Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders

Objectives: Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. Methods: We did a cross-sectional evaluation of sexual and reproductive health...

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Bibliographic Details
Published in:	Women's health (London, England) England), 2022-01, Vol.18, p.17455065211070543
Main Authors:	Gibson, Britton, Hoff, Emily, Haas, Alissa, Adams, Zoe M, Price, Carolina R, Goddard-Eckrich, Dawn, Sheth, Sangini S, Dasgupta, Anindita, Meyer, Jaimie P
Format:	Article
Language:	eng
Subjects:	Birth control Bivariate analysis Clinical trials Confidence intervals Contraception Contraception Behavior Contraceptives Crime Cross-Sectional Studies Disease prevention Disorders Drug use Female Health risks Health services HIV HIV and Women’s Health: Where Are We Now HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Humans Judicial system Pregnancy Prevention Prophylaxis Reproductive behavior Reproductive Health Risk taking Sexual behavior Sexually transmitted diseases Statistical analysis STD Substance use Substance use disorder Substance-Related Disorders - complications Substance-Related Disorders - epidemiology Substance-Related Disorders - prevention & control Womens health
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Summary:	Objectives: Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. Methods: We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes. Results: Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09–4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13–0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors. Conclusions: This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women’s expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.
ISSN:	1745-5057 1745-5065