The Context of HIV Risk Among Drug Users and Their Sexual Partners

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Using the same interview questions as the Chicago MACS, but employing a random household survey of unmarried males living in the San Francisco neighborhoods with the highest rates of reported AIDS cases, Stall and Wiley (1988) reported on the NMPD use patterns of 1,034 men aged 25 to 54, of whom 286 said they were exclusively heterosexual and 748 were gay or bisexual. Using a somewhat different definition of heavy drinking (5 or more drinks on 2 or more nights per week), the San Francisco Men’s Health Study (SFMHS) sample had rates of 19 percent and 11 percent heavy drinkers among the gay/bisexual and heterosexual subsamples, respectively, compared to rates of 28 percent and 19 percent at the first two baseline assessments of the gay/bisexual men in the Chicago MACS/CCS. Except for the oldest group (45 to 54 years) in the SFMHS sample, gay/bisexual men did not differ from heterosexual men in terms of alcohol use patterns. In terms of NMPD use prevalence, however, the SFMHS data for gay/bisexual men is similar to what was found in the Chicago MACS/CCS at baseline and significantly higher than in the San Francisco heterosexual male subgroup. Stall and Wiley (1988) reported 25 percent and 18 percent prevalence use rates for downers and hallucinogens in their gay/bisexual sample, which compares to the 19 percent and 18 percent rates in the Chicago cohort and 9 percent and 12 percent rates for downers and hallucinogen use by the San Francisco heterosexual male sample. The SFMHS gay/bisexual subgroup did report somewhat higher baseline rates of reported use of cocaine (52 percent), opiates (4 percent), and uppers (28 percent) than did the Chicago sample. Conversely, popper use was reported by 58 percent of SFMHS respondents and MDA use by 9 percent, compared to initial rates of use of 71 percent and 15 percent, respectively, by the Chicago MACS/CCS sample. The third relevant sample is the diverse community-based sample of 746 New York City (NYC) gay/bisexual men recruited by Martin and Dean in early 1985 (Martin et al. 1989). In three yearly interviews of their cohort, the investigators determined both prevalence of NMPD use and alcohol abuse/dependence disorder. They reported a 12 percent rate of alcohol abuse or dependence in 1986, which dropped to 9 percent in 1987. In terms of NMPD use, Martin and Dean’s NYC cohort appears similar to the Chicago MACS/CCS cohort during the period 1984-1987, with the exception of inhaled nitrites, which were reportedly used by 45 percent of the NYC cohort in 1984/1985 and approximately 25 percent of the men in 1986/1987. 95
A fourth study of gay/bisexual men, the Boston Partners Study, has recently published rates of NMPD use over the previous 5 years reported at entry between 1985-1988. For the most commonly used drugs reported by seronegative (N=275) and seropositive (N=206) men, respectively, prevalence rates were 79 percent and 88 percent for marijuana, 64 percent and 84 percent for poppers, and 56 percent and 73 percent for cocaine (Seage et al. 1992). Differences among these five studies may reflect differences in sampling methods and retrospective recall periods, or may indicate actual differences in NMPD use preferences among gay/bisexual men in different United States cities. These studies indicate the relative popularity of specific NMPDs among gay/bisexual men in four cities and recruited through differing mechanisms during the mid-1980s, a time of particularly high rates of drug use in these communities. In fact, approximately half of the men in both the SFMHS and Chicago MACS/CCS cohorts reported the use of three or more categories of NMPDs during the last 6 months of 1984, at the simultaneous start of the two studies. PATTERNS OF SEXUAL RISK BEHAVIOR AS RELATED TO NMPD USE Since the original observations that gay/bisexual men participating in AIDS epidemiology cohort studies who used alcohol and NMPDs with sexual partners were more likely to engage in high-risk sexual activities, most notably unprotected anal intercourse (UAI), and were less likely to reduce their sexual risk than abstaining men (Stall et al. 1986; Ostrow et al. 1987), there has been a plethora of confirmatory studies. Leigh and Stall (1993) have reviewed the published literature in this area; this section summarizes some of the conclusions of that comprehensive and scholarly review. Leigh and Stall’s group studies of the relationship between NMPD use and risky sexual behavior into three general categories. 1. Global association studies examine NMPD use and high-risk sexual behaviors, but these behaviors are not linked temporally. Thus, these studies are unable to determine whether or not the high-risk sex occurred in the context of NMPD use. 96
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National Institute on Drug Abuse RE
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ACKNOWLEDGMENT This monograph is ba
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Drug Use and HIV Risk Among Male Se
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Partners. The review was held April
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Inciardi, J.A.; Lockwood, D.; and P
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highlights the critical importance
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AUTHOR Richard H. Needle, Ph.D., M.
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Blower and colleagues (1991) have p
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Even in areas with low seroprevalen
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involves using a syringe to draw bl
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Hispanics were less likely to repor
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victimization through theft, violen
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sharing? When are needles deliberat
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Chitwood, D.D.; McCoy, C.B.; Inciar
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Page, J.B.; Smith, P.C.; and Kane,
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HIV/AIDS Risks Among Male, Heterose
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during that time, and the possibili
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All of these issues and considerati
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ecoming the norm for both male and
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the skin on his penis while having
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REFERENCES Ball, J.C., and Chambers
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Johnson, A.M.; Petherick, A.; David
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Vogt, M.W.; Craven, D.E.; Crawford,
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transmission from males to females
Page 49 and 50: (this volume), there is little atte
Page 51 and 52: Clayton, R.; Voss, H.; Robbins, C.;
Page 53 and 54: Female Drug Abusers and the Context
Page 55 and 56: have the data but interpret it supe
Page 57 and 58: important to examine current studie
Page 59 and 60: found in this study was low socioec
Page 61 and 62: who trade sex for crack; and simila
Page 63 and 64: esponsibilities in perspective. Suc
Page 65 and 66: Robles and colleagues (1990) examin
Page 67 and 68: The lack of rational thought separa
Page 69 and 70: Factors Associated With Sexual Risk
Page 71 and 72: Factors Associated With Poverty A n
Page 73 and 74: encouraging such women to leave the
Page 75 and 76: Hispanic women but extramarital aff
Page 77 and 78: coherence—the sense that life is
Page 79 and 80: the change agent may be a crucial f
Page 81 and 82: Centers for Disease Control and Pre
Page 83 and 84: Jemmott, J.B.; Jemmott, L.S.; Spear
Page 85 and 86: O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88: Drug Use and HIV Risk Among Gay and
Page 89 and 90: with 34.6 percent of gay men and 28
Page 91 and 92: found among both hustlers and call
Page 93 and 94: Substance Use and HIV-Transmitting
Page 95 and 96: TABLE 1. Prevalence of substance us
Page 97 and 98: less than 2 percent of participants
Page 99: TABLE 2. Quantity of alcohol use am
Page 103 and 104: in mind, however, that most of the
Page 105 and 106: seropositivity and reported NMPD us
Page 107 and 108: interaction and education than men
Page 109 and 110: Geographic differences found in the
Page 111 and 112: that they are intending or desirous
Page 113 and 114: enough is known in general about th
Page 115 and 116: REFERENCES Calzavara, L.M.; Coates,
Page 117 and 118: Ostrow, D.G.; Beltran, E.; Chmiel,
Page 119 and 120: Drug Use and HIV Risk Among Male Se
Page 121 and 122: prostitutes were HIV positive, as c
Page 123 and 124: Trade hustlers are usually heterose
Page 125 and 126: TABLE 1. Number of Completed Interv
Page 127 and 128: diagnosed slightly more often than
Page 129 and 130: TABLE 2. Injection Drug Use by Type
Page 131 and 132: By the 100th interview, the screeni
Page 133 and 134: SUMMARY AND CONCLUSIONS In general,
Page 135 and 136: Plant, M. Sex work, alcohol, drugs
Page 137 and 138: HIV Risk in Drug-Using Adolescents
Page 139 and 140: AUTHOR Vincent L. Smeriglio, Ph.D.
Page 141 and 142: comprise 23 percent of all adolesce
Page 143 and 144: 232 (18 percent) of the cases; and
Page 145 and 146: Although these data provide an over
Page 147 and 148: Most of these were unprotected sexu
Page 149 and 150: national epidemiologic survey of hi
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Hawkins et al. 1992; Newcomb et al.
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higher rates of HIV/AIDS in adolesc
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Boyer, C.B. Psychosocial, behaviora
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Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
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the types of intervention strategie
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from a study group of 52 youths who
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forearm during a sexual episode. At
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I was nice looking, like I can do a
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It is unclear whether the disinhibi
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continual sexual dysfunction was re
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TWEAKING, FREAKING, AND OVER-AMPING
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highway of love. It’s like, I’d
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Unprotected sexual activity is more
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alternatives and opportunities, and
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the night and food for the morning.
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7. also can help youths explore and
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Jessor, R., and Jessor, S.L. Proble
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AUTHORS Mary Jane Rotheram-Borus, P
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Brunswick goes on to discuss the le
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permission-giving introductions to
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conversion and perhaps even serocon
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TABLE 1. Ecological paradigm of con
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TECHNICAL ISSUES Technical issues i
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eliability. It seems obvious that q
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sometimes as many as three zip code
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Resources and effort are required t
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Brunswick, A.F.; Lewis, C.S.; and M
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The Context of Risk: Ethnographic C
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same meaning may be extended to dru
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THE CONTEXT OF RISK Context is an a
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hurried, and adequate needle cleani
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degrading sexual acts, poignantly m
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searched me and I had stashed the c
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REFERENCES Agar, M. The Professiona
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Ouellet, L. J.; Jimenez, A.D.; John
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Assessing the Reliability and Valid
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TABLE 1. Sociodemographic profile o
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Table 2 shows percentage agreement
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FORENSIC TECHNIQUES TO DOCUMENT SEL
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cross-tabulated with dichotomous me
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TABLE 6. Relationship of question t
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aggravate self-presentation bias. T
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TABLE 8. Percent of subjects report
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intercourse, and since anal interco
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Future Directions for Studies on th
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abusers, and other variables are ne
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Behavior patterns can be clarified
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As Des Jarlais noted, designs and a
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strengths within a setting or indiv
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National Institute on While limited
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62 NEUROSCIENCE METHODS IN DRUG ABU
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89 BIOLOGICAL VULNERABILITY TO DRUG
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111 MOLECULAR APPROACHES TO DRUG AB
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127 PROGRESS AND ISSUES IN CASE MAN
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NIH Publication No. 94-3750 Printed
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The Context of HIV Risk Among Drug Users and Their Sexual Partners

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