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

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Going Nowhere Fast: Methamphetamine Use and HIV Infection Mary Jane Rotheram-Borus, G. Cajetan Luna, Toby Marotta, and Hilarie Kelly INTRODUCTION Adolescents who are unconventional or atypical often are drawn and pushed into environments and subcultures where illicit drug use is endemic. Their sexual behavior is influenced by the settings, norms, and values of other members of these substance-using subcultures. To decrease the level of human immunodeficiency virus (HIV) risk for these youths, it is necessary to understand the contexts of adolescents’ sexual behavior in order to develop successful intervention programs. In addition to focusing on the age of initiation, types of acts, and rates of sexual activities by specific members of marginalized subcultures, one must understand the behavioral practices and patterns that typify subcultural groups and consider the accompanying developmental and life challenges (Commission on Behavioral and Social Sciences Education 1993). This chapter describes the contexts and activities of gay and bisexual male youths that may place them at high risk for HIV infection. To understand and appreciate the characteristics of these subcultures, descriptive and ethnographic research strategies are required. This chapter presents selected life episodes and case studies of three gay or bisexual youth living with HIV or acquired immunodeficiency syndrome (AIDS). Their lives were characterized by substance use and methamphetamine abuse. This chapter examines how their developmental course was effected as the youths came to terms with their sexual orientations while functioning within methamphetamine-addicted subcultures. The chapter discusses common paths into methamphetamine use or “getting high”; describes the behavioral patterns while addicted, including “tweaking, freaking, and over-amping”; and explores individual attempts to adapt, function, curtail, or discontinue methamphetamine use and self-destructive practices that pervaded their environments. After examining the context of their HIV-risk behaviors, the authors suggest 155
the types of intervention strategies that appear to help youths modulate or cease methamphetamine use and thereby to reduce future HIV-risk activity. BACKGROUND Sexual activity typically begins during adolescence. About 80 percent of adolescents experience intercourse by the age of 18. Adolescent intercourse often is unprotected, placing youths at risk for acquiring HIV (Rotheram-Borus et al., in press). In developing interventions to reduce youths’ risk for HIV infection, adolescent sexuality cannot be separated from their broader developmental task of exploring and committing to their sexual role and personal identity (Erikson 1968; Miller and Rotheram-Borus in press; Rotheram-Borus 1989). The context of adolescent sexual behaviors and substance use (with whom, what acts, where, at what age, in what place, why, and under what circumstances) critically influences the risk of contracting HIV and the type of intervention program needed. It also impacts the adolescent’s long-term adjustment. Knowledge of the contexts of adolescent sexual behavior and substance use is very limited (Commission on Behavioral and Social Sciences Education 1993). Epidemiological data from schools and national household surveys indicate that the age ‘and sequencing of sexual activities (e.g., oral, anal, or vaginal sex) vary by gender, ethnicity, and socioeconomic status (Boyer, this volume). In the last 7 years, researchers have identified subgroups of youths at relatively higher risk of HIV infection than their peers: gay and bisexual youths, runaway and homeless youths, delinquents, those who are sexually abused, teenage mothers, and injecting drug users (IDUs) and their partners (Rotheram- Borus et al., 1994). Among these subgroups of youths at high risk for HIV infection, sexuality is linked to other problems in their lives (Ibid). These youths are not only at risk for unprotected sexual activity, but are also more likely to abuse alcohol and drugs, experience academic and behavioral problems at school, have contact with the criminal justice system, and feel depressed or suicidal (Dryfoos 1990; Jessor and Jessor 1977). Certain youths are at risk for HIV infection, are involved in early sexual activity, and have multiple problem behaviors in part because they are atypical from their peers in some way. For example, youths who 156
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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
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TABLE 1. Prevalence of substance us
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less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
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A fourth study of gay/bisexual men,
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in mind, however, that most of the
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seropositivity and reported NMPD us
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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 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: Zweig Greenberg, MS.; Singh, T.; Ht
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
Page 197 and 198: TECHNICAL ISSUES Technical issues i
Page 199 and 200: eliability. It seems obvious that q
Page 201 and 202: sometimes as many as three zip code
Page 203 and 204: Resources and effort are required t
Page 205 and 206: Brunswick, A.F.; Lewis, C.S.; and M
Page 207 and 208: The Context of Risk: Ethnographic C
Page 209 and 210: 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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