Synthesis of qualitative and quantitative findings was an iterative process. Nevertheless, the common-sense notion of agency as a measure of individual empowerment and efficacy is valued by drug users and can be a powerful component of successful drug treatment P. The pursuit of pleasure is one arena in which feelings of agency may play out. Qualitative data were organized thematically.
But never not high. This fostering of sexual desire is connected to the relatively high levels of sexual activity reported by participants. The intersection of drug use, sexual pleasure and sexual risk behavior is rarely explored when it comes to poor women who use drugs. Women described this practice as inherently linked to methamphetamine use. In addition, perceptions of the impact of methamphetamine use on sexual behavior were examined using a standardized scale. Interviews were digitally recorded, transcribed and entered into Atlas Ti Atlas.
The study described here was deed to use mixed methods from its inception. An enhanced evidence base — one which incorporates the perceived rewards and benefits of sexual behavior in the context of drug use — may be needed to develop more effective sexual risk reduction strategies. In addition, the widespread criminalization and social condemnation of drug use contributes to a research environment that rewards scientists for focusing on disease and risk, and provides little incentive to delve into areas like pleasure that appear vaguely disreputable, not to mention difficult to quantify and analyze Duff, The marginalization of desire and pleasure in HIV research may imperil our ability to develop effective prevention strategies.
Quantitative data was used primarily to reveal the prevalence of different sexual behaviors and patterns of drug use. The sample was racially diverse, and over half of participants were age 40 or older.
Over half of women reported engaging in marathon sex in the past 30 days table 2. Rather, research regarding HIV and sexual behavior among female drug users is dominated by a risk-focused epidemiological paradigm which narrowly defines risk behaviors, measures their prevalence and explores the correlates of these behaviors e.
In addition, we reviewed field notes by interviewers that summarized their observations and impressions from the quantitative and qualitative interviews, and counseling sessions. Participants were asked about the use of several drugs, including methamphetamine, crack cocaine and heroin.
Desire, pleasure and disinhibition arose as central themes relevant to sexual behavior and methamphetamine use, as well as to definitions of the self. Eligibility criteria for the study were a biological female; b age 18 or older; c methamphetamine use in past 30 days; d one or more male sexual partners in past 6 months; e referred by another participant with RDS recruitment coupon except initial recruits.
Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization. It [methamphetamine] definitely made - increased my libido, to put it nicely… So that part of it I enjoyed. In the process of strategically targeted sampling, the research team met weekly to discuss emerging quantitative and qualitative findings regarding methamphetamine use and sexual behavior, and identified potential candidates for in-depth qualitative interviews.
Through the lens of this specific line of inquiry, transcripts were re-read and re-analyzed to cull the full range of data supportive, negative and null that described and helped illuminate the experience and meaning of sexual pleasure and desire in the context of risk-taking.
One explanation for this absence is the emphasis on pathological theories of drug use in the U. Similarly, drug-related needs — not pleasure or desire — are seen as the primary motivation for sexual engagement. And sometimes I wish that I could have that sexual pleasure feeling forever. The identical question was asked regarding female partners. By extending the boundaries of conventional HIV risk assessment; this research strives to bring new depth and insights to understanding the sexual behavior of women who use drugs.
Findings were mixed on whether methamphetamine use increased sexual risk behavior. Topics included life history, family and intimate relationships, drug use history, sexual experiences and preferences, and methamphetamine use. The mean days of methamphetamine use in the past month was The median of male partners was 4 interquartile range 2, In addition, over a third of participants had one or more female sexual partners.
Values from 1—4 was ased to responses in this order. The participant described an intensification of sexual desire directly related to methamphetamine use. Point prevalence data describing demographic characteristics and prevalence of risk behaviors obtained using SAS Version 9. In this framework, it is difficult to make room to document the potentially positive aspects of sexual behavior and drug use.
The full study sample consisted of women, of whom 34 participated in qualitative data collection. In open-ended interviews, many participants described methamphetamine as creating an intense desire for sex. Women described feelings of power and agency related to sexual behavior while high on methamphetamine.
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Research team members discussed transcripts in monthly meetings, identifying key constructs, new themes and emerging findings, and modifying codes as warranted. The repeated interactions with study participants 1 interview, 2 counseling sessions, and 1 qualitative interview provided further opportunities to collect qualitative observations regarding institutional interactions and structural vulnerabilities, made in the form of field notes by study staff. In a second phase of analysis, the authors focused in on the relationship of sexual behavior and methamphetamine use.
These items were followed with questions regarding the of partners by type steady, casual and paying in the past six months. Participants linked methamphetamine use with a desire for more frequent and prolonged sex. Response are: strongly disagree, somewhat disagree, somewhat agree and strongly agree. Topic areas were loosely defined and somewhat fluid, as findings rarely matched up neatly across paradigms P Bourgois, Data were integrated in order to add depth and richness to findings, rather than a directed effort at triangulation.
Interview transcripts were entered into Atlas Ti and coded accordingly. Rather, desire, pleasure and disinhibition arose as central themes. To assess the similarity of qualitative subsample to the larger quantitative sample, we compared the two groups on a of demographic, drug use and sexual behaviors Table 1.
Data were then grouped by theme e. To date, interventions to reduce sexual risk behavior among drug users, tested in randomized controlled trials, have been moderately successful at best. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women who use drugs in San Francisco, CA.
Using mixed methods, it delves into different dimensions of sexual behavior and methamphetamine use — inclusive not only of the risk of unprotected intercourse, but of desire, pleasure and the challenges of overcoming trauma.
The qualitative subsample did not differ ificantly from the rest of the sample in terms of demographic characteristics, frequency and modes of methamphetamine use or sexual behavior Table 1. Interpretation of these findings is enriched by qualitative data which suggest a strong relationship between methamphetamine use and sexual desire.
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Eligibility was determined through a screening process that masked criteria by including several questions unrelated to eligibility. For the SEMS subscale, means were calculated per participant and then combined for overall scores. The use of mixed methods afforded important insights into the sexual behavior and priorities of methamphetamine-using women. Our goal was to understand sexual behavior as an experience rather than solely as a risk behavior. Quantitative data were summarized in a series of tables and cross-tabulations.
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Greene refers to the emergence of new concepts as a result of mixed methods analysis as initiationthe development of fresh insights and areas of inquiry Greene, Thus, in this paper, mixed methods served both the purposes of complementarity as planned and initiation as discovered.
Vital knowledge has been gained about drug-using women and sexual risk behavior such as unprotected sex and multiple male partners using epidemiological methods S. However, the focus on violence, trauma and social disadvantage often predominates to the degree that it obscures any sense of agency or pleasure women who use drugs may experience.
Levels of sexual activity were often attributed to methamphetamine use. Based on the knowledge that sexual behavior among disadvantaged women is complex and multi-dimensional, the intention was to complement quantitative findings with qualitative data regarding the contexts and circumstances of unprotected sex. We also sought variation in sexual experiences and frequency of unprotected sex. The lackluster showing of sexual risk behavior interventions suggests that we may be missing key information about sexual behavior among drug users, and that intensive efforts to date may not be pursuing a productive direction.
Interpreting data using mixed methods requires active engagement in both views Ciccarone,much like looking through the dual lenses of a pair of binoculars. In addition, methamphetamine use contributed to protracted sexual encounters, or marathon sex.
Qualitative data collection reached the point of saturation at 34 interviews, as the research team noted the repetition of central findings with little new information arising. Data were integrated for mixed methods analysis. While many participants reported sexual risk behavior unprotected vaginal or anal intercourse in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behavior and methamphetamine use in qualitative findings.
Quantitative and qualitative data collection was conducted simultaneously from July — June in San Francisco, California. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma.
Following informed consent, open-ended interviews lasting 60—90 minutes were conducted using a topic-based interview guide. Our overarching measure of sexual risk behavior was unprotected vaginal or anal sex with male partners. Rather, the two methodological approaches provide different perspectives on similar, but often not identical, issues. Codes were then compared, expanded and refined to develop a working codebook. Participants were then given six coupons to recruit other methamphetamine-using women that they knew, and so on, using this process to build the quantitative sample.
Similarly, as we began to note themes from qualitative findings, we selected participants and modified topics to further pursue our ideas, while simultaneously sampling strategically for the null hypothesis to control for potential subjective analytical bias and for potential distortions inherent to purposeful sampling Bourgois, Qualitative participants were recruited when they returned to the field site for HIV and STI counseling, one week after the quantitative interview.