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

ADOLESCENT PATHS, TASKS, AND RESOURCES
Methamphetamine (known as meth, speed, crystal, and crank) has gained
popularity as a hard drug in many western cities (Currie 1993).
Thousands of illicit methamphetamine laboratories are estimated to be in
the United States, mainly in the West and Southwest; as evidence, there
were 775 reported seizures of methamphetamine labs in 1987 alone
(Currie 1993). In San Francisco and Los Angeles, methamphetamine use
defines a lifestyle and subculture characterized by activities that place
disenfranchised youths at higher risk for HIV and dominate their lives
(Marotta 1989, 1991, 1992). Many of these marginalized young people
already have become infected with HIV (Bermudez and Shalwitz 1992).
Youths who become enmeshed in this subculture are not short-term
runaways who are rescued easily and reintegrated into foster care or
families. These are long-term disenfranchised youths. Physically, these
youths may sometimes appear threatening, offensive, obnoxious, or
generally disagreeable. These features are consequences of lives
permeated with chronic substance use and the effects of permanent or
intermittent street life. Three case studies illustrate the social and
behavioral contexts that characterize HIV-risk activity for three young
men enmeshed in methamphetamine-using subcultures and social worlds.
Mark
Mark was 13 when he first arrived in San Francisco from the suburbs. He
was ejected from his home for being gay. As a result, he has been
responsible for his own survival for the last 6 years. Similar to other
disenfranchised youth, he soon learned that he could earn easy money
through full-time sexual activity for money on the streets and in gay bars.
He liked the attention paid to him; his previous family and peer
relationships were isolating. He remembers that he was “high” the first
time that he had sex with another male, an adult, when he was 13 years
old. Marijuana made the whole “sexual thing” easier. He later
experimented with crack cocaine and heroin and had a long stretch of
alcohol abuse that “clouded over” his life the past 5 years. In fact, he has
a hard time remembering his specific activities during this period because
his long- and short-term memory have been affected. He does remember
clearly that he began using speed in pill form at age 16 and has injected
speed almost continuously since he was 17 years old. His first injectable
speed experience was with an older man who “kept” him for a short
period of time. He remembers the older man “shooting him up” in the
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