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

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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 157
from a study group of 52 youths who were HIV seropositive and had been interviewed repeatedly. Focus was on youths already seroconverted. The ranges of lifestyles, scenes, and subcultures that characterize their lives were identified. Youths were recruited from community-based agencies, support groups, and snowball sampling from street contacts. Some had participated in other studies before this project began. The strength of the qualitative data presented here rests on the observational and networking skills of the researchers. Therefore, the personal and professional backgrounds and expertise of the ethnographers in working with the population and in conducting ethnographic work were central assets of the current study.’ This expertise allowed for rapid identification of the ranges and characteristics of the social roles and niches occupied by youth living with HIV and AIDS. Involvement in homosexual activity was a pathway for each of these youths’ becoming substance users and their subsequent activities. Because the youths were gay-identified, they often were stigmatized and marginalized from families or peers. The degree of marginalization varied depending on the degree of financial disenfranchisement. Some lived in underclass sex and drug trade zones in the inner city and were totally disconnected. Other middle-class youths were connected to the support services of community-based agencies. The cases selected for this chapter represent themes emerging from the total study group. In general, youths varied in how and when they identified themselves as gay or bisexual, in their socioeconomic backgrounds and resources, and in the circumstances of their initiation and continuation of substance use. Nevertheless, similarities in behavioral patterns and themes illustrate how social settings, subcultural groupings, and activities affect HIV risk-seeking and risk-taking behavior. There were also parallels in their reasons for involvement in methamphetamine-using subcultures. However, the youths’ methods and abilities for ending methamphetamine use and disassociating from these social worlds differed, and those differences suggest factors that must influence prevention programs. 158
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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
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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 and 160: Zweig Greenberg, MS.; Singh, T.; Ht
Page 161: the types of intervention strategie
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
Page 211 and 212: 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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The Context of HIV Risk Among Drug Users and Their Sexual Partners

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