title: Qualitative analysis of cocaine and heroin users' main partner sex-risk behavior: is safety in love safety in health?
abstract: BACKGROUND
  In 2009, 27% of the 48,100 estimated new cases of HIV were attributed to heterosexual contact with an infected or at-risk person. Sexually active adults are less likely to use condoms in relationships with main partners than with non-regular partners, despite general knowledge that condom use reduces HIV transmission.
  
  
  METHODS
  The purpose of this secondary qualitative analysis was to explore and contextualize perceptions of main partnerships, HIV risk, and attitudes toward condom use within main partner relationships among a subsample of intervention-arm cocaine- and/or heroin-using patients enrolled in a negative trial of brief motivational intervention to reduce the incidence of sexually transmitted disease and unsafe sexual behaviors. The open-ended portion of these interview audiotapes consisted of questions about perceptions of risk and attitudes about condom use with main partners. Enrollees were aged 18-54, English or Spanish speaking, and included in this analysis only if they reported having a main partner. We identified codes and elaborated important themes through a standard inductive three step coding process, using HyperRESEARCH™ software.
  
  
  RESULTS
  Among 48 interviewees, 65% were male, half were non-Hispanic white, over 60% were 20-39 years of age, 58% had intravenous drug use (IDU), and 8% were HIV-positive. Participants defined respect, support, trust, and shared child-rearing responsibility as the most valued components of main partner relationships. Condom use was viewed occasionally as a positive means of showing respect with main partners but more often as a sign of disrespect and a barrier to intimacy and affection. Enrollees appraised their partners' HIV risk in terms of perceptions of physical health, cleanliness, and sexual and HIV testing history. They based decisions regarding condom use mainly on perceived faithfulness, length of involvement, availability of condoms, and pregnancy desirability.
  
  
  CONCLUSIONS
  Risk appraisal was commonly based on appearance and subjective factors, and condom use with main sexual partners was described most often as a demonstration of lack of trust and intimacy.
  
  
  BACKGROUND
  NCT01379599.
authors.affiliation: Boston University School of Medicine, Boston, MA, USA. ebernste@bu.edu
authors.forename: Edward
authors.initials: E
authors.lastname: Bernstein
authors.forename: Valerie
authors.initials: V
authors.lastname: Ng
authors.forename: Lois
authors.initials: L
authors.lastname: McCloskey
authors.forename: Kathy
authors.initials: K
authors.lastname: Vazquez
authors.forename: Desiree
authors.initials: D
authors.lastname: Ashong
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stapleton
authors.forename: Jasmin
authors.initials: J
authors.lastname: Cromwell
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D019970:Cocaine-Related Disorders / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006556:Heroin Dependence / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000523:psychology; D055815:Young Adult