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

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
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