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

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
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