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

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top of (you). If I wouldn’t have been high on something I never would have went with her (laughs).” Survival often is dependent on drug connections. Other “players” and their gatherings provide the context for unprotected sexual activity to occur. For example, Mark identified Daniel as the person he would go to for help. Daniel is his 34-year-old “former lover” who is also one of the main methamphetamine suppliers in his neighborhood. Daniel provides Mark with a free $20 bag of speed daily, and does not make any sexual or financial demands in return. According to Mark, “He loves me.” Mark reported that he is not now actively involved full-time in sexual activity for money, although he does sometimes run into former clients and “falls into old patterns.” Occasionally he will walk down the main male sex worker street (“my daily stroll”) while high on methamphetamine, and if a car stops, he does not say no to advances. HIV-risk behavior can escalate within the context of sex-for-money exchanges. Jim’s first experience with anal receptive intercourse occurred with a trick. He had not anticipated being the receptive partner when sexual activity began. “The first time I did do it and it was for money, we had already got to his house and we agreed that he’d pay me $50 to have oral sex. Right in the middle of it, he told me he’d give me an extra $100 if I’d let him do that (anal sex). I said okay and he put on a rubber and did it....It hurt! I felt that feeling, for months, ugh! I couldn’t stand it, I hated it! It made me feel like a woman! I felt real cheap.” Similar routine, negotiated, or forced sexual situations or behaviors are dictated by immediate survival needs. Relationships often are entered into only for support, protection, or survival. Mark, for example, emphasized that he is not attracted to men his own age because he feels they are “generally stupid and without direction.” While Mark likes the financial stability usually characteristic of older men (age 40 to 50), he describes these men as generally dysfunctional, saying they “fall in love too easily.” While discounting those his own age, Mark’s choice of partners usually is based on the potential benefits he can obtain. Money to purchase speed is a frequent benefit of his cross-generational relationships. “...My track record, I mean it’s not exactly, you know, making the best time, the best mileage, I’ve left a lot of accidents (laughs) on my 169
highway of love. It’s like, I’d be the first person to tell you, excuse me, but you really don’t want to be in love with me (laughs). Because I’ll work you, because if I know that somebody is going to do anything for me, I will work them. Not really bad, but I will work them, just like Daniel. Daniel came to pick me up in jail and gave me money and sex, that’s why she’s (sic) the first person that I called, I knew he’d pick me up and I knew he’d have sex with me.” For Mark, chronic methamphetamine use has also had negative social side-effects, including periods of self-imposed isolation and paranoia. “I mean I was so tweaked out from the weekend it wasn’t even funny, I was in my room, I had my little friend, my little mouse, see, to this day I don’t even know if I actually saw that little mouse or not, but I thought I saw this little mouse, and for a whole weekend I was in my room and I’d pick up my coat, and I was trying to leave, and I go like this (gestures) making sure there was no mouse in my coat...I woke up Sunday morning and the first thing I did was, like throw up stomach acid, and I said gee, girl, (sic), when was the last time you ate (laughs)?” Following long periods of sleep, the postcrash depression is less pronounced and the exhaustion gone. The task then is to arrange for a new supply of speed, the sooner to begin another “high”—another “run.” MODERATING OR DISCONTINUING METHAMPHETAMINE USE Given the interconnected nature of sexual activity and speed use, it is difficult to prevent HIV sexual-risk activity if methamphetamine use continues. Some youth, especially those already living with HIV and AIDS, are fatalistic, experience hopelessness, and do not want to change their drug use practices. For example, Mark described his unwillingness to change his life situation and patterns in the following way: “... as far as I can see, I’m just going to die anyway, so why bother getting my life together when I’ll probably die before I do it (laughs). Tomorrow I could be in the hospital with some tubes coming out of me.” 170
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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
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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 and 172: continual sexual dysfunction was re
Page 173: TWEAKING, FREAKING, AND OVER-AMPING
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
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
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NIH Publication No. 94-3750 Printed
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