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

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4. counseling, meals, a medical clinic, crisis management, long-term housing, and job development and placement opportunities. Community-based agencies like the Larkin Street Center with active outreach and drop-in services are a bridge for youths to begin building new social support networks. An understanding of youths’ substance use practices and patterns is central to determining the features of interventions to reduce HIV-risk activity. When youths are high, condom use often is overlooked. Chronic substance use allows for the disinhibition of unprotected sexual acts, avoidance of difficult life situations and negative emotions, and temporary enhancement of feelings of selfworth. It eventually prohibits the development of truly intimate and supportive relationships with others. These factors derail adolescents’ healthy development and eventually may have consequences in their adult life. Counselors must help each youth identify and chronicle their behavioral patterns and activities. 5. Repeated and consistent consciousness-raising activities on drug use and sexual activity are needed. These activities are crucial for youth functioning in the “fast lane” who have little time for introspection. The development of personal projects could be beneficial (Etwart 1991). For some, personal projects are a prerequisite to behavioral change. A project could be disclosing sexual orientation or HIV status to family, returning to school, or learning skills to reduce stress and increase relaxation. Underlying feelings of low self-worth (e.g., “I’m no good; I’m a user”) associated with youths’ selfdestructive acts must be confronted and addressed in personal projects. Youths must be convinced they are entitled to better lives. Positive reinforcements should be included in the definition of personal projects. Setting career goals, finding employment opportunities, and establishing specific plans for the future are basic to motivating behavioral change. Each of these components of a comprehensive program with case management appears necessary to effect behavioral change and facilitate exiting methamphetamineusing social worlds. 6. The existential dimension of life should be emphasized in interventions. This area typically is not addressed in most programs or theories. Posing questions such as “Why am I here?” or “Where am I going?” and the discussions that follow can help individuals develop meaning and purpose in their lives. Discussions of this type 177
7. also can help youths explore and commit to personal projects and encourage a future orientation. In addition to the necessary service interventions, a research agenda is needed to detail the risk behaviors associated with methamphetamine use and HIV transmission. Longitudinal field studies must be conducted, following youth in depth and over time to ascertain strategies individuals have employed for moderating or discontinuing their drug-use habits. Specific attention must be given to identifying and chronicling the “turning points“ in their drug-using patterns and sexual careers. These turning points may be the only times when interventions and outreach programs can be truly effective. NOTES 1. G. Cajetan Luna has conducted local, national, and international research and policy development on street youth and AIDS for 12 years (Luna 1987, 1991; Luna and Rotheram-Borus 1992). He worked out of the main San Francisco youth service agencies. He interviewed youth in natural locations and studied their friends living with HIV or contacts who were not clients of service agencies. All but one of these youth were currently using methamphetamines. None was receiving experimental AIDS treatments; all believed that their drug use was not detrimental to their HIV status; and all lived on a day-to-day basis. Mark is typical of the youth Luna interviewed. Toby Marotta has been studying sexual and drug-using subcultures in San Francisco since 1976 (Marotta et al. 1982). While doing ethnography with youth living with HIV in San Francisco, he has been interviewing moderate and heavy speed users for the first behavioral study funded by the National Institute of Mental Health entitled “Ice and Methamphetamine Use: A Three Year Exploration.” Marotta employed longtime key informants to access and study youth living with HIV and AIDS in the downtown area who were not attending youth service agencies. To compare the lives of these youth with those who receive support, he subsequently is studying youth served through the Public Health Department. Jim and Rob are typical of the youth he has been studying through both informal and formal channels. 178
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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
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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 and 180: alternatives and opportunities, and
Page 181: the night and food for the morning.
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
Page 231 and 232: 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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