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

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Sexual Risk Behavior More adolescents are commencing sexual intercourse at younger ages than ever before; therefore, they are placing themselves at risk for STDs and unintended pregnancies at younger ages than ever before. The incidence of sexual behavior increased significantly from 1971 to the mid-1980s in all age cohorts between the ages of 15 and 19. In 1988, 26 percent of white females, 24 percent of African-American females, 24 percent of white males, and 69 percent of African-American males initiated sexual intercourse by age 15 (Irwin and Shafer 1992). Epidemiologic data of high school students grades 9 to 12 indicate that 54 percent reported experiencing sexual intercourse at some point, of which 39 percent reported sexual experience during the 3 months prior to being surveyed. Differences in the prevalence of sexual experience by gender and race also were found. Sixty-one percent of males and 48 percent of females reported sexual contact, as did 52 percent of white students, 72 percent of African-American students, and 53 percent of the Hispanic students. The percentages of students engaging in sexual intercourse increased significantly with each higher grade (CDC 1992). In a sample of urban middle school students ages 10 to 14, 21 percent reported engaging in sexual intercourse at least once. Males also were more likely than females to have engaged in sexual intercourse (35 percent versus 8 percent, respectively) (Irwin and Shafer 1992). In addition to engaging in sexual intercourse at early ages, some adolescents have nonmonogamous sexual relationships or have multiple sexual partners within a short period of time in a pattern of serial monogamy. Having multiple sexual partners, in addition to inadequate use of barrier-method contraceptives, increases the risk of STDs, HIV transmission, and unintended pregnancies. Based on national samples of sexually experienced adolescent and young adult females ages 15 to 24, 75 percent had two or more lifetime sexual partners, and 45 percent reported four or more lifetime sexual partners (Forrest and Singh 1990). Among males 15 to 19 years of age, over 50 percent reported more than one lifetime sexual partner, and 32 percent reported six or more lifetime sexual partners (Forrest and Singh 1990; Sonenstein et al. 1989). Recent data from an urban public STD clinic reveal that among adolescents and young adults ages 12 to 20, the mean number of lifetime sexual partners among the males was 33 (45 percent had 7 to 25 sexual partners), and the mean number for females was 9 (35 percent had 4 to 6 sexual partners). 141
Most of these were unprotected sexual encounters; 48 percent of males and 64 percent of females never or rarely used condoms (Boyer et al. 1993). In addition, some teenagers engage in other sexual risk behaviors that also increase their risk of negative health outcomes, especially HIV transmission. For example, some adolescent males engage in anal intercourse without the use of barrier methods to protect against disease transmission (Remafedi 1990). Clinical surveys of adolescent females attending family planning clinics found that 12 to 26 percent engaged in anal intercourse (either as a form of birth control or as a means of sexual experimentation), which also may increase their risk for certain STDs (Catania et al. 1990; Moscicki et al. 1988). Contraceptive Use Behavior The concurrent epidemics of STDs and unintended pregnancies among adolescents suggest that most teens, like many adults, do not use contraceptives effectively. The role oral contraceptives play in the acquisition of STDs and their sequelae of PID is unclear. It appears that while the use of oral contraceptives provides some protection against gonococcus-related PID, it may increase the risk of chlamydia-related PID (Shafer and Sweet 1990). Use of the latex condom is effective in reducing the risk of STDs, including HIV. However, the extent to which teens use them is unclear; differences in samples and in questions asked of adolescents make it difficult to compare results of the studies. National epidemiologic data from high school students reveal that, among students who engaged in sexual activity within the 3 months prior to the survey, 78 percent of females and 79 percent of males reported use of some form of contraception (birth control pills, condoms, withdrawal, or another method) during their last sexual encounter. However, when queried specifically about the use of condoms, the number decreased; only 40 percent of the females and 49 percent of the males reported use of this form of protection (CDC 1992). In addition, ethnic/racial differences in the use of contraceptives have been found. A large survey of adolescent and adult women ages 15 to 44 indicates that, compared to their white counterparts, African-American women are significantly more likely to use oral contraceptives and are less likely to use condoms or 142
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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
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with 34.6 percent of gay men and 28
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found among both hustlers and call
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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 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: Although these data provide an over
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
Page 191 and 192: permission-giving introductions to
Page 193 and 194: conversion and perhaps even serocon
Page 195 and 196: 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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