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

diaphragms, suggesting that these women are at increased risk of
acquiring a disease (Mosher and Pratt 1990).
Other patterns in teens’ use of contraceptives also have been noted. As
sexual experience increases, the use of oral contraceptives also increases,
and the use of condoms and other barrier methods decreases (Morrison
1985). Thus, many teens initially attend family planning clinics with the
intent of changing from the use of condoms to the use of oral
contraceptives. Moreover, with the recent push for use of hormonal
implants among adolescents, research is needed to determine the role of
nonbarrier forms of contraception in influencing adolescents’ risk for
acquiring sexually transmitted infections. It is also evident that
adolescents need to be educated about the important differences in the use
of contraceptives for birth control and for disease prevention.
Antecedents of Sexual Risk Behaviors
Adolescents’ decisions to initiate and consistently use barrier-method
contraceptives are as complex as their reasons for initiating sexual
intercourse or for engaging in behaviors that place them at risk for STDs
and HIV transmission. Many reviews exist that attempt to explain this
phenomenon (Boyer 1990; Brooks-Gunn and Furstenberg 1989; Irwin
and Shafer 1992; Kegeles et al. 1988). This research addresses the need
to understand the role of sociodemographic, cultural, biological,
developmental, psychosocial, and academic factors. For example,
Brooks-Gunn and Furstenberg (1989) underscore the importance of
understanding the psychosocial and emotional needs that sexual
intercourse fills for some adolescents. In contrast, Talmadge (1985)
describes the influence of contextual factors such as attitudes, beliefs, and
social interactions.
Alcohol and Drug Use Behavior 3
The high prevalence of alcohol and drug use in adolescents poses a
significant threat to their health and well-being. Use of these substances
is associated with motor vehicle accidents, homicides, and suicides
among adolescents and is responsible for major medical, psychological,
and social morbidity in teens (CDC 1989; Dryfoos 1990).
Although adolescents’ use of illicit substances has declined in recent
years, their overall level of use continues to be high, while their use of
alcohol has remained constantly high (Bachman et al. 1991). A recent
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