Native women, violence, substance abuse and HIV risk.

Violence has become a critical public health issue in the United States. It has had a particularly devastating impact on the health and well being of Native American women and children. The relationship between aggression and substance use is an intrinsic one: Native women often bear the brunt of violence in drinking situations, which places them and their children at extremely high risk for physical and sexual abuse. In urban environments, many Native American women find themselves in adult relationships that mirror the abuse they experienced and witnessed as children or adolescents. Not only does violence often occur while substances are being used, but conversely, substance use is a frequent consequence of sexual abuse. Clearly, the mental health repercussions of physical or sexual abuse are often severe. Trauma is associated not only with psychological distress, but also with risky behavior and social role impairment. Traumatized women engaging in substance abuse and unsafe sex are at high risk for contracting HIV/AIDS. This article explores the intersection of substance abuse, sexual and physical abuse, and increased HIV risk among urban Native American women in the San Francisco Bay Area.