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

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etween specific NMPD use and high-risk sexual behaviors, any number of intrapersonal and interpersonal factors could be contributing to the observed behavioral relationships. MECHANISMS The author and other researchers (Cooper 1989; Leigh 1990; Stall et al. 1986) have speculated upon the types of underlying causal mechanisms that might account for the frequently observed associations between NMPD use and high-risk sexual activity among adolescents and gay or bisexual men. While space constraints do not permit exhaustive consideration of the evidence supporting or refuting them all, an overview of the most frequently discussed potential causal mechanisms is included in the following paragraphs. Behavioral Disinhibition Specific psychopharmacological activities of NMPDs and alcohol could potentially cause the release of strongly suppressed behaviors. It is perhaps important that alcohol, which has strong disinhibiting effects on a variety of suppressed behaviors (particularly under stressful or anxious conditions), has been linked to failure to use condoms by adolescent/young adult heterosexuals (Cooper 1989) and gay/bisexual men lapsing or relapsing to unprotected RAS after a period of change to safer sexual practices (Kelly et al. 1991a). However, it is likely that learned or innate expectancies about NMPD use effects are at least as responsible for the observed associations as are specific psychopharmacological effects (McKirnan and Peterson 1989b), again highlighting the difficulties of distinguishing direct from indirect causal pathways. It seems appropriate to begin to think of the combined interaction of underlying personality characteristics, social/environmental circumstances, and pharmacological effects that may ultimately underlie the observed associations. Intoxication or Cognitive Effects Models Certainly recreational drugs and alcohol can affect information processing and psychomotor task performance, and their use is associated with accidents. If intoxicated enough, individuals can forget to take precautions or improperly utilize condoms. The next question is whether gay/bisexual men who combine NMPD use with high-risk sex decide first 105
that they are intending or desirous of the sexual or NMPD use activity. Is it coincidental that most popular meeting spots for casual sexual partnerships are places where alcohol and/or poppers are sold, or is this the result of marketing that takes advantage of the synergistic interaction of sex and drugs? The latter suggests the possibility that NMPDs differ in their relative abilities to diminish unpleasant affects associated with sexual intercourse (mainly anxiety and cognitive suppression of preferred but feared activities) and maximize pleasurable feelings, such as euphoria and sensual pleasure. The relative balance of such properties can be conceptualized as the aphrodisiac index of each NMPD, but the possibility should be considered that such pharmacological effects are subject to differences in dosage as well as individual, social, and cultural variations. Social Influences and Social Setting Models Use of NMPDs is frequently associated with special types of behaviors or celebrations-a time out from normal social restraints and an inducement to unusual or otherwise prohibited behaviors. To the extent that modern societies have institutionalized times such as holidays and vacations, and commercialized settings such as pick-up bars or crack houses where NMPD use and sexual encounters are mutually available, people may learn to associate NMPD use with high-risk sexual activities. Certain personality types and heavy participants in either or both activities can be expected to be most susceptible to social influence or setting effects on subsequent behavioral patterns. Intrapersonal Factors Most studies concerned with possible causal relationships have made mention of either the high-risk personality, characterized by impulsive and sensation-seeking behavior, or the addictive personality. Either of these personalities could predispose to both NMPD use and multiple casual sex partners or high-risk sexual behaviors. Researchers’ inability to disentangle any direct effects of NMPD use upon sexual behaviors from cross-sectional or even prospective studies may ultimately be a relatively unimportant consideration. Such personality characteristics are probably represented more frequently among gay/bisexual men who combine NMPD use with high-risk sexual behaviors than among men who are abstinent from either type of activity, at least to the extent that men with impulsive, sensation-seeking, or addictive personalities are prevalent among gay/bisexual men. 106
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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.;
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Female Drug Abusers and the Context
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have the data but interpret it supe
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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 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: Geographic differences found in the
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
Page 155 and 156: Boyer, C.B. Psychosocial, behaviora
Page 157 and 158: Irwin, C.E., Jr., and Shafer, M.A.
Page 159 and 160: 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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