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

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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 189
TABLE 1. Ecological paradigm of contextual influences on behavior Moral MACROSYSTEM Values, Norms and Social Expectancies Governing Behavior, Defined by: General economic and political climate Gender Ethnicity/race Birth cohort Legal and Institutional EXOSYSTEM Situational and Institutional Arrangements Spatial and Temporal Factors: Timing of specific events: Isolation of virus Pharmacological advances (AZT, etc.) Availability of and access to sterile injection equipment Treatment availability Neighborhood violence SOURCE: Adapted from Brunswick 1985 Interpersonal MICROSYSTEM Interpersonal Settings, Social Networks and Interpersonal Relationships of All Types and Sizes: Familial (Spousal, parental, children) Peer Educational Neighborhood groups and organizations Networks within and outside own neighborhood Intrapersonal ONTOGENIC SYSTEM (within person Biopsychosocial Attributes and Life Histories: Attitudes Beliefs Self-image Health
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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
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AUTHOR Vincent L. Smeriglio, Ph.D.
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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 and 190: Brunswick goes on to discuss the le
Page 191 and 192: permission-giving introductions to
Page 193: conversion and perhaps even serocon
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
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Page 241 and 242: Future Directions for Studies on th
Page 243 and 244: 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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