title: "When you get old like this … you don't run those risks anymore": influence of age on sexual risk behaviors and condom use attitudes among methamphetamine-using heterosexual women with a history of partner violence.
abstract: BACKGROUND
  Drug use and partner violence affect older women, yet few studies highlight age-specific HIV risks and prevention strategies. This study compares sexual risk behaviors, condom use attitudes, and HIV knowledge between midlife/older women (ages 45+) and younger women (ages 18-44) reporting methamphetamine use and partner violence in San Diego, California.
  
  
  METHODS
  Our mixed methods study used themes from a qualitative substudy (n = 18) to inform logistic regression analysis of baseline data from an HIV behavioral intervention trial (n = 154).
  
  
  RESULTS
  Age-related qualitative themes included physiologic determinants, HIV knowledge, and "dodging the bullet," referring to a lifetime of uncertainty surrounding HIV serostatus after engaging in unsafe drug and sex practices. Midlife/older age was associated with never being married (24.2% vs. 51.2; p = .03), having less than a high school education/GED (12.1% vs. 34.7%; p = .04), lower condom use self-efficacy (2.87 vs. 3.19; p = .03), lower positive outcome expectancies (1.9 vs. 2.1; p = .04), and lower HIV knowledge (85.3% vs. 89.7%; p = .04); however, sexual risk behaviors were not associated with age group. In the multivariate analysis, midlife/older age remained independently associated with lower condom use self-efficacy (adjusted odds ratio, 0.49; 95% CI, 0.27-0.87) and lower HIV knowledge (adjusted odds ratio, 0.96; 95% CI, 0.93-0.99).
  
  
  CONCLUSIONS
  Midlife/older methamphetamine-using women with experiences of partner violence present similar sexual risk profiles, but possess different HIV-related knowledge and attitudes toward prevention methods compared with their younger counterparts. Clinicians and public health practitioners can have a positive impact on this overlooked population by assessing HIV risks during routine screenings, encouraging HIV testing, and providing age-appropriate HIV prevention education.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Natasha
authors.initials: N
authors.lastname: Ludwig-Barron
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wagner
authors.affiliation: Department of Anthropology, The Ohio State University, Columbus, Ohio.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Syvertsen
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Ivy J
authors.initials: IJ
authors.lastname: Ewald
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, California.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, California.
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Semple
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California. Electronic address: jstockman@ucsd.edu.
authors.forename: Jamila K
authors.initials: JK
authors.lastname: Stockman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019969:Amphetamine-Related Disorders / Q000523:psychology*; D002140:California; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D016017:Odds Ratio; D036301:Qualitative Research; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D008694:Methamphetamine