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

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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 159
forearm during a sexual episode. At that time he believed he was in love. He stated that he has not had similar beliefs since that time. Jim Jim is an outgoing 21-year-old male who identifies himself as bisexual. He reported a troubled childhood in Tucson. His mother was a heavy drinker, a “bar-woman” who ignored him and her other children. He was frequently cared for by his stepfather’s father, who regularly got him drunk on alcohol when he was a child. His older brother taught him how to smoke marijuana and chew tobacco before he was 10 years old. For as long as he can remember, he used illicit substances. He “got high” every day, except during the long stretches of time he spent in reform school or jail. Throughout his early adolescence he was in and out of reform school, usually taking “raps” for his older brother, until one particularly threatening crime and the prospect of jail caused him to run away. Previous problems with the criminal justice system led him to the Southeast, where he found that his relatives and friends smoked locally grown marijuana. Subsequently he hitchhiked to Portland, OR where he stole a motor, scooter and traded it for some speed. After getting into trouble with the local police when he was “wired,” Jim decided to go to Los Angeles and then San Francisco. “From the way I heard it, this was the place to be if, it was real liberal. They called it the ‘Gay Bay,’ down here. I figured I’ll go check out the Gay Bay! (laughs) I never left! This is where I fit in! I think I fit in.” Rob Rob discovered that he was homosexual at 15. He was able to develop a gay lifestyle in the Northwest United States without losing the love and support of his family. His upbringing was middle class. In his early adolescence, Rob encountered a variety of drugs being used among his friends: “Acid basically, acid, cocaine, marijuana. I never injected anything, I would never put a needle in my arm. I never have. I’ve tried crack, 160
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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
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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 and 162: the types of intervention strategie
Page 163: from a study group of 52 youths who
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
Page 213 and 214: 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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