Increased condom use with psychological abuse among drug-abusing women in Tehran

Abstract

Aims: Drug abuse, violence victimization, and risky sex are interrelated health problems.We examined abuse and risky sexual behavior in drug-abusing women in Tehran, Iran. Methods: 120 drug-using women were recruited from a rehabilitation center in Tehran in 2009. Women reported sexual behavior for the last 12 months (condom use and multiple partners categorized as 10), and reported abuse using the Revised Conflict Tactics Scale (CTS2). We conducted bivariable and multivariable analyses in SAS. Results: In unadjusted analyses, psychological abuse was positively associated with condom use (mean abuse score 2.92 vs. 2.17 for any vs. no condomuse, p=0.01). In assessing possible confounding, we found higher condom use among younger women (mean age 29.4 vs. 32.7 for users vs. non-users), unmarriedwomen (51.5% vs. 43.0%), women with more sexual partners (37.4%, 66.7%, and 100% for 10 partners), and ecstasy users (38.9% vs. 15.4%). Psychological abuse scoreswere higher for youngerwomen (r=−0.28, p=0.004), womenwithmore sexual partners (2.46, 2.74, and 2.96 for 10 partners) and ecstasy users (2.80 vs. 2.44). In multivariable models, the odds ratio for condom use relative to a one-point increase in psychological abuse was reduced from 1.43 (p=0.01) to 1.32 (p=0.06) when controlling for age, and 1.32 (p=0.10) when controlling for age, marital status, ecstasy use, and multiple partners. Conclusions:Drug-abusingwomenwhohavemultiplepartners may be more likely to use condoms, and experience psychological abuse. It is possible that residual confoundingmay partially underlie our adjusted association of 1.32. However, our results point to a set of adverse circumstances and risky behavior in these women, with low control in abusive relationships. Financial support: Tehran University of Medical Sciences, School of Public Health, Health Education and Health Promotion Division; and by NIH grant U10DA013727 (PI Brady).