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

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“There were like 20 people or so, but most of them I didn’t, I wasn’t interested in being associated with, they were queeny or whatever... But it was good to have it, because I did meet some people that I could relate to, that I’m still friends with today, and I met someone I became involved with.” Rob successfully used this therapeutic youth group to connect with others. After donating to a campus blood drive in the fall of 1992, Rob learned that he had been infected with HIV. For help adjusting to his new status, Rob went to a support group for youth living with HIV and AIDS. In the winter of 1993, he was working up the courage to tell his family and his lover his HIV status. He had started using condoms regularly, stopped using drugs, and decided never again to use speed. The steps Rob had taken-joining a support group, seeing a therapist, finding new employment, taking an apartment with another person living with HIV, beginning an intimate relationship with a non-drug-user-were examples of the dramatic life changes that are associated with drug use cessation (Kandel and Raveis 1989; Stall and Biernacki 1986). With a variety of social supports, Rob’s resolve to change the conditions of his life may be reinforced and succeed. Unfortunately Mark and Jim do not share the same resolve or have positive support networks available. IMPLICATIONS FOR INTERVENTIONS AND CONCLUSIONS Methamphetamine use can provide youths with an illusion of excitement and satisfaction in their lives. Initially it is a means to an end: to get high, to increase sexual potency, to facilitate intimacy with others. Eventually, chronic use becomes an end in itself, as waking hours are spent from one run to the next and all efforts are geared towards getting more drugs. Instead of sexual potency, sexual dysfunction results; instead of intimacy, further isolation and paranoia occur. The developmental tasks that face all youth are distorted or retarded. Metaphorically and in reality, methamphetamine use is equivalent to going nowhere fast. Youths like Mark, Jim, and Rob who participate in methamphetamineusing activities and subcultures clearly are at risk for HIV infection. These youths have multiple problems in their lives, and the contextual factors that influence their HIV risk are on many levels. At the most basic level, some youths frequently are concerned with finding shelter for 175
the night and food for the morning. With such immediate and basic concerns, youths are not thinking about dying from AIDS 10 years in the future. Unless the youth’s life is considered holistically, the salience of primary and secondary HIV prevention will be transient at best. A needshierarchy approach must be adopted to the design of intervention strategies (Maslow 1970). Therefore, the authors make following recommendations. 1. Unless immediate needs for survival (food, shelter), security (food and shelter tomorrow), safety (some protection from violence), and social support are met, youths will be unlikely to practice HIV-preventive behaviors consistently. Youths whose survival needs are not met often need to trade sex for money and drugs (Abel- Peterson 1992). In such bartering, the person who needs money is in a less powerful negotiating position (Cohen 1992). Reid and colleagues (1993) found that gay youths who bartered sex were far less likely to decrease their HIV-risk behaviors. Youths living with HIV or AIDS who have received housing supplements feel more secure and may choose to remain at home instead of going out to barter sex. They know they will have shelter the next day. The need to raise quick money for housing is eliminated. 2. Alternatives must be developed and encouraged whereby youths can meet their needs for intimacy and community in ways other than unprotected sexual activity and shared drug use. Providing youths with a positive social support network can reduce the need for seeking sexual intimacy in risky ways. The challenge in developing interventions and programs for these youths is whether programs should address short- or long-term needs, or both. 3. There are not enough long-term placements to serve the numbers of disenfranchised, alienated youths (Rotheram-Borus et al. in press). Federal, State, and municipal agencies typically have devoted their resources to emergency or temporary shelters instead of more stable, long-term facilities. A major goal for social service agencies should be to develop a system to relocate youths gradually from drugsaturated environments to less seductive and less toxic long-term settings. They also must provide vocational and employment opportunities whereby youths can satisfy their basic survival needs in more conventional ways. The program at Larkin Street Youth Center in San Francisco is an example of a successful approach (Kennedy 1989). The Center offers street outreach services, daily drop-in 176
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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
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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
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 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: alternatives and opportunities, and
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
Page 225 and 226: TABLE 1. Sociodemographic profile o
Page 227 and 228: Table 2 shows percentage agreement
Page 229 and 230: 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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