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

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are short-term sexual partners from whom Mark receives money, whereas “johns” can be “worked” over long periods of time, as is the case with “sugar daddies.” The youths’ descriptions of bartering sex demonstrate how initial attributions of self-worth and potency associated with chronic drug use eventually are replaced by alienation, as demonstrated by Mark’ s account. “He is in love with me too, another sorry guy who fell in love with me (laughs), I kept saying, well I want to buy some dope with you... so she (sic) says, here’s the money go buy the coke...She likes to get people real full (high) and give them dope and have sex.” Methamphetamine use as a means of connecting and experiencing intimacy with others eventually evolves into situations where drug use increases, and the relationships dissolve in conflict. Rob’s description of his problems with Alex demonstrates this pattern. “Alex was addicted and at first he told me he was gonna quit. And then he didn’t, and then, when he and I started to fall apart, he started to do methamphetamine a lot more, and then I started to do it with him, cause it was one way we could be together.” Youths get high and use methamphetamine for various reasons that often influence their present circumstances. Rob succinctly summarized the reasons for his former partner’s speed use. “He said he was doing it to lose weight, but that wasn’t the truth. The truth was he was trying to forget that his father abandoned him, his uncle molested him, or his mother didn’t love him; his brothers were messed up, and he was gay.” Youths who become part of the methamphetamine-using subculture find that their sexual satisfaction is enmeshed with their survival needs and feelings of self- worth. To them, getting high is characterized by a euphoric physiological rush, and is used to increase personal feelings of self-worth and sexual potency, to connect with others, and to explore one’s sexual orientation without guilt. Getting high also makes it easier to participate in undesirable but necessary sex work in order to provide for one’s immediate survival needs. However, in time, the long-term consequences of chronic methamphetamine use become more apparent: sexual dysfunction, alienation from others, and marginalization into destructive interdependent subcultural social networks. 167
TWEAKING, FREAKING, AND OVER-AMPING: LIFE ON METHAMPHETAMINE In street vernacular, shooting speed and having sex are linked together and referred to as “tweaking and freaking.” Tweaking and freaking represent a pattern and rhythm to the lives of some young people. For example, Jim reported that once he became a regular tweaker, he exhibited mood swings and self-destructive phases as effects of his drug use. Every time he injected speed, he would try to stay as high as he could for as long as he could for as many days as possible. His goal was to get as high as he could (get full) without over-amping (too many drugs for too long). Over-amping would make him too nervous and too irritable to be comfortable. To avoid the manic-like state that accompanied crashing, he stayed high by shooting up “just the right amount” of “just the right stuff’ at “just the right time” intervals. The goal was to stay awake until he was so exhausted that he could put himself to sleep with a little alcohol. This cycle of tweaking, freaking, and over-amping methamphetamine leads to acts that further marginalize youths. Theft and petty crime are characteristic activities of the methamphetamine-using subculture. For example, Jim was hustling full-time when he joined in the petty crime that is a feature of the local speed scene. “If I was tweaked enough, I’d get a trick and he’d invite me to stay. I’d spend the night and tweak around, drawing and scribbling. If they were dumb enough to go to sleep when I was tweaking (laughs) in their house, they’d get robbed most of the time....Because that way I wouldn’t have to go back on the street and hustle....I’d go to my dealers. With a new flight jacket, get 1/2 gram for it. Jewelry, I had a gold class ring that I took, it had a sapphire in it, I got 1/16th for it!” In addition to the economic relationship between drugs and sex, drugs may have a psychologically numbing effect in sexual activity. Pleasure and self-worth are disassociated from behaviors. Mark explained how drugs allowed him to participate in otherwise unpleasurable sexual activity. “Just like the big fat guy that picked me up one time, gave me $300. But she (sic) wasn’t the most attractive thing in the world... but all she wanted to do was lay on top of (you), and do nothing, but lay on 168
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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,
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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 and 170: It is unclear whether the disinhibi
Page 171: continual sexual dysfunction was re
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
Page 221 and 222: 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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