Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse

Purpose: In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. Methods: Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. Results: Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. Conclusion: Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.