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

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2. Situational association studies examine the frequency of high-risk sexual behaviors and also examine the extent to which sexual activities occur in conjunction with NMPD use. These studies establish the occurrence of high-risk sex and of sex while using drugs or alcohol, but do not determine if high-risk sex is more likely to occur when drugs or alcohol are used. 3. Event analysis studies examine sexual behaviors and NMPD use in specific sexual encounters. While these studies can assess the temporal association of high-risk sexual behaviors and drug or alcohol use, they share the limitations in terms of causal inference of the other two categories of studies. Yet, event analysis studies are useful in distinguishing circumstantial within-person associations. None of the seven event analysis studies involving gay/bisexual men cited by Leigh and Stall demonstrated a significant difference in the likelihood of risky sex when NMPDs were used, and only one study found an association between drinking and UAI (McCusker et al. 1990). The most recently published event analysis studies of gay/bisexual men, from the multisite Project Sigma of Great Britain (Weatherbum et al. 1993) and the Talking Sex Project of Toronto (Myers et al. 1992), also failed to detect any differences in the incidence of unprotected receptive or insertive anal intercourse between events involving the use or nonuse of alcohol or NMPDs, respectively. The general failure of event analysis studies to confirm a link between NMPD use in specific sexual encounters and risky sexual behaviors does argue for possible underlying interpersonal personality or character factors, rather than circumstantial factors, as underlying the NMPD-risky sex associations documented below. MECHANISMS AND THEORIES OF ASSOCIATIONS BETWEEN NMPD USE AND HIGH-RISK SEXUAL BEHAVIOR AMONG GAY/BISEXUAL MEN Leigh and Stall conclude that “it is clear that there is a positive relationship between substance use and high risk sex; what is less clear is the level at which this link exists.... findings from these studies are consistent with a number of explanations-causal, correlational, and confounding” (p. 1038). To the extent that any specific underlying mechanisms have important HIV prevention implications, they need to be considered as priorities for future research efforts. It is important to keep 97
in mind, however, that most of the prior studies that reported a positive association between UAI and NMPD use can be at least partially explained simply on the basis of a relationship between NMPD use and increased frequency of sex or number of sexual partners, regardless of mechanism. However, the author and colleagues believe that any associations observed between specific drug categories and specific high-risk activities can be cited in support of multiple causal mechanisms, from the social, physiological, cognitive, and clinical domains of behavioral science. Summary of Findings from Three Ongoing Prospective Studies Three ongoing cohort studies of gay and bisexual men provide the most detailed evidence of the nature and mechanisms of the association between NMPD use and HIV-transmitting sexual behavior: the Chicago MACS/CCS cohort, whose NMPD use history is detailed above; the Boston Partners Study, also described above (Seage et al 1992); and the Toronto Sexual Contact Study, which recently published an analysis spanning the 5-year period of 1984/1985 to 1989/1990 (Calzavara et al. 1993). These three studies are reviewed according to a hierarchy of evidence that combines the three category methodological typology of Leigh and Stall with whether or not the outcome examined is sexual risk behavior or rates of HIV infection. Cross-Sectional Global Associations of NMPD Use and High-Risk Sexual Behavior. Table 3 summarizes the significant associations across 6 years of global NMPD use and unprotected receptive anal sex (RAS) among members of the Chicago MACS/CCS cohort (Ostrow et al. 1993). Among the 10 categories of NMPDs examined at all 12 semiannual assessments, only popper use showed a consistent and strong cross-sectional association with unprotected RAS. While the other commonly used NMPDs had inconsistent associations with high-risk sex in this cohort, the use of both poppers and either cocaine or marijuana was associated with the highest rates of unprotected RAS throughout the study period. Association of Global NMPD Use and HIV Infection Rates. Both the Chicago MACS/CCS (Chmiel et al. 1987) and Boston Partners Study (Seage et al. 1992) demonstrate baseline prevalence rates of HIV infection that were significantly higher among NMPD users when compared with nonusers. Similar odds ratios for cross-sectional HIV 98
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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
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(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 and 100: TABLE 2. Quantity of alcohol use am
Page 101: A fourth study of gay/bisexual men,
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
Page 151 and 152: 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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