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

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HIV Risk in Adolescents: The Role of Sexual Activity and Substance Use Behaviors Cherrie B. Boyer and Jonathan M. Ellen INTRODUCTION In order to understand adolescents’ risk for acquiring the human immunodeficiency virus (HIV), it is first imperative to have knowledge of the sociodemographic characteristics of the adolescent population as well as the significance of developmental and psychosocial changes during adolescence that influence their behavior. Moreover, it is necessary to understand differences in the prevalence and patterns of risk behaviors in adolescents as well as the context in which these behaviors occur, since exposure to HIV is not equal among all adolescents. Therefore, this chapter includes an overview of the prevalence of negative health outcomes of adolescent risk-taking behaviors, with a particular focus on acquired immunodeficiency syndrome (AIDS), HIV, sexually transmitted diseases (STDs), and pregnancy; a description of the primary risk factors that are associated with acquisition and transmission of STDs/HIV; and a brief overview of the antecedents and correlates of sexual and alcohol/drug-using behaviors, with an emphasis on sociodemographic and psychosocial factors. Sociodemographic Factors: Who Are the Youth at Risk? There are approximately 28 million youth and adolescents in the United States between the ages of 10 and 17. Most individuals between these ages are white (81 percent); 15 percent are African American; and 4 percent are of other ethnic and racial backgrounds. Of all adolescents, 10 percent are categorized as being of Spanish/Latin ancestry. However, in the West and Southwest regions of the country (primarily California and Texas), the majority of the schoolage children are Hispanic or of other nonwhite origin. The nonwhite population is increasing, due largely to higher rates of birth and immigration. By the year 2000, 20 percent of adolescents in the United States will be African American and 18 percent will be Hispanic; by 2010, Hispanic adolescents will 135
comprise 23 percent of all adolescents, while African-American teens will make up 21 percent of this population (Dryfoos 1990). 1,2 One in four of the Nation’s youth and adolescents currently live in single-parent-headed households. However, among African-American adolescents, more than half live in female-headed households. Although 70 percent of women with teens between the ages of 14 and 17 are in the workforce, living in a female-headed household increases the likelihood that an adolescent lives in poverty. While 11 percent of all families live in poverty, 46 percent of female-headed households with schoolage children live in poverty (Dryfoos 1990). Race and geographic place of residence are strongly associated with poverty status. African-American and Hispanic youths are more likely to be impoverished than white youth; 45 percent of African-American and 41 percent of Hispanic youths live in poverty, compared to 13 percent of white youths who also live in poverty (Dryfoos 1990). Almost half of all individuals under the age of 18 live in suburban areas, 30 percent live in inner cities, and 23 percent live in rural areas; however, African- American teens are more likely to live in inner cities. While 35 percent of all white inner-city teens live in poverty, 57 percent of all African- American inner-city teens live in poverty (Dryfoos 1990). These factors are significant in that poverty is strongly associated with poor health status. In general, adolescence is a time of excellent physical health, but rates of morbidity and mortality in this age group have increased dramatically in recent decades (Irwin 1990; Rosen et al. 1990), due largely to many of the behaviors that are prevalent in adolescents. Adolescent Development and Risk-Taking Behavior Adolescence is the period between childhood and adulthood that is marked by rapid biological, emotional, cognitive, and social change. It is also a period of tremendous exploration and experimentation, when many teenagers perceive themselves to be invulnerable to accidents and disease and often engage in a wide range of risk-taking behaviors. The term “risk-taking“ describes the patterns of behaviors initiated during adolescence that are responsible for many negative health outcomes that occur during this time period. Specifically, adolescent risk-taking is defined as follows: “young people with limited or no experience engage in behaviors with anticipation of benefit and without understanding the immediate or long-term consequences of their actions” (Irwin 1990). 136
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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
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Centers for Disease Control and Pre
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Jemmott, J.B.; Jemmott, L.S.; Spear
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O’Leary, A.; Celentano, D.; Maiba
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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 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: AUTHOR Vincent L. Smeriglio, Ph.D.
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.
Page 183 and 184: 7. also can help youths explore and
Page 185 and 186: Jessor, R., and Jessor, S.L. Proble
Page 187 and 188: AUTHORS Mary Jane Rotheram-Borus, P
Page 189 and 190: 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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