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Correlates of Sexual Coercion among People Who Inject Drugs (PWID) in Los Angeles and San Francisco, CA


Experiences of coerced or forced sex have been associated with risk for HIV infection for all adults and may be more common for gays, lesbians, bisexuals (GLB) and people who inject drugs (PWID). In this study, we explored factors associated with prior 12-month experiences of forced or coerced sex among a sample of PWID, with a focus on sexual orientation and gender. PWID (N = 772) from Los Angeles and San Francisco were recruited using targeted sampling methods in 2011–2013 and surveyed on a range of items related to demographics, drug use, HIV risk, and violence, including experiences of forced or coerced sex in the prior 12 months. In this racially/ethnically diverse, mostly homeless, and low-income sample of PWID, 25% of participants were female and 15% identified as GLB. Sexual coercion was reported by 9% of gay and bisexual men, 8% of heterosexual females, 5% of lesbians and bisexual women, and less than 1% of heterosexual men. In multivariate analyses, compared to heterosexual males, gay or bisexual males (adjusted odds ratio [AOR] = 10.68; 95% confidence interval [CI] = 2.03, 56.23), and heterosexual females (AOR = 9.69; 95% CI = 2.04, 45.94) had increased odds of coerced sex in the prior 12 months. Having a paying sex partner (AOR = 3.49; 95% CI = 1.42, 8.54) or having had forced sex prior to the age of 16 by someone at least five years older (AOR = 4.74; 95% CI = 1.88, 11.93) also elevated the odds of coercive sex. Sexual coercion is common among PWID, but especially for gay and bisexual men and heterosexual females. Efforts to reduce sexual violence among PWID are urgently needed.

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The following research staff and volunteers also contributed to the study and are acknowledged here: Sonya Arreola, Vahak Bairamian, Philippe Bourgois, Soo Jin Byun, Jose Collazo, Jacob Curry, David-Preston Dent, Karina Dominguez, Jahaira Fajardo, Richard Hamilton, Frank Levels, Luis Maldonado, Askia Muhammad, Brett Mendenhall, Stephanie Dyal-Pitts, and Michele Thorsen. The research was supported by NIDA (grant nos: R01DA027689 and R01DA038965) and the National Science Foundation Graduate Research Fellowship Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We also thank the participants who took part in this study.

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Correspondence to Derek T. Dangerfield II.

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The study protocol was reviewed and approved by Institutional Review Boards at the University of Southern California and RTI International.

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Williams, J.E., Dangerfield, D.T., Kral, A.H. et al. Correlates of Sexual Coercion among People Who Inject Drugs (PWID) in Los Angeles and San Francisco, CA. J Urban Health 96, 469–476 (2019).

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  • Injection drug use
  • Sexual violence
  • Sexual coercion
  • HIV risk