imperil our ability to develop effective prevention strategies.
To date, interventions to reduce sexual risk behavior among drug users, tested in randomized controlled trials, have been moderately successful at best. The lackluster showing of sexual risk behavior interventions suggests that we may be missing key information about sexual behavior among drug users, and that intensive efforts to date may not be pursuing a productive direction.
An enhanced evidence base — one which incorporates the perceived rewards and benefits of sexual behavior in the context of drug use — may be needed to develop more effective sexual risk reduction strategies. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women who use drugs in San Francisco, CA.
Using mixed methods, it delves into different dimensions of sexual behavior and methamphetamine use — inclusive not only of the risk of unprotected intercourse, but of desire, pleasure and the challenges of overcoming trauma.
Our goal was to understand sexual behavior as an experience rather than solely as a risk behavior. By extending the boundaries of conventional HIV risk assessment; this research strives to bring new depth and insights to understanding the sexual behavior of women who use drugs. Rather, the two methodological approaches provide different perspectives on similar, but often not identical, issues.
Interpreting data using mixed methods requires active engagement in both views Ciccarone,much like looking through the dual lenses of a pair of binoculars. The study described here was deed to use mixed methods from its inception.
Based on the knowledge that sexual behavior among disadvantaged women is complex and multi-dimensional, the intention was to complement quantitative findings with qualitative data regarding the contexts and circumstances of unprotected sex. Desire, pleasure and disinhibition arose as central themes relevant to sexual behavior and methamphetamine use, as well as to definitions of the self. Greene refers to the emergence of new concepts as a result of mixed methods analysis as initiationthe development of fresh insights and areas of inquiry Greene, Thus, in this paper, mixed methods served both the purposes of complementarity as planned and initiation as discovered.
Quantitative and qualitative data collection was conducted simultaneously from July — June in San Francisco, California. Participants were then given six coupons to recruit other methamphetamine-using women that they knew, and so on, using this process to build the quantitative sample.
Eligibility criteria for the study were a biological female; b age 18 or older; c methamphetamine use in past 30 days; d one or more male sexual partners in past 6 months; e referred by another participant with RDS recruitment coupon except initial recruits.
Eligibility was determined through a screening process that masked criteria by including several questions unrelated to eligibility. We also sought variation in sexual experiences and frequency of unprotected sex. In the process of strategically targeted sampling, the research team met weekly to discuss emerging quantitative and qualitative findings regarding methamphetamine use and sexual behavior, and identified potential candidates for in-depth qualitative interviews.
Similarly, as we began to note themes from qualitative findings, we selected participants and modified topics to further pursue our ideas, while simultaneously sampling strategically for the null hypothesis to control for potential subjective analytical bias and for potential distortions inherent to purposeful sampling Bourgois, Qualitative participants were recruited when they returned to the field site for HIV and STI counseling, one week after the quantitative interview.
The repeated interactions with study participants 1 interview, 2 counseling sessions, and 1 qualitative interview provided further opportunities to collect qualitative observations regarding institutional interactions and structural vulnerabilities, made in the form of field notes by study staff. Following informed consent, open-ended interviews lasting 60—90 minutes were conducted using a topic-based interview guide. Topics included life history, family and intimate relationships, drug use history, sexual experiences and preferences, and methamphetamine use.
Interviews were digitally recorded, transcribed and entered into Atlas Ti Atlas. In addition, we reviewed field notes by interviewers that summarized their observations and impressions from the quantitative and qualitative interviews, and counseling sessions. Qualitative data collection reached the point of saturation at 34 interviews, as the research team noted the repetition of central findings with little new information arising.
Quantitative data was used primarily to reveal the prevalence of different sexual behaviors and patterns of drug use. In addition, perceptions of the impact of methamphetamine use on sexual behavior were examined using a standardized scale. Our overarching measure of sexual risk behavior was unprotected vaginal or anal sex with male partners.
The identical question was asked regarding female partners. These items were followed with questions regarding the of partners by type steady, casual and paying in the past six months. Participants were asked about the use of several drugs, including methamphetamine, crack cocaine and heroin. Response are: strongly disagree, somewhat disagree, somewhat agree and strongly agree. Values from 1—4 was ased to responses in this order. Point prevalence data describing demographic characteristics and prevalence of risk behaviors obtained using SAS Version 9.
To assess the similarity of qualitative subsample to the larger quantitative sample, we compared the two groups on a of demographic, drug use and sexual behaviors Table 1. For the SEMS subscale, means were calculated per participant and then combined for overall scores. Codes were then compared, expanded and refined to develop a working codebook. Interview transcripts were entered into Atlas Ti and coded accordingly. Research team members discussed transcripts in monthly meetings, identifying key constructs, new themes and emerging findings, and modifying codes as warranted.
In a second phase of analysis, the authors focused in on the relationship of sexual behavior and methamphetamine use.
Through the lens of this specific line of inquiry, transcripts were re-read and re-analyzed to cull the full range of data supportive, negative and null that described and helped illuminate the experience and meaning of sexual pleasure and desire in the context of risk-taking.
Data were then grouped by theme e. Synthesis of qualitative and quantitative findings was an iterative process. Quantitative data were summarized in a series of tables and cross-tabulations. Qualitative data were organized thematically. Topic areas were loosely defined and somewhat fluid, as findings rarely matched up neatly across paradigms P Bourgois, Data were integrated in order to add depth and richness to findings, rather than a directed effort at triangulation.
The full study sample consisted of women, of whom 34 participated in qualitative data collection. The qualitative subsample did not differ ificantly from the rest of the sample in terms of demographic characteristics, frequency and modes of methamphetamine use or sexual behavior Table 1. The sample was racially diverse, and over half of participants were age 40 or older. The mean days of methamphetamine use in the past month was The median of male partners was 4 interquartile range 2, In addition, over a third of participants had one or more female sexual partners.
Interpretation of these findings is enriched by qualitative data which suggest a strong relationship between methamphetamine use and sexual desire. In open-ended interviews, many participants described methamphetamine as creating an intense desire for sex. Levels of sexual activity were often attributed to methamphetamine use.
It [methamphetamine] definitely made - increased my libido, to put it nicely… So that part of it I enjoyed. The participant described an intensification of sexual desire directly related to methamphetamine use. In addition, methamphetamine use contributed to protracted sexual encounters, or marathon sex. Over half of women reported engaging in marathon sex in the past 30 days table 2. Women described this practice as inherently linked to methamphetamine use.
But never not high. Participants linked methamphetamine use with a desire for more frequent and prolonged sex. This fostering of sexual desire is connected to the relatively high levels of sexual activity reported by participants. Women participating in the study described sexual pleasure as a key benefit of methamphetamineuse. Methamphetamineuse facilitated sexual satisfaction: Many women felt their orgasms were better when using methamphetamine and some reported only having orgasms when high. Another dimension of pleasure was that sexual activity on methamphetamine was longer lasting.
Being on meth, I…it, it prolonged the orgasming. Some women described methamphetamine in instrumental terms, as a pleasure-increasing sex aid. These findings suggest that a key reason women used methamphetamine was to enhance sexual pleasure. The mean score on the scale was 2. A strong relationship between methamphetamine use, disinhibition and sexual pleasure was described by many women. Loss of inhibition was considered a positive experience that improved sexual encounters. I do like the way it [methamphetamine] makes me feel sexually. Women described methamphetamine as promoting sexual exploration and freedom.
You have sex for hours… nonstop, every position — every which way but loose laughs. Any which way you Lookn 4a female that wants pleasure come over now laughs. Sex was fun. I get so horny…I wanna have two men on me, never one… My sexual pleasures are more intense. I get real freaky. The loss of inhibition associated with methamphetamine use felt sexually empowering to some women.
They described feeling more confident and assertive. Another said she feels more sexually attractive when using methamphetamine. In addition to enhancing confidence, methamphetamine use allayed insecurities regarding body image for some participants. One woman described how methamphetamine use made her more comfortable being naked in front of her husband.
Another compared sex while not high to sex while high as follows:. This suggests a fluid relationship between the seeking of pleasure and avoidance of pain for some participants. As the excerpt above suggests, some women felt methamphetamine helped them cope with uncomfortable sexual situations. In these instances, methamphetamine use was more focused on amelioration of pain rather than enhancement of pleasure. One woman who described methamphetamine as both numbing her feelings and enhancing her focus:. The use of methamphetamine to assuage sexual pain is perhaps best understood in the context of extremely high levels of adverse sexual experiences among study participants, both in childhood and as adults.
A majority of women reported engaging in sexual behaviors that could potentially create HIV risk Table 2. In addition, the prevalence of condom use was low. Over a third of women reported unprotected vaginal sex with sex trade partners in the past six months, and the proportion increases with casual and steady partners Figure 1.
Perceptions of the relationship between methamphetamine use and sexual risk-taking varied considerably among women in the study. However, some women described a loss of inhibition or a feeling of invulnerability that undermined considerations about sexual safety. The long duration of sexual activity while high on methamphetamine was also seen to undermine safer sex efforts. Other women described proactively assessing potentially risky sexual situations created by methamphetamine use and adapting to control them.Lookn 4a female that wants pleasure come over now
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Sexual Pleasure and Sexual Risk among Women who Use Methamphetamine: A Mixed Methods Study