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

The likelihood of intervention at the level of such basic personality
characteristics or behavior patterns seems diminishingly small. Still, the
examination of the use of specific NMPDs and their potential interaction
with sexual behavior and personality patterns may shed significant light
on the underlying bases of those associations, through both direct and
indirect paths.
Biological Interactions
In terms of specific drug use and HIV infection, the findings of Seage and
colleagues (1992) in terms of prevalent HIV infection, and the Chicago
MACS/CCS findings (Ostrow et al. 1993) concerning incidence of
infection both suggest potential biological interaction(s) between the
likelihood of infection and popper use during unprotected RAS. This
finding has been hypothesized as due to vasodilation within the rectal
mucosa, which increases the likelihood of rectal bleeding and the ability
of infected semen to enter the bloodstream of the receptive partner (Seage
et at. 1992). Equally plausible would be an acute immunosuppressive
effect of NMPD use during intercourse that would decrease immune
surveillance, thereby increasing the likelihood that HIV-infected cells
entering the bloodstream would infect the receptive partner. In fact, a
recent study of amyl nitrite exposure in HIV-seronegative men
demonstrated acute suppression of circulating natural killer cell activity
(Dax et al. 1991).
Researchers may never disentangle whether the observed associations
between NMPD use and sexual risk-taking behaviors or HIV infection
are the result of direct causal links, reflect common underlying
personality or coping styles, or indicate more severe psychopathology.
Obviously, a variety of mechanisms may be responsible for the
associations between sexual and NMPD use behaviors. Perhaps a single
causal mechanism may never be found. It may not matter in the long run
if researchers can find effective prevention interventions that work in
reducing the likelihood of unprotected sex occurring in the context of
NMPD use.
Prevention Implications
A crucial consideration at this time might be the issue of whether enough
is known about these associations to launch controlled intervention trials,
or whether further descriptive and causal studies need to be performed
before such interventions are tested. The author believes that, while
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