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Background: Despite heightened risk, women experiencing sexual coercion are less engaged in health-care. We investigated how STD treatment pathways may be altered for women experiencing forced sex.
Methods: The National Survey of Family Growth (2011-2013), nationally representative of those aged 15-44, was used to conduct logistic regressions controlling for age, race/ethnicity, poverty level and education. Examining women (n=5,501), lifetime sexual coercion was regressed on: risky sex (no condom use at last sex or 2+ partners in 12 months), risky partners (MSM, IDU, or HIV+ partners), and substance abuse (4+ drinks within two hours, use of crack, cocaine, crystal, or IDU). Logistic regressions assessed the link between coercion and 12-month STD testing, lifetime diagnoses of herpes, genital warts or syphilis, 12-month diagnoses of chlamydia or gonorrhea, and 12-month STD treatment.
Results: Women experiencing sexual coercion were more likely to have risky sex (AOR=1.76, 95% CI:1.22-2.53), risky partners (AOR=2.15, 95% CI:1.30-3.54), and report substance abuse (AOR=1.77, 95% CI:1.24-2.54). They were more likely to have STD testing in the past 12 months (AOR=1.62 95% CI:1.32-2.60), and more likely to test if coercion occurred before age 18 (AOR=1.84, 95% CI:1.15-2.95). Coerced women were more likely to ever be diagnosed with herpes (AOR=2.15, 95% CI:1.26-3.66) and genital warts (AOR=2.59, 95% CI:1.84-3.65), but no more likely to be diagnosed with chlamydia, gonorrhea or syphilis than those who were never coerced. There was no link between sexual coercion and STD treatment, however, coercion moderated the link between lifetime STD diagnoses (herpes, genital warts or syphilis) and treatment in the past 12 months (AOR=0.35, 95% CI:0.16-0.74).
Conclusions: Women experiencing sexual coercion are more likely to report sexual risk-behavior, STD testing and diagnoses of herpes and genital warts. However, women experiencing forced sex may not be receiving treatment for certain STDs, and treatment pathways may be disrupted.