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

SUBSTANTIVE ISSUES
Following the ecological model, structural or macrosystem attributes are
considered first, including gender, cohort, period, and ethnoracial issues
that are closely tied to social stratification. Analysis of these factors is
expected to capture differences, not only in types of risk behaviors and
risk exposures, but also in the societally imposed roles and patterns of
behavior that apply to minority versus white groups and women versus
men within those groups. Macrosystem factors would take into account
not only the patterns and norms that prevail generally in society, but also
those within specified subcultures. Examples of some of these issues are:
Do women IDUs share works with their sex partners relatively more
often than do men? Does this sharing occur in Hispanic subgroups
(which ones) or among African Americans? Do men universally go first
when sharing occurs? Cohort effects also need to be considered at this
level (e.g., broad changes over time in norms governing standards for
drug or sexual behavior and for sex roles). Cohorts born at varying times
experience these changing norms differently. In addition, the
macrosystem calls into question singular historic changes that impact all
cohorts simultaneously (although not necessarily all social strata), such as
economic and industrial “revolutions” and economic recession and
depression.
Secular time also enters at the next level of analysis—the exosystem
(table 1). Policy and related factors that influence institutional allocation
of resources are subsumed here. These reflect situational variations in
time and place. Particularly in HIV/AIDS research, time cannot be
ignored as a situational variable: the time when data are collected,
analyzed, and reported must be given primary consideration because of
the rapid changes in primary transmission vectors, host population,
biotechnological and pharmaceutical developments, and even in the agent
itself (e.g., HIV-2 now is reported in West Africa and among West
African immigrants) (Onorato et al. 1993). For HIV/AIDS research, it is
of interest, for example, to note what effect an announcement of infection
on the part of a public figure such as Magic Johnson has upon public
perceptions and awareness. It is less clear whether changes at this level
are translated into changes in risk and risk avoidance behavior
(Kalichman and Hunter 1992).
Some have analyzed changes in rates of infection, latency periods, and
the nature of symptoms as the epidemic progresses over time.
Additionally, data need to be specified by place—region and specific
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