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

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make sense of their world.” Koester discusses the two ethnographic approaches to data collection, participant observation and open-ended interviews, and how these approaches are combined over time to gain insights and a fuller understanding of a particular group of people. However, he observes that the traditional ethnographic approaches have been modified within the context of HIV research to solve a narrow research question. Specifically, Koester discusses the contributions of ethnographic research on the meaning of risk and on the micro and macro contexts in which risk behaviors take place. In addition to the review of the qualitative methodology for the collection of information on HIV risk behaviors, he points out the importance of the phrasing and context of the questions asked by the researcher in a variety of settings and the relationship of the responses received to time, situation, and role of the respondent. In conclusion, Koester relates the importance of having a multidimensional measure of risk behaviors in order to gain sufficient information to intervene and alter or modify these behaviors through planned community, environmental, and individual programs. Finally, Gibson and Young in their chapter, Assessing the Reliability and Validity of Self-Reported Risk Behavior, examine the issues of the meaning of data collected through quantitative approaches, specifically structured questionnaires. This chapter reviews the authors and others’ research that examines the extent to which drug abusers report certain behaviors reliably and the degrees to which self-report instruments obtain valid responses. Three aspects of these issues are discussed: (1) the truthfulness of the information on HIV risk practices provided by intravenous drug users; (2) the extent to which the tendency to provide socially desirable responses “contaminate” self-report(s); and (3) methods researchers can use to reduce response bias when collecting information on sensitive behaviors. Gibson and Young present the analyses of their studies with intravenous drug users, which show that questions regarding drug use-particularly sharing of injection equipment-were threatening to the respondents, and questions regarding oral and anal sex were sensitive areas of inquiry. They tested different data collection techniques to determine which were best for these two behavioral areas. They found that response bias was reduced by utilizing a questionnaire format that used long, 185
permission-giving introductions to each set of questions and by asking sensitive questions later in the interview. It is clear that these chapters do not cover all the methodological issues associated with using multidimensional approaches to collecting information to better understand HIV risk-taking behaviors. One obvious omission is analytic approaches that can address the needed temporal and multilevel analyses. However, conceptualization of substantive issues must of necessity precede a focus on analytic techniques. Until this technical review, substantive contextual issues had not been addressed by such a diverse group. This monograph should serve as a stimulus to researchers focusing on HIV transmission to begin to broaden their conceptualization of their measures and to be challenged not only to include the many dimensions suggested in these chapters, but also to include researcher colleagues who represent disciplines other than their own to work with them on studying this very serious public health problem. It is only through a clear understanding of these decisionmaking processes that the scientific community will be able to prevent the spread of HIV and other infectious diseases. AUTHOR Zili Sloboda, Sc.D. Acting Director Division of Epidemiology and Prevention Research National Institute on Drug Abuse Parklawn Building, Room 10A-38 5600 Fishers Lane Rockville, MD 20857 186
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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
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By the 100th interview, the screeni
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SUMMARY AND CONCLUSIONS In general,
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Plant, M. Sex work, alcohol, drugs
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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 and 182: the night and food for the morning.
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: Brunswick goes on to discuss the le
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
Page 233 and 234: TABLE 6. Relationship of question t
Page 235 and 236: aggravate self-presentation bias. T
Page 237 and 238: TABLE 8. Percent of subjects report
Page 239 and 240: 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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