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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. Eligibility was determined through a screening process that masked criteria by including several questions unrelated to eligibility.

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We also sought variation in sexual experiences and frequency of unprotected sex. 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.

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 results counseling, one week after the quantitative interview.

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. Following informed consent, open-ended interviews lasting 60—90 minutes were conducted using a topic-based interview guide. Topics included life history, family and intimate relationships, drug use history, sexual experiences and preferences, and methamphetamine use. Interviews were digitally recorded, transcribed and entered into Atlas Ti Atlas.

In addition, we reviewed field notes by interviewers that summarized their observations and impressions from the quantitative and qualitative interviews, and counseling sessions. 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.

Quantitative data was used primarily to reveal the prevalence of different sexual behaviors and patterns of drug use. In addition, perceptions of the impact of methamphetamine use on sexual behavior were examined using a standardized scale. Our overarching measure of sexual risk behavior was unprotected vaginal or anal sex with male partners. The number of male partners was measured with the item: The identical question was asked regarding female partners.

These items were followed with questions regarding the number of partners by type steady, casual and paying in the past six months. Participants were asked about the use of several drugs, including methamphetamine, crack cocaine and heroin. Values from 1—4 was assigned to responses in this order. Point prevalence data describing demographic characteristics and prevalence of risk behaviors obtained using SAS Version 9. To assess the similarity of qualitative subsample to the larger quantitative sample, we compared the two groups on a number of demographic, drug use and sexual behaviors Table 1.

For the SEMS subscale, means were calculated per participant and then combined for overall scores. Codes were then compared, expanded and refined to develop a working codebook. Interview transcripts were entered into Atlas Ti and coded accordingly. Research team members discussed transcripts in monthly meetings, identifying key constructs, new themes and emerging findings, and modifying codes as warranted. In a second phase of analysis, the authors focused in on the relationship of sexual behavior and methamphetamine use.

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. Data were then grouped by theme e. Synthesis of qualitative and quantitative findings was an iterative process.

Quantitative data were summarized in a series of tables and cross-tabulations. Qualitative data were organized thematically. 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. The full study sample consisted of women, of whom 34 participated in qualitative data collection. The qualitative subsample did not differ significantly from the rest of the sample in terms of demographic characteristics, frequency and modes of methamphetamine use or sexual behavior Table 1.

The sample was racially diverse, and over half of participants were age 40 or older. The mean days of methamphetamine use in the past month was The median number of male partners was 4 interquartile range 2, In addition, over a third of participants had one or more female sexual partners. Interpretation of these findings is enriched by qualitative data which suggest a strong relationship between methamphetamine use and sexual desire.

In open-ended interviews, many participants described methamphetamine as creating an intense desire for sex. Levels of sexual activity were often attributed to methamphetamine use.

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It [methamphetamine] definitely made - increased my libido, to put it nicely… So that part of it I enjoyed. The participant described an intensification of sexual desire directly related to methamphetamine use. In addition, methamphetamine use contributed to protracted sexual encounters, or marathon sex. Over half of women reported engaging in marathon sex in the past 30 days table 2. Women described this practice as inherently linked to methamphetamine use. But never not high. Participants linked methamphetamine use with a desire for more frequent and prolonged sex.

This fostering of sexual desire is connected to the relatively high levels of sexual activity reported by participants.

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Women participating in the study described sexual pleasure as a key benefit of methamphetamineuse. Methamphetamineuse facilitated sexual satisfaction: Many women felt their orgasms were better when using methamphetamine and some reported only having orgasms when high. Another dimension of pleasure was that sexual activity on methamphetamine was longer lasting. Being on meth, I…it, it prolonged the orgasming. Some women described methamphetamine in instrumental terms, as a pleasure-increasing sex aid.

These findings suggest that a key reason women used methamphetamine was to enhance sexual pleasure. The mean score on the scale was 2. A strong relationship between methamphetamine use, disinhibition and sexual pleasure was described by many women. Loss of inhibition was considered a positive experience that improved sexual encounters. I do like the way it [methamphetamine] makes me feel sexually. Women described methamphetamine as promoting sexual exploration and freedom. You have sex for hours… nonstop, every position — every which way but loose laughs. Any which way you can laughs.

I get so horny…I wanna have two men on me, never one… My sexual pleasures are more intense.

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I get real freaky. The loss of inhibition associated with methamphetamine use felt sexually empowering to some women. They described feeling more confident and assertive. Another said she feels more sexually attractive when using methamphetamine.

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In addition to enhancing confidence, methamphetamine use allayed insecurities regarding body image for some participants. One woman described how methamphetamine use made her more comfortable being naked in front of her husband. Another compared sex while not high to sex while high as follows:. This suggests a fluid relationship between the seeking of pleasure and avoidance of pain for some participants. As the excerpt above suggests, some women felt methamphetamine helped them cope with uncomfortable sexual situations.

In these instances, methamphetamine use was more focused on amelioration of pain rather than enhancement of pleasure. One woman who described methamphetamine as both numbing her feelings and enhancing her focus:. The use of methamphetamine to assuage sexual pain is perhaps best understood in the context of extremely high levels of adverse sexual experiences among study participants, both in childhood and as adults.

A majority of women reported engaging in sexual behaviors that could potentially create HIV risk Table 2. In addition, the prevalence of condom use was low. Over a third of women reported unprotected vaginal sex with sex trade partners in the past six months, and the proportion increases with casual and steady partners Figure 1.

Perceptions of the relationship between methamphetamine use and sexual risk-taking varied considerably among women in the study. However, some women described a loss of inhibition or a feeling of invulnerability that undermined considerations about sexual safety. The long duration of sexual activity while high on methamphetamine was also seen to undermine safer sex efforts. Other women described proactively assessing potentially risky sexual situations created by methamphetamine use and adapting to control them.

Sexual Pleasure and Sexual Risk among Women who Use Methamphetamine: A Mixed Methods Study

Several said they avoided men while high on methamphetamine in order to avoid sexual situations. One woman explained why, despite increased sexual desire, she chooses to be alone when high on methamphetamine. Still other women insisted that methamphetamine use did not influence their sexual risk behavior. These women felt they used the same preventative measures whether or not they were high on methamphetamine.

These measures included using condoms with selected partners -- new partners or sex trade partners — but not steady partners. One woman described how she relies on her powers of observation and judgment skills to stay safe:. The sexual safety measures described by these participants evoke a practical sense of agency, even though some measures are generally considered more effective than others U.

Using quantitative data, we examined whether being high on methamphetamine was associated with condom use during the most recent sexual encounter, as reported by participants.

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There were no statistically significant differences in condom use at last encounter according to whether participants were high on methamphetamine.