Abstract
This research uses multi-level modeling to investigate the context of unprotected sex of homeless women. Based on interviews with 429 randomly selected women living in temporary shelter settings in Los Angeles, this project investigates multiple levels of influence on unprotected sex with particular partners. Previous studies have investigated condom use of homeless women primarily at the individual level. This project investigates unprotected sex at the level of the partnership, the individual woman, and her social network. Homeless women who believe in the efficacy of condoms to prevent HIV infection, believe that they have low susceptibility to HIV and have a greater proportion of their non-sex partner social network ties with whom they speak about HIV are less likely to engage in unprotected sex. Women are more likely to engage in risky sexual behavior in relationships in which they have high commitment to their partner and experience physical violence.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2005, vol. 17. Atlanta: US Department of Health and Human Services, CDC; 2007. (Rev. ed).
Forney JC, Lombardo S, Toro PA. Diagnostic and other correlates of HIV risk behaviors in a probability sample of homeless adults. Psychiatr Serv. 2007;58(1):92–9.
Kilbourne AM, Herndon B, Andersen RM, Wenzel SL, Gelberg L. Psychiatric symptoms, health services, and HIV risk factors among homeless women. J Health Care Poor Underserved. 2002;13(1):49–65.
Centers for Disease Control and Prevention. HIV/AIDS in the United States. Atlanta: Centers for Disease Control and Prevention; 2008.
Tortu S, McMahon JM, Hamid R, Neaigus A. Drug-using women’s sexual risk: an event analysis. AIDS Behav. 2000;4:329–40.
McDonnell KA, Gielen AC, O’Campo P. Does HIV status make a difference in the experience of lifetime abuse? Descriptions of lifetime abuse and its context among low-income urban women. J Urban Health. 2003;80(3):494–509.
Nyamathi A. Health promotion among homeless women at risk of AIDS. Rockville: National Institute of Mental Health; 1994.
Sikkema KJ, Heckman TG, Kelly JA, Anderson ES, Winett RA, Solomon LJ, et al. HIV risk behaviors among women living in low-income, inner-city housing developments. Am J Public Health. 1996;86(8):1123–8.
Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K, Perlman J, Becker K, et al. Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: a comparison of sheltered and low-income housed women in Los Angeles County. Prev Med. 2004;39(3):617–24.
Seal DW, Ehrhardt AA. HIV-prevention-related sexual health promotion for heterosexual men in the United States: pitfalls and recommendations. Arch Sex Behav. 2004;33(3):211–22.
Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull. 1999;125(1):90–132.
Hader SL, Smith DK, Moore JS, Holmberg SD. HIV infection in women in the United States—status at the millennium. JAMA. 2001;285(9):1186–92.
Snelling D, Omariba DWR, Hong S, Georgiades K, Racine Y, Boyle MH. HIV/AIDS knowledge, women’s education, epidemic severity and protective sexual behaviour in low- and middle-income countries. J Biosoc Sci. 2007;39(3):421–42.
Cooper ML. Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. J Stud Alcohol. 2002:101–17.
Fromme K, D’Amico EJ, Katz EC. Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? J Stud Alcohol. 1999;60(1):54–63.
Macaluso M, Cheng H, Akers R. Birth control method choice and use of barrier methods for sexually transmitted disease prevention among low-income African-American women. Contraception. 2000;62(1):5–13.
MacDonald TK, MacDonald G, Zanna MP, Fong GT. Alcohol, sexual arousal, and intentions to use condoms in young men: applying alcohol myopia theory to risky sexual behavior. Health Psychol. 2000;19(3):290–8.
Dermen KH, Cooper ML, Agocha VB. Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. J Stud Alcohol. 1998;59(1):71–7.
McKirnan DJ, Vanable PA, Ostrow DG, Hope B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. J Subst Abuse. 2001;13(1–2):137–54.
National Institute on Alcohol Abuse and Alcoholism. Alcohol and HIV. Alcohol Alert. 2002;57:1–4.
Dermen KH, Cooper ML. Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Exp Clin Psychopharmacol. 2000;8(2):198–206.
George WH, Stoner SA, Norris J, Lopez PA, Lehman GL. Alcohol expectancies and sexuality: a self-fulfilling prophecy analysis of dyadic perceptions and behavior. J Stud Alcohol. 2000;61(1):168–76.
Fortenberry JD, Orr DP, Katz BP, Brizendine EJ, Blythe MJ. Sex under the influence—a diary self-report study of substance use and sexual behavior among adolescent women. Sex Transm Dis. 1997;24(6):313–9.
Leigh BC, Stall R. Substance use and risky sexual-behavior for exposure to HIV—issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035–45.
Weinhardt LS, Carey MP, Carey KB, Maisto SA, Gordon CM. The relation of alcohol use to HIV-risk sexual behavior among adults with a severe and persistent mental illness. J Consult Clin Psychol. 2001;69(1):77–84.
Latkin C, Forman V, Knowlton A, Sherman S. Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Soc Sci Med. 2003;56(3):465–76.
Morrill AC, Ickovics JR, Golubchikov VV, Beren SE, Rodin J. Safer sex: social and psychological predictors of behavioral maintenance and change among heterosexual women. J Consult Clin Psychol. 1996;64(4):819–28.
Macaluso M, Demand MJ, Artz LM, Hook EW. Partner type and condom use. AIDS. 2000;14(5):537–46.
Tucker JS, Elliott MN, Wenzel SL, Hambarsoomian K. Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County. Health Psychol. 2007;26(5):644–9.
Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson D. Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. J Womens Health. 1998;7(3):371–8.
Cabral RJ, Pulley L, Artz L, Brill I, Macaluso M. Women at risk of HIV/STD: the importance of male partners as barriers to condom use. AIDS Behav. 1998;2(1):75–85.
Jones R, Oliver M. Young urban women’s patterns of unprotected sex with men engaging in HIV risk behaviors. AIDS Behav. 2007;11(6):812–21.
Misovich SJ, Fisher JD, Fisher WA. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1(1):72–107.
Kenny DA, Kashy DA, Cook WL. Dyadic data analysis. New York: The Guilford Press; 2006.
Sherman SG, Latkin CA. Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis. Drug Alcohol Depend. 2001;64(1):97–104.
McCarty C. Measuring structure in personal networks. JoSS. 2002;3(1).
Snijders T, Spreen M, Zwaagstra R. The use of multilevel modeling for analysing personal networks: networks of cocaine users in an urban area. J Quant Anthropol. 1995;5(2):85–105.
Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K. Sexual risk among impoverished women: understanding the role of housing status. AIDS Behav. 2007;11(6):S9–20.
Sobo EJ. Finance, romance, social support, and condom use among impoverished inner-city women. Hum Organ. 1995;54(2):115–28.
Marin BV, Tschann JM, Gomez CA, Gregorich S. Self-efficacy to use condoms in unmarried Latino adults. Am J Community Psychol. 1998;26(1):53–71.
St Lawrence JS, Eldridge GD, Reitman D, Little CE, Shelby MC, Brasfield TL. Factors influencing condom use among African American women: implications for risk reduction interventions. Am J Community Psychol. 1998;26(1):7–28.
Williams M, Ross MW, Bowen AM, Timpson S, McCoy HV, Perkins K, et al. An investigation of condom use by frequency of sex. Sex Transm Infect. 2001;77(6):433–5.
Wenzel SL. Alcohol use and HIV risk among impoverished women (R01 AA015301). Bethesda: National Institute on Alcohol Abuse and Alcoholism; 2005.
Burt M. Homelessness, definitions and estimates. In: Levinson D, editor. Encyclopedia of homelessness. Thousand Oaks: Sage; 2004.
Fisher JD. Possible effects of reference group-based social influence on AIDS risk behavior and AIDS prevention. Am Psychol. 1988;43(11):914–20.
Latkin C, Mandell W, Oziemkowska M, Celentano D, Vlahov D, Ensminger M, et al. Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS. Drug Alcohol Depend. 1995;38(1):1–9.
Mitchell JC. The concept and use of social networks. In: Mitchell JC, editor. Social networks in urban situations. Manchester: Manchester University Press; 1969. p. 1–50.
Scott J. Social network analysis: a handbook. London: Sage; 1991.
Wasserman S, Galaskiewicz J, editors. Advances in social network analysis: research in the social and behavioral sciences. Thousand Oaks: Sage; 1994.
Campbell KE, Lee BA. Name generators in surveys of personal networks. Soc Networks. 1991;13(3):203–21.
McCarty C, Bernard HR, Killworth PD, Shelley GA, Johnsen EC. Eliciting representative samples of personal networks. Soc Networks. 1997;19(4):303–23.
Golinelli D, Ryan G, Green HD, Kennedy DP, Tucker JS, Wenzel SL. Sampling to reduce respondent burden in personal network studies. Field Methods. 2009 (accepted for publication).
McCarty C, Killworth PD, Rennell J. Impact of methods for reducing respondent burden on personal network structural measures. Soc Networks. 2007;29(2):300–15.
Sherbourne CD, Stewart AL. The Mos social support survey. Soc Sci Med. 1991;32(6):705–14.
Koegel P, Burnam MA. Course of homelessness among the seriously mentally ill. Bethesda: National Institute of Mental Health; 1991.
Wenzel SL. Drug abuse, violence, and HIV/AIDS in impoverished women (R01 DA 11370). Bethesda: National Institute on Drug Abuse; 1999.
Castañeda D. The close relationship context and HIV/AIDS risk reduction among Mexican Americans. Sex Roles. 2000;42(7–8):551–80.
Drigotas SM, Rusbult CE. Should I stay or should I go—a dependence model of breakups. J Pers Soc Psychol. 1992;62(1):62–87.
Rusbult CE, Johnson DJ, Morrow GD. Predicting satisfaction and commitment in adult romantic involvements—an assessment of the generalizability of the investment model. Soc Psychol Q. 1986;49(1):81–9.
Straus MA, Hamby SL, BoneyMcCoy S, Sugarman DB. The revised Conflict Tactics Scales (CTS2)—development and preliminary psychometric data. J Fam Issues. 1996;17(3):283–316.
Tolman RM. The validation of the psychological maltreatment of women inventory. Violence Vict. 1999;14(1):25–37.
Morokoff PJ, Quina K, Harlow LL, Whitmire L, Grimley DM, Gibson PR, et al. Sexual assertiveness scale (SAS) for women: development and validation. J Pers Soc Psychol. 1997;73(4):790–804.
Bogart LM, Kral AH, Scott A, Anderson R, Flynn N, Gilbert ML, et al. Condom attitudes and behaviors among injection drug users participating in California syringe exchange programs. AIDS Behav. 2005;9(4):423–32.
Brown IS. Development of a scale to measure attitude toward the condom as a method of birth-control. J Sex Res. 1984;20(3):255–63.
Gibson DR, Lovelle-Drache J, Young MT, Chesney M. HIV risk linked to psychopathology in IV drug users. Int Conf AIDS, Amsterdam. 1992.
StataCorp LP. Stata statistical software. Release 9.2 ed. College Station: StataCorp LP; 2007.
Morrill AC, Noland C. Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of “testing by proxy’’. J Health Commun. 2006;11(2):183–98.
Ryan GW, Stern SA, Hilton L, Tucker JS, Kennedy DP, Golinelli D, et al. When, where, why and with whom homeless women engage in risky sexual behaviors: a framework for understanding complex and varied decision-making processes. Sex Roles. 2009;61(7–8):536–53.
Martin JJ, Pryce JG, Leper JD. Avoidance coping and HIV risk behavior among gay men. Health Soc Work. 2005;3(3):193–201.
Tuten M, Jones HE, Svikis DS. Comparing homeless and domiciled pregnant substance dependent women on psychosocial characteristics and treatment outcomes. Drug Alcohol Depend. 2003;69(1):95–9.
Padgett DK, Hawkins RL, Abrams C, Davis A. In their own words: trauma and substance abuse in the lives of formerly homeless women with serious mental illness. Am J Orthopsychiatry. 2006;76(4):461–7.
American Psychiatric Association. Diagnostic and statistical manual of psychiatric disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Browne A. Family violence and homelessness—the relevance of trauma histories in the lives of homeless women. Am J Orthopsychiatry. 1993;63(3):370–84.
Browne A, Bassuk SS. Intimate violence in the lives of homeless and poor housed women: prevalence and patterns in an ethnically diverse sample. Am J Orthopsychiatry. 1997;67(2):261–78.
Banyard VL. Childhood maltreatment and the mental health of low-income women. Am J Orthopsychiatry. 1999;69(2):161–71.
Stein JA, Leslie MB, Nyamathi A. Relative contributions of parent substance use and childhood maltreatment to chronic homelessness, depression, and substance abuse problems among homeless women: mediating roles of self-esteem and abuse in adulthood. Child Abuse Negl. 2002;26(10):1011–27.
Rayburn NR, Wenzel SL, Elliott MN, Hambarsoomians K, Marshall GN, Tucker JS. Trauma, depression, coping, and mental health service seeking among impoverished women. J Consult Clin Psychol. 2005;73(4):667–77.
Shapiro DL, Levendosky AA. Adolescent survivors of childhood sexual abuse: the mediating role of attachment style and coping in psychological and interpersonal functioning. Child Abuse Negl. 1999;23(11):1175–91.
Anderson DG, Rayens MK. Factors influencing homelessness in women. Public Health Nurs. 2004;21(1):12–23.
Wright MO, Emily C, Sebastian K. Positive resolution of childhood sexual abuse experiences: the role of coping, benefit-finding and meaning-making. J Fam Violence. 2007;22(7):597–608.
Hazan C, Shaver PR. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. 1987;52(33):511–24.
Feeney JA, Kelly L, Gallois C, Peterson C, Terry DJ. Attachment style, assertive communication, and safer-sex behavior. J Appl Soc Psychol. 1999;29(9):1964–83.
Hammer JC, Fisher JD, Fitzgerald P, Fisher WA. When two heads aren’t better than one: AIDS risk behavior in college-age couples. J Appl Soc Psychol. 1996;26(5):375–97.
El-Bassel N, Gilbert L, Wu E, Go H, Hill J. HIV and intimate partner violence among methadone-maintained women in New York City. Soc Sci Med. 2005;61(1):171–83.
Blankenship KM, Smoyer AB, Bray SJ, Mattocks K. Black–White disparities in HIV/AIDS: the role of drug policy and the corrections system. J Health Care Poor Underserved. 2005;16(4):140–56.
Acknowledgments
This research was supported by Grant R01AA015301 from the National Institute on Alcohol Abuse and Alcoholism. We thank the women who shared their experiences with us, the service agencies that collaborated in this study, and the RAND Survey Research Group for assistance in data collection.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kennedy, D.P., Wenzel, S.L., Tucker, J.S. et al. Unprotected Sex of Homeless Women Living in Los Angeles County: An Investigation of the Multiple Levels of Risk. AIDS Behav 14, 960–973 (2010). https://doi.org/10.1007/s10461-009-9621-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-009-9621-3