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

The Context of Risk:
Methodological Issues
Zili Sloboda
The behaviors that put most adolescents and adults at risk for human
immunodeficiency virus (HIV) infection are those that enable the
transmission of the virus through the sharing of bodily fluids from an
infected to an uninfected person. This is the epidemiologic approach to
the problem. Much of the available information that is derived from both
epidemiologic and prevention intervention studies has been based on the
numeric counts of specific behaviors that become surrogate measures of
this exposure. Although useful, these measures generally fail to take into
consideration partners’ HIV status and to eludicate the behaviors
themselves; the decisionmaking processes that underlie the choices to
perform these behaviors; the values or perceptions of norms and
expectancies that are associated with these behaviors; and other
environmental, social, and cultural determinants of the behaviors.
The previous sections of this monograph discuss the context and, within
population groups, the values and circumstances that have been found or
are thought to influence the engagement in and performance of these
behaviors. This section presents three chapters that grapple with the
issues related to measurement of these behaviors in the context of the
dyadic or group relationships involved and the social, temporal, cultural,
and environmental circumstances that define their performance.
Brunswick, in her chapter, Bringing the Context in From the Cold:
Substantive, Technical, and Statistical Issues for AIDS Research in the
Second Decade, challenges the reader and her research colleagues with a
multidimensional matrix that she terms an ecological model, representing
several levels of influence on the behaviors of individuals and
populations. Brunswick suggests that the theoretical models that underlie
the HIV prevention strategies currently being assessed depend greatly on
the Health Belief Model. The limitations of such a cognitive model are
that it principally examines behaviors from the individual viewpoint and
does not adequately include the social influences of the family, peers, and
the community on the extent to which individual behaviors are
self-determined and self-controlled.
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