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

self-identify as homosexual may feel different from the majority of their
peers in their sexual orientation. Often youths who recognize they are
homosexual have no adult role models for developing sexual identity,
feel isolated from their peers, and lack opportunities to establish
relationships that are not highly sexualized with same-sex partners
(Martin and Hetrick 1988). Fearing discovery as homosexual, many of
these youths leave home or lead multiple lives, masking their
homosexuality (Ibid). Parents who learn of a youth’s homosexual
orientation often reject and then eject these youths from home, leaving
them with few housing options (Hunter and Schaecher 1990). Without a
stable living situation or social support network, some of these youths
become marginalized. Marginalization often is associated with
involvement in substance-abusing subcultures.
While some unconventional adolescents seek situations that may involve
them in multiple problem behaviors, others involuntarily find themselves
in social settings or life situations where high-risk HIV activities are
common. One-third of the girls identified as HIV seropositive at one
hospital in New York City had previously had fewer than three sexual
partners at the time of their diagnosis and had never injected drugs
(Futterman et al. 1993). Yet these girls live in neighborhoods that have
high HIV seroprevalence rates, which is related to the endemic substance
abuse in these same neighborhoods. Girls living in rural environments
with low seroprevalence rates may engage in the same behaviors as those
in urban environments, yet have very little risk of HIV infection.
Similarly, homeless youths are at increased risk for HIV infection due to
their living situation. Some of these youths become homeless because of
unconventional behaviors. However, many are homeless because their
families are homeless (20 percent), their families have rejected them, or
the family environment is victimizing. For example, 42 percent of
runaway girls were found to be victims of sexual abuse (Rotheram-Borus
et al. 1992). Many youths at high risk for HIV infection are at risk due to
their living situations-situations they were not responsible for creating.
METHODOLOGY
The life episodes and case studies that follow were obtained from
October 1992 to April 1993 in ethnographic interviews and observations
as part of a larger project on secondary prevention of HIV and AIDS
conducted in San Francisco and Los Angeles and supported by the
National Institute on Drug Abuse (NIDA). These cases were selected
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