Life Events and Sexual Risk among HIV-Negative, Heterosexual, Methamphetamine Users
Semple, Shirley J., Strathdee, Steffanie A., Zians, Jim, Patterson, Thomas L., The Journal of Sex Research
Methamphetamine use rates are high both nationally and worldwide (Iritani, Hallfors, & Bauer, 2007; United Nations Office, 2007). Widespread use of this drug has been documented among men who have sex with men (MSM) and heterosexuals, especially in Western U.S. states (e.g., Halkitis, Parsons, & Stirratt, 2001; Molitor, Truax, Ruiz, & Sun, 1998; Reback, 1997; Semple, Patterson, & Grant, 2004a).
Although studies on methamphetamine use involving heterosexuals are few in number, they have consistently yielded an association between methamphetamine use and high-risk sexual behaviors. For example, a population-based study of heterosexual male methamphetamine users in California reported a strong association between methamphetamine use, sex with anonymous and casual female partners, anal intercourse, and sex with an injection drug user (Centers for Disease Control, 2006). In another study of heterosexual encounters, methamphetamine use was associated with unprotected anal sex and unprotected sex with a new partner (Zule, Costenbader, Meyer, & Wechsberg, 2007).
High-risk sexual behaviors associated with methamphetamine use have been implicated in increasing rates of HIV and other sexually transmitted infections (STIs) among MSM (Centers for Disease Control, 2004; Drumright, Patterson, & Strathdee, 2006); it is likely that a similar trend will emerge among heterosexual methamphetamine users. Thus, to develop effective HIV and STI prevention approaches, it is critical to identify psychosocial factors or targets associated with sexual risk behavior among methamphetamine-using heterosexuals (Sheeran, Abraham, & Orbell, 1999).
Negative Life Events and Health Outcomes
Negative or stressful life events have been associated with a variety of health outcomes. For example, there is an abundance of literature that identifies negative or stressful life events as a risk factor for substance use among adolescents, college students, and adults (He, Kramer, Houser, Chomitz, & Hacker, 2004; Nation & Heflinger, 2006; Perreira & Sloan, 2001; Taylor, 2006). Other adverse health outcomes associated with stressful life events include drug overdose (Neale & Robertson, 2005), suicide attempts (O'Hare, Sherrer, & Shen, 2006), depression (Kohn et al., 2001), and reduced quality of life (Han et al., 2006). To date, there is a paucity of research on negative life events and sexual risk outcomes among adults.
Positive Life Events and Health Outcomes
A limited number of studies have examined positive life events in relation to health outcomes. Most of the work in this area has focused on mental health outcomes. In a large-scale, community-based study, positive life events were associated with positive adjustment (Zautra & Simons, 1979). High levels of subjective happiness have also been associated with positive life events such as starting a new relationship, pregnancy, and educational achievement (Ballas & Dorling, 2007). In a study of life events among adolescents with psychiatric diagnoses, patients with major depressive disorder had significantly fewer positive events compared to control subjects (Horesh, Ratner, Laor, & Toren, 2008). In studies of the elderly, positive life events have been associated with better quality of life and reductions in depressive symptoms (Grimby & Svanborg, 1996; Krause, 1988). To our knowledge, no studies have examined positive life events in relation to sexual risk behaviors among adults.
How Might Negative Life Events be Associated with Higher Levels of Sexual Risk Taking Among Methamphetamine Users?
Negative life events are typically associated with unpleasant emotions and substance use is a common strategy for regulating mood (Reynolds et al., 2005). The "self-medication" hypothesis contends that individuals use substances to avoid or reduce the distress associated with negative emotions (Khantzian, 1985; Reynolds et al. …