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

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The investigator believes that the questions in both studies were not as good or extensive as they should have been to overcome the reluctance of respondents to report unsafe injection practices and gather good reliable data. Perhaps a future study should ask a number of questions about the setting and occasion of first injection and subsequent injections to gather more details about first injection and other occasions when sharing might take place. Hopefully, it will reveal better results. Condom Use In addition to HIV risks involved with drug injection, male sex workers also are at risk for unsafe sexual practices. Self-reports about condom use were generally high in the second survey; more than 9 out of 10 reported the use of condoms in the previous year, and nearly three-quarters in the previous week they had sex. There were significant differences in the rates of condom use for different types of sexual behaviors, different partners, and different types of sex workers. Hustlers, or sex workers who solicit clients in public places, reported less frequent condom use during anal intercourse than call men. Oral sex with condoms varied by levels of education, but unexpectedly; men who reported attending some college (usually call men) also reported that they used condoms during oral sex less frequently than men with lower education levels. 4 The variation by different sexual partners was as expected; condoms were used more frequently with customers than intimate or other nonpaying partners (Waldorf and Lauderback 1992). It also was found that condoms slip off and break 2.39 percent of the time and that hustlers report more condom failures than call men (Waldorf and Lauderback 1993). These findings suggest that many male prostitutes, and hustlers in particular, regularly engage in unsafe sexual practices. AIDS Prevention Efforts Among Sex Workers San Francisco has generally done a good job of providing AIDS prevention information, condoms, and bleach to sex workers in the city. During the second study, sex workers reported they had received free condoms from 15 different social agencies, as well as information about HIV risks. In many bars in the Tenderloin, condoms are provided in large bowls as a regular service. During January 1992, Prevention Point, the large and successful needle exchange program, began to provide syringe exchanges near Polk Street with a particular focus on sex workers in the area. Another site in the Tenderloin generally did not reach male sex workers. 127
SUMMARY AND CONCLUSIONS In general, large numbers of male sex workers in San Francisco participate in considerable injection drug use, most particularly methamphetamines and cocaine. It is expected that much of this has to do with the particular drug scenes of Polk Street, the Tenderloin, and the Castro District, neighborhoods that have very active drug scenes and where many sex workers work and live. Male sex workers also report considerable syringe sharing, but it is felt that many workers underreported sharing. Both practices, along with unsafe sexual activities, place many sex workers at risk of HIV. Other studies of male street sex workers in Atlanta and New Orleans also have found substantial percentages of IDUs among street workers in those cities, but this was not the case in New York City. With the exception of the San Francisco study, most studies of male sex workers have focused on street workers and have neglected call men, or men who solicit clients over the telephone. To date there has not been any study that has tested call men for HIV, and none of the other studies included them in their samples. Any future work should consider call men as well as street workers. Studies that undertake to explore syringe sharing should take care in how questions are worded and attempt to find ways to overcome sex workers’ reluctance to report unsafe injection practices. Simple screening questions will not be adequate. The author recommends that future research use indepth qualitative questions to explore the phenomena. NOTES 1. 2. In general, most male sex workers will take clients wherever they find them-in the street, in bars, at social gatherings, via advertisements-but most have some general modus operandi that allows them to be categorized by the principal method they use to locate clients. Whenever differences are mentioned they will be statistically significant (at the .01 level). When differences are not significant, they will be designated as not statistically significant. 128
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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
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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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Hispanic women but extramarital aff
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coherence—the sense that life is
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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 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: By the 100th interview, the screeni
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
Page 177 and 178: Unprotected sexual activity is more
Page 179 and 180: alternatives and opportunities, and
Page 181 and 182: 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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