Breaking the blue wall of silence: risk factors for experiencing police sexual misconduct among female offenders.

OBJECTIVES: We assessed the prevalence of and risk factors for trading sex with a police officer among women recruited from drug courts in St Louis, Missouri. METHODS: In 2005 to 2008, we recruited women into an HIV intervention study, which surveyed participants about multiple sociodemographic, lifestyle, and risk factors. Regression analyses assessed risk factors for trading sex, a form of police sexual misconduct (PSM). RESULTS: Of the 318 participants, 78 (25%) reported a lifetime history of PSM. Among women who experienced PSM, 96% had sex with an officer on duty, 77% had repeated exchanges, 31% reported rape by an officer, and 54% were offered favors by officers in exchange for sex; 87% said officers kept their promise. Only 51% of these respondents always used a condom with an officer. Multivariable models identified 4 or more arrests (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.29, 5.97), adult antisocial personality (AOR = 9.0; 95% CI = 2.08, 38.79), and lifetime comorbid cocaine and opiate use (AOR = 2.9 [1.62, 5.20]) as risk factors; employment (AOR = 0.4; 95% CI = 0.22, 0.77) lowered the risk of PSM. CONCLUSIONS: Community-based interventions are critical to reduce risk of abuse of vulnerable women by police officers charged with protecting communities.

Feasibility and effectiveness of HIV prevention among wives of heavy drinkers in Bangalore, India.

Few studies have examined the effectiveness of community based HIV interventions for monogamous married women. We examined prevalence of risky behaviors and effectiveness of a Western intervention on increased knowledge and reductions in risky behaviors among wives of heavy drinkers in an urban slum in Bangalore, India. Household enumeration was conducted on 509 households; wives of the youngest married man 18-50 years of age who scored 8+ on the Alcohol Use Disorder Identification Test (AUDIT) were selected (N = 100) and assessed with Indian adaptations of the Substance Abuse Module (SAM), the Washington University Risk Behavior Assessment for Women (WU-RBA-W), the Violence Exposure Questionnaire (VEQ), the CES-D, the Diagnostic Interview Schedule (DIS-IV), and a Proxy AUDIT. After random assignment to either the Standard (Pre-post HIV counseling; N = 50) or the Enhanced Intervention (Standard + Body Wise Intervention; N = 50), women were re-assessed at 2 months; a 100% follow-up rate was achieved. Though no major intervention effects were found, at follow-up women were less likely to report victimization and perpetrated violence, more likely to feel empowered to make decisions about birth control, and were more knowledgeable about how to protect themselves from STDs and HIV. The findings have implications for HIV prevention among at risk monogamous women in community settings.

Risky business: focus-group analysis of sexual behaviors, drug use and victimization among incarcerated women in St. Louis.

Incarcerated women report multiple vulnerabilities and, yet, are under-represented in research. This study used focus-group methodology to explore high-risk sexual behaviors, drug use, and victimization among female offenders in St. Louis. Inmates of the St. Louis Medium Security Institution (MSI) were invited to participate in one of five focus groups between May and September 2005 in preparation for an NIH/NINR HIV-prevention intervention study among female offenders in Drug Court. The focus group sample of 30 women was 70% African-American, with a mean age of 36 years. Results indicated that oral sex was the most common sex trade activity. Consistent with the literature, condom usage was described as irregular. In terms of drug use, participants reported that crack was most commonly used, with binges often lasting for several days. Regarding victimization, women frequently reported sexual abuse in childhood, and some described abusive relationships as adults. Participants also reported being beaten and raped by customers, which led to their concealing knives in purses and razors under the tongue. Consequently, perpetrated violence, including murder, was reported as protection against further violence. These findings confirm the vulnerability of this population of women who are at high risk for HIV. Effective HIV-prevention interventions are needed to assist these incarcerated women in making lifestyle changes during incarceration and sustaining them after release.

Effects of major depression on crack use and arrests among women in drug court.

AIMS: We examined whether a current major depressive episode (MDE) at baseline predicted crack use and arrests at follow-up among women enrolled in drug court. DESIGN: Primary analyses used zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) regression analyses to predict both yes/no and number of (i) days of crack use and (ii) arrests at 4-month follow-up from current (30-day) MDE at baseline. Secondary analyses addressed risk conferred by current versus past MDE at baseline. SETTING/PARTICIPANTS: Participants were 261 women in drug court. MEASUREMENTS: MDE was assessed using the Diagnostic Interview Schedule. Days using crack and number of arrests were assessed using the Washington University Risk Behavior Assessment for Women. FINDINGS: Having a current MDE at baseline predicted likelihood of crack use at follow-up, but not days of crack use among those who used. Current MDE at baseline did not predict presence or number of arrests at the 4-month follow-up. Women with current MDE at baseline were more likely to be using crack at follow-up than were those with recent (31+ days to 12 months) but not current MDE (odds ratio = 5.71); past MDE at baseline did not increase risk of crack use. CONCLUSIONS: Predictors of any versus no crack use or arrests appear to differ from predictors of frequency of these behaviors. Current major depression, but not past major depression, appears to be associated with increased risk of crack use among women attending drug court.

Risk factors associated with Hepatitis C among female substance users enrolled in community-based HIV prevention studies.

BACKGROUND: Hepatitis C virus (HCV) infection is one of the most frequent chronic blood-borne infections in the United States. The epidemiology of HCV transmission is not completely understood, particularly in women and minorities. FINDINGS: We examined the HCV associated risk factors in substance abusing females involved in National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse (NIDA) funded HIV prevention studies of street recruited women. As a part of the 12 month follow-up, participants were interviewed about substance use and sexual risk behaviors, including drug implement sharing practices, tattoos, body piercing and blood transfusions and the sharing of personal hygiene equipment including tweezers, toothbrushes and razors. Urine and blood testing for HCV antibody (Ab), HIV and sexually transmitted diseases (STDs) was conducted at the time of assessment.Among 782 predominantly African American women, 162 (21%) tested positive for HCV Ab. Older age (p < 0.001), history of injection drug use (p < 0.001), lifetime crack cocaine use (p = 0.004) and having a tattoo (p = 0.01) were significantly associated with HCV Ab positivity. Other risk factors previously reported in association with HCV Ab positivity such as sexual risk behaviors were not significantly associated with the presence of a positive HCV Ab. CONCLUSIONS: This large community based sample of predominantly African American substance abusing women showed high prevalence of HCV Ab positivity and low awareness of their HCV serostatus. Our study demonstrated that in addition to intravenous drug use (IDU), other factors were significantly associated with HCV Ab positivity such as having a tattoo and a lifetime history of crack use. Other potential routes of HCV transmission should be further studied among high risk female populations.

Problem drinking among married men in India: comparison between husband's and wife's reports.

INTRODUCTION AND AIMS: This study compared the husband's report and wife's report of her husband's problem drinking, among residents of an urban slum in Bangalore, India. DESIGN AND METHODS: The data come from a feasibility study to prevent HIV infection among at-risk women in Bangalore. Household enumeration was carried out (n = 509) to choose 100 married men between 18 and 50 years who reported problem drinking (scores 8 and above) on the Alcohol Use Disorder Identification Test (AUDIT). Wives of these married men, considered to be at risk for HIV because of their husband's hazardous drinking, were subsequently recruited for the study (n = 100). Written informed consent was obtained; wives were asked about the drinking history of their husbands through the AUDIT-WR (Wife's Report) developed for the present study. RESULTS: Prevalence of problem drinking in the enumerated sample (n = 509) was high (n = 186; 37%). The husband's report and his wife's report of his problem drinking was concordant (r = 0.57-0.75) on eight out of 10 items, and the total AUDIT score. DISCUSSION AND CONCLUSIONS: The AUDIT-WR is a reliable and culturally relevant measure of husband's problem drinking. In India, men with problem drinking are hard to reach. Therefore, proxy report of the wife may be useful when the husband is either unavailable or uncooperative for assessment.