1. Sexual Interactions in the Drug- Using Context and Sexual Violence among Young Adult Nonmedical PO Users in New York City Lauren Jessell, LMSW, Pedro Mateu-Gelabert, Ph.D., Honoria Guarino, Ph.D., Sheila P. Vakharia, Ph.D., LMSW, Elizabeth Goodbody, Anastasia Teper, MA

2. Lauren Jessell, LMSW jessell@ndri.org National Development & Research Institute 71 West 23 rd Street New York, NY

3. - This qualitative study explored the experiences of non- medical PO using young adults. - It informed a 5-year, NIDA-funded study aiming to interview & test for HIV/HCV/STIs 600 PO using young adults in New York City.

5. - One in five females are raped during their lifetime. 1 - Nonmedical prescription opioid (PO) use in the U.S. has increased significantly in recent years and is particularly high among young adults. 2 - Drug and alcohol use, including nonmedical PO use, may place users at heightened risk for sexual violence & create opportunities for perpetration. 3 - There is an absence of research on sexual violence and PO use specifically. 1.CDC, 2012 2.SAMHSA, 2013 3.Mateu-Gelabert, Guarino, Jessell & Teper, 2014; Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007

6. METHODS - Interviews with 46 NYC young adults who reported nonmedical PO use. - In-depth, semi-structured interviews (~90 minutes in length) inquiring about drug and sex risk behavior. - Analysis informed by grounded theory 4 with portions of interviews related to sexual violence inductively coded for key themes. - All names changed to pseudonyms. 4. Glasser & Strauss, 1967

7. RESULTS - 46 participants, mean age: 25.3 (range 18-32) - 27 male, 18 female, 1 transgender - 32 White/Caucasian, 9 Latino, 3 African American/Black, & 2 Asian/Pacific Islander - 14 attended some high school, 9 had a GED/high school diploma, 14 attended some college, & 9 were college graduates or had some post-graduate education

8. The PO Using Context & Sexual Violence -Participants described the PO using context & the sexual interactions within this context as risky for involvement in sexual violence. -Themes identified within the PO using context: implicit and explicit exchanges of sex for drugs and/or money, negative sexual characteristics ascribed to PO users by society and peers, internalized stigma, & fear of the police.

9. Drug Exchanges & Implicit Quid Pro Quo Expectations -Some participants described a quid pro quo expectation surrounding sex and drug exchanges. I think that there is an expectation that if a man gets a woman high, she’s supposed to sleep with him or give him pleasure, and…Yes, that’s definitely happened and honestly, I have had sex, I think, with a couple people that I didn’t really want to just to shut them up. (Karen, 30, White, Female)

10. Drug Exchanges & Explicit Expectations - Some participants engaged in overt exchanges of sex for drugs and/or money I had this one girl, Jennie, call me, you know what I mean? She’s like, “You know, I’m really sick. I’m really sick and I have no money… She said, “I’ll sleep with you,” you know what I mean? Yeah, yeah, I did. I slept with her.” (John, 21, White, Male)

11. Negative Sexual Characteristics Ascribed to PO Users By Society and Peers - Participants described being viewed as unworthy of sexual respect. There’s guys that will know that these girls have blacked out and have no idea what they’re doing. And they’re like, “I’m gonna hook up with her anyway”— and they end up having sex with them and I just think it’s disgusting like [imitating a male’s voice], ‘Yo, I’m gonna get it. Anyone high tonight? Like yo, this girl’s a fucking dumb bitch. Like she’s a whore, like she doesn’t know what she’s doing’” (Mary, 18, White, Female)

12. PO Users & Internalized Stigma - Participants also described themselves in negative terms, revealing the internalized stigma they held regarding their status as drug users. I felt guilty. I felt really guilty. I mean, I don’t like being a manipulative, disgusting drug addict. I just am one. (Karen, 30, White, Female)

13. Fear and Mistrust of the Police - Participants explained that they did not trust that the police would help and cited past negative experiences with them. - Sexual violence remained largely unreported among participants. I was scared of cops…I never trusted cops. I was always afraid of them. (Heather, 26, White, Female)

14. DISCUSSION -Recommendations include prevention efforts that address the PO using context. -Facilitating safer environments for PO users to report sexual violence to the police. -Education for and by service providers that reduces victim-blaming and acknowledges the variety of contexts in which sexual violence occurs. -Efforts to effect a normative change among PO users and their peers.

15. CONCLUSION - Limitations: results may not be generalizable to all PO users - Our research outlines the importance of addressing PO using context in prevention efforts aimed to reduce sexual violence among PO users and their peers.

16. "This study is supported by Grant No. R01DA035146 from the National Institute on Drug Abuse. Points of view, opinions, and conclusions in this presentation do not necessarily represent the official position of the U.S. Government, or National Development and Research Institutes.“ QUESTIONS? jessell@ndri.org