title: Sexual health risks and health-seeking behaviours among substance-misusing women.
abstract: OBJECTIVE
  To report on a survey of sexual health service needs among substance-misusing women attending a substance misuse service.
  
  
  BACKGROUND
  Substance-misusing women carry a disproportionate burden of sexual ill health, yet the range and frequency of their sexual health risks, morbidities and service engagement are poorly understood.
  
  
  METHODS
  A cross-sectional survey of a convenience sample of substance-misusing women attending a substance misuse service.
  
  
  METHODS
  From 4 April 2010-17 September 2010, substance-misusing women in Hastings & Ore, UK, were invited to complete a paper questionnaire addressing: drug use; cervical cytology, sexually transmitted infection and HIV screening history; pregnancy history, perceived pregnancy risk and contraceptive advice and supply; sexual activity and assault. Of 91 respondents, 77 attended local drug treatment services - results comprise analysis of this sub-sample.
  
  
  RESULTS
  The study sample was characterized by long-term opioid and crack cocaine use. Of 53% sexually active in the previous 4 weeks, 66% perceived they had experienced sexual intercourse that could lead to pregnancy during that time. Fifty-five per cent had been forced to have sex against their will during their lifetime. High rates of sexually transmitted infections, pregnancy termination, miscarriage and abnormal cervical cytology were reported.
  
  
  CONCLUSIONS
  Findings indicate the need to recognize the breadth of elevated sexual health risks and morbidities experienced by substance-misusing women with long-term opioid/crack use, including those not identifying as intravenous drug users. Poor recall of drop-in and appointment times, reluctance to disclose substance misuse and likelihood of previous sexual assault present significant challenges to nurses, who must take a sensitive, opportunistic approach to referral and provision of sexual health interventions to substance-misusing women.
authors.affiliation: Centre for Health Research, University of Brighton, Falmer, UK.
authors.forename: Natalie Lois
authors.initials: NL
authors.lastname: Edelman
authors.forename: Harish
authors.initials: H
authors.lastname: Patel
authors.forename: Anthony
authors.initials: A
authors.lastname: Glasper
authors.forename: Leanne
authors.initials: L
authors.lastname: Bogen-Johnston
mesh_terms: D000028:Abortion, Induced / Q000451:nursing* / Q000706:statistics & numerical data; D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000451:nursing; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid; D015897:Comorbidity; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000451:nursing; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000451:nursing*; D011795:Surveys and Questionnaires; D016387:Women's Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D016578:Crack Cocaine
keywords: contraception; injecting drug use; nursing; sexual health; substance misuse; women