Violence, Homelessness, and HIV Risk Among Crack-Using African-American Women

Abstract

This study compares the characteristics of out-of-treatment, homeless, crack-using African-American women with those who are not homeless to determine what risks and protective factors differentiate the two groups. From 1999 to 2001, 683 out-of-treatment, African-American crack-using women (of whom 219 were categorized as homeless) were interviewed and serologically tested. Risk factors that were examined include adverse childhood experiences, psychological distress, physical health, violence and victimization, drug use, and risky sex behaviors. Protective factors that were examined include marital status, education, public assistance, and the responsibility of caring for children. Overall, both groups of women started crack use in their mid-twenties and started drug use with alcohol in their teenage years, though differed significantly on each risk factor examined. Logistic regression analysis found that variables associated with increased odds of being homeless are physical abuse before age 18, crack runs greater than 24 hours, income less than $500 in the last 30 days, depression, and current cigarette smoking. Protective factors found are marital status, living with children under 18, having had a physical in the past year, and receiving money from welfare in the last 30 days. Being sexually assaulted in the past 90 days was marginally associated with homelessness in the model. These findings, specific to crack-using African-American women, suggest that not only do these women overall report painful histories and currently stressful lives, but homeless women are more likely than women who are not homeless to have experienced childhood abuse and are more involved with drug use. Interventions designed for these women need to consider gender, cultural, and contextual issues that not only incorporate aspects of risk reduction related to violence, alcohol use, and comorbid conditions, but also linkages that will address housing issues, education, and skills for independence.

• Homelessness
• Crack use
• African-American women
• HIV risk
• Protective factors

Additional information

Notes on contributors

Wendee M. Wechsberg

Dr. Wendee M. Wechsberg, Ph.D., is a Senior Program Director for the Substance Abuse Treatment Research program at Research Triangle Institute, a nonprofit research organization. She has over 20 years of experience as a clinical addiction professional and a dozen years as an applied researcher in HIV prevention. Dr. Wechsberg has also served as project director in community-based human immunodeficiency virus (HIV) prevention projects with hard-to-reach populations and substance abuse treatment evaluations. She currently directs several studies funded by the National Institute on Drug Abuse (NIDA) and the Center for Substance Abuse Treatment (CSAT).

Wendy K. K. Lam

Dr. Wendy K. K. Lam, Ph.D., is a Research Psychologist at Research Triangle Institute. She has more than a decade of clinical and research experience with child and family services, with an emphasis on high-risk populations. She has coordinated a longitudinal evaluation of programs for families at risk and has conducted psychometric and secondary analyses for process, outcomes, and policy research.

William Zule

Dr. William Zule, Dr.P.H., is a Research Health Analyst at Research Triangle Institute with more than 10 years’ experience in community-based HIV prevention studies. He has been a co-investigator, project director, associate project director, and ethnographer on several large HIV prevention research projects that targeted drug users in the community. In addition to his research activities, Dr. Zule is experienced in program evaluation.

Grace Hall

Ms. Grace Hall, M.P.H., is a Health Analyst at Research Triangle Institute. She has more than a decade of experience in nonprofit community development organizations, with an emphasis on health education and volunteer advocacy. A returned Peace Corps volunteer from Paraguay, Ms. Hall is bilingual in English and Spanish.

Rachel Middlesteadt

Ms. Rachel L. Middlesteadt is a Health Research Analyst at Research Triangle Institute. Ms. Middlesteadt has been active in the Greater Raleigh/Triangle (NC) area social work arena for several years. Working in conjunction with local churches, government, and private institutions, Ms. Middlesteadt has provided advocacy for homeless, abused, HIV, and drug-addicted populations.

Jessica Edwards

Ms. Jessica Edwards, M.A., has a master's degree in anthropology and is currently a doctoral student in the Department of Maternal and Child Health in the School of Public Health at the University of North Carolina at Chapel. Her research interests are in drug use, homelessness, sexual behavior, and HIV/STIs.