title: Challenges to Practicing HIV Sex-Risk Prevention Among People in Continuing Care for Cocaine Addiction.
abstract: Intimate partnerships are discouraged during early recovery, despite research that highlights their capacity to be resources for change.
  
  
  
  This study seeks to provide descriptions of intimate partnerships and how such partnerships challenge and/or support minimizing HIV sex-risk among participants in continuing care for cocaine addiction in order to inform substance use programming.
  
  
  
  Forty-two recorded continuing care counseling sessions of 33 people who discussed HIV sex-risk behavior were transcribed and analyzed using thematic analysis. This sample was derived from a larger randomized controlled trial that looked at the impact of a continuing care intervention for people with cocaine use problems.
  
  
  
  Although participants expressed the desire for a primary intimate partnership, casual intimate partnerships that often involved HIV sex-risk behavior were more prevalent. Challenges to having a primary intimate partner included the belief that intimate partnerships do not support recovery, difficulty in developing friendships with women among heterosexual men, and the ubiquity of drug use and sex work in home environments with limited economic opportunity. Despite these challenges, some participants reported having primary intimate partners that supported their recovery through open communication.
  
  
  
  Clinicians providing substance use interventions can consider encouraging components of intimate partnerships that support recovery. In addition, the strong environmental influence on individual HIV sex-risk behavior should be considered in delivering any substance use intervention.
authors.affiliation: a School of Social Policy & Practice, University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: Alexandra S
authors.initials: AS
authors.lastname: Wimberly
authors.affiliation: b Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: Max R
authors.initials: MR
authors.lastname: Stern
authors.affiliation: c Department of Applied Psychology , New York University , New York , New York , USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Rosenbach
authors.affiliation: b Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: Tyrone
authors.initials: T
authors.lastname: Thomas
authors.affiliation: b Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000628:therapy*; D003376:Counseling / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data
keywords: HIV sex-risk; cocaine; continuing care; substance use