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

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Given this isolation, methamphetamine use often provides a way for gay youths to connect with others. As Mark stated: “I had been alone for so long that I was desperate, and I had found someone and I wasn’t alone anymore. I felt like I had a real somebody in the world. I had a place in the world and I didn’t want to lose that.” This isolation may enhance the importance of romantic partnerships, and lead to shared needle use and unprotected sexual activity as a way of demonstrating love and commitment to partners. For example, Jim had unprotected sex with an HIV seropositive partner to show that the partner was “somebody in the world.” Jim “loved” the partner and wanted to share his fate. “Finally, I knew that’s how you caught it but I didn’t care at the time. Me and him have a pact that when we go, we’re just gonna go together.” Rob expressed his fears that if he did not engage in unprotected sex, he may lose his partners. “I thought if I didn’t make them use it (the condom) maybe they’d want to be with me, or stay, and I just didn’t care, I didn’t think it would happen...I mean, I don’t know if I could say, give a reason for every time why, there’s too many times to count.” Thus, drug use and sexual risk often occurred while searching for love and affection. In addition to enabling youth to connect with others, one effect of methamphetamine use is to disinhibit behaviors otherwise perceived as taboo. Adolescents who are uncomfortable exploring homosexual or bisexual feelings may place responsibility for their homosexual acts on their drug-induced state. Jim described his first homosexual encounter while under the influence of methamphetamine. “I was staring at my brother and I didn’t know why (laughs). My brother did bad things too, he used to play with me and stuff. When he was high. Even when he wasn’t high, when we was kids, he’d touch me and stuff....that’s the first time I really thought about it. In a homosexual way.” 163
It is unclear whether the disinhibition reported by youths is solely the physiological consequence of the speed use or whether it provides a rationale that allows the youth to engage in taboo behavior and maintain self-esteem. Other youths may be less honest with themselves regarding sexual desires that may only be acted upon while under the influence of methamphetamine. Rob, for example, minimized the differences in his sexual behaviors in a “stoned” versus an “unstoned” state. “I mean maybe they made me a little less inhibited, yeah, but I wouldn’t blame anything on these drugs... Because I was doing these things anyway, or was wanting to do these things anyway.” The association between drug use and sexual orientation existed in the recollections of each youth but in different contexts. For example, Rob identified as gay at 15. Social isolation and masking his orientation were primary precipitants of Rob’s drug use. He did well in high school, where he was “out.” “People usually didn’t mess with me. I very rarely had any trouble, and when I did, I just ignored it, so I figured the only way it’s gonna hurt me is if I let it hurt me. Of course, it wasn’t the best feeling, to be excluded for that, but I had my own friends.” Rob was a successful and productive student. However, at age 16, his partner was using methamphetamine, and the relationship ended abruptly and dramatically. “I was tired of the Midwest, I was upset. Ben (my partner) was doing things I didn’t like...he would go out and not come home, and even hustling or whatever he was doing....I just needed to get out.” Rob left home and moved to San Francisco. Because there were no openly gay students in his new suburban high school, Rob went “back into the closet.” He explained: “Well, I knew I was gay. My mom knew I was gay, but she and I never really talked about it, and when I went to high school, I just let everyone think I was straight. I mean I didn’t act gay, so... I went out with girls, and I went with the guys, and whatever... I don’t remember having any sex during that time. It was about 6 months... my brother who is gay, one of my brothers from my father... came down a couple of weeks after I moved out here and he took me up to 164
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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
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enough is known in general about th
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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 and 164: from a study group of 52 youths who
Page 165 and 166: forearm during a sexual episode. At
Page 167: I was nice looking, like I can do a
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
Page 215 and 216: degrading sexual acts, poignantly m
Page 217 and 218: 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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