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El-Bassel et al. (2004) analyzed data from a random sample of 322 men attending a methadone maintenance treatment program and found couple drug involvement to be directly related to male psychological dominance (i.e., "psychological maltreatment of women by their male partners in intimate relationships" [p. 433]) and sexual HIV risk behavior. Male psychological dominance was also found to be directly related to physical intimate partner violence (IPV) and sexual HIV risk behavior. Among their recommendations, El-Bassel and colleagues reason that establishing a nonjudgmental, trusting atmosphere will enable drug-involved men "to discuss sensitive issues related to how relationship power dynamics affect their control over when drug use and sex occur and whether or not condoms are used. ... HIV ... prevention strategies need to help men and their sexual partners raise awareness of how their process of sexual decision-making leads to unsafe sex, helping them to identify how power imbalances in their relationship and their drug-involvement as a couple [contribute] to unprotected encounters" (pp. 437-438).

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