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

consumed alcohol in the previous month. Moreover, significant
ethnic/racial differences also were found; almost half of the white,
Mexican-American, and Native American males reported consuming five
or more drinks in one setting in the 2 weeks preceding the survey.
Significantly fewer Hispanic, Asian-American, and African-American
males reported such abuse of alcohol. The prevalence of alcohol abuse
among females generally paralleled that of males, albeit at lower levels.
As striking as these data are, they are not reflective of teens who drop out
or are chronically absent from school, who are in juvenile detention
centers, and who are homeless; these teens are thought to be at highest
risk. Therefore, these data clearly underrepresent the actual prevalence of
alcohol and drug use among all adolescents.
Antecedents of Substance Use and Abuse Behavior
Many studies have examined risks for substance abuse and initial patterns
of use. Numerous factors have been identified as significant markers of
substance use (Dryfoos 1990; Hawkins et al. 1992); however, there is
little empirical evidence that describes the relative significance and
interactions between the risk factors (Hawkins et al. 1992). Moreover,
there is no consensus about how to categorize or measure substance abuse
risk factors. For example, Dryfoos (1990) identified 21 risk factors
across 4 domains: (1) demographic (e.g., age, gender, race/ethnicity);
(2) personal (e.g., school performance, peer influences, psychological
factors); (3) family (e.g., poverty, parental influences, culture); and
(4) community (e.g., quality of school and neighborhood).
In contrast, Hawkins and his colleagues (1992) identified 17 factors
across two broad domains: (1) contextual factors, including societal and
cultural influences related to legal and normative expectations for
substance use behaviors as well as economic factors; and (2) individual
and interpersonal factors that take into account the individual within the
context of social, behavioral, and biological influences on adolescent
decisionmaking and subsequent substance use behavior.
Although there is no consensus about risk domains, there is agreement
regarding the significance of several key risk factors (Dryfoos 1990;
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