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

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ethnographic research and focus groups, it is possible to identify those information sources and community leaders whom such men respect and find credible. CONCLUSION By targeting multiple, culturally appropriate approaches that seek to support abstinence from both recreational substance use and unprotected sexual intercourse, researchers may be able to prevent future epidemics of sexually transmitted HIV and AIDS among specific at-risk populations. By simultaneously evaluating both the process and outcome of such interventions, researchers can learn how to mount more effective interventions and also improve the understanding of the mechanisms linking recreational substance use and HIV-transmitting sexual behaviors. NOTES 1. Throughout this chapter, the abbreviation HIV is used to indicate HIV-1 (or the human immunodeficiency virus, type 1), the predominant form of HIV in all but Western Africa. 2. The Multicenter AIDS Cohort Study (MACS) in Chicago is performed at the Howard Brown Health Center and Northwestern University Medical School under the direction of John Phair, M.D., and Joan Chmiel, Ph.D., and is supported by NIAID Contract #N01- Al-32535. The Coping and Change Study (CCS) of Men at-Risk of AIDS is performed at the Chicago MACS study sites and the University of Michigan, under the direction of John Maassab, Ph.D., David Ostrow, M.D., Ph.D., and Jill Joseph, Ph.D., M.D., and supported by NIMH grant #R01 MH39346. I am extremely grateful to the MACS/CCS participants and the staff and investigators of both studies for making these observations possible. In particular, Wayne DiFranceisco, M.S., prepared the table and figures used in this chapter. By answering detailed questionnaires about sexual and drug use behaviors every 6 months for almost 10 years, the study participants have generously permitted us to access the most intimate details of their lives. I hope that the resulting observations and insights will help them and others in their battle to overcome and recover from HIV infection. 109
REFERENCES Calzavara, L.M.; Coates, R.A.; Raboud, J.M.; Farewell, V.T.; Read, S.E.; Fanning, M.M.; and MacFadden, D.L. Ongoing high-risk sexual behaviors in relation to recreational drug use in sexual encounters: Analysis of 5 years of data from the Toronto Sexual Contact Study. Ann Epidemiol 3:272-280, 1993. Chmiel, J.S.; Detels, R.; Kaslow, R.A.; Van Raden, M.; Kingsley, L.A.; Brookmeyer, R.; and the Multicenter AIDS Cohort Study. Factors associated with prevalent human immunodeficiency virus (HIV) infection in the Multicenter AIDS Cohort Study. Am J Epid 126:568- 577, 1987. Cooper, M.L. “Adolescent High-Risk Sexual Activities and Alcohol Use.” Paper presented at the Symposium on Recreational Drug Use and High-Risk Sexual Behaviours at the 4th ASAM Conference on Aids and Substance Abuse, Miami, FL, February 1989. Dax, E.M.; Adler, H.; Nagel, J.E.; Lange, W.R.; and Jaffe, J.H. Amy1 nitrite alters human in vitro immune function. Immunopharmacol Immunotoxicol 13:577-587, 1991. Des Jarlais, D.C.; Friedman, S.R.; and Woods, J.C. Intravenous drug use and AIDS. In: Ostrow, D.G., ed. Behavioral Aspects of AIDS. New York: Plenum Publishing, 1991, pp. 139-155. Easterbrook, P.J.; Chmiel, J.S.; Saah, A.J.; Hoover, D.R.; Kaslow, R.A.; Rinaldo, R.A.; and Detels, R. Racial and ethnic differences in HIV-1 seroprevalence among homosexual and bisexual men. Am J Epid 138:415-429, 1993. Gold, R.S.; Skinner, M.J.; Grant, P.J.; and Plummer, D.C. Situational factors and thought processes associated with unprotected intercourse in gay men. Psychol Health 5:259-278, 1991. Kelly, J.A.; St. Lawrence, J.S.; and Brasfield, T.L. Predictors of vulnerability to AIDS risk behavior relapse. J Consult Clin Psychol 59:163-166, 1991a. Kelly, J.A.; St. Lawrence, J.S.; Diaz, Y.E.; Stevenson, L.Y.; Hauth, A.C.; Brasfield, T.L.; Kalichman, S.C.; Smith, J.E.; and Andrews, M.E. HIV risk behavior reduction following intervention with key opinion leaders of population: An experimental analysis. Am J Public Health 81:168-171, 1991b. Kelly, J.A.; St. Lawrence, J.S.; Hood, H.V.; and Brasfield, T.L. Behavioral intervention to reduce AIDS risk activities. J Consult Clin Psychol 57:60-67, 1989. 110
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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
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found in this study was low socioec
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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
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Page 77 and 78: coherence—the sense that life is
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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 and 110: Geographic differences found in the
Page 111 and 112: that they are intending or desirous
Page 113: enough is known in general about th
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
Page 161 and 162: the types of intervention strategie
Page 163 and 164: 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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