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

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Battjes and colleagues’ (1990) finding is contrary to the findings of Schoenbaum and colleagues (1989), who found heterosexual contact with other IDUs to be an independent risk factor for HIV infection when drug use and demographic factors were controlled statistically. Other predictors of seropositivity included the number of injections per month, the percentage of injections with used needles, the average number of cocaine injections per month, and the percentage of injections with needles shared with strangers. These studies may have divergent findings as a result of differences in target groups studied. Battjes and colleagues (1990) studied recent drug injectors on admission to methadone treatment; Schoenbaum and colleagues (1989) studied a methadone intreatment sample, some of whom had stopped injecting some time earlier. Schoenbaum found sexual risk stronger among former injectors compared with current injectors. Battjes and colleagues point out that the heterosexual transmission of HIV may be relatively more important for younger IDUs who are more sexually active and engage in lower levels of drug-using HIV risk behaviors. The relative roles of needle sharing and sexual transmission may differ depending on the seropositivity level of the community. As IDUs increasingly adopt safer needle-using practices, sexual transmission can be expected to play an increasingly more important role in the spread of HIV among heterosexual IDUs, unless corresponding changes in highrisk sexual behaviors are also made. A recent study in Sydney conducted by Ross and colleagues (1992) has reported significant differences across sexual orientation in HIV serostatus for IDU males, with homosexual men having the highest HIV seroprevalence rate (35 percent), bisexual men intermediate (12 percent), and heterosexual men lowest (3 percent). INJECTION RISKS Currently, injecting drug use continues to be the second most common risk behavior associated with AIDS in the United States (CDC 1993; Des Jarlais and Friedman 1988; Lewis et al. 1990). Many studies have reported the increased risk for infection for IDUs who share needles and syringes (Chaisson et al. 1987; Chitwood et al. 1990; Hopkins 1988; Magura et al. 1989; Schoenbaum et al. 1989). 11
Even in areas with low seroprevalence rates, needle sharing can be common (Metzger et al. 1991). It is, however, by no means a universal practice of IDUs. Not all IDUs share needles, and some IDUs have begun to seek new needles (Guydish et al. 1990). Nevertheless, it may be possible to identify those variables that increase the risk of HIV through injection behaviors. Many studies have described the situational nature of needle sharing. An addict who has the drugs and his or her own outfit will not share. Needle sharing is related to the supply of needles available. Many studies have reported that the availability of needles and the problems associated with procuring them play a major role in needle sharing (Murphy 1987; Murphy and Waldorf 1991; Power et al. 1988; Waldorf and Murphy 1989; Watters 1988). Qualitative work has pointed to the issue of availability of clean needles as the main factor for needle sharing. It will be interesting to determine the impact of needle exchange programs on needle sharing. Dolan and colleagues (1987) have identified several variables that discriminated needle sharing among drug abusers admitted to a 30-day inpatient drug treatment program. Compared with other injecting drug abusers, needle sharers were more likely to engage in polydrug use, were more likely to use a shooting gallery, and had higher scores on a drug use severity test. No demographic or personality variables, such as age, race, education, or any of the 24 Minnesota Multiphasic Personality Inventory (MMPI) scores, discriminated needle sharers from nonsharers. Guydish and colleagues (1990) have found that needle sharing is predicted by earlier time of admission to drug treatment, cocaine use, and being younger in age. This is supported by a study performed by Kleinman and colleagues (1990), who report that new drug users (persons who had been using drugs for only 1 or 2 years) are significantly less likely than others to practice risk-reduction measures and are less likely to have salient knowledge about AIDS transmission. Magura and colleagues (1989) reported that needle sharing is related to peers’ injecting drug use, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Factors that did not predict needle sharing are also of interest. Knowledge of AIDS risks, knowing someone with AIDS, gender, age, ethnicity, marital status, and time in methadone treatment were not associated with sharing. In this sample, in which knowledge of AIDS risks was high, needle sharing could not be attributed to ignorance about the consequences of such 12
Page 1 and 2: National Institute on Drug Abuse RE
Page 3 and 4: ACKNOWLEDGMENT This monograph is ba
Page 5 and 6: Drug Use and HIV Risk Among Male Se
Page 7 and 8: Partners. The review was held April
Page 9 and 10: Inciardi, J.A.; Lockwood, D.; and P
Page 11 and 12: highlights the critical importance
Page 13 and 14: AUTHOR Richard H. Needle, Ph.D., M.
Page 15: Blower and colleagues (1991) have p
Page 19 and 20: involves using a syringe to draw bl
Page 21 and 22: Hispanics were less likely to repor
Page 23 and 24: victimization through theft, violen
Page 25 and 26: sharing? When are needles deliberat
Page 27 and 28: Chitwood, D.D.; McCoy, C.B.; Inciar
Page 29 and 30: Page, J.B.; Smith, P.C.; and Kane,
Page 31 and 32: HIV/AIDS Risks Among Male, Heterose
Page 33 and 34: during that time, and the possibili
Page 35 and 36: All of these issues and considerati
Page 37 and 38: ecoming the norm for both male and
Page 39 and 40: the skin on his penis while having
Page 41 and 42: REFERENCES Ball, J.C., and Chambers
Page 43 and 44: Johnson, A.M.; Petherick, A.; David
Page 45 and 46: Vogt, M.W.; Craven, D.E.; Crawford,
Page 47 and 48: transmission from males to females
Page 49 and 50: (this volume), there is little atte
Page 51 and 52: Clayton, R.; Voss, H.; Robbins, C.;
Page 53 and 54: Female Drug Abusers and the Context
Page 55 and 56: have the data but interpret it supe
Page 57 and 58: important to examine current studie
Page 59 and 60: found in this study was low socioec
Page 61 and 62: who trade sex for crack; and simila
Page 63 and 64: esponsibilities in perspective. Suc
Page 65 and 66: Robles and colleagues (1990) examin
Page 67 and 68:
The lack of rational thought separa
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Factors Associated With Sexual Risk
Page 71 and 72:
Factors Associated With Poverty A n
Page 73 and 74:
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
Page 81 and 82:
Centers for Disease Control and Pre
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Jemmott, J.B.; Jemmott, L.S.; Spear
Page 85 and 86:
O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88:
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,
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Ostrow, D.G.; Beltran, E.; Chmiel,
Page 119 and 120:
Drug Use and HIV Risk Among Male Se
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prostitutes were HIV positive, as c
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Trade hustlers are usually heterose
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TABLE 1. Number of Completed Interv
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diagnosed slightly more often than
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TABLE 2. Injection Drug Use by Type
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By the 100th interview, the screeni
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SUMMARY AND CONCLUSIONS In general,
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Plant, M. Sex work, alcohol, drugs
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HIV Risk in Drug-Using Adolescents
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AUTHOR Vincent L. Smeriglio, Ph.D.
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comprise 23 percent of all adolesce
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232 (18 percent) of the cases; and
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Although these data provide an over
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Most of these were unprotected sexu
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national epidemiologic survey of hi
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Hawkins et al. 1992; Newcomb et al.
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higher rates of HIV/AIDS in adolesc
Page 155 and 156:
Boyer, C.B. Psychosocial, behaviora
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Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
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the types of intervention strategie
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from a study group of 52 youths who
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forearm during a sexual episode. At
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I was nice looking, like I can do a
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It is unclear whether the disinhibi
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continual sexual dysfunction was re
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TWEAKING, FREAKING, AND OVER-AMPING
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highway of love. It’s like, I’d
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Unprotected sexual activity is more
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alternatives and opportunities, and
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the night and food for the morning.
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7. also can help youths explore and
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Jessor, R., and Jessor, S.L. Proble
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AUTHORS Mary Jane Rotheram-Borus, P
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Brunswick goes on to discuss the le
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permission-giving introductions to
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conversion and perhaps even serocon
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TABLE 1. Ecological paradigm of con
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TECHNICAL ISSUES Technical issues i
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eliability. It seems obvious that q
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sometimes as many as three zip code
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Resources and effort are required t
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Brunswick, A.F.; Lewis, C.S.; and M
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The Context of Risk: Ethnographic C
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same meaning may be extended to dru
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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
Page 219 and 220:
REFERENCES Agar, M. The Professiona
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Ouellet, L. J.; Jimenez, A.D.; John
Page 223 and 224:
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
Page 261:
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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