How Do Gender Related Inequities in Substance Abuse Treatment Influence the Recovery Process of Incarcerated African American Women at Risk for HIV Infection?

Background and Purpose: There is a need for the exploration of gender inequities within substance abuse treatment which affect service delivery, relapse rates, and recovery among African American women. There are variations that exist between men and women who seek treatment for substance abuse. Women in treatment programs are less likely than men to have graduated from high school, employed, and have other health problems (NIDA, 2013). The use and abuse of illegal drugs has had a detrimental effect on the health and overall well-being of African American women in particular. Due to economic disparities, many African American women who use illegal substances are more likely to engage in risky sexual behavior in exchange for money (Sterk, Elifson, & German, 2000).

This study sought to answer the following research questions:

RQ1:   What are the gender inequities that exist in substance abuse treatment, whereby the oppressive issues such as race, class, gender, which have also been seen as barriers to substance abuse treatment for African-American women, can be addressed?

RQ2:   How does forced recovery (incarceration) influence women's perceptions of their substance abuse?

RQ3:   What is the perceived susceptibility of risk for HIV among African-American women in recovery?

RQ4:   Are women who do not successfully complete substance abuse treatment at greater risk for HIV infection?

Methods: There was a total of 14 women recruited for this mixed methods study. All of the participants had been arrested for prostitution and identified “Crack” as their drug of choice. The sample was composed of African-American women (100%). The use of purposeful sampling ensured that a diverse and representative cohort from the Women for Women Program participants was implemented. The theoretical frameworks that guided data collection procedures included the Health Belief Model and Black Feminist Theory.

Results: Although both quantitative and qualitative data collection methods were used, the qualitative interviews and focus group served as the main source of data collection to answer the research questions. There were three categories identified as gender inequities that emerged from the in-depth interviews. These included: power, relationships with men, and childhood abuse and neglect (feelings of depression).

Conclusion and Implications: 1. Relationships maintained with both family as well as with significant others have typically affected the successful treatment completion rates of African American women who are substance abusers, 2. Women between the ages of 18 and 34 in the study perceived themselves to be at collective risk for HIV as well as individually. However, women over the age of 35 acknowledged that collectively, African American women were at risk for HIV, however, did not acknowledge their own individual risk, 3. Power, the ability to earn money, as well as the perceptions of intimate relationships affect sexual decision making of substance abusing African American women, 4. All of the women in the study indicated that HIV Prevention education was key in substance abuse treatment and decreasing the rates of HIV and AIDS infection among substance abusing women.