The converging epidemics of mood-altering-drug use, HIV, HCV, and partner violence: A conundrum for methadone maintenance treatment

Background: Accumulating evidence suggests that partner violence may be ass ociated with HIV risk behavior and drug use among women in methadone mainte nance treatment programs (MMTPs), yet the mechanisms linking these overlapp ing problems remain unclear. The main purpose of this qualitative study is to explore in detail how drug-related activities and HIV risk behavior occu r in the context of a recent episode of partner violence among women in MMT Ps. Methods: We conducted and analyzed in-depth interviews with 31 women who re ported having experienced physical or sexual violence by an intimate partne r during the past year. Guided by existing research, feminist theory and tr auma theory we constructed a set of questions which were designed to explor e multiple ways in which drug-related activities or HIV risk behavior may b e linked directly or indirectly to the recent event. To examine the extent and significance of the woman's and/or her partner's drug-related activitie s or sexual HN risk issues occurring immediately before, during and/or afte r the most recent event, we adapted a series of techniques for thematic ana lysis of qualitative data. Results: Of the 31 women who reported recent events: 83.8 % (n=6) recalled recent events in which there was some drug-involvement; 40% (n=13) indicate d that both she and her partner were involved in drug-related activities du ring the most recent event of partner abuse; 35% (n=11) reported that the p artner was drug-involved; and only two women (6.4%) indicated that they alo ne had been drug-involved. One-fifth (19.3%, n=6) of the women indicated th at they had used drugs immediately after the event because they were upset or in physical pain. One-fifth of the women (n=6) reported that they had co erced, unprotected sex during or after the most recent incident. Conclusions: The multiple ways in which the use of mood-altering drugs are related to partner violence and the occurrence of coerced, unprotected sex underscore the need to design specific interventions for preventing drug re lapse, and HIV and HCV infection among abused women in MMTPs. Treatment and policy implications of study findings are discussed.