Motivating Reasons for Leaving a Violent Relationship, Drug Use, and Transactional Sex: A Qualitative Study among HIV High-Risk African American Women Open Access

David, Naomi Sarah (2015)

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Background: Human immunodeficiency virus (HIV) is a growing epidemic in the southern U.S., and African American women are disproportionally affected. Intimate partner violence (IPV), drug use, and transactional sex are each significant risk factors for HIV acquisition. Women experiencing IPV, drug use, and transactional sex simultaneously may have a compounded risk for contracting HIV. Furthermore, IPV, drug use, and transactional sex are interrelated and may increase the occurrence of one another. More research on the syndemic relationships of IPV, drug use, and transactional sex is needed to help with HIV prevention efforts in this high-risk, difficult-to-access population.

Objectives: To understand more about how and why women decide to leave IPV, and terminate drug use and transactional sex, this study explored the commonalities of motivating reasons women leave/terminate each, and the barriers encountered in doing so.

Methods: In-depth interviews were conducted with 14 women who had experienced IPV in the previous 12 months, and used drugs and/or engaged in transactional sex in the previous five years.

Results: Women reported a range of motivating reasons for leaving IPV, drug use, and transactional sex. There were some overlapping themes across each domain, which included children, physical health and safety, and life dissatisfaction. Financial insecurity and dependence were common barriers to leaving all three.

Discussion: Women may have varying motivating reasons for deciding to leave IPV, drug use, and transactional sex, but future research can further explore the themes of children, physical health and safety, and life dissatisfaction. Future HIV prevention interventions among women experiencing each domain may want to integrate an economic component that promotes financial security and independence for women.

Table of Contents

Chapter One: Introduction 1-6

Epidemic of HIV among African American Women 1

HIV Risk among Women Experiencing IPV, Drugs and Transactional Sex 1

Syndemic Relationship of IPV, Drugs, and Transactional Sex 3

Research Question 5

Study Purpose and Significance 5

Chapter Two: Comprehensive Literature Review 7-19

Overview 7

Introduction 8

African American Women and HIV Vulnerability 8

Drug Use and Sexual HIV Risk 10

Transactional Sex and HIV Risk 11

Intimate Partner violence and HIV Risk 12

Syndemic Relationship of Drug Use, Transactional Sex, and IPV 13

Common Motivations for Leaving a Violent Relationship, Drug Use, and Engagement in Transactional Sex 16

Multi-Faceted HIV Interventions for Women 17

Gap in Literature 18

Chapter Three: Manuscript 20-49

Title Page 20

Contribution of Student 21

Abstract 22

Introduction 23

Methods 25

Results 29

Discussion 44

Conclusion 48

Chapter Four: Conclusion & Public Health Implications 50-54

Summary of Results 50

Strengths 51

Limitations 52

Conclusion 52

Public Health Implications 53

References 55-58

Appendices 59-66

Appendix A: Informed Consent for Interview Participants 59

Appendix B: Interview Guide for Interviews with Study Participants on IPV, Drug Use, and Transactional Sex 63

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