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

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HIV Risk Behaviors of Heterosexual Male Drug Users Richard H. Needle Since reporting of acquired immunodeficiency syndrome (AIDS) cases began in the United States, over 325,000 persons have been reported as having been diagnosed with AIDS, and more than 200,000 deaths have occurred. Approximately 30 percent of AIDS cases in the United States have been injecting drug users (IDUs), and most of these AIDS classified cases (80 percent) are among heterosexual IDUs. More AIDS cases have been reported among heterosexual male IDUs (about 75 percent) than among female IDUs (Centers for Disease Control and Prevention 1993). Available surveillance data on AIDS cases do not permit tracking of trends in heterosexual male or female crack users who have become human immunodeficiency virus (HIV) infected or acquired AIDS through sexual transmission. In this monograph, Stephens and Alemagno review the injection and sexual risk behaviors of male heterosexual IDUs, and Inciardi reports on HIV/AIDS risks among male heterosexual non-IDUs who exchange crack for sex. Stephens and Alemagno focus on HIV risk-taking behaviors of IDUs related to the multiperson use of contaminated needles and other drug injection paraphernalia, their sexual risk practices, and the potential for acquiring or transmitting HIV. Their review reveals that individual behavioral patterns and risks of HIV exposure depend on a number of factors, many of which are beginning to be recognized as contextual. These factors include community prevalence, availability of syringes and paraphernalia, availability of drugs, presence of shooting galleries and needle exchanges, and availability of condoms (both female and male). They also review some newly emerging data on indirect needle-sharing practices, such as frontloading and backloading, and on the use and nonuse of condoms, sexual behaviors, and other sexual risk practices. While their review focuses on heterosexual male IDUs and emphasizes sharing of needles and other injection paraphernalia among IDUs as the major mode of HIV transmission, that practice is clearly not the only mode for acquiring or transmitting HIV infection. Stephens and Alemagno’s review of sexual practices of male heterosexual IDUs 5
highlights the critical importance of researchers’ awareness of the increasing percentage of AIDS cases among women who have had sex with IDUs. Stephens and Alemagno also reviewed the growing literature on the effectiveness of intervention programs targeted at changing behaviors related to HIV/AIDS. They review data from the National AIDS Demonstration Research (NADR) program sponsored by the National Institute on Drug Abuse (NIDA) and discuss changes in HIV risk-taking behaviors of the IDU population. While many drug users reported reducing their HIV risk behaviors, others continued to practice high-risk behaviors. NADR data, and more recently the Cooperative Agreement (CA) for AIDS Community-Based Outreach/Intervention Research Program data, suggest that it is very important to begin to focus more on IDUs’ sexual risk practices to help prevent the spread of HIV. Far less is understood about HIV risk-taking behaviors of male heterosexual non-IDUs, particularly crack users who engage in sexual practices that put them at risk for acquiring or transmitting HIV infection. The crack epidemic emerged during the mid-1980s, years after the first AIDS case was reported to the Centers for Disease Control and Prevention (CDC). Most of the HIV epidemiology focused on the modes of transmission in the high prevalence groups of gay/bisexual men and male and female IDUs. To date, only 7 percent of AIDS cases are attributable to heterosexual exposure, and the percentage of AIDS cases among male heterosexual non-IDUs is very low (Centers for Disease Control and Prevention 1993). There is no separate CDC category to classify men or women who are noninjecting crack users, have had sex with HIV-infected men or women, and attribute their HIV/AIDS status to sexual transmission and noninjection drug use. These cases would be classified in the exposure category of heterosexual contact, and more specifically classified as sex with an HIV-infected person, risk not specified (Centers for Disease Control and Prevention 1993). Inciardi developed his chapter on crack, sex, and secondary spread of HIV by relying on literature related to the efficiency of female-to-male transmission; cofactors in female-to-male transmission of HIV; and the small, but rapidly growing, ethnographic literature on bartering of sex for crack cocaine. The chapter reviews explanations for the documented higher rates of female-to-male infections in Africa and Europe than in the United States. While the epidemiologic data are not adequate to permit estimates of cases attributable to crack-using heterosexuals who have sex 6
Page 1 and 2: National Institute on Drug Abuse RE
Page 3 and 4: ACKNOWLEDGMENT This monograph is ba
Page 5 and 6: Drug Use and HIV Risk Among Male Se
Page 7 and 8: Partners. The review was held April
Page 9: Inciardi, J.A.; Lockwood, D.; and P
Page 13 and 14: AUTHOR Richard H. Needle, Ph.D., M.
Page 15 and 16: Blower and colleagues (1991) have p
Page 17 and 18: Even in areas with low seroprevalen
Page 19 and 20: involves using a syringe to draw bl
Page 21 and 22: Hispanics were less likely to repor
Page 23 and 24: victimization through theft, violen
Page 25 and 26: sharing? When are needles deliberat
Page 27 and 28: Chitwood, D.D.; McCoy, C.B.; Inciar
Page 29 and 30: Page, J.B.; Smith, P.C.; and Kane,
Page 31 and 32: HIV/AIDS Risks Among Male, Heterose
Page 33 and 34: during that time, and the possibili
Page 35 and 36: All of these issues and considerati
Page 37 and 38: ecoming the norm for both male and
Page 39 and 40: the skin on his penis while having
Page 41 and 42: REFERENCES Ball, J.C., and Chambers
Page 43 and 44: Johnson, A.M.; Petherick, A.; David
Page 45 and 46: Vogt, M.W.; Craven, D.E.; Crawford,
Page 47 and 48: 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
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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
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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
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Substance Use and HIV-Transmitting
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TABLE 1. Prevalence of substance us
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less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
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A fourth study of gay/bisexual men,
Page 103 and 104:
in mind, however, that most of the
Page 105 and 106:
seropositivity and reported NMPD us
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interaction and education than men
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Geographic differences found in the
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that they are intending or desirous
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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
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prostitutes were HIV positive, as c
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Trade hustlers are usually heterose
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TABLE 1. Number of Completed Interv
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diagnosed slightly more often than
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TABLE 2. Injection Drug Use by Type
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By the 100th interview, the screeni
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SUMMARY AND CONCLUSIONS In general,
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Plant, M. Sex work, alcohol, drugs
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HIV Risk in Drug-Using Adolescents
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AUTHOR Vincent L. Smeriglio, Ph.D.
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comprise 23 percent of all adolesce
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232 (18 percent) of the cases; and
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Although these data provide an over
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Most of these were unprotected sexu
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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
Page 155 and 156:
Boyer, C.B. Psychosocial, behaviora
Page 157 and 158:
Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
Page 161 and 162:
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
Page 185 and 186:
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
Page 219 and 220:
REFERENCES Agar, M. The Professiona
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Ouellet, L. J.; Jimenez, A.D.; John
Page 223 and 224:
Assessing the Reliability and Valid
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TABLE 1. Sociodemographic profile o
Page 227 and 228:
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
Page 261:
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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