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UBC Theses and Dissertations

Sexual violence among a cohort of injection drug users Braitstein, Paula


Objectives: To determine the prevalence of and factors associated with sexual violence in childhood, adolescence and adulthood, among injection drug users (IDU). To determine how much of the HIV epidemic among this population is attributable to a history of sexual violence. Methods: The Vancouver Injection Drug User Study is a prospective cohort of I DU begun in 1996. The analysis included all individuals who completed the baseline questionnaire who responded to the question about sexual assault. Multivariate modeling was used to determine to what extent a history of sexual violence, and at different ages, is predictive of later self-destructive behaviors and health care utilization. Attributable risks were calculated using HIV incidence and prevalence estimates entered into standard attributable risk calculations. Results: There were 1437 eligible individuals, of whom 518 (36%) reported a history of sexual violence. This included 306 (21%) individuals who were at or below age 12 when the first incident occurred. Women were more likely to report a history of sexual violence (AOR: 9.0, 95% CI: 7.0 - 11.5). After controlling for sociodemographic factors, any history of sexual violence was predictive of ever being in the sex trade (AOR: 3.7, 95% CI: 2.8-4.9), having knowingly borrowed rigs from HIV+ people (AOR: 1.7, 95% CI: 1.3 - 2.3), having ever attempted suicide (AOR: 1.7, 95% CI: 1.2 - 2.3), and ever being diagnosed with a mental disorder/disability (AOR: 2.0, 95% CI: 1.6 - 2.6). A clear gradient of effect was associated depending on the age at onset of abuse, with those experiencing child sexual abuse having the worst outcomes. Childhood sexual abuse (but not other ages) was predictive of using the emergency department in the past six months (AOR 1.8, 95% CI: 1.3 - 2.4), and ever being hospitalized for mental illness (AOR 1.5, 95%o CI: 1.1-1.9). Approximately 25% of the HIV prevalence among individuals who have experienced sexual violence can be attributed to their history of sexual violence, and approximately 10% of the HIV prevalence in all of VIDUS can be attributed to sexual violence. Conclusions: These data suggest that 36% of the cohort has ever experienced sexual violence, and 21% was first experienced in childhood. This history is strongly associated with a plethora of H IV risk and self-destructive behaviors, and can be causally associated in the case of child sexual abuse. Approximately 10% of the HIV prevalence among this cohort can be attributed to a history of sexual violence.

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