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

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the city. It was the first time I’d ever been to this one gay area, and I said ‘Wow. I don’t believe this.’ There was guys holding hands walking down the street together, it’s amazing... But I didn’t go back up there for a while just because I was busy doing things with straight people, with people my own age, which was also something very strange, cause I never hung out with people my own age in the Midwest.” It was during this period of masking his sexual orientation that Rob started using drugs. Most of the youth in the larger study group experienced conflict over “coming out” and choosing a gay or bisexual lifestyle. This conflict was interconnected with methamphetamine use for Mark, Jim, and Rob. Many youths who identify as gay or bisexual do not adopt substanceabusing patterns. However, negative societal reactions to gay and bisexual youths appear to lead some youths out of traditional mainstream cultural practices in order to find acceptance, personal worth, and value. Some social worlds and subcultures are more accepting of diversity and welcome gay youths. Once accepted into alternative subcultures, some youth become vulnerable to the negative or destructive activities or practices characteristic of these adopted social worlds. While many youths experienced an increased sense of meaning, self-worth, pleasure, and disinhibition associated with initial methamphetamine use, eventually there were negative consequences of chronic use. For each benefit, a contrasting cost arose-costs far higher than the benefits and almost unavoidable. As Jim summarized: “So it just kept going down, down, down, and so he moved, and kept doing more drugs, and I did drugs with him. We stayed up all night and we’d fight, and we’d get back together again and have great sex.” Most youths experienced a downward spiral and were addicted to the drug and to the lifestyle that surround usage. Activities and relationships of physical and emotional ecstasy and disinhibition became dysfunctional. For example, while methamphetamine was initially an aphrodisiac, it soon became necessary for sexual arousal. Episodic or 165
continual sexual dysfunction was reported in each interview with young homosexually active methamphetamine users. As Rob stated: “You know, it’s hard to get an erection when you’re on crystal or a lot of crank.” Jim’s account also points to how methamphetamine use potentially may lead to high-risk situations. “You can’t get an erection when you’re on speed, it’s concentration. He (meaning, his lover) can never get an erection! (laughs) Hardly ever. When he’s high, if we play games, it’s easier for him to get it up ... (laughs). Like play sex games like handcuffs.” Mark also became disinterested in sex and only engaged in sexual activities for money or as a means of getting personal validation from others. “I have to be on drugs to have sex with anybody. Period, ‘cause I do not enjoy having sex. I do not go out and look for sex. I don’t even masturbate. I don’t, like it’s part of my manic depressiveness. Depressed people do not like to have sex... That doesn’t appeal to me. I won’t (have sex) unless I’m on speed.” Methamphetamine use is characterized by increased sexual activity not only because of myths suggesting increased potency but also in circular fashion due to an interdependency with sex work as a means of support for the “meth habit.” Two of the three youths described in this paper traded sex for drugs or money. As Jim’s comments illustrate, involvement in the drug-using subculture may place youths in situations where sex is bartered. “We bought this bag and we went back to my hotel...and I split it with him. He did half and I did the other half, and it instantly sobered me up, I remember. I didn’t know what was going on and stuff like that, and I thought I was beautiful and all this stuff, and I came out to try to make some more money, and I did, and that was how I got into that whole trap of money, making money for sex and constantly doing speed.” The methamphetamine subculture has clear normative roles for sex work. For example, Mark distinguishes between “johns” and “tricks.” “Tricks” 166
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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,
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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 and 168: I was nice looking, like I can do a
Page 169: It is unclear whether the disinhibi
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
Page 219 and 220: 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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