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

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TABLE 3. Prevalence of use of substances by receptive anal sex risk: Summary of twoway table analysis, waves 1-12 [1] Receptive Anal Sex Risk [2] at Wave: Substance: [3] 1 2 3 4 5 6 7 8 9 10 11 12 Marijuana/Hashish Poppers Cocaine Crack Cocaine [4] MDA Hallucinogens Downers Ethyl Chloride [5] Heroin [6] Uppers Other Drugs Cigarettes Alcohol Volume Total N Per Wave: 825 830 763 742 657 650 650 597 608 603 543 538 [l] Based on 2x2 contingency tables analyzing the use-prevalence for each substance by the incidence of risky sexual practices at each wave. Estimates of statistical significance were determined by Chi-Square tests. The findings from the analyses are summarized here according to the symbols: “++”: positive association and p-level < .01 “+”: positive association and p-level < .05, but > .01 “x”: no significant association, p-level > .05 [2] A “risk-index.” combining information on both number of partners for receptive anal sex (RAS) and condom usage, was constricted from the data at each wave of the Coping and Change Study. The measures for this analysis compared two risk-levels: “safe”-respondents who, during the prior one-month period, had been celibate, had refrained from RAS, or had had only one partner who always wore a condom: and “unsafe”-monogamous individuals, who had not used condoms, or individuals reporting multiple RAS partners, regardless of condom usage. [3] Substance-use data are from the Chicago MACS questionnaires for the first 12 visits, spanning the years 1984-90. The variables denote the percentage of men who used each substance during the preceding 6-month period. The dichotomous alcohol measure contrasts abstemious or moderate with heavy drinking (an average of 60 or more drinks per month) over the previous six months. [4] Not included as a separate item in the MACS interview until Visit 12. [5] Dropped from the MACS interview after Visit 7. [6] Dropped from the MACS interview after Visit 11.
seropositivity and reported NMPD use were reported in both cohorts, with users of all categories except barbiturates (downers) showing odds ratios with 95 percent confidence intervals greater than 1 for prevalent HIV infection. These odds ratios ranged from 1.6 (CI=1.3-2.0) for any NMPD use in the MACS cohort to 2.0 (CI=l.2-3.2) for marijuana use and 2.9 (CI=1.9-4.5) for popper use among the Boston Partners Study (Seage et al. 1992). Association of NMPD Use with Sexual Partners and Prevalence of HIV Infection. All three of these studies have demonstrated an increased likelihood of HIV infection among those men reporting the use of certain NMPDs or combinations. Since the likelihood of becoming HIV infected is highly dependent on the numbers of partners with whom unprotected intercourse is engaged in, these analyses have controlled for either the numbers of sexual partners or specific practices. When this is done, it is consistently observed that the use of poppers and/or insufflated cocaine are associated with increased prevalence of HIV infection beyond that expected on the basis of numbers of partners or potential anal exposures. The investigators in the Boston Partners Study reported a particularly strong effect on risk of HIV infection among men who reported always using poppers whenever engaging in RAS. These men, who comprised approximately 10 percent of the study group, were almost 34 times more likely to be HIV infected than men with no history of unprotected RAS or popper use, and three times more likely to be HIV infected than men who only sometimes combined unprotected RAS and poppers. These and other findings (summarized below) have led to the suggestion by Seage and colleagues that the use of certain NMPDs, most notably poppers, during UAI may actually increase the likelihood of HIV infection for any given exposure (Seage et al. 1992). This possibility and possible biological mechanisms for such an interaction are discussed below. Association of Prior Change in NMPD Use and Changes in High- Risk Sexual Behavior and Incidence of HIV Infection. Among men in the Chicago MACS/CCS cohort, those who reported the initiation of popper use were significantly more likely to lapse to unprotected RAS during the same 6-month period (Ostrow et al. 1993). Of particular interest in terms of potential mechanisms was the finding that the association was specific for lapsing and was not evident in the reverse direction (e.g., men giving up popper use did not exhibit greater propensity to move from unprotected to protected anal intercourse), and was only observed for receptive (not insertive) anal sex with nonmonogamous partners. While not accounting for all or most of the 100
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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
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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 and 102: A fourth study of gay/bisexual men,
Page 103: in mind, however, that most of the
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.
Page 153 and 154: 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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