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

involves using a syringe to draw blood from the user’s arm, mixing the
drawn blood with the drug already taken into the syringe, and injection of
the blood/drug mixture into the vein. Many IDUs believe that this
practice potentiates a drug’s effects; however, this procedure is reported
to leave traces of blood in the needle and the syringe, thus placing
subsequent users of the injection equipment at higher risk. Inciardi and
Page (1991) have studied frontloading and backloading practices in
Miami-procedures for making the speedball solution (heroin and
cocaine mixed together) in which two needles and syringes are used.
This practice potentially doubles the risk of HIV transmission.
There is preliminary evidence that suggests that the type of drug used
(heroin, cocaine, etc.) may increase the likelihood of needle sharing
(Turner et al. 1990). Due to cocaine’s short effect time, cocaine injectors
require more injections to maintain their high than heroin injectors. One
study found amphetamine users were more likely to share needles than
heroin users and were less likely to be in contact with formal agencies
and consequently HIV prevention services (Baxter and Schlecht 1990).
Koester and colleagues (1990) studied IDUs in Denver and detailed how
IDUs may inadvertently transmit HIV. They found that drug preparation
and injection involves a complex series of steps that may be influenced
by any number of variables, including the type of drug being injected, the
beliefs and customs of the users, and socioeconomic and psychosocial
factors. Page and colleagues (1990) have identified some of the customs
practiced in settings where injecting drug use takes place and have found
these customs may shift as conditions and interpersonal relations change
in a given scene.
Several studies have indicated the importance of not only needle- and
syringe-sharing practices in HIV transmission but the sharing of drug
containers, cotton, and other injection paraphernalia (Inciardi 1990;
Inciardi and Page 1991; Page et al. 1990). Furthermore, the use of
contaminated syringes may not entail sharing, in the sense of the social
act of passing a recently used needle to a waiting partner, but rather
pooling of used needles (Chitwood et al. 1990).
Virological studies have indicated that HIV can survive in ordinary tap
water for extended periods of time (Resnick et al. 1986); thus, shared
rinse water represents a considerable potential transmission risk. Koester
and colleagues (1990) have described how IDUs often clean their works
from the same cup of water that others are using to prepare their heroin
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