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

HIV Risk in Drug-Using
Adolescents
Vincent L. Smeriglio
Studies of adolescents and young adults have examined the prevalence of
acquired immunodeficiency syndrome (AIDS) and human
immunodeficiency virus (HIV) infection, knowledge and attitudes about
HIV and AIDS, alcohol and other drug use, sexual behavior, and sexually
transmitted diseases (STDs). Findings document substantial risks for
HIV and AIDS and provide insights into similarities and differences in
risk across subgroups of adolescents. The current body of knowledge on
adolescents and their risk behaviors is valuable in the development and
targeting of interventions (e.g., Bowler et al. 1992; DiClemente 1992).
Design and targeting of HIV prevention strategies would be enhanced by
further elucidation of factors that may contribute to or protect from risk.
Potentially critical factors include the context of risk behaviors,
developmental variation in risk behaviors, and effects of competing
risks-all of which are likely to be diverse across adolescent subgroups
and changeable over the course of adolescent development. Contextual
variables include the individual’s cognitive and emotional status, the
social grouping in which behavior occurs, economic conditions, and
prevalence of substance abuse and HIV infection in the environment.
Reviews of data provided by Boyer and Ellen (this volume) and by others
(e.g., Bowler et al. 1992) indicate that although the cumulative number of
AIDS diagnoses in the 13- to 19-year-old age group is low, when the
long intervals between HIV infection and AIDS are taken into account
and HIV seroprevalence data are considered, infection risks during the
adolescent years are striking. Through June 1993, a cumulative total of
1,301 AIDS cases among adolescents 13 to 19 years of age had been
reported in the United States (Centers for Disease Control and Prevention
1993). For the same period, the cumulative number of AIDS cases was
11,840 in young adults 20 to 24 years of age (the majority of whom are
assumed to have been infected during adolescence), and 47,777 in the
25- to 29-year-old age group (a substantial portion of whom are likely to
have been infected during adolescence). The 60,918 AIDS cases for the
13- to 29-year-old age group constitute almost 20 percent of all reported
AIDS cases in the United States. HIV seroprevalence data indicate wide
variation in infection rates within the adolescent population, including,
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