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

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the first study and most of the second. This was a conscious strategy to offset possible hostile reactions in the gay community to nongay staff. From the onset, the study endeavored to develop good relationships in the gay community to facilitate interviewing. During the second survey, each respondent was asked if he had been interviewed during the previous study conducted 2 years earlier. Only 1 in 12 (8.0 percent) reported that they had been interviewed previously; this seems to indicate that the population of male sex workers may be large or transitory with a high turnover. The high turnover of the population was further revealed in data about other cities where workers had sold sex. Only a third (34 percent) reported that they had worked as sex workers only in San Francisco, while two-thirds (66 percent) mentioned at least two cities. More specifically, 8 percent mentioned 6 different cities, 14 percent 5 cities, 25 percent 4 cities, and 40 percent 3 cities. Hustlers had worked in more cities than call men. The most frequently mentioned other cities were Los Angeles and New York City. SELF-REPORTS ABOUT AIDS AND ARC DIAGNOSES AND HIV TESTING The first study was conducted during the period when HIV testing was very controversial in San Francisco. Many people in the gay community were suspicious of and hostile to agencies and projects that proposed widespread HIV testing. Testing was considered during that study, but the idea was abandoned because the climate around testing was so volatile at the time. The study did gather data about self-reports of medical diagnoses of AIDS and AIDS-related complex (ARC) and results from HIV testing from both samples and found very consistent findings. During the first study, self-reports revealed that 12.7 percent were either HIV positive or had been diagnosed as having AIDS or ARC. One in 20 (5.5 percent) reported that they had been diagnosed as having AIDS or ARC, and another 7.2 percent reported that they were HIV positive. Call men reported being HIV positive and diagnosed with ARC or AIDS slightly more often than hustlers, but the differences were not statistically significant. 2 The second study did not consider or plan HIV testing, but interviewers asked about diagnoses and the results of the last HIV test. Reports were similar to the first sample; 12.1 percent reported being either HIV positive or diagnosed, and again call men reported being positive or 121
diagnosed slightly more often than hustlers. In general, self-reports may under-estimate the actual rates. DRUG USE SCENES IN SAN FRANCISCO The Tenderloin is an area in San Francisco where a large number of male prostitutes work and live. Unlike other cities in the United States, there appears to be considerable diversity of drug use in San Francisco. For example, phencyclidine (PCP) and methamphetamines, which are only occasionally available in many cities and appear to be used by only small percentages of people in most cities, are readily available in San Francisco and are widely used in selected drug scenes. In the Mission District, a Hispanic community, PCP is readily available and is used quite extensively by Hispanic youth, but it is seldom used by African Americans or whites. Methamphetamines are readily available in the Tenderloin and Castro Districts of the city, which are areas where many male sex workers live and work, and are used regularly by gay-identified males and sex workers who live in those communities. These drugs are in addition to staple drugs such as marijuana, cocaine hydrochloride, and heroin, which are also readily available. Despite the ready availability of methamphetamines, there is very little “ice” (a smokeable methamphetamine) available in the city, so use of that drug is low. Cocaine hydrochloride has been widely available since the mid-1970s and continues to be readily available up to the present day. Rock cocaine, or crack, was relatively slow arriving in San Francisco; it did not become widespread until 1988 and 1989, unlike in other cities such as Miami, New York, and Los Angeles. It was not readily available during the first study but was during the second study. The use of amyl nitrates (or poppers), widely used in the San Francisco gay community during the 1970s and the early 1980s, declined sharply during the early days of the AIDS epidemic when it was believed that AIDS was a direct result of amyl nitrate use. Amyl nitrates never reemerged as a widely used drug. Injection Drug Use Drug use was generally high for both samples; virtually everyone interviewed for both studies reported some illicit drug use. Respondents in the first study reported very high incidence of injection drug use; more 122
Page 1 and 2:
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
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esponsibilities in perspective. Suc
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Robles and colleagues (1990) examin
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The lack of rational thought separa
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Factors Associated With Sexual Risk
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Factors Associated With Poverty A n
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encouraging such women to leave the
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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 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: TABLE 1. Number of Completed Interv
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
Page 165 and 166: forearm during a sexual episode. At
Page 167 and 168: I was nice looking, like I can do a
Page 169 and 170: It is unclear whether the disinhibi
Page 171 and 172: continual sexual dysfunction was re
Page 173 and 174: TWEAKING, FREAKING, AND OVER-AMPING
Page 175 and 176: 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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