The relationship between drug abuse and sexual performance among women on methadone. Heightening the risk of sexual intimate violence and HIV

PURPOSE: Through in-depth interviews with 38 women recruited from methadone maintenance treatment programs (MMTPs), this paper examines subjective experiences regarding the effects of illicit drugs on the women's sexual behavior and that of their male sexual partners, mainly changes in libido; performance, and pleasure. METHODS: This paper addresses several questions: (1) How does drug use affect women's sexual performance? (2) How does drug use affect their partners' sexual performance and the sexual dynamics in their relationship? (3) How does drug use affect these women and their partners differently? (4) How are sexual disparities between women and their partners, heightened by drug use, linked with sexual and physical violence and risk of HIV? RESULTS: Three major themes are discussed: some women believe that drugs, particularly heroin, increase their sexual performance, libido, and pleasure, but for others, drugs, particularly crack cocaine, inhibit their sexual performance and desire. Many of the women believe that crack cocaine and heroin enhance a man's sexual desire, performance, and pleasure. However, other women deem that these drugs are responsible for their partners' abusive and coercive behavior. The data further indicate that gender disparities, in how crack cocaine and heroin affect the sexual dynamics between drug-involved couples, often lead to sexual coercion and physical abuse. CONCLUSION: This in-depth narrative study of abused women in MMTPs draws implications from their subjective experiences for understanding the contextual mechanisms linking drug use, intimate sexual abuse, and HIV risk. It also suggests implications for designing HIV prevention programs that take into account the differential effects of drugs on sexual intimate violence and HIV risk. Education about the effects of drugs on sexuality and on the risks of sexual violence and HIV transmission is crucial for drug-involved women. (Editor's abstract.)