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

freaking that he could no longer have sex without using
methamphetamine. Their lives contained many poignant contradictions.
As evident in the recollections of all three young men, methamphetamine
use was initiated and maintained in order to facilitate intimacy with
others. Implementation of HIV prevention strategies by using condoms
and stopping drug use was limited by fears of alienating others, conflict,
or losing a partner. Rob reported that he was depressed because he did
not have an intimate partner. He began to attend a youth rap group
sponsored by a gay-affiliated advocacy group. He also “cruised” gay
bars. Regardless of the setting, Rob’s condom use was dependent on his
partner’s desires.
“If I wanted someone, if I wanted to date someone, I wouldn’t make
them wear one, but if it was just a one-night thing, I would.”
The same fear of rejection was evident in Jim’s relationship, even when it
was known that his partner was seropositive. Jim and his partner used
condoms inconsistently. Fear of HIV was less salient than demonstrating
their love and loyalty.
Given these complicated circumstances, it might appear impossible for
youth to be able to stop using methamphetamine. However, in almost
every instance an opportunity existed when interventions could be
successful. Chronic methamphetamine use characteristically is
sequential, from getting high and running to the inevitable crash or
coming down. Youth seem to be especially receptive to interventions
during that period when they are coming down (or immediately
following) and before they begin another run.
Unfortunately, Mark rarely comes down, and his periods of sobriety are
few. He currently is living alone in a downtown Tenderloin “skid row”
hotel room provided by a program for seropositive youths. He listens to
the radio when home and while high on speed. The rest of his day is
spent borrowing, stealing, or “scamming” money for “shopping sprees” to
obtain more speed. He does not socialize with others at the hotel, most of
whom are also drug users and sex workers. His immediate primary social
world is composed of his speed supplier, his regular johns, and other
youths from the seropositive youth program.
The goals for HIV prevention with an adolescent like Mark are to
promote his self-esteem, to provide him with realistic and achievable life
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