Transcript (SAVA) Syndemic Among Women of African

African-Caribbean & African- American Women’s Study
M.B. Lucea, J.K. Stockman, J.D. Draughon,
D. Bertrand, J.C. Campbell, D.W. Campbell,
and the ACAAWS Research Team
Learning Objectives
 The audience will be able to
 identify factors that influence the engagement in
transactional sex in this sample of African Caribbean
women in the U.S. Virgin Islands and African American
women in Baltimore, Maryland.
 list possible nursing strategies for early identification of
and intervention in the SAVA syndemic.
SAVA Background
 SA: Substance abuse rates among adults in the U.S.
 14.6^ lifetime; 3.8% prior 12 months (Kessler et al, 2005)
 6.3% among AA women; 2.8% among Caribbean Black
women (Broman et al, 2008)
 V: 1 in 4 women experienced severe IPV in the US (Black
et al, 2011)
 81% of these women report short or long term health
impacts related to IPV
 A: HIV/AIDS risk behaviors include exchanging sex for
money, drugs, housing, etc.
 Little known regarding the prevalence of exchange sex,
particularly among women of African descent
SAVA Background
 The synergistic epidemics of substance abuse,
violence, and HIV/AIDS – the SAVA syndemic –is
highly prevalent among vulnerable women worldwide
 Ethnic minority women disproportionately affected.
 SAVA has been explored as a predictor of high-risk
behaviors, including exchanging sex for drugs or
money
 GAP: Not yet elucidated specifically among women of
African descent.
Purpose
Investigate the synergistic epidemics of
substance abuse, intimate partner abuse (IPA),
and HIV/AIDS risk among African Caribbean
(AC) and African American (AA) women
Explore how the SAVA syndemic contributes
to a history of exchange sex among these
women.
Methods
 Recruited women from health clinics.
 Eligible women were of African descent, aged 18-55,
with an intimate relationship within 2 years.
 Survey included demographics, IPA, and HIV risk
factors.
Measures: Outcome & Sociodemographics
 Outcome: Exchange Sex
 Have you had exchange male sex partners, that is, men you
have sex with in exchange for food, money, shelter or drugs?
(yes/no)
 Socio-demographics
 Site (Baltimore, St. Thomas, St. Croix)
 Age groups (18-24, 25-34, 35-44, 44+)
 Education (no HS diploma, HS diploma, some college, college grad)
 Having children under 18 in household (yes/no)
 Employed(yes/no)
 Monthly individual income (categories)
 Receiving government aid/assistance (yes/no)
 Partnership status (current partner : yes/no)
Measures: Predictors
 Abuse history*
 Recency: No abuse, Lifetime IPA, Past 2 year IPV
 Based on responses to AAS, WEB, SVAWS, Danger Assessment
 Past Year Drug Use
 How often in the past year have you used drugs (street drugs, drugs
that weren’t prescribed to you or were taken in a non-recommended
way)? (yes if at all; no if never)
 PTSD (PC-PTSD) (Prins et al, 2003)
 Depressive symptoms(CESD-10) (Andresen et al., 1994)
Results: Overall
 Of the total sample completing the full survey (n=901),
892 women (99%) reported their participation, or not,
in exchange sex and illicit drug use.
 357 controls; 473 cases
 Of these women,

7% (n = 61) had engaged in exchange sex.


3% of controls; 10% of cases (χ2 15.23, p<0.001)
9.3% (n=83) reported using illicit drugs

6% of controls; 12% of cases (χ2 8.26, p<0.01)
Results:
2
χ
Analyses
 Significant associations (χ2 p<.05 with exchange sex)
 Site, receipt of government aid, having children in
household
 Recency of Abuse
 Drug Use, Alcohol Use, PTSD, Depressive Symptoms
 Non-significant associations (χ2 p>.10 with exchange
sex):
 Age, Education level, Employment status, Current
relationship status, Monthly income
 These variables were not retained for further analysis
Results: Predictors of Exchange Sex
Unadjusted OR (95% CI)
Adjusted OR (95% CI)
Site
Baltimore
St. Thomas
St. Croix
No Government Aid
(ref)
0.77 (0.43 – 1.38)
0.41(0.20 – 0.85)
0.44 (0.21 – 0.90)
(ref)
0.70 (0.36 – 1.34)
0.34 (0.15 – 0.76)
0.63 (0.28 – 1.42)
Children <18
2.07 (1.03 – 4.15)
1.39 (0.65 – 2.99)
(ref)
2.03 (0.81-5.09)
4.42 (2.18-8.95)
9.26 (5.20 – 16.46)
(ref)
2.03 (0.75 – 5.47)
2.95 (1.32 – 6.62)
5.50 (2.86 – 10.59)
Alcohol Use
1.22 (1.10 – 1.37)
1.04 (0.92 – 1.19)
PTSD
3.27 (1.83 – 5.84)
1.89 (0.94– 3.80)
Depressive symptoms
2.69 (1.58 – 4.58)
1.25 (0.67 – 2.35)
Recency of Abuse
None (control)
Lifetime IPA
Past 2 year IPV
Drug Use
OR = Odds Ratio, CI = Confidence Interval
Discussion of Findings
 Rates of drug use comparable to previous literature
findings—significantly higher among those
experiencing IPV than those non-abused women
 Very few of the socio-demographics were
independently related to exchange sex
 Recent IPV and past year drug use were both
independently associated with exchange sex, a
behavior linked to HIV risk.
 Results support influence of SAVA syndemic
 Women in St. Croix were independently less likely to
engage in exchange sex than women in Baltimore
Strategies for Early ID and Intervention
 Important to acknowledge risk for and assess for
violence when working with women with a history
of substance abuse, and vice versa
 When working with HIV+ or women at risk for
HIV, discussion of HIV risk behaviors should
encompass exchange sex
 it may be a substantial risk factor, compounded by
substance abuse and IPV.
Strategies for Early ID and Intervention
 Presence of the complex SAVA syndemic necessitates
that nursing ensures adequate assessment of all
possible elements
 Need to develop interventions to address all three
elements that profoundly affect women’s health
Thank you!